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Discussion

Do you know where you are?

To assess orientation in the PACU, once my patients are awake enough to have a prayer of knowing the answers, I ask all of them (except young pedi) some version of the "pop quiz":

1. Can you tell me where you are?

2. Can you tell me what day of the week it is?

3. Do you know what surgery you had today (or, if they are more awake, name of surgeon)?

4. Something else like who is the president of the United States, what is your birthday, who is in the Superbowl, etc.

When I was on orientation, we had a patient who had undergone a craniotomy, so after cranial nerve assessment, assessing orientation was my next priority. The patient was an adorable little old lady who, unbeknownst to us, was very feisty. I leaned over so she could hear me and said, "I'm going to ask you a few questions that I ask all of my patients. Do you know where you are?" She nodded. "Can you tell me where you are?" I asked. She opened her eyes a tiny slit and declared (in a voice that clearly indicated that I had lost my mind), "I'm RIGHT HERE." Guess she told me...

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    • Featured Replies

    My mother was in the hospital. Her neighbor was in to visit, and said, "Do you know who I am?" right in her face, in a loud voice. My mother said, "Yes. Why, don't you?"

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    I was doing a neuro exam on a Spanish speaking patient. I asked him where he was the best I could in my bad Spanish. He replied back to me in Spanish "Here in the bed". I called him a smarty pants and laughed. He knew he was in the bed LOL. He eventually answered that he was in the hospital. He laughed at me though the rest of the night.

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    • Experts

    I listened one night to a med student trying to a work-up a young man who came in w/a headache r/o meningitis.

    Med student: Who's the president?

    pt answers correctly.

    Med student: who was the president before him?

    correct answer again.

    Med student: who was the president before him?

    Pt: LINCOLN!! Who the [ ] cares!!!

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    Recently I was assessing one of my residents and he was telling me that he had a horrid time remembering months/dates. So I asked him if he knew the month....he laughed and said "you're mean" and I told him he had a 50/50 chance of getting it right as the month started with "M" so not missing a beat he said "Merry Christmas". Oh now when I see him, he and I laugh about it!

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    I work night shift and half the time I can't appropriately answer "What day is it/what's the date?"

    I once did an MMSE with a very depressed and withdrawn patient. He scored 29 out of 30. I only had to correct him on the date. Later I had to go tell him he actually scored 30 out of 30, while his nurse scored 29 out of 30. First time I'd ever seen him laugh!

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