Child Life: A Normal Boy

John*, a seven year old boy has been a patient at Red Cross Children’s Hospital for the past four years. John was initially treated for a flame injury when he was a toddler and has been seen on an outpatient basis ever since for therapy and reconstructive surgery. John is consistently accompanied by his mother when he is at the hospital, who has always been supportive and attentive to her son. The family’s first Language is Afrikaans, but they are fluent in English as well.

John’s latest admission was for a tissue expander procedure. A tissue expander is a balloon-like apparatus that is surgically placed under the first few layers of skin. Over a period of months, the balloon is injected with saline to slowly expand the skin tissue. This process creates additional (healthy) skin to be used for grafting. Because the graft is so thick, scarring is minimal and leaves the skin smooth. In this boy’s case, the expander was placed under his chin to be grafted over his scarred cheek. John was referred to child life by the social work department after displaying anxiety with his expansion procedures which occur every 1 to 2 weeks, and continue until it has reached the desired size. Since child life was so successful in easing John’s fears and getting him to cooperate with the medical team for his expansions, child life was then asked to assist John through his surgery to have the expander removed.

Child life presented John with the theatre preparation book that shows pictures of the operating theatre. His attention span being that of a flea’s, John didn’t show any interest in the book and, instead, chased a ball in circles around the child life specialist. He did, however, making a very passive comment about the anesthesia mask. He said, “Uh-uh. I don’t like that mask. I don’t want it.” Many children don’t like the smell and confinement of the mask over their faces. However, many children prefer it over the alternative drip (IV) placement. However, with proper education and implementation of coping strategies, the drip can be a much less invasive alternative, especially for the older children.

John was told that he had the option of receiving his “special sleepy medicine” through a drip instead. John’s response was, “can we play a new game now?”

On the morning of his surgery, child life presented John with the materials for a drip and a teddy bear. John ceased from climbing, running, and poking through a bag of toys every now and then to ask a question and observe the process. Even still, the efforts seemed fruitless.

When child life informed the surgeon that John had requested a drip, he raised his eyebrows and seemed concerned. With a little convincing, the surgeon finally just shrugged and said, “ok, then” and left with a smile. John was given some numbing cream on his forearms in preparation for the drip. The surgeon found a vein in no time and placed the drip on the second try with only a brief flinch and sharp inhale from John.

Before long John was asleep and mom and child life were leaving the theatre. Mom would not stop beaming as she gloated that this was the first time she had ever left the theatre without crying. Assuming that the mother meant that she was becoming more accustomed to theatre and better able to cope, child life assured her, “Aw, you were BOTH so brave!” Mom nodded and continued,“He was very brave! Every other time he fights and yells and then he cries and then I cry. But today, he was a normal boy.”

Now the mother was crying, but she was smiling as she thanked child life. At that moment it was apparent that the preparation and play was not useless.  John is a perfect example of why we should always listen closely to children and continue offering our services, even when they seem fruitless. Very often the ones who need our services most are those who seem to need them the least.

* Not the patient’s real name. Photos of children in this article feature Connect-123 child life volunteers with patients at Red Cross Children’s Hospital whose families have given permission for these images to be used.

Danielle Surprenant, a qualified and experienced Child Life specialist, served as Connect-123’s Child Life Program Director at Red Cross Children’s Hospital in 2010. She has since returned to the US, where she works at an Early Intervention Center in Massachusetts.