When a nurse calls you and tells you there is a patient who needs your help, as the child life specialist, you try to help. But what if said patient is a young adolescent who keeps to himself, chooses not to answer any questions asked by child life, and inserts earbuds any time you enter the room? How do you help in a situation like that?
Nurse: “Do you know Joe? (name changed for privacy)”
Me: “To be honest, I have had a handful of brief conversations and that is about it. What’s up?”
Nurse: “He is crying, shaking, and refuses treatment. No one here on the team really has a relationship with him and knows what to do.”
Me: (trying to sound calm and confident) “Well, I would be happy to see if there is anything I can do. I will be right there.”
As soon as I hung up, I paced around in my office for a moment. What in the world would I do? I have known Joe for over six months and have never once had a breakthrough with him. How could I be the one to break down his wall today?
Considering Joe’s affect and development, I imagined he would benefit from doing something with me as opposed to us just sitting and talking about feelings. What could I bring to help him engage and process his treatment?
Just a deck of cards.
“How could I be the one to break down his wall today?”
I entered the room and Joe was expressionless and staring at the wall, not moving a muscle. In true Joe fashion, he had his earbuds in his ears and you could hear the piercing sounds of the heavy metal music. He was clearly shut down.
I began engaging his parents and asking how the visit had been going. They shared that they believe Joe was having such a difficult time today because he hates how the medication he would be receiving makes him feel…but it is difficult to say because Joe doesn’t verbalize any of his feelings to his parents.
I was aware of how Joe could see I was clearly talking to his parents about him, so I decided it was time to loop him into the conversation.
Me: “Hey, Joe. I hear it has been a hard morning so far.”
Joe: “I don’t know.”
Me: “Well, the nurse shared that you were crying earlier. I am so sorry to hear that this medication has been making you feel sick. That sucks. I can only imagine how difficult it must be to go along with the treatment any ways.”
Joe turned and looked at me. Validation. He needed it.
I then started talking to Joe about the very limited topics of conversation I knew he enjoyed: music and food. This was my attempt to build more rapport and trust with Joe.
Then, I offered to teach him a simple card game: Polish Poker.
Joe immediately refused.
Me: “C’mon, Joe. You are just going to be sitting here for the next few hours getting this infusion. Let me just teach you a new card game for ten minutes of your four hour day here.”
(Side Note: It can be a challenge as a child life specialist to know when to push a patient vs. when to respect their choices. This is where assessment comes into play to try to gage what you think the patient needs. Do they need the control of saying ‘no’ to you? Or do they perhaps need to be pushed to try something new?)
Joe reluctantly agreed and the challenge was on. As we began playing together, I started asking him more and more questions about him, his family, friends, and his treatment and how he has been coping with it. Had we not been playing cards, it was unlikely Joe would have ever answered my questions. But instead, with each flip of the card, Joe began to let his guard down and respond more openly of how he was coping. I listened. I validated. And then I gently began offering coping suggestions from “what other teens have told me that has helped for them.”
Though Joe was much more open to talking to me, we didn’t have an intense heart-to-heart discussion necessarily. He didn’t cry tears of happiness and say I changed his life forever. However, the most meaningful interaction was when Joe began to smile.
Joe smiled.
The same Joe who I have never once seen him smile during the six months of working with him. The same Joe who moments ago sat stone faced staring at a wall refusing to talk to me. Even his parents noticed his contagious smile they had missed seeing so much and were grateful to see it.
Sometimes in child life, it is those small moments where we see, “hey! You are having some fun right now even in the midst of some horrible circumstances” that are the most rewarding.
Did I know that a simple deck of cards was the tool to break down Joe’s wall that day? No. There will be times when child life specialists face unknowns that feel like an impossible challenge. But child life specialists must consider development and commit to taking risks and promoting play (even for teenagers) as a way to help patients reflect and process their emotions.
I concluded my time with Joe by looking him directly in the eyes, “Joe. I know none of us can ever understand all the pain you are experiencing to fight cancer. But I am so proud and inspired by you today and how you chose to comply with treatment even though you didn’t want to. I am so proud of your courage for facing today with strength despite feeling otherwise. Continue to take each day one step at a time.” Joe looked back at me, nodded, and softly said “thank you.”