When I look back on my child life career so far, there is one story that immediately comes to mind when I had a huge and necessary learning opportunity. And let me tell you, it’s not pretty.
It was a Wednesday afternoon when I got the call.
“Umm…hey, Allie. We kind of need you here.” In the background I could hear screaming. Always a good sign, right?
When I got to the nurses station the staff briefed me on the situation: 9 year old girl. Has a 1 inch x 1 inch tegaderm dressing that needs to be removed so the doctor can look at her wound. Just look at with her eyes it to make sure it healed. Girl is crying. Screaming. Panicking. Doesn’t want dressing to come off. Got it.
So..deep breath, in I go.
Sure enough, the patient, “Angela”, is cowering in the corner and is violently shaking.
I start by going through all of my child life tricks: I describe what I am seeing. She is crying. I wonder why she is crying. Oh, “she is scared and doesn’t want the bandaid to come off.” Makes sense. I validate. I assure her that we will work with her to support her and be on her team. I inform her of why she needs the bandaid to actually come off.
“That is what we all were holding out for: that maybe with just one more minute longer, Angela would miraculously comply and we could all do this the easy and cheery way.”
And then, I begin to negotiate strategies of how we can take off the bandage. I negotiate for, get this, TWO HOURS.
Two hours, people! Two hours of offering choices, bargaining, trying every coping strategy I could think of. All the while the medical staff sat outside and were more than understanding of the time (this is extremely rare!) and hoping that I would have a breakthrough with Angela and that she would comply and let them take off the freaking bandage. That is what we all were holding out for: that maybe with just one more minute longer, Angela would miraculously comply and we could all do this the easy and cheery way.
Then, Angela dropped the bomb on me and her mom after those two long hours.
“If you take off this bandage, I am going to kill myself! I want to die!”
“Angela, those are very big words to say,” I stammered. Somehow I then found a way to politely excuse myself from Angela and her mom while I stepped outside to panic to the staff and beg they call social work when this was all said and done.
I then made the executive decision that it was time to utilize a “comfort hold” (aka: mom kind of holds on to her child while she thrashes around resulting in five of us pinning Angela down to the table.) It was go time.
“But what I remember as I closed the door was feeling a sense of utter defeat. I looked at sad Angela who also had a look of defeat in her eyes, too.”
I walked into the room with my posse of nurses and told Angela, “you have been very brave today and I appreciate you letting me try different things that could help. But now, the bandage is still on, and in order for the doctor to make sure your cut is healing, we have to take it off before you can go home. We care about making sure you are healthy, Angela. So now, we are going to help you hold still to take off the bandage.”
We did accomplish the goal and finally took off the bandage. Angela’s cut was indeed healing nicely.
But what I remember as I closed the door and left the social worker to remain with the patient was feeling a sense of utter defeat. I looked at sad Angela who also had a look of defeat in her eyes, too.
Where was the “magic” of child life, and why couldn’t I break through to Angela?
I spent lots of time reflecting with seasoned professionals about this situation to help me learn what I could have done differently. In my mind, something like removing a small bandage should NEVER lead into a 2 hour stand off.
The common advice that I received from other child life specialists is this: did you complete your checklist? Did you:
- Validate the patient’s feelings?
- Explain what the procedure is and why it is being done?
- Offer appropriate choices?
- Rehearse coping strategies?
- Involve parents/caregivers in a plan?
If you have done all those things and the patient is still not compliant, then maybe it is time to take a breath and then… “rip off the bandaid.” And if it does come to that, then don’t just just bid the patient adieu. Instead, go through the debriefing checklist:
- Validate the patient’s feelings once again
- Debrief with the patient. Ask how the procedure went for them. What was hard? What surprised them? What could we try next time?
- Engage in medical play in the hospital or provide materials for home (I always like to try the same procedure on a teddy bear for the patient to take home)
So, next time you find a patient who is like Angela, think through the check list, remind yourself of the goal, and then get to it. Because sometimes waiting it out for two hours only breeds more anxiety and prolongs the process when you could instead get to debriefing and helping the patient return to baseline.