Surgery produces wonderful results. But if kids are the patients, it can produce fear. At Children's Hospital, however, the staff has developed a process that eases the shock. My associate, Michelle Hall, followed a girl through an operation to see how that process works. Her report:
Like many children her age, 3-year-old Heather Norden suffered from an excess of fluid in her ears. Doctors recommended that she have tiny tubes inserted into her inner ears to provide drainage. Heather's condition was made worse by swollen adenoids, which blocked drainage further.
The tubes work loose within a year and often must be replaced regularly until ears develop fully (usually at age 5). The operation means an end to months of suffering, and can prevent permanent hearing loss. This was to be Heather's second tube-implantation. Before her first, a year ago, she had a 30-decibel hearing loss in both ears.
"We still feel bad," said 39-year-old Butch Norden, an unpretentious teddy bear of a man with gray hair and glasses. "We would get impatient with her because she wouldn't answer us. She couldn't hear us." Walking in the woods near the family's home after her first operation, Heather heard birds sing for the first time.
The Sunday afternoon before her Tuesday surgery, Heather, her parents and her 4-month-old brother John William joined several other families at the hospital for a special tour.
There is one tour for children who must stay overnight and another for those like Heather who go home the day of surgery. Each child in our group was scheduled to have ear tubes inserted.
Tour guide Francine Favretto greeted Heather, Chad Lee, Vivek Kocharlakota, Erika Jacobson, Scott Buffardi and their families. The guides, who have backgrounds in teaching and child development, try to make the hospital enjoyable and familiar. Yet they are honest about what will happen to the children on the day of surgery.
Francine Favretto quickly put the kids at ease by letting them touch and try out potentially scary medical instruments that would be used on the day of surgery. We moved on to the playroom, a veritable child's paradise. Dolls, books and stuffed animals abounded. Pediatric Nurse Practitioner Sue Moschella, described the playroom as "just a place where the kids can relax, calm down a little bit."
Kids between 2 and 12 are anesthetized in induction rooms, which were painted by the mother of a former patient. Kids choose between the space room, the Disney room, the Sesame Street room and the jungle room.
Favretto explained that on surgery day, a doctor would tickle the kids' noses and ask them to blow up a special balloon. Parents can usually accompany a child into the induction room and stay until the child goes to sleep. Each child may bring something special from home to see when they wake up.
After cookies and juice in the cafeteria, the families headed for the auditorium to see a Clipper the Clown puppet movie. In the movie, a little girl goes to the hospital to have her tonsils out. Clipper befriends her and calms her fears.
At 6:30 a.m. Tuesday, I met the Nordens at the A.M. Surgical Admissions Center. Baby John William had stayed home, but a very bald Cabbage Patch doll dressed in white lace was in his place.
Heather proudly announced that the doll's name was Karen. Beth Norden, an entomologist on a fellowship at the Museum of Natural History and a PhD candidate at the University of Maryland, explained that her university colleagues had tried to buy the doll for Heather. But since it was the last one at the Greenbelt Bradlees, the managers insisted it was their gift.
Butch Norden, who works at the Maryland Department of Natural Resources with endangered plant and animal species, asked Heather what she was going to do when the nurses pricked her finger. "Hurt the nurses' ears!" she answered.
Indeed, Heather kept her promise! The playroom soon brought a smile back to her face, though, as she romped from toy to toy in red terry cloth slippers and blue pajamas imprinted with bicycles. Despite the fun, however, Heather occasionally stopped, put a finger to her bottom lip, and looked with trepidation at the door leading to the operating room.
"I'm scared," Heather told her mother. "My finger hurts."
"That's the wrong finger," noted mom.
Heather giggled and insisted, "It hurts, too."
Beth Norden recalled having her tonsils out when she was a child: "What I remember most is the feeling of isolation. I was there for three days, and I remember wanting my mommy so much . . . . And they didn't explain things . . . . They told me it would be lots of fun . . . . When I woke up, I knew I'd been lied to. That was the worst part -- that I'd been lied to, betrayed.
"Heather, I need a big hug. I'm feeling kind of sad," said her mother. Once again chipper, Heather stuck out her tongue before giving in with a hug and a kiss.
The operation went smoothly, and we rejoined Heather in the Short Stay Recovery Unit less than an hour after it had begun. A very groggy but still feisty Heather insisted: "I want some ice cream," and "I want to go for a little walk." Beth Norden gently rocked her daughter in her arms and sang softly to her, waiting for her to wake up fully.
The staff at Children's believes that kids recover more quickly at home. As Beth Norden said, "It sure makes a lot of difference to get home and get in your own bed." Short stay provides "safe, quality care with the least trauma to the child and family. It is cost-efficient" for the family and the hospital, said Sue Moschella.
"Our experience here has been fantastic," said Beth Norden. "The people here are so genuine -- they really care."
"We wouldn't take her anywhere else if we could avoid it," added her husband.
At home the next day in College Park, Beth Norden said, "I was so happy to be in my own tiny house with the family all together last night. I kept looking at Butch and smiling, and he felt it, too."
So did the patient. She took the phone from her mom. "Hi!" she piped up. "I'm feeling better." Which was the best news of all.
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