Five times over the next 40 minutes or so, Krauss came in and re-applied the anesthetic, gently squeezing the site with his thumb and forefinger. Why, I wasn’t sure. Was it a dosing thing? Was he just numbing the wound even more before the scary stitching began? With each visit, he engaged Julia to learn something new about her. For instance, she loves to draw.
And, she loves snacks. On my way back from the cafe with treats, Krauss stopped me in the hall and said something like, “I’m going to stitch her up; it really won’t be bad.” I rolled my eyes. But, he added, “I need you to work with me. I’m going to give you a task.” Fine, I said, though the whole thing sounded a little gimmicky.
Krauss returned with an oversized 101 Dalmations coloring book and a handful of Magic Markers. He opened to a page overflowing with dog outlines. “Julia,” he said. “I want you to color each dog’s ear a different color, OK? Which color do you want to start with?”
“Purple,” she said, grabbing the marker. Focused, driven and completely oblivious to the large needle now going into her head, Julia colored in dog ears for the next 30 minutes. (This is a kid who, when awaiting her first flu shot, sprinted down a hallway until cornered by three nurses.) Every once in a while, Julia checked with Krauss to see if he approved of the colors. Great, he said. “Now, their paws. Each a different color.”
...As we left the hospital, hand in hand into the night, my daughter looked up at me and grinned. “Well, Mama, at least I didn’t have to get stitches.” I looked back at Julia, with her bandaged head and big eyes: “But honey, you did get stitches.” “Really?” she twirled. “Well it was fun.” And she jumped into the car.
Dr.Baruch Krauss has done years of research on how to alleviate children and parents' anxiety to provide excellent pain management during procedures. As I read this I was envious because when I was a child the tendency was to downplay the amount of pain children could feel and I was told repeatedly "this won't hurt" and it turned out not to be true. It has caused trust issues that still affect me today. I also wonder if his sensitivity to the link between parent and child would enable him to notice mothers like mine who have Munchausen's by proxy and want more medical procedures and treatments for their children than they actually need. An MBP mom's affect is usually off in a very particular way. Where another mother would be anxious or at best relaxed and trusting, she is excited and dramatizes the experience. She is performing and may be also calling family members and exaggerating the situation for effect. I think this doctor would pick up on that pretty quickly.
I also couldn't help but think of the studies that show that black children are not given sufficient pain management. There are also issues with Latino/a children's pain management because of language barriers creating poor communication with medical providers, particularly concerning aftercare. See also: http://nationalpainreport.com/white-kids-likely-get-pain-meds-er-8821762.html
I'm trying to imagine how Dr. Krauss' methods would work with a language barrier in place or through an interpreter.
And I also wonder if elements of this could be applied to adults, modified with more information about the procedure because that's something most adults want and need. I remember being in the recovery room after my carpal tunnel surgery and the lady in the bed next to me was in horrible pain. One nurse walked by and told her sternly to just relax and she'd feel better. Finally another nurse came over and helped her focus on taking slow, deep breaths. That helped calm her down and focus on something other than pain.
I hope his methods achieve greater attention and are implemented more widely.