In the Wake of a Trach

When I first began my pursuit into child life, I quickly learned that it all revolved around meeting children right where they’re at;

  • looking at them at the same eye level
    • requires physically squatting down
  • speaking to them with words that they understand
    • requires the use of developmentally-appropriate language
  • expanding my “kid-smart” knowledge
    • similar to street-smarts, but rather than being able to deal with difficult situations on the streets, I’m able to name all of the Paw Patrol characters or sing the Mickey Mouse Clubhouse theme song at the drop of a hat
    • requires studying HARD on all things hip and popular for children
      • right now that includes Paw Patrol, PJ Masks, Baby Shark, Frozen, Moana and Blippi on YouTube

IMG_3463Child life specialists are there to help normalize the hospital experience for patients and families. Sometimes this normalization manifests itself by making patients’ dolls look just like them. If they’re in the hospital for an accident, so is Aladdin. If they need an emergency trach placed, then so does Elsa. This is the perfect way to meet the child where they’re at in their hospital journey, with their own doll, and provide them with education regarding their new limitation/accessory.

My most recent experience with this occurred earlier this month when we had to do an emergency tracheostomy for a sweet, five-year-old girl. This procedure happens by creating an opening in the middle of the neck into one’s trachea/windpipe. For this particular patient, she frequently had respiratory issues causing there to be severe amounts of secretions building up in her lungs that she just wasn’t strong enough to cough out on her own. She also had a history of seizures and the doctors were most worried that if she had a seizure, she wouldn’t be able to breathe, and due to the secretions it was possible they wouldn’t be able to maintain her airway for her. Giving her a trach (tube placed in neck after a tracheostomy) was the smartest choice for her. This would prohibit her from speaking for the next week or so until the secretions subsided and her speech therapist was able to place a passy muir (speaking valve) on top of her trach.

I had spent time playing with her at bedside often due to her family’s work schedule.  I noticed that I had to adjust a lot of the things I was so used to doing with other patients. In order to build rapport, I frequently ask patients lots of questions about their family, school, pets, and hobbies, but with her, I was strictly limited to “yes” and “no” answers for our first week prior to her speaking valve being placed.

IMG_3686I provided her with an Elsa doll as Frozen was her absolute favorite movie (I don’t think this movie will ever lose it’s popularity, especially now that there’s a second one on the way), and I made Elsa have a trach just like her. This opened the line of communication regarding her trach and why all the nurses and therapists kept moving stuff on her neck. I was one of the first people to show her what she looked like in a handheld mirror and talked to her about how that was helping her breathe and relating that back to her Elsa doll and her trach.

Ending this post on a funny note: This was probably my third or fourth interaction with her. She was sitting in her bed alone watching Moana. She smiled as I came in. I knew that she hadn’t had any visitors for the morning as her family was not in to see her yet, so I quickly began to engage her in conversation; again, with all the “yes/no” appropriate-answer questions since I would have to carry the bulk of the conversation at this point. I asked her several “yes/no” questions about the movie and shortly after those initial questions she stopped looking at me and answering my questions.

Me: “Am I talking too much?”
Her: nods head “yes”
Me: “Do you want me to just be quiet and watch the movie?”
Her: nods head “yes”

Bless. So that’s exactly what I did. I got paid to watch Moana with a five-year-old that day and I didn’t have to say a single word more!

I love child life because no day is ever the same.

One day I’m making a trach for an Elsa doll;

next I’m running across the hospital to the Adult ICU to help prepare a child to see his severely injured father for the first time since the car accident

One day I’m prepping a child for an upcoming MRI;

Next, I’m creating elaborate bulletin boards for the unit.

 

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