Several weeks ago, I provided anesthesia for the daily dressing change of a child who was severely burned. In the weeks that have passed, her condition has improved, the skin grafts are looking fine. I was sent again to anesthetize her. But the plastic surgeon said that at this point in her recovery there is no need for anesthesia. She had already begun walking with the aid of a walker. However, she continues to scream and cry anytime the nurses touch her, or even approach her with scissors. Since pain is a subjective experience, it is difficult, especially in children, to determine if the behavior is because of pain, anxiety or both.
As the nurses began to remove her bandages, I observed her behavior. My gut feeling was that her screams were more from stress and anxiety than from pain. Surely she had good reason to be anxious. This little girl has experienced more than her share of suffering. I tried to engage her in conversation to try to divert her attention from what the nurses were doing. I had little success, the nurses were concentrated on what they were doing and didn't realize what I was doing and so there was no cooperation on their part. The girl had fasted in anticipation of the anesthesia which probably added to the stress. I made my mind up, I won't anesthetize her. I gave her a cup of water. While she was drinking, she didn't notice what the nurses were doing, which confirmed my instincts. A therapist also joined in the proceedings. She took measurements for a pressure suit that the girl will have to wear to improve the healing of the skin. Even the measuring tape frightened her.
At this point it was futile to try to calm her. So many people were talking at the same time to try to sooth her and it was having the opposite effect.
Truth be told, I was becoming irritated at the staff who prevented me from doing what I do best, induce relaxation. I don't necessarily need drugs for that, just the right attitude. I refrained from reprimanding the staff in front of the girl and her father. I didn't want to embarass them or add to the level of stress in the room.
After the bandages had been changed, the nurses were about to put a fresh diaper on the girl. I said, "No diaper!" Amazing, they listened, and dressed her in hospital pajamas. I took the father aside and told him that this is an important step in her rehabilitation. For three months she has been serviced by the staff and her family, justifiably, but now is the time for her to become an active participant in her recovery. So let's start with this. She is old enough to tell you if she needs to use the toilet. If so, then she can use the walker, a wheel chair or even be carried there. This is the beginning to restoring her autonomy.