How not to have an operation

by Wolf Pascoe on January 25, 2011

The first operation with ether.

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Recently, I wrote an essay for The Sun Magazine about the consequences of an operation I had when I was five. (The first part of the essay is available online. The complete version is in the printed magazine.)

The operation was a tonsillectomy, for which I was given anesthesia with open-drop ether. In those days, the original nineteenth-century technique for handling children in an operating room still prevailed: Say nothing. Take them by surprise and hold them down.

One ramification of that operation is that I became an anesthesiologist (my day job.) I developed my own ideas about how to be with kids in scary situations.

The world has changed since my tonsillectomy. The need to communicate with children isn’t news. But here’s something I’ve learned as a physician that’s just as important:

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Children will react as their parents do.

A mother or father who can’t handle their own turmoil will teach a young child that the world is a threatening place. Calm, empathetic parents tell the child that she’ll live to see another day.

It’s one thing to know this as a doctor. It’s another matter entirely to put it into practice as a parent. This was underscored for me recently when I came home from work to find that Nick had been attacked by a rose bush.

He lay moaning on the couch. One of his hands pressed an ice pack to his head. The thumb of the other hand was in his mouth. Nora stood by, her face white.

“Nick ran into the rose bushes without looking,” she said. “He cut his head on a thorn.”

“Okay, let’s see.”

I found an inch-and-a-half gash in Nick’s scalp. It was oozing blood. I couldn’t tell how deep the cut was, but it looked respectable. Nick’s squirming prevented me from probing the wound.

“Dada, am I going to die? Do I need an operation?” Many, many tears.

“Nick, it’s going to be okay. Mommy and I will take care of you. We’re going to the emergency room. The doctor there knows just what to do.”

Nick managed to hold it together until we were in the car. Then he started to lose it. Then I started to lose it.

“It’s going to hurt,” he said.

“We’re going to have it looked at,” I said. “The doctor will do what needs to be done.”

“But what if I need an operation? What if they have to sew it up?”

“They’ll give you a local. You won’t feel the stitches.”

“What’s a local?”

“It’s a shot to numb you up.”

“How can a shot in the arm numb it up?”

“It’s not a shot in the arm. They inject your scalp around the cut.”

“They give you a shot in the head?”

Pandemonium in the back seat. Now Nick was ringing his hands and tearing his hair.

“Maybe Nick doesn’t need to hear all this,” Nora said.

What on earth was I doing?

I was acting calm, but I wasn’t really calm, not on the inside. I couldn’t stand Nick being so terrified, couldn’t stand to look at it. So I tried to argue him out of his terror. Instead of taking care of him, I took care of me. Which left him all alone.

“You’re finding all this scary,” I said at last. But empathy had come too late.

“I’m not going in there,” Nick said when we arrived.

“Nick,” I said, “Your choice is walking in or being carried.”

He walked, whimpering, with Nora’s arm around him.

My friend Dave was on call that night. With sureness, patience and tenderness, Dave cleaned Nick’s scalp and applied antibiotic ointment.

“He’s current on tetanus?” Dave said.

Thank God, Nick had been immunized.

“It’s superficial,” said Dave. “Ointment twice a day. It’ll close right up.”

“I don’t need an operation?” said Nick.

“Nope. We’re done.”

In the car on the way home, Nick asked me what superficial meant.

“It means just a scratch,” I said.

“You said too much to me, dada.”

I had a vision of carrying him struggling into that emergency room. It was not unlike the memory of myself on that long-ago operating table.

“I know, Nick. I’m sorry.”

. . .

RELATED POSTS:

I’m not your house elf

Night and sleep

Friends and neighbors

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You might also enjoy:

Wolf Pascoe’s essay in the Sun, “Going Under.” The first part of it, anyway.

This video, also called “Going Under,” shows a contemporary anesthesia induction. It’s a lot better than holding a kid down without warning, but the adults here over-talk a bit, ministering to their own anxieties, just as I did in the car:

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from Singlemommyhood: A child’s questions about death

from Privilege of Parenting: Paying loving attention to attachment

. . .

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Painting credit: “The First Operation with Ether” by Robert Cutler Hinckley, displayed in the Ether Dome at Massachusetts General Hospital in Boston. It depicts the first public demonstration of ether anesthesia by W.T.G. Morton on Friday, October 16, 1846. Morton’s tombstone reads:

By whom, pain in surgery was averted and annulled
Before whom, In all time, Surgery was Agony
Since whom, science has control over pain

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Any experiences with kids, scratches, or operations? I’d love you to add your comment below. I always respond here.

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{ 24 comments… read them below or add one }

kathryn kates January 25, 2011 at 9:13 am

I sat giggling on the sofa, hearing your soft voice saying “they’ll give you a local you won’t feel the stitches” thinking……….. WHAT ARE YOU SAYING TO HIM!!

very funny stuff. love reading it

and now I have to go and unearth the earlier posts; I’m late to this party.

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Wolf Pascoe January 25, 2011 at 9:21 am

Kathy,

Honest to God, it didn’t occur to me when I was writing that this was funny, but you’re right to laugh. I am my own comedian, I guess.

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BigLittleWolf January 25, 2011 at 10:46 am

Oh, this is both funny and wrenching! And a bit reassuring to know that even a doctor goes through this sort of turmoil when seeing his own child hurt – even “superficially.”

A delightful piece, Wolf. And full of lessons.

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Wolf Pascoe January 25, 2011 at 10:58 am

Always glad to be reassuring. It seems to be my purpose on this site.

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jeff January 25, 2011 at 11:01 am

Great that it all worked out I wonder what local means to him to me its living near to me

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Wolf Pascoe January 25, 2011 at 11:09 am

As I said, this is instruction about how NOT to have an operation. Just call me anytime if anyone you know is confused about anything medical. I’ll clear it right up for them.

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Dan January 25, 2011 at 11:12 am

Love the part about taking care of yourself, not of him. A grudging admission, but a gift to your readers. Loved it all, actually.

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Wolf Pascoe January 25, 2011 at 11:18 am

When the oxygen masks drop down in the airplane, you’re supposed to put yours on first, then help your child put his on, right? (But at least in the plane, you’re aware you’re ministering to yourself first.)

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Sirena January 25, 2011 at 2:09 pm

You are so right – if the parent is O.K., the kid will be O.K. My stock, although I believe always the correct, response to any crisis is “you’ll be fine” (said reassuringly of course). I’m finding, as one who is prone to blathering on and on about things, that in most instances, not just in a crisis, the less said, the better. If you get through the three gates: 1) Is it true? 2) Is it kind? 3) Is it necessary? then you can say it. Of course, if you abide by these rules you probably wouldn’t be talking much lol….

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Wolf Pascoe January 25, 2011 at 3:01 pm

Lincoln was very fond of “this too shall pass” because it tends to restore equilibrium in both good and bad times.

As to good, true and necessary, the only problem is that there are times when I thought I was being all three and what I was really doing was the opposite. I try to leave a lot of room for being wrong.

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Sirena January 25, 2011 at 4:51 pm

I know it’s an old one, but I’ve always liked “this too shall pass” – me and Lincoln – always good to put things into perspective. I think I’ve said this before, but I urge you not to be so hard on yourself. None of these “mistakes” are irreparable, really. Nothing wrong with being wrong, or right, or not so wrong, or REALLY right, or sort of a little wrong, well, you get the idea. You are an ever mindful parent and Nick is very lucky to have you and Nora!!!

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Wolf Pascoe January 25, 2011 at 10:58 pm

Thanks for the kind words, Sirena.

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Jose Luis January 25, 2011 at 6:02 pm

Reminds me of the story (can’t remember the details) of the king who heard there was a ring that would make sad people happy and happy people sad. Long long story, but one of his servants finally found someone to make the ring and delivered it to the king who read the inscription on the inside which said, “this too shall pass”. Love your blog!

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Wolf Pascoe January 25, 2011 at 11:16 pm

Jose Luis,

I heard that story too! I’d forgotten it until you mentioned. I wonder if Lincoln heard it?

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Clark Kent's Lunchbox January 25, 2011 at 10:04 pm

This reminds me of when my oldest ran down the hall, slipped on a newspaper and sliced his ear on the corner of the wall. He was 2 and screaming like crazy. We calmed him down during the ride to the ER but he started back up when the Dr tried to put in stitches. He had to be strapped to a board–hardest thing to watch. His mother understandably couldn’t. I had been trained as an EMT by the Army so I knew how important it was to keep outward emotions under control. I did my best to sooth him, but he fought to the point of wearing himself out. That was the only way they could sew up the ear. one of the less than desirable aspects of parenting.

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Wolf Pascoe January 25, 2011 at 11:21 pm

Oh, Lord, what a nightmare. Does he remember it?

Nick broke his foot when he was three and wore a cast for ten days. He was very brave, but the thought of being broken really troubled him. I wonder if this one tapped into the old memories.

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BigLittleWolf January 26, 2011 at 12:01 am

I just recalled one little episode with my elder. He was about 5, and wanted to be a doctor from the time he was 2 (and watching a baby born on PBS, following by questions about the placenta… ). At 5, in kindergarten, he slipped, cut above his eye, and had to go to the ER. Not only did he not cry, he calmly requested a mirror of the nurse, and proceeded to watch himself get stitched up.

Yours truly couldn’t watch. I think he still remembers that, and chuckles. I had enough trips to the ER with two boys to not chuckle…

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Wolf Pascoe January 26, 2011 at 4:34 pm

Extremely unusual for a 5 year old. In fact, reportable in the medical literature. Well, consider it reported.

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Barbara January 26, 2011 at 4:50 pm

It’s good to know that even doctors get a little freaked out over their kids’ injuries! When my son Daniel was 2 (and I was pregnant) he had one thing after another requiring trips to the ER; the worst was when he swallowed a penny and had to be knocked out – the scariest thing ever for me! I’m not sure how they presented it to him – his dad had taken him and I just met them there right as they were carting him to the operating room. I can still feel that fear!

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Wolf Pascoe January 26, 2011 at 8:06 pm

That’s the scariest thing, when a child’s airway is at risk. Nick had croup once when he was 1 1/2. It was terrifying. It helped not at all that I’m an anesthesiologist by day.

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Tom January 30, 2011 at 1:52 pm

Glad Nick is OK with only a superficial cut and great to see that your wonderful essay on your childhood tonsillectomy was published in The Sun.

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Wolf Pascoe January 30, 2011 at 2:14 pm

Thanks, Tom. And thanks for the visit.

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Karen February 1, 2011 at 10:00 pm

I enjoyed your article in The Sun and your post here as well. Although it’s not the focus of your piece, your comment about the immune function of tonsils (in the first paragraph) piqued my interest. Can you recommend any further resources on the current thinking about tonsillectomy in children?

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Wolf Pascoe February 1, 2011 at 11:29 pm

I like this article from a Texas pediatric group:

Tonsils and Tonsillectomy

Hope that clarifies.

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