Making Hospitals More Hospitable with The Tongue Depressor Challenge

 

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My colleague, child life specialist Jon Luongo, is one of the most playful professionals that I have the pleasure of knowing. He taught me all about the “tongue depressor challenge”, which is described in detail in our co-authored chapter in the Handbook of Medical Play Therapy and Child Life.  Below is a brief introduction to the activity by Jon:

I encourage the doctors to tap into their imaginative playfulness to complete what I call the ‘tongue depressor challenge.’ The task is to co-construct a teaching tool alongside a patient to explain a part of the body, a particular medical condition, or piece of medical hardware. The challenge for doctor and patient is to use at least one tongue depressor in their design; like a single LEGO brick in a set of construction toys, the tongue depressor represents a humble piece of medical paraphernalia with limitless creative building potential.

 

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As with many great ideas, I borrowed Jon’s and tweaked it a bit. This past July, I brought the activity with me to the Klicek Foundation Summer Camp in Malejovice, Czech Republic. Camp directors Jiri and Marketa Královcovi graciously allowed me to lead the campers in a slight variation on Jon’s theme. Continue reading

Driving the Camel Installment #2

 

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Driving the Camel; Adventures of a Child Life Specialist

Installment #2

Chapter 1: Two for One Sale continued

…..But today it was my turn to be the patient. As I pushed my way through the revolving doors of the very hospital where I had provided solace and healing, it struck me that I was the one in need of these things. Who was going to take care of me, the caretaker?  It was such an odd homecoming, familiar yet strange. The actual building I entered had not even been in existence when I’d worked there. But it held the same smell and the decor was familiar, as were the uniforms of the security guards at the information desk.  

Entering the lobby as a patient, without the authority of an employee ID badge, I felt like a lobster shedding its shell, soft, pink and vulnerable waiting for a new protective coat of armor to form. I had taught children and parents so many coping skills over the years. Would these skills be available to me now, or would terror hijack all of my working synapses and block my access? A rip current of anxiety carried me along a shoreline just out of reach. I could feel my feet scrambling for solid ground.

At the check in desk on the 4th floor, I supplied my birthdate, those eight digits that granted me access to the world of treatment.  Like a POW stating name, rank and serial number, I would repeat those numbers countless times over the coming months. Mark and I found seats on one of the many couches in the waiting room. Although most seats were filled, there was a hush to the large room. Patients and caregivers sat in small groupings, sipping coffee, reading magazines, texting quietly on cell phones. One woman appeared clearly ill, a greyish pallor smudged over protruding cheekbones. Overdressed for the spring weather, she huddled in her scarf and coat, a hat pulled low over her forehead. She tried her best to curl into her chair, her eyes closed in exhaustion. Was that going to be me soon? Others looked no different than me, dressed for work, no outward signs of illness or distress. Mark pulled out his blackberry and zeroed in on work emails. That and his bouncing foot were his only tells.

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Soon enough, we sat across a desk from Dr. Fodor, while he drew an anatomical diagram of my breasts upside down, so that we could see it from our seats.

“You have three tiny tumors,” he began. “Two here, and one here. They are what we call “in situ,” Stage One. So first of all, I want to tell you, you are not going to die from this. “

I looked over at Mark and our eyes met in shared relief.

“Now our data shows that there is no difference in outcome between a mastectomy and a lumpectomy for this type of cancer. So we recommend a bilateral lumpectomy along with a sentinel node removal and biopsy, followed by four weeks of radiation. You should be done with this whole business by the end of the summer.”

“Thank God!” I thought. No horrible decision to be made between a mastectomy and a lumpectomy. No chemo. It was mid May, and as a professor I didn’t work summers. This already felt manageable. Dr. Fodor, sporting a bow tie and the lanky build of a basketball player, exuded calm reassurance. This was no big deal. He saw this every day.

“So, what do you think about next week?” he said.

My heart sped up. “Surgery? Next week?”

“Yes, let’s get you on the schedule for next week and get this started. My assistant will give you all of the pre-op information, so that you’ll know what to expect and what you need to do to get ready.”

Mark and I walked out of the doctor’s office an hour later with a schedule for surgery and pre-op appointments. Dr. Fodor had explained that in addition to routine blood work and an EKG, I would need to be injected with radioactive isotopes, scanned, and have seeds placed in both my breasts to localize the tumors and sentinel lymph nodes so that he would know where to cut. It was a lot to take in, but I didn’t have a lot of time to think about it.

The very next day, I boarded a plane to Denver to attend the Child Life Council’s annual conference. 

The CLC is a membership organization for the field of Child Life. It oversees certification, provides support and resources to child life specialists, and runs an annual conference. This year, the Council had awarded me a scholarship for Innovations in Play, and the Disney Corporation would  underwrite my trip. I had two presentations to give, both on the topic of play. In addition to the scholarship, the CLC had recently hired me as the project leader to design and conduct an international survey on the state of play in North American hospitals. My career was beginning to expand beyond the walls of the small college where I taught courses in play and child development for child life specialists and teachers. I was excited and a bit overwhelmed by the tasks that lay ahead. Cancer certainly hadn’t been part of the bargain when I signed up for these opportunities. But there was no turning back now.

I sat on the plane, reviewing my presentation notes and drifting in and out of focus. Thoughts were ricocheting around my head like pachinko balls. The running monologue followed no linear path, and went something like this. “Holy Sh*t! I have cancer! Weird, I don’t feel sick. How the hell am I going to concentrate on presenting to over 200 people? What if I cry? Holy Sh*t! I’m having surgery next week! How big a chunk is Dr. Fodor going to take out of me?  What if Dr. Fodor is wrong? What if these damn tumors metastasize and kill me? Will I be able to go on vacation in August like we planned? How the hell am I going to get all of my work done for the CLC?  Will I be able to meet their deadlines? Is radiation going to hurt? My skin is so sensitive and my mother had such a hard time with radiation. Will it be worse for me?”

My mother had been diagnosed with breast cancer 6 years earlier. She had a tough time with post surgery complications and the radiation had left her scarred and in chronic pain. But thankfully, she was alive and kicking at the age of 80. A great role model for me, Joyce projected an infectious sense of joy and a thirst for learning and growing. I would definitely be relying on her life perspective in the coming months.

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Arriving at the hotel, I was greeted by texts from my 2 co-presenters, who were eager to gather to rehearse our presentation. I had never met Loxy before, as she worked with Caitlin at a children’s hospital in Texas. But I knew she was more than a child life assistant and co-worker. She was a dear friend and mother figure to Caitlin, who had moved to Texas knowing no one. Caitlin, with her freckles and strawberry blonde hair, was one of those precious gems in my life, a student who had graduated and turned into a close friend and colleague. Continue reading