A Six-Year-Old Gets Stitches, Doesn't Feel A Thing, Goes Skipping Out Of The Hospital
Rachel Zimmerman writes at WBUR about her six-year-old daughter's head laceration and a visit to the ER and the incredible doctor, Baruch Krauss, who cared for her daughter. Initially, her daughter cried, saying she didn't want stitches:
Dark, lean and intense, Dr. Krauss shook my hand and then went straight to Julia, complimenting her pink, sparkly shoes. She lit up and was eager to chat. They talked about exactly how old she was (nearly six-and-three-quarters) and what she likes to do (climb trees). Then he gently rubbed a bit of Novocaine gel on her cut and said he'd be back.I hovered nervously around Julia, checking and rechecking the cut and generally exuding anxiety, while my husband sat quietly, telling me to calm down. Sure, that'll work.
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."
My job was to hold the coloring book up straight.
...As Julia drew, Krauss stitched, about five or six tiny loops in her head. He continued to chat with Julia about the picture and her color scheme; then he'd return to stitching. Soon, it was over. Julia finished her picture and signed it: "To Baruch, Love Julia."
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.
She continues:
It turns out Krauss has been focusing for more than 20 years on how to minimize acute pain and anxiety in children undergoing medical procedures. "I first became interested in it when I was working at Cambridge Hospital in the late 1980s," he said in an interview. "At that time there really was no emphasis on managing pain in children. And I witnessed children going through procedures, and they were really suffering, not only from pain, but also, more so, from anxiety and stress. And at that point I became really committed to doing something about that."
At the link are some of Krauss's thoughts on how to keep the suffering out of the experience. Here's a biggie:
Seems So Simple, How Does It Work?It's almost as if the consciousness has two components. You can imagine it as the central component and the peripheral component. The peripheral is like your hard drive. So in your peripheral at the moment is perhaps the sound of the fan in the room, or the sensation of your pen against your fingers, the ambient room temperatures. In the central would be the sound of my voice, certain body sensations that you have. Now, my job is to move all the sensations of that laceration from the central compartment to the periphery. So for Julia, what I'm doing there may be no different from the sensation she has in her left great toe. She has it, but she's not paying much attention to it. It has no emotional valence for her.
Once I'm able to successfully move or shift her awareness, then what's in the central compartment is an empty file, which I can fill, in this case, with coloring and the developmental tasks she's trying to do, etc. So that her experience at the end is that she doesn't remember what happened here because for her it was no different than the sensation in her left great toe. What she does remember is what she was focused on."
I wonder how much the ER bill was? And
How many MD's can afford to spend an hour on a five minute procedure?
It is the parents job to reduce anxiety, and to teach the child that occasionally things are going to hurt a little bit. It is part of how we learn to deal with life and become an adult.
Bet these people did not have an ACA policy.
Isab at May 4, 2014 4:13 AM
Isab,
It doesn't really matter how much the ER bill was or what the insurance policy they had. This is purely a matter of the quality of the staff.
When most people go into an ER or urgent care they are in an excited to panicky state, especially the injured person. A well trained staff knows this and does their job to get the patient (and surrounding friends and family) to a calmer state. Until then it is harder to treat them.
Children usually panic a little easier, but are easier to divert, especially if the adults around them help.
So it sounds like the author just ran into a fantastic doctor that had the time and experience to really take care of her daughter in the best way possible.
I'm sure there have been times the ER was packed wall-to-wall where the doctor didn't have time to take 30-40 minutes for a 5 minute set of stitches. But that is not a function of insurance or the ACA. Health care is not health insurance. The staff is going to be there regardless of what the patient load is.
Jim P. at May 4, 2014 5:14 AM
That's incredible. I love it. There are many things that CAN be done to ease pain, anxiety., and discomfort that simply aren't done.
The last time I had to get a medical procedure I left rather upset. The doctor knew that I was going to have the procedure (a uterine biopsy) but didn't let me know beforehand so that I could take an ibuprofen. The first thing he did was walk into the room and grab my phone out of my hand. That might have been a good distractor for me. He said that women had thrown them at him. Perhaps so. Some women have described the procedure as more painful than childbirth.
For me, there are also psychological repercussions when I'm told that I should feel a five minute pinch, but the cramps last the entire 11 days that I'm left bleeding from the procedure. And by the way. When docs do a procedure that causes bleeding, wouldn't it be thoughtful to either warn women before-hand or give them a pad so that they don't have to scamper straight home because of soiled clothing?
Jen at May 4, 2014 6:57 AM
I went to Chile with a few of my dental classmates to treat Chilean children in an isolated town. We were tasked with removing decay and extracting hopeless teeth. We administered novocaine to children who did not speak our language, so talk about an exercise in patient management and anxiety management. I was able to give anesthesia and take out a few teeth from a 6 year old by distracting him with sounds and my light, and he giggled the whole time.
It was incredible experience. I guess I just wanted to brag.
Katie at May 4, 2014 8:09 AM
Amy Alkon
https://www.advicegoddess.com/archives/2014/05/a-six-year-old.html#comment-4582186">comment from KatieWow, Katie -- that's amazing.
Amy Alkon
at May 4, 2014 9:02 AM
Amy Alkon
https://www.advicegoddess.com/archives/2014/05/a-six-year-old.html#comment-4582189">comment from JenJen, that doctor sounds awful.
And I bet nobody throws anything at the doctor mentioned in the piece.
Amy Alkon
at May 4, 2014 9:03 AM
Decades ago I had my vasectomy by a guy recommended by my family doctor. Later he asked how it went and I told him it went okay but that they guy was a little rough. The family doc told me that he had stopped recommending that particular surgeon 'cause he was a former Navy doctor that 'had a history'.
Typically I've found that time has little to do w/things ruled by personality.
Bob in Texas at May 4, 2014 9:20 AM
Similar experience with my daughter and vaccinations. If she was distracted, the barely felt it.
Mike at May 4, 2014 6:03 PM
I don't think that it is that he is a terrible person.
I think it has more to do with the way that doctors are trained. This is the third doctor who has acted in much the same manner.
Not all people, including doctors, naturally have this type of emotional intelligence. As a matter of fact, it may be systematically trained away from them.
When I studied Early Childhood (required to become an elementary school teacher) we were trained not to register disgust in any way or say, "pee-yew" even if it was with a smile, We were supposed to talk to the babies, smile, and say their name.
Doctors and nurses need to be trained to take care of patients and not increase their stress and pain levels.
Jen at May 4, 2014 6:07 PM
genius care.
I've seen, and experienced, a somewhat related technique which provides relief from headaches.
gcotharn at May 6, 2014 12:17 PM
Isab, after reading your comment, I suspect you 1) have never had stitches, 2) have never visited an emergency room, 3) have no idea how medical services and offices work, and 4) do not have children.
Getting stitches is not a 5 minute procedure. The last time I needed stitches I was in the treatment room for an hour or so. First the nurse cleaned up the wound and stopped the bleeding, then put a cold pack on thw wound. Then the doctor came in, looked at the wound, came back after I few more minutes icing and injected the local anesthetic. Then we waited for 10-15 minutes for it to take effect. Then the doctor came in and carefully did the stitches. Then the nurse gave me a tetanus shot and a prescription for painkillers, and a return appointment. The care was outstanding, by the way. And guess what? The doctor was doing other things and seeing other patients while he was out of my treatment room. He wasn't just standing there killing time like you seem to imagine.
Same thing in the case in the article. They were lucky enough to get an excellent doctor, who handled things efficiently with his patient's best interests in mind. He took time to make sure the anesthetic was working (more applications of gel to get it to penetrate), the squeezing was to close the wound, and the distraction was brilliant. Once agian, the doctor was seeing other patients, etc. while out of the room.
We should all be so lucky as to get a doctor this good when we need patched up. By the way, I hit a time when the doctor on duty was board certified in both internal medicine and surgery. Trust me, he knew what he was doing.
Nolo Contendere at May 6, 2014 4:04 PM
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