Seeing the Difference

By Greg Raver-Lampman 

The CHKD Surgery Experience

Time was importantisk of infection.

When 5-year-old Elizabeth Rainey skittered out of the elevator on the third floor of the CHKD Health and Surgery Center at Princess Anne, a nurse greeted her.

“Hi, Sweetie,” said Karen Perry, her nurse. “You look pretty in pink.”

Moments before, Elizabeth’s parents, Jay and Ruth, swung into the surgery center parking lot, anxious about what lay ahead. Elizabeth needed eye surgery to correct strabismus, also known as crossed eyes. While some may consider the procedure relatively minor, no surgery is minor to parents when it comes to their child.

As the Raineys entered the CHKD center at Princess Anne, they saw immediately that this would be different from their own experiences in an adult outpatient surgery center.

Toys transformed waiting rooms into playrooms. Cheerful colors and enormous pictures of children graced the walls. In a room for teens, a 14-year-old patient clutched a controller, utterly transfixed by a video game.

Elizabeth seemed to feel right at home.

Efforts to help her feel that way began long before surgery day when she received CHKD’s “Healthy Bear Has Surgery” coloring book at her home. The always smiling Healthy Bear describes the surgery process in a child’s terms, making it seem like an adventure. Parents learn to follow Healthy Bear’s lead, and Elizabeth’s mom, a guidance counselor at Granby High School, jumped into it long before surgery day, creating sand art, talking about the movies and games she and Elizabeth would play after surgery, and having a celebratory Jell-O breakfast.

By the time she arrived on surgery day, Elizabeth seemed excited, telling everyone, “They have to move a bone in my eye.”

Ian in January 2007.
At CHKD’s surgery centers, pediatric nurses focus on making kids comfortable, speaking directly to children and teens to set them at ease.

At CHKD’s surgery centers, pediatric nurses focus on making kids comfortable, speaking directly to children and teens to set them at ease. After gathering weight and height information, her nurse lead Elizabeth past a table overflowing with plush teddy bears.

“What color do you want?” she asked Elizabeth.

“Pink,” Elizabeth said, selecting one.

Inside a curtained, clinical space, Perry used another picture book to go step by step through the surgical process, demonstrating on a teddy bear. She explained that Elizabeth would soon meet a “go-to-sleep” doctor with a plastic mask similar to one she gently placed on the teddy bear’s face.

“You get to pick a flavor to breathe – watermelon, bubble gum, cotton candy…”

“Cotton candy,” Elizabeth chimed in enthusiastically.

“And after surgery, you’re going to get a slushee,” Perry added. Elizabeth beamed.

In the playroom, Elizabeth, decked out in her jammies, perched on a small red plastic chair playing with toys, her parents nearby. When her surgeon, Dr. Joel Lall-Trail of Virginia Ophthalmology Associates, entered, Elizabeth leapt up and tossed him a sand-art card she had made for him. “Catch,” she instructed.

Dr. Lall-Trail snagged the card that bore the likeness of a princess and on the back read: Dr. Lall-Trail ™ Elizabeth

Smiling appreciatively, the surgeon asked what flavor Elizabeth chose for her mask.

“Cotton candy,” Elizabeth said.

No surgery is minor to parents when it comes to their child.
No surgery is minor to parents when it comes to their child.

“Excellent choice,” Dr. Lall-Trail responded.

Elizabeth’s “go-to-sleep” doctor, pediatric anesthesiologist Dr. Cynthia Muñoz, walked in a few minutes later in full scrubs and knelt to make eye contact with Elizabeth while speaking. A few minutes later, the two strolled hand-in-hand from the playroom to the operating room.

Dr. Muñoz lifted Elizabeth, still clutching her pink teddy bear, onto the operating room table. Then she took out the mask with the cotton candy scent. Elizabeth briefly pushed the mask away to ask, “Can I close my eyes now?”

Dr. Muñoz eased Elizabeth back, stroking her hair, whispering, “You’re doing such a good job. Your mom and dad would be so proud of you.”

Dr. Lall-Trail started surgery at precisely 11:15.

Surgeons understand that all those efforts to calm the patient can make a significant difference when working with a child.

“I strongly believe that when children have a good experience, we can ensure better outcomes,” Dr. Lall-Trail said. “A patient who is tense experiences more post operative pain and discomfort.”

In Elizabeth’s case, he was performing a relatively complex method of correction for strabismus that included re-attaching a tiny muscle toward the back of the eyeball with a special technique known as a posterior fixation suture. Knowing that every clinician in the room is trained in pediatrics and that all of the pediatric equipment is sized for children of all sizes gives Dr. Lall-Trail an added measure of comfort.

“The fact that the overall experience is good puts me in a better mindset,” the surgeon said. “I want to concentrate on the task at hand and not be distracted, worrying about how the child is going to be treated.”

In just under an hour, Dr. Lall-Trail finished surgery successfully, including the tricky posterior suture.

These people obviously know how to put children at ease.
These people obviously know how to put children at ease.

Minutes later in the recovery room, Ruth settled into a rocking chair to rock her drowsy daughter in her arms as post-op nurses monitored her vital signs and prepared for her discharge. Elizabeth turned to her father with a request. “I want my…”

She trailed off, whispering a word ending in “eee.”

“You want your daddy?” Jay asked.

“No,” Elizabeth said, speaking more forcefully. “I want my slushee.” The nurse produced the promised drink from a slushee machine located right in the recovery room.

About an hour later, the Raineys were on their way home with instructions for at-home care.

Jay carried Elizabeth back to their van, both amazed and relieved.

“I’m not surprised because we have a high opinion of CHKD,” he said, “but I am really impressed. These people obviously know how to put children at ease.”

This story was featured in the fourth quarter 2009 issue of KidStuff, a publication of Children's Hospital of The King's Daughters.