The call came early one morning. Rich and Christine were very upset. Their 6-year-old daughter, Mariella, had seen a flashing light in her left eye that would not go away. A trip to the emergency department revealed a small retinal tear. The ophthalmologist wanted to operate the next day to prevent a major tear and to save Mariella's vision. Rich and Christine wanted me to meet with her before surgery.
I asked myself several important questions: Could one meeting with a young child be helpful? How much should I say to the parents and to the child when time is short? Could I trust that a child as young as Mariella would know how to use the consultation to her best advantage or would it be more effective if I structured the time according to my own notion of what might be useful?
Like mother, like daughter
I first became involved with Mariella's family when Christine had a major retinal tear 4 weeks after giving birth to Mariella, her fourth child and only girl. Christine immediately underwent major eye surgery. For 8 weeks afterward, she had to lie face down and motionless to allow her reattached retina to heal properly; she could not lift anything, including her infant daughter, and she was unable to breast-feed.
I was called in then to help Christine, who was anxious about the outcome of her surgery and about the impact the constraints of her recovery would have on her baby and family. I visited Christine's home twice weekly and offered a combination of interventions. I talked with her about her feelings, treated her anxiety and despair with antidepressant medication, and dispensed parenting advice. Occasionally, I would play with her sons and elicit their ideas and questions about what was going on. My main focus was to help Christine get through her ordeal, which she was experiencing as a trauma.
So, when Rich and Christine called me that morning about Mariella's own unexpected ophthalmological crisis, I agreed to meet with the 3 of them. Rich and Christine were at a loss; the surgery would take place within 24 hours. They had no time to buy doll furniture to create an operating room so that Mariella might play out what was to come, nor did they have time to read her books about children in hospitals.
Mariella and her parents trudged into my office late that evening for the emergency appointment. Christine plunked down in the patient chair while Richard pulled up the rocking chair that I kept in the corner of my office. Mariella slumped her gangly frame against her mother's legs and absently swirled her finger across the carpet.
During our meeting, Mariella sobbed quietly. She had been told that any abrupt motion of her head, including "hard" crying, might make it more difficult for the doctors to fix her eye. As I looked on, Rich and Christine tried to explain the operation to their daughter. Their main concern was to assure Mariella that she would get through the surgery and be all right. They explained to her that the 3 of them would go to the hospital the next morning and that they would stay together until the anesthetic caused Mariella to feel very tired and unaware of what was happening to her. (Friends had told them to distinguish between "going to sleep" and anesthesia.) The doctors would fix her eye and she would not experience any pain. The medicine would make her forget all that would occur in the operating room—including memories that might upset her.
Mariella was not happy with her parents' explanations. "Why are you telling me all this?" she asked. "Stop talking so much."
Meanwhile, Rich and Christine were pressing their daughter to say that the information they were sharing was helping her. "Now do you understand?" Rich asked. They asked her, "Now are you feeling safe?" over and over with rapid and loud speech. Despite their best intentions, this was beginning to look to me like an interrogation.
I gently explained that nothing Christine and Rich could say would help Mariella feel better. She needed to know what was going to happen, but it was not going to calm her fears. Having never had surgery or any serious medical interventions before, it was perfectly natural for Mariella to have dire expectations despite her parents' reassurance. Mariella wanted the next day to be like every other day; she would be with her family, go to school, play with friends, and then come home. She was angry and scared, and those feelings made sense given the circumstances. I told Rich and Christine that they should not expect her to feel better about the surgery until it was over.