On one of the last days of my anaesthesia rotation this year, we had a 10-year-old kiddo with quadriplegic cerebral palsy and lots of anxiety. He was a super intelligent, pleasant kid, who was understandably very scared of getting an IV--he was known to be a relatively “difficult poke”, so most of the IVs he had in his life required multiple attempts. For his history and current conditions, we felt a total intravenous anaesthetic (TIVA) would benefit him, but unfortunately we were not able to get the IV in on the first attempt. He became extremely stressed and we negotiated one more attempt for him to hopefully spare him from previous side effects he’d experienced with the inhaled anaesthetics, but unfortunately that attempt was also unsuccessful.
We were quick to reassure him that there would be no third attempt while he was awake, and the entire time we got him prepared for his inhalational induction he was apologizing for getting upset.
“I’m so sorry that I was so upset,” he said. “I know you were just trying to do what was best for me, and that you just want to take care of me. But I really, really hate needles, and I know when I get stressed out my veins are even harder to find, and that really sucks.”
“It really does, buddy,” I told him. “But I want you to know it was not your fault for getting upset! You are always, always allowed to get upset. The most important thing is that you were so incredibly brave--even though you were stressed and upset, you did your very best to let us take care of you. Unfortunately today your veins didn’t cooperate with us, but you didn’t do anything wrong. You don’t have to be sorry for feeling the way you feel.”
“Okay,” he said. “Okay, well, I’m sorry for shouting. I didn’t need to shout, even if I was upset.”
“You know what, my friend? Sometimes we just gotta shout it out. You’re right, we shouldn’t shout at people because it can hurt their feelings. But I promise no one’s feelings were hurt today, we were just sad that you were upset by the needles. That’s why we said two tries only, right?”
He sniffled a bit and wiped at his face. I let him pick a scent for his mask (we use a drop or so of essential oil inside the face mask so it smells like oranges or strawberries or watermelon--it’s actually kind of neat!).
“Are you ready to go to sleep now?”
“Yeah. I know you guys will take care of me.”
That day, I learned a lot about patient-centred care from this little gentleman. I also learned a lot about emotional regulation and how our emotions can affect others when we externalize or internalize them. I learned how our emotions can be recognized and how we can take responsibility for our emotion-driven actions, and how we can still prioritize kindness even when we’re upset and overwhelmed.
No matter how much experience or education we may have, we will always have something to learn. My favourite teachers are usually my patients. Even if the lessons they have to teach me may be a little hard to swallow at times, they teach with such purity and general adorableness that these are lessons for my heart and soul as much as they are for my brain.
Thank you to all of my little (and okay, fine, sometimes not-so-little, when they’re adolescents and taller than I am...) teachers <3
