British Medical Journal, Volume 316: Page 1616, 23 May 1998.
As a child psychiatrist, one of my missions in life has been to teach medical students that children have feelings. A simple point, which as part of my job I have also had to remind paediatric colleagues about at times. Why then, was I so shocked by my own son's response to surgery?
Last year at the age of 7, my younger son had to have a circumcision. We had not taken the decision lightly, but he had had several local infections as a result of not being able to retract his foreskin. Fortunately, when we explained what was needed, he responded well. After some initial anxiety he took matters into his own hands, and came back from school one day with a list of those boys who had had the "special" operation. This seemed to reassure him enormously.
The staff at the local hospital were excellent. Apart from embarrassment at having to wear a backless theatre gown, the preoperative preparation went well. The hospital had a power cut just as we were going to theatre, but contingency plans were quickly put in place. Once there, the anaesthetist delivered an obviously well rehearsed line about drinking a glass of milk in a special way. He showed him the milky fluid in the syringe, and managed to change his story quickly and convincingly in response to the immediate retort, "But I don't like milk."
After surgery, my son woke up abruptly. I told him that he had had his operation and he gently lifted the covers and peered downwards. "Have they killed my willie?" he asked. "They have, they've killed it." I was shocked and hastily tried to reassure him even though my own brief glance had taken me aback too. His penis was, of course, very swollen and bloody. I managed to remember that he had also had a penile block and may well have been feeling that his organ was dead.
As the local anaesthesia wore off, he experienced pain which was helped by paracetamol. However, the magic syrup did not serve to modify his indignation and outrage about what had happened. For several days (as the parent at home and looking after him) I was subjected to tirades about nurses and doctors and how wicked they were. (Did he mean me too?) "They're just there to torture children, to hurt them, and make them cry. They're evil." He seemed clear that he was "never ever going to that hospital again." He refused to drink so that he did not have to pee. I tried hard not to get into a battle about this, but of course ended up using bribery as an alternate strategy.
At times, he literally roared with rage. This was interspersed with more quiet reflective periods when I would catch him staring down at his penis with tears in his eyes. Thankfully at other times he seemed lost in the world of video entertainment. He took pleasure in commanding me to bring him snacks composed of various delicacies, including pepperamis (a long standing favourite), which had to be arranged to his satisfaction on the plate before serving. I told a colleague who telephoned that I was being put through an emotional wringer.
Worse was yet to come. On the third day it became obvious that he had a wound infection. I telephoned the surgery and asked for a home visit. The receptionist passed me on to the general practitioner, who gave me a hard time, even though I explained that he was ill, and even if he were not that I would not be able to get him to put on pants or trousers. He agreed to come but when he arrived saw fit to lecture me further. I was close to tears and could not fight back even though I wanted to and was annoyed at myself for not doing so. He dismissed my claim that my son had been pyrexial the night before, but seemed to mellow as he looked at his penis and agreed that he did have an infection. As well as prescribing antibiotics, he told me that I would have to deslough the wound regularly. Adhesions under the foreskin meant that the wound consisted of not just the sutured area, but also most of the glans. During the following few days I spent hours painstakingly softening and removing the detritus with a cotton bud, thankfully to good effect.
When the general practitioner referred us back to the hospital on the sixth day my heart sank. How would I get this child who was so full of loathing for the staff to go back there to see them? Surprisingly easily as it happened. My son has always been a very contained little boy outside of our home. Even though he gives us a very hard time about not wanting to go to school, for example, he is a model pupil, and as it turned out, even though he put me through hell at home, he was a model patient when we returned to the outpatient department. Our visit marked the abating of his fury and the beginning of his recovery. His penis now looks beautiful, and works effectively too. He had a brief period practising peeing up the bathroom wall but since then all has been well.
Children react in different ways to illness and loss. I felt under attack during the period of my son's recovery from a minor operation and was left in no doubt that the experience had had a profound effect on him. I am not sure that general practitioners or hospital professionals appreciate what parents have to do in these situations. Those whose children have longer term illness or need repeated surgery have to cope with far more than I did and need our affirmation and support in order to do so.
senior lecturer in child and adolescent psychiatry, London
© British Medical Journal 1998
Contact details for Dr. Anne McFadyen, MB ChB Glas. 1980, MSc Brunel 1991, MRCPsych 1984:
[Responses to the Editor]
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