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  I decided to keep a diary of events in the hope of recording a follow-through account of the reactions of a young child to tonsillectomy that would add to understanding of how a child might best be helped to cope with such an experience. In this I shared the interest of my husband.



  March 1st. Jean was seen by the surgeon today, and he recommended removal of her tonsils and adenoids. This was said in her presence, but as she has been rather deaf because of the ear infection (otitis) she seemed not to have heard. The operation was arranged for six weeks ahead, and I have decided not to say anything to Jean about it until about a week before she goes to hospital.

March 2nd to 5th. During these few days Jean became increasingly difficult about her food. She ate little and appeared angry or unhappy at mealtimes. This puzzled me until I overheard her say to herself, “Don’t eat it. Better not eat it or you’ll go to sleep.” So, although I had planned to give her only about a week to adjust to the idea of an operation and a stay in hospital, I decided to begin telling her at the first opportunity lest her eating disturbance was in fact connected with fantasies about anaesthetics.

March 6th. Today I told Jean that she would go to hospital one day to have her tonsils taken out. I chose a moment when she was complain­ing about having to stay in the house because of a sore throat and cold. Together we looked out of the window and named the children who had been ill and were now well again. I pointed out two children who had had their tonsils out, and Jean added two more names to the list.

She said, “I wouldn’t like to go to hospital without you. I would want you all the time. I wouldn’t stay there.” I told her that I would stay with her in the hospital. She said, “All the mummies don’t stay with their children all the time in hospital. Why don’t they? Susan’s mummy didn’t stay with her.” I reminded her that Susan’s mummy had visited her every day instead: “Susan is a bigger girl than you are. She goes to school and is used to being away from her mummy.” Jean said, “Susan didn’t like it when she didn’t see her mummy in the night, did she?” I agreed that Susan had been a bit unhappy, but because she was seven she could wait until the morning for her mummy; and told her I knew that girls of four wanted their mummies to stay with them, but added that when she was bigger she wouldn’t mind sometimes being without her mummy.

I told her very briefly what would happen in hospital—that she would go to sleep, her tonsils would be taken out, and that we would stay in hospital for three days. She did not ask for more information.

  March 7th. Jean began eating again almost normally. She searched among her Daddy’s papers for the pictures she called “Tonsil Boy” and “Laura.” She brought them to me and asked to be told the “hospital story.” She searched anxiously for a picture she remembered, showing child and mother going home, and when she failed to find it she appealed to me.

March 8th. At breakfast she examined her fork, and said, “This fork would dig right into my throat, and it would hurt. I’ve got a big hole in my throat, haven’t I?” Later she asked for the stories of Laura and Tonsil Boy. “Why do the doctors wear that thing on their faces? Why must they not cough germs at the ill children? Can I cough at you?”

March 9th. Jean saw me open a tin with a tin opener as she had often done before; She handled the tin opener for a few minutes, and then asked: “What’s this for? What do you do with it?” Twice during the day she asked to be told the story of Laura and Tonsil Boy.

When an ambulance stopped outside our flats she said, “Look! The ambulance has stopped because someone is ill.” And later, “It’s all right, it has gone now.” (There is an ambulance station in our road, and she sees many ambulances every day.) Later when she saw an ambulance driver walk by she remarked, “It’s all right now. He is going home to tea round the corner.”

March 10th. Jean stopped in the middle of her lunch, lay back and sucked her thumb. I asked if she was tired. She sat up and said, “A little girl has died. Michael said she didn’t die, but she has.” I asked, “Why did she die?” and Jean answered, “Because it was time for her to die.” I told her that little girls did not die when they had their tonsils out. She asked, “Why don’t they? They might if the Doctor couldn’t get their tonsils out properly.”

I again explained the hospital procedure, and Jean ran to get the Laura and Tonsil Boy pictures. As I went through them with her, she added some remembered explanations. She counted each picture as a day. For the rest of the day she was active and cheerful, but she slept badly.

March 11th. At breakfast Jean made a fuss about the salt cellar. She refused to let anyone else have use of it, because she wanted to have one of her very own. “Can I buy one for myself on Saturday with my own pocket money?”

March 12th. At teatime she cut her poached egg very carefully, say­ing, “I want it (the yolk) to run out.” She watched her Daddy having tea half an hour later, and said, “Look, when Daddy cuts his egg it all runs out.” (A week before this record started Jean had said, “When all the blood runs out of cut and hurt people they die.”) She put her thumb and first finger in her mouth and pinched the back of her tongue, remarking, “It hurts when I do it.”

March 14th. Jean saw a picture of a man, a prisoner being led between two policemen; and for the next twenty minutes she questioned me persistently about “naughty men.” “Do children go away when they are very naughty? Were you naughty, Mummy? Did you go away when you were little?” I spoke of the coming hospitalization, and we talked about the reasons for it.

March 15th. At lunch she talked again of knives and forks being sharp. 'They could poke our throats,' she said, then ate her lunch mostly with her fingers. She pretended to cut my hand and arm with a knife. She asked to be shown the sharp end, then pushed it into her mouth very slowly and carefully until it appeared to touch the back of her throat. She then withdrew it. She said nothing.

March 16th. After breakfast Jean had a temper tantrum and aggres­sively banged a drum until the top caved in. In the afternoon, while listening to a radio program playing records for children in hospital, she sat handling a little fruit knife. For a quarter of an hour as she listened she made cutting movements on the chair arm, the table, the cushions, my arm, hand and face. When the program had finished, she asked, “Why are those children in hospital? When will they go home again? Read me Tonsil Boy and Laura.”

March 17th. Several times today I saw Jean standing quietly putting her thumb and first finger far into her mouth with a pinching movement.

March 19th. Jean bought a gun with her pocket money, and played shooting for the rest of the day. Later she wanted explosive caps to make bigger bangs.

March 20th. She had no interest in games other than shooting—the bigger the bang the more she liked it.

March 21st. This was the first fine day of spring, and our family went strolling in the park. Jean drew attention to herself by shooting every­one she met. When her explosive caps were finished, she wanted to go immediately to buy more and was furious when told it was Sunday and the shops were closed. She could find no pleasure in the park, and asked to be taken home.

March 22nd. There has been no mention of hospital for several days, but Jean has become very aggressive toward me and has scratched and bitten her sister with very little provocation.

March 23rd. Her very aggressive behaviour continues.

March 24th. Today Jean overheard an adult talk about a child who had been killed on the road. I spoke with her later about it, but she would not admit that a child could be killed on the road in this way.

March 25th. Her aggressive behaviour continues. Temper tantrums in which she throws herself on the floor at the slightest upset have become rather frequent. As she had not mentioned the coming operation for a week, I decided to reintroduce the topic.

After a tantrum I linked her behaviour to the operation, and she talked willingly about it. “They will hurt me. Very ill people go to hospital, and they have to go in an ambulance. I don’t want to go.” At bed­time she said, “Wash my hands when I’m in bed. I’ll shut my eyes tightly, then I won’t know that you are doing it.”

March 26th. Jean awoke in the night screaming. She complained tear­fully, “It hurts, it hurts!” and pointed into her mouth as if at an aching tooth. After an aspirin and half an hour in my bed she returned to her own room and slept. This morning I took her to the dentist, but he could find nothing to cause toothache. This morning Jean did not notice when I undid her nightdress be­cause we were talking. With delight and surprise she explained this to me. “It was just like my tonsils, I did not feel you do it.”

March 27th, 28th, and 29th. Many aggressive outbursts.

March 30th. When asked not to scratch her sister, she said, “‘Well, we didn’t talk about the hospital yesterday. That’s why!” She found Laura and Tonsil Boy and asked to be told and retold their stories. She dug her fingers into her mouth, and asked, “Which bits of skin will the doctor take away?”

March 31st. At bedtime Jean asked with a whisper for both hospital stories. A few minutes before she had been examining her navel, asking what it was and how it came.

April 1st. We bought some puzzles and other oddments to occupy her while in hospital, and Jean put them in a case under her bed. This evening she took longer than usual to settle down. When I gave her usual dose of Anthisan (the drug used to control her allergy) she told me to put the bottle into the case with her hospital things. When I said the Anthisan should not go into the case, because it was not yet her turn to go to hospital, her restlessness subsided and she slept.

April 2nd. Today has brought many minor accidents—for instance she caught her thumb in her tricycle and later caught her foot in a chair. Her skin is more sensitive than of late, her eyes and skin become inflamed very easily, and her tummy and thighs show signs of having been scratched a lot.

April 4th. Several of the children were playing hospital in the garden, and Jean was the patient.

April 5th. She talked of other children known to her who had been to hospital. Some time after she had been settled for the night, she called out, “I want to play with the hospital puzzle.”

April 6th. Jean had a very active and happy day. When I discussed with her sister the arrangements for her care while Jean and I were away, Jean asked “Why?” as if the whole idea were new to her, and added, “But I don’t want to go to hospital.”

At teatime Katherine complained of stomach-ache. Jean asked, “Has Katherine got a pain like Susan? Will she have to go to hospital?” Later she asked me to list those of her friends who had been to hospital. She agreed to some names, but denied others. She asked to have a bandage over her eyes.

April 8th. When I told Jean that this was the day for us to go to hospital, she flushed and said, ~‘I don’t want to go to hospital—not today. Let’s go tomorrow.” Half an hour later she said, “Can I take my party dress? Can I take three dresses, and three cardigans? I’ll play outside for a few days (I) first.” And later still she said, “I might not want to come home again. I might want to stay there.”

Saying that she might want them, she asked to take two dollies, dolly blankets, a windmill, and many other toys. To her sister she said, “Mummy will be with me and you won’t see her.”

She played in the garden with her friends for the next hour, dancing and skipping about and behaving as if she were going to a party. She boasted of where she was going. Now and again she came in to me with an anxious face. “I don’t want to go to the hospital today,” and almost in the same breath, “When is Daddy coming to take us to the hospital?

—Daddy must come and bring stamps to me every day.—When my tonsils are out I won’t keep getting ill.—When I come home my tonsils will be all gone.—I won’t know when the doctor takes out my tonsils.”