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She dozed in the car on the way home, obviously tired, but when we reached home she strongly resisted being put to rest. She silently watched her playmates for a while from the window, then slept for two hours. She awoke in good spirits, and played actively and happily all afternoon.

That evening she would not be left alone in her bedroom. She asked for several readings of Tonsil Boy. I sat on her bed until she was asleep. At 9 pm she awoke coughing and crying, "My throat hurts. But I’m crying because I’m by myself?’ I was unable to settle her, so took her into bed beside me and there she slept restlessly throughout the night.

April 12th. Second Day Home. There were several aggressive outbursts today. Immediately after a drink, which hurt her throat, she slapped me hard, saying, "I don’t like you, because you took me to the hospital." She saw an ambulance from the window: "There is an ambulance; perhaps someone is in it."

On leaving hospital yesterday we had unexpectedly been presented with Jean’s tonsils and adenoids in a small glass jar. This morning Jean held the jar for a long time, peering intently at the contents and tilting them this way and that. I asked her what should be done with them. With great tenderness she said, "I’ll keep them. I’ll put them on the shelf in my room." I queried this: "Do you really want to keep them?" She replied emphatically: "Yes, I do!" She disappeared into her room with the jar in her hand, then returned ten minutes later with a flushed face: "No, Mummy. Let’s throw them away."

She herself threw them into the dustbin.

April 13th. Third Day Home. I told Jean that we had been invited back to the hospital to have tea with the Big Nurse. She replied, "Yes. But just to see her, not to stay there." She added, "Why did you take me to that hospital?  I wanted to come home the very first minute I was there." She recalled with a laugh how her flying toy had hit the Big Nurse. "I shall get my gun and shoot you all away."

She sat bending her hand to and fro, and pointing to the creases on her wrist, "Look at my hand. There are the lines where it could break off."

She saw three off-duty nurses in the street. She looked casually at them and said, "Yes, they do wear dresses like that." And as we passed the local hospital she remarked, "That’s another hospital—not mine."

April 14th. Fourth Day Home. This was a good day. Jean seems to have found her place in the group again. She ate a little at each meal with enjoyment, and asked for her after-meal toffee.

This evening she was asleep by 6 pm, but awoke at 8 with a heavy nosebleed. She was very uncooperative, would not have a compress applied to her nose nor would she suck ice. This inevitably caused some tension between us, because I knew we might have to return to hospital to have the bleeding checked. But by 10:30 pm, however, the nose-bleeding had subsided and she was asleep in my bed. We both spent a restless night.

Because of the bleeding the hospital doctor ordered 48 hours bed rest.

April 15th. Fifth Day Home. Jean was cheerful and looked well. She wanted to get up, so I let her get dressed and she spent the day on a settee in the living room.

She played a game of not being able to see or hear. She dug a finger into each ear, shut her eyes, then asked me to speak to her, saying, "I can’t hear you now, and can’t see you."

During the day she displayed and examined her genitals, laughing and looking at me to bring her behaviour to my notice.

At bedtime she talked for a long while about her hospital experiences:

"When I had my tonsils out I didn’t feel it. I didn’t hear and I didn’t see. Why didn’t I? It was funny. First of all I was ordinary asleep, then I smelled the funny smell, but I didn’t know because I was asleep. Then I had the tonsils sleep. I would know if I was ordinary asleep."

She was rather lively, and kept bouncing her head on and off the pillow. This seemed to bring a hazy recollection. She said, "Was it yesterday you kept telling me to lay my head on the pillow? I didn’t want to— I wanted to sit up." (Her recollection was in fact from the half hour immediately after the operation six days previously, when she had been extremely restless and apparently disoriented and I had tried to get her to keep her head on the pillow. It had been thought unlikely that she would have memory of that phase of recovery.)

She asked again for many bedtime stories, and clung to my hand when I eventually tried to leave the room. She made no complaint when I left the room, however, and was probably helped by the fact that her sister had just come to bed in the same room. She called out several times, but not with anxiety. She fell asleep with a penicillin tablet in her mouth. I opened her mouth to remove it, and was surprised that instead of resisting she seemed to open her mouth still wider and did not wake.

April 16th. Sixth Day Home. When she awoke she sang a song about "wobbly" (her own name for penis). She wanted very much to be active, but had to continue resting on the settee. I said she could get up when her tonsils were better, and she corrected me, "I haven’t got tonsils, only a throat. The dustman has taken my tonsils away. I wonder where he puts all the rubbish?" She exhibited her genitals several times during the day.

In the afternoon I allowed her up to play quietly at a table. She resented the restriction on her movements, and was aggressive until the further concession was made that she could walk about. Later she was aggressive again when, after eating a nutcake, her throat pained her.

Looking out of the window at a strange family passing in the Street, she said, "That girl was in hospital with me." She went to her room, dressed in her nurse’s uniform, and played with her dollies and pram.

At bedtime she insisted on "five" stories. She was quiet for a few minutes after I left her, then cried out for "just one more story." She was obviously tired, held her cuddly, put her thumb to her lips but not into her mouth—she just stopped short of her usual relaxed sleeping position. She asked me to sit on her bed and to sing songs. While I did so she wriggled about, still resisting sleep. She slept well.

April 17th. Seventh Day Home. A good day with only two negative patches. When put to bed she asked for "two stories," then cried when I proposed to leave the room, saying "I don’t want to be all alone. Did the hospital doctor talk to you on the telephone today?" I sat on the bed and she fell asleep within a few minutes. She did not suck her thumb. Once during the night she cried in her sleep.

April 18th. Eighth Day Home. Quite a good day, with only occasional aggressive and negative patches. For the first time since the day before the operation she asked to have long plaits in her hair.

At bedtime she refused to be washed or get undressed, and screamed when I insisted. She asked for "four bedtime stories." First of all I retold her own hospital story, and during the telling she made such remarks as,. "Yes, I am cross with you for taking me to hospital. I didn’t want to go. There was a little child there without his Mummy. I am sure he wanted his Mummy. The big boy won’t be cross with his Mummy because he is big. He knows that sometimes children just have to go to hospital.— Yesterday you asked me to shut the door, but I wouldn’t. I pretended that I couldn’t. I opened it wide and put a chair there, and then I fell down."

Five minutes later while I was reading her stories she sat up, held my hand to her face, and cuddled round my neck: "I do like you Mummy. I do like you. I liked the Big Nurse—she brought letters to me. I didn’t answer when she first asked me, and she walked away—then afterwards I took the letters from her pocket and she didn’t know who had taken them." I said, "Shall we go to see the Big Nurse one day?" and she answered, "Yes, just to see her, just to have tea with her."

April 19th. Ninth Day Home. Rather more aggressive and temperamental behaviour than during the past few days. She showed more anger against her Daddy. "We could have put a bed in our hospital room for Daddy."

April 20th. Tenth Day Home. A day somewhat like yesterday, with some aggressive and a few tyrannical outbursts. There were many "Why" questions.

She saw a large building which had two open swing doors. A baby lay in a pram outside. She looked intently, and after we had passed she kept looking back. Then she said, "Why is that baby going in there?" I told her that the building was a library. She said, "It looks like a hospital, but it isn’t." In the evening she was loudly good-spirited and more affectionate to her Daddy.

April 21st. Eleventh Day Home. A good day. I was out for the whole of the afternoon, and Jean stayed happily with her Daddy. She showed him much affection.

She did not want to be left alone at bedtime. I read many stories, and then sat on her bed until she slept.

April 22nd. Twelfth Day Home. For most of the day she was active and in good spirits, sometimes with a slightly manic tinge. When crossed, however, she immediately threw temper tantrums. She behaves like the so-called "spoiled" child. The "Why" questions today were more specifically about marriage and conception.

April 24th. Fourteenth Day Home. The "Why" questions continued throughout yesterday and today. At bedtime she asked, "Who takes people to prison?" I assured her that children did not go to prison. She said, "When children are naughty, their Mummy and Daddy make them good again, don’t they?" I suggested that children were sometimes naughty because they were worried and unhappy about something they could not understand. She said "Yes," thoughtfully, and twenty minutes later went on: "I don’t know what makes me unhappy. Perhaps I won’t be naughty tomorrow, and won’t hit you." She slept easily.

April 25th. Fifteenth Day Home. At breakfast Jean lay back, quietly licking a grape. With a puzzled frown she said, "It was my Big Nurse who pricked my leg. I didn’t like it. Why did she?" (This apparently referred to the injection given before the operation by the ward sister—Jean’s "Big Nurse." Until today Jean had insisted that the prick had been given by a student nurse with whom she had no relationship.)

April 26th. Sixteenth Day Home. She told her sister Katherine with impish laughter of the time when her flying toy hit the Big Nurse’s leg. She is very keen to have fairness. "She hit me, so I hit her. She hurt me, so I hurt her" is a recurrent theme. She watched two playmates fighting:

"It’s all right, Tommy. You can hit Betty because she hit you. Go on, Tommy, it’s all right."

Later she said, "Hazel nearly died today—she was so sick. She did, she nearly died. I was sick with all the blood" (recalling her own postoperative blood vomit).

April 27th. Seventeenth Day Home. During last night she had a nightmare, with "doggies" in her bed. At breakfast she grumbled about not being given a tomato with her bacon; and when given a tomato she complained that it was too firm. She said often, "I don’t like you."

She asked to have her toast cut into little pieces, and then divided them according to size into "mummies, daddies, and children." "I’ll eat the children first. What was the name of the little baby who cried in hospital? Was it a boy or a girl?—Its Mummy wasn’t there and it cried." I reminded her that the Mummy had in fact visited the child each day. She said, "But perhaps the baby wouldn’t know which was his very own Mummy. Perhaps they would all wear the very same coats." I asked: "Do you think perhaps the Mummy wouldn’t know it was her very own baby?" She nodded.

A letter came from the Big Nurse and I read it to her. She took possession of the letter and said she would like to go for tea with the Big Nurse. She went to her doll’s pram and said, "I want a coat for my dolly. I can’t find it, I’ll put on her nightie instead. Doesn’t she look sweet in her nightie?"

A few minutes later I heard her singing in her room. "And then her tonsils popped out, and if I do she’ll be sure to die." (In this she was parodying the end of the nursery rhyme “Little Boy Blue”: “Will you wake him? No not I, For if I do he’ll he's sure to cry.”)

Shortly afterwards she came to me and said, “I won’t ever have to go to hospital again, will I? I don’t want to.” When I reminded her that mummies go, for instance to have babies, she said, “When I’m a mummy I won’t mind, because then I’ll be big.”

A little later she came in from the garden to ask: “What is a stomach? Peter (a playmate who had recently had his tonsils and adenoids removed had something in his nose.” I explained about adenoids, and linked it with her nosebleed after the operation. She stood quietly pinching her tongue with finger and thumb, as she had done often before the operation.

Later she was playing doctors with a little boy with dolly for patient.

She said, “We must have a doctor, and you be the doctor. You must hurt her leg and then you must make her quite better.”

April 28th. Eighteenth Day Home. “I didn’t like the Big Nurse pricking my leg. Which leg did she prick? Did she make a hole?” She fell over many times during the afternoon, and each time she came to show me the cuts and bruises on her legs.

April 29th. Nineteenth Day Home. At breakfast she recalled: “When I cut my finger the blood came out. I licked it and the blood went down into my tummy. It doesn’t matter, does it? Blood can go down?”

Ten minutes later she called me to the lavatory and said very brightly, “Mummy, I feel sick.” I did not take her seriously, and she said again:

“I do feel sick—something might dribble out—I did dribble out all the blood, lots of it. Why did I? Why do tonsils make blood in my tummy? I want to go to see the Big Nurse today.”

April 30th. Twentieth Day Home (Day of Return Visit to Hospital). She seemed happy to be going to visit the Big Nurse. As we approached the hospital a mother and two children were ahead of us. One of the children carried a case. Jean made a quick inference: “That little girl is going to stay in the hospital. I’m not, am I?”

She showed no anxiety as we went into the hospital. When we reached the ward she skipped ahead of us, almost dancing, and went straight to her former cubicle. She showed it to Katherine, and then took her on a tour of the ward and showed her things with a proprietorial air. She pointed to where the ward sister’s hat and cloak hung: “That’s my Big Nurse’s.” She did not talk to the nurses, but smiled and nodded in answer to the ward sister.

Her ball ran into the induction room, and she was hesitant to go after it until encouraged by the ward sister. She tiptoed in, and in picking up her ball she peeped quickly into the operating theatre which lay beyond, then hurried out with a flushed face. (She knew the purpose of these two rooms.)

She saw a little girl walk about the ward asking and looking for her mummy. Later she asked: “Where was that little girl’s mummy?”

On the way home she said, “I want to visit the Big Nurse again.”

At this point it seemed that Jean had worked through her hospital experience. She looked well, ate and slept normally, spoke little of hospital, and showed no special anxieties. She had started nursery school for the first time, and settled quickly and happily. After a few days she insisted that I should not accompany her to school, and went cheerfully with a neighbour and her children. Her increased confidence and independence of me was commented on by our neighbours. Her extreme fear of dogs had almost disappeared, as she herself remarked, “That dog looked at me, and I wasn’t even afraid.”

For these reasons the Diary was discontinued at this point, three weeks after the operation. But the following narrative, which begins eleven weeks after the operation, shows how external events reactivated her anxieties.

  June 23rd to August 28th. Eleventh to Twentieth Week Home. During the first week of this period Jean’s behaviour suddenly deteriorated. She cried easily, grumbled at everything, threw temper tantrums, refused to go to the lavatory alone “because it comes too quickly,” and in general acted much as she had done immediately before going to hospital.

After a few days during which we could not account for the change, we realized that three external events had reactivated her anxieties. These were:

  a.       one of her playmates went to hospital to have her tonsils out;

b.      the mother of a neighbouring family went away from home for two weeks and left two young children in the care of their father;

c.       the anticipation of our annual seaside holiday.

  The Playmate’s Tonsillectomy, On June 23rd a five-year-old girl living in the block made it known that she would soon go to hospital, by herself, to have her tonsils out. The other children in the group appeared to take no special notice, but Jean and Hazel became inseparable. Although hitherto they had been only casual playmates, they now held hands, walked about with arms around each other, and whispered together.

A week later, Jean saw Hazel go off by car to hospital; and during the day she spoke of it many times. For the next two days she wore her nurse’s uniform most of the time, and came in from play often to ask:

“Is Hazel in hospital now? Are her tonsils out? Will her mummy go to see her?”

Hazel in fact suffered a setback. On the second day she had a haemorrhage and a policeman came to tell the mother to go to the hospital. This was known to all the children and there was much talk and reminiscence about blood and operations. Hazel’s return was delayed, and Jean became increasingly anxious because Hazel did not come home on the expected day. She asked many times for her, and was irritable, fretful, and easily provoked into tantrums.

Hazel came home after a week, and had to stay in bed for three days. Each morning Jean called up at her window, and became very excited when Hazel appeared and waved down to her. Four days after Hazel had resumed play in the garden, Jean again called up to her window. Hazel was slow to appear and Jean greeted her with, “Hello, Hazel. I thought you were dead. You didn’t come when I called you.”

Children Left by Their Mother. On July 8th, the day after Hazel’s return from hospital, the mother of another family had to leave home for two weeks to care for a sick relative—leaving two children to be looked after by their father. A week later, in response to a remark of mine about mothers looking after children, Jean exploded with: “They don’t always. Mary’s mummy has gone away for lots of days and left her alone.”

Anticipation of the Holiday. From the beginning of July there was much talking over of arrangements for the family holiday which was to begin on August 1st. Toward the end of the month I realized that this was adding to Jean’s anxieties, because there were similarities between this waiting period and that which had preceded her going to hospital. I was using similar phrases to deal with her impatience for the holiday as had been used to prepare her for hospital: “Soon we will be going. We will put these things ready in the case. We will have to wait a few more days, because it isn’t our turn yet.” I talked with her about this similarity, and during the whole of the next day there were no temper tantrums.

Her behaviour gradually improved, and by the fourth day of the holi­day she seemed to be over this period of difficulty and anxiety. This good state continued when these notes were written up which is three months after our holiday and eight months after the tonsillectomy.


 COMMENTS BY ANNA FREUD