"I crashed my bike!!" 9-year-old Shane told me anxiously. As triage nurse in a busy emergency department, I interpreted this as, "I'm afraid I'm going to have to get stitches!!"
Quickly making sure that bleeding from the laceration on his right hand was under control, I asked all the pertinent questions: "When did this happen? Were you wearing your helmet? Did you hit your head? Did you get knocked out? What hurts now?" I learned that he'd been wearing his helmet but hadn't hit his head when he fell. The nasty laceration on his hand was the only injury, and the hand's circulation, sensation and movement were normal. I told Shane and his mother that his hand would need some sutures. Shane asked me hopefully, "Can you glue it?"
"No," I gently explained to him. The cut was too deep and in an area where the glue wouldn't hold because of his hand's natural movement.
"I could hold it real still!!" he promised sincerely. I smiled and told him that it would take several days to heal. He'd need stitches. Crestfallen, he moved closer to his mother.
To distract him, I gave him my standard pitch: Think about where your favorite place to be is, then go there in your mind. Think about what that place looks like, what you usually hear there, and the pleasant smells you might find there. He listened attentively to all I said, then turned to his mother. I left them to talk it over.
When Dr. Jay was ready to repair Shane's laceration, we explained everything that Shane could expect to happen during suturing. While the physician pulled on his gloves, I asked Shane about his favorite place. Brightening noticeably, he said, "On the basketball court!!" As Dr. Jay began injecting the local anesthetic, I tried to engage Shane's attention by asking about his experiences playing basketball. But to my dismay, he was soon screaming before, during, and after each injection. Clinging to his mother, he totally ignored me.
Dr. Jay paused. We decided to take a break, hoping that Shane would calm himself in the meantime.
As I sat and talked with Shane and his mother, I had an inspiration. "Shane, do you know what I do when I have trouble falling asleep at night? I think of a pleasant problem, then solve it. My mind gets so busy thinking of pleasant things that I drift right off to sleep. Because I love my gardens, I usually think about a garden problem, such as where to dig up some daffodils to transplant somewhere else. Maybe you could think of a pleasant problem, then solve it while you get your stitches." I left Shane and his mother to mull that over.
When Dr. Jay headed back to Shane's bed, I wondered if my brainstorm would work. As Dr. Jay once again donned gloves, Shane announced, "I'm going to choose my Dream Team!!" As Dr. Jay got to work, Shane and his mother quietly discussed the pros and cons of every basketball player they knew, carefully selecting the best person for each position. Dr. Jay soon started adding his own assessments of the players. By the time he placed the last suture, they were hotly debating the crucial center position. Finally, Shane and the physician high-fived their agreement: only Shaquille O'Neal would do for Shane's Dream Team!!
I covered Shane's wound with a sterile dressing and gave him and his mother instructions for its care. When I mentioned how much easier it was to do something unpleasant while solving a pleasant problem, Shane agreed, "Pleasant problems are the best kind!!"