Many years ago, as Dr. Zeev Kain watched a 3-year-old get wheeled to an operating room for a tonsillectomy, a colleague turned to him and said, "The walk to the OR for a child is the longest place in the world."
The remark captured precisely what Kain had been feeling. As a pediatrician and anesthesiologist, he had become increasingly concerned about the pain and anxiety endured by children undergoing surgery and other invasive medical procedures.
"I noticed that more kids were crying and screaming, and didn't want to be separated from their parents," he said.
So he wondered: Could he prove that this stress was compromising outcomes for these small patients? And if so, could he then find demonstrably effective methods of reducing the anxiety experienced by kids about to undergo surgery?
Such questions took him on a decades-long journey that continues to this day, and has established him as perhaps the foremost authority in the very specific but crucial field of pain and anxiety management of perioperative children.
Indeed, Kain's research has proved so influential that pediatric care has been changed in hospitals throughout the world as a direct result of his work. It's not an exaggeration to suggest that thousands of families have him to thank for reducing the strain of seeing a beloved child forced to undergo surgery.
When Kain graciously agreed to meet with me recently at his office near Children's Hospital of Orange County, I fully expected to be impressed by his intellect. After all, the Newport Beach resident has an illustrious résumé so long it would take far more space than this column allows to list his many accomplishments. Indeed, as we talked it was hard to miss the two massive bound volumes of his work that sat on his desk.
A native of Israel, he attended medical school at Ben-Gurion University before moving to the United States, where he trained in pediatrics and anesthesiology at Yale and Harvard. He is a professor at both Yale and UC Irvine, somehow managed to squeeze in an MBA degree from Columbia University and, as executive director of the UCI Center on Stress and Health, he has pioneered research and techniques that have made him an internationally renowned expert and sought-after speaker.
But what I hadn't anticipated, and what really bowled me over about Kain, was his highly engaging, flat-out passion.
When I asked him what initially led him toward his specialty, his immediate response was to throw up his hands and smile.
"I love kids," he exclaimed, before launching into a more detailed explanation of the appeal of the intensity of working in critical care and his interest in what he called the "bio-psycho-social" response of patients and their families.
"Medicine has become very sterile, especially in critical care," he explained. "The human factor has to be added."
But early on, Kain realized that despite his interest in addressing the emotional component, he would need to approach the issue in a highly scientific fashion. And that meant doing a lot of research.
Through a series of studies, he and his colleagues — in particular another Yale professor, Linda Mayes — have been able to demonstrate that children who are more anxious about their surgeries have longer hospital stays, experience more pain and have more disrupted sleep patterns. What's more, parents expressed greater dissatisfaction.
By contrast, he showed that kids who felt less stress ate better, had less pain and healed faster after their surgeries, while their parents were more satisfied overall.
The next step for Kain was finding effective ways to ameliorate anxiety. Drug therapy is one obvious method, but he didn't want the answer to revolve mainly around the use of sedatives because of the potential for negative side effects.
He saw the behavioral aspect as more meaningful, and has focused his attention on that part of the equation — everything from the use of music to coaching health-care providers and parents on tested and proven techniques for reducing stress.
One good way to decrease children's anxiety, he has found, is through distraction. For example, parents might be advised to bring their child's favorite toy or book, and nurses can ask questions about video games, sports or movies in order to focus the patient's attention on something other than the medical procedure. Humor can be another effective tool.
One common mistake, he has found, occurs when the desire to express empathy for the patient actually leads to greater anxiety. For example, such statements as "I'm sorry," or "I know how hard it is" should be avoided, as should excessive medical talk.
Kain, who has two daughters in their early 20s and is married to a UCI radiologist, is now turning some of his attention to another difficult-to-measure question: whether positive behavior exhibited through social media can influence others in a beneficial way. And he continues his groundbreaking studies into stress and pain. One area of research, for instance, is looking at Hispanic patients' reaction to anxiety, which might ferret out cultural differences.
Considering the impact he's already had helping families under the most trying circumstances, I'm looking forward to seeing where else Kain's abundant passion for children will take him.