‘We try to make it as normal as possible.’ : To Patient Therapists, Work Is Child’s Play

After he gets chemotherapy, David Brocoff, 13, is usually very sick. “Usually the medicine helps,” he said, but the nausea and the pain start again “about two hours after I get it.” David usually receives the treatment in his room when he is asleep, he said, but “it feels better when you’re awake, having someone to talk to.”

That someone is often Carolyn Spungin, director of the Child Life program at UCI Medical Center. After David has had his treatment for Ewing’s sarcoma, a form of bone cancer, Spungin comes by and offers to talk with him.

David has been going to the hospital one week a month for a year since the cancer was diagnosed. When he’s at home in Irvine, he goes to school, plays soccer with his friends and leads a pretty normal life, Spungin said. “When he comes in to have his chemo, it reminds him that he has cancer.”

Sometimes, when the pain is bad, she tells him to imagine a place he’d rather be. He usually thinks about being at an amusement park or in his room at home, and usually he falls asleep. Sometimes Spungin will tell him to think of “the chemo as soldiers getting rid of the enemy,” she said.

“When I’m not sick,” David said, being in the hospital “is a blast.” Spungin has brought in videotapes of movies such as “Star Wars” and “Return of the Jedi” for him to watch and has taken him and other patients to the hospital’s kitchen to make popcorn, tacos and, David’s favorite, candy apples. Spungin does not wear a white coat nor carry needles, nor does she perform any medical procedures. She may hold a child’s hand during a painful or frightening procedure or talk about a child’s fear of surgery. But her main job as a child life specialist is to help young patients to play.

“Children’s work is play,” said Sue Ahearn, nurse manager of the pediatric floor. Play can relieve the boredom, depression and stress of being in the hospital, and “if a child becomes stressed or depressed, they don’t get better as quickly,” she said.

Now ‘a Profession’

“Carolyn is viewed as a safe person because she doesn’t give them shots, she doesn’t give them medicine,” Ahearn said. “Her office is a place they can get away from the other things.”

UCI Medical Center is one of about 350 hospitals in the nation that have programs concerned with the emotional needs of child patients, Spungin said. “It started out as (volunteers) going in and being play ladies, and as people started seeing the benefits, it got to be a profession,” she said. UCI has been operating the program for five years. Director Spungin sometimes calls on volunteers to assist her with the patients.

According to Ericka Waidley, president of the Southern California chapter of the Assn. for the Care of Children’s Health, colleges and universities across the country are beginning to offer child life majors and degrees in child development and child and family services. Many child life specialists have backgrounds in other fields and degrees in nursing, occupational therapy or education.

Tries to See All

Spungin has a master’s degree in education and served several internships at hospitals with child life programs while she was completing her bachelor’s degree in education, she said.

Because children learn and develop through play, Waidley said, “maintaining the developmental needs of children when they are in the hospital is important.” Even for the child who is in the hospital overnight, play can provide needed structure, she said.

When Spungin gets to work in the morning, she checks with the medical staff to see what kind of night the children have had, whether any is scheduled for a medical procedure, and whether any new ones have checked in. She said she will see the children who “need support” first, but she tries to spend time with all the patients.

Ariella Martin, 2, grinned and waved from the red wooden wagon as she was wheeled from her room in the pediatric ward of the UCI Medical Center to the playroom. Ariella had had surgery on her leg earlier in the week and could have been taken to the playroom in a wheelchair, but “for a healthy child at home, it’s fun going places in a wagon,” Spungin said.

In the playroom, Ariella, with Spungin’s help, bandaged a doll’s right leg at the knee very much like the way her own leg was bandaged. She played with a miniature bed that had movable sides like her hospital bed and asked to be read a story about “Nurse Nelly and Dr. Lion.” Ariella engaged in what Spungin calls “play therapy,” acting out some of the things that she experienced that week. When adults “are under a stressful situation, they talk about it all the time,” Spungin said. Children, too, need to talk about their worries.

Debbie Martin, Ariella’s mother, said that the play therapy helps her daughter “express her needs, her wants. A lot of the time, she’ll say Snoopy wants this when really it’s her.”

The child life program “has helped Ariella to see it’s not just shots, it’s not just pain here,” Debbie Martin said. “It’s OK to play here.”

Play Medical Equipment

Spungin has a bag of play medical equipment that includes toy needles, intravenous tubing and surgical masks. “They can control these materials and get a better feel of what these are about,” she said. When a toddler is going to have surgery, Spungin often asks the parents to put on surgical masks so that the child can see that there is a person behind the mask. There is a slide program for children that shows a boy’s experience from entering the hospital to surgery to recovery. The audio tapes that accompany the program are in several languages. “The tape says he didn’t do anything wrong,” Spungin points out. “Many times the kids think (they are ill because) they’ve done something wrong.”

A child’s fears may be expressed through play therapy, and when that happens, Spungin, the doctors and the parents can talk about them. A boy who had undergone a number of surgeries was able to talk about his fear of dying after Spungin saw him do a play medical procedure on a doll and then pull a blanket over its head, she said.

She tries to keep the staff and “particularly new residents” aware that they are treating children, she said. “My role is being the advocate of the child.

“It used to be common to say ‘you’re going to to be put to sleep’ for surgery,” Spungin said. A statement like that can cause a lot of fear, especially in a child whose family pet has been put to sleep, because “children think so concretely.”

Spungin “says the things (children) would say if they could,” said Dr. Beverly Morgan, chairwoman of the pediatrics department. For instance, she said, operations are usually scheduled when it’s convenient for the doctor or the hospital. But if a child has some fears about surgery and the surgery can wait, Spungin “will say, ‘Hey, can’t we do this tomorrow?’ ”

‘Totally Involved’

Spungin “does the things we don’t have time to do,” said Dr. Claibourne Dungy, chief of general pediatrics at the medical center. “She’s totally involved with all the patients. She’s an integral part of the ward team.”

Because Spungin can sit and play with a child for 30 or 40 minutes, she picks up developmental lags in them, Ahearn said. For instance, when playing with a 6-month-old, “she may say, ‘This child does not know how to pass things from one hand to another,’ ” something an infant at that stage should be able to do.