When she first saw the little boy, he was cowering behind his mother’s legs, tears streaming down his face. A few minutes later, the tears have stopped, but his eyes betray the anxiety he feels. He holds up five fingers when asked how old he is.
Declan Gist is in the pre-op area at Riley Hospital for Children, waiting with his mom before it’s time for minor surgery. A steady stream of physicians, nurses and other clinicians have been in and out of the small waiting room, asking questions, taking notes and explaining what’s about to happen.
It’s overwhelming for this child and so many others who come to Riley for outpatient surgery every day. That’s why Beth Strange feels a responsibility to do all she can to make things a little less scary.
As one doctor leaves the room, he motions for Strange to go in, saying, “He needs you in there.”
She gets down on her knees so she can be eye level with Declan, asking him about the stuffed bulldog he’s brought with him. She speaks softly before reaching into her bag of tricks in true Mary Poppins form. Inside the bag are more than a dozen varieties of ChapStick (more about that later), an anesthesia mask, a balloon, a bandage, a plastic hose that looks (and sounds) like an elephant’s trunk, a wand, a toy doctor’s kit and more.
Strange is a certified child life specialist in the pre-op area, a job she’s held for seven-plus years. Before that, she worked for six years in the same role in critical care, split among the PICU, burn unit and the emergency department. All of her professional experience has been at Riley, a fact that gives her immense satisfaction.
It’s where she believes her mother, a nurse, wanted her to be. Strange was a senior at Purdue University, nearing graduation with a degree in child development and family studies, when her mom was dying of pancreatic cancer.
Strange needed an internship to graduate, but time was running out. She was visiting her mother at their farmhouse in northwestern Indiana one day, when she went upstairs to grab a washcloth out of the linen closet. She opened the door, and piles of towels fell out. The stress she felt over her mother’s illness and her own future brought her to her knees that day.
“I just laid on the floor and cried. I didn’t know how I was going to take my next step. My heart was just breaking.”
Then the phone rang. On the line was Melissa Sexton, supervisor of the child life specialist team at Riley. She wanted to offer Strange an internship.
“It was a God thing,” Strange said. “I went into our sunroom where we had mom’s bed, and I whispered in her ear, ‘Mom, I got it. I got the internship at Riley.’ “
For days, the older woman had been barely conscious. But at that moment, Strange remembers her mom’s eyes opening. “Oh, she had the most beautiful smile on her face, and she looked at me. She could see me. That was mom’s last smile and I got to have that. I knew I had her blessing.”
That was 14 years ago, and Strange has carried her mom’s spirit with her every day at Riley. “She was an amazing nurse,” she said through tears.
Strange is a mom herself now. She and her husband, Josh, have two children, ages 6 and 2. She job-shares with another child life specialist so she can have more time with her family, but she loves the time she spends at Riley.
“My job is to help educate, prepare and support before surgery,” she said. “I work alongside parents in a child-friendly and developmentally appropriate way to help a child understand what is going to happen. Things they’re going to see, things they’re going to hear and things they’re going to smell.”
The mask that kids wear for anesthesia can be scary, she knows. That’s why she lets them try it on beforehand; they can even try it on their stuffed animal pal who might be going with them to the operating room.
“We don’t see so much pain in pre-op,” she said. “What we battle is fear. Fear of the unknown, fear of pain, fear of separation from parents. So we do a lot of medical play,” she said.
“I bring in our masks for kids to see and feel and practice taking big deep breaths and hopefully making that experience less scary for them. If they’ve brought a stuffed animal, I’ll show how the mask fits on their bear’s face. They can be the doctor for their bear – lots of kids do that; they take their bear back with them and hold the mask on their bear while they take deep breaths through their mask.”
To eliminate the plastic or chemical smell of the mask and the medicine, Strange lets kids choose from an assortment of ChapSticks to apply a scent to the mask. Declan wants to smell them all before he chooses: strawberry, cherry, watermelon, kiwi, root beer, vanilla, cotton candy, bubble gum, Sprite, Dr Pepper, Skittles and on and on.
Strange obliges until Declan settles on two that he wants in his mask. As the anesthesiologist comes in to talk to his mom, Amanda, Declan busies himself putting stickers onto the mask with Strange. She asks if he would like for her to go back to the operating room with him, where they can play a game on her tablet until he falls asleep. He agrees and within minutes, she is helping him up onto the bed to be wheeled into the OR, while his mom waits behind.
Amanda Gist is relieved that her son has calmed down and credits Strange for the transformation. “She is perfect for this job.”
Strange doesn’t always get to spend this much time with a patient. She has to fit her job into the busy schedule of the clinicians preparing patients for surgery.
“It’s a dance we all do because we all have to get our jobs done,” she said.
Her goal is to increase understanding and decrease anxiety, but she has to assess needs and moods and build rapport with patients quickly.
“My job is to meet patients where they are and find out what they know about why they’re here. I work very closely with our team to figure out the best coping plan possible for each patient,” she said.
On a typical day in pre-op, Strange might see 15-25 kids ages 1 and older. “We try to see as many as we can,” she said.
For her, the best part of the job is making a scary day just a little easier for patients and families.
“There’s nothing like walking into a room where a patient is upset, crying, hiding, and by the time I leave they’re right beside me. They’re playing and laughing,” she said. “I have been able to put them at ease, give them the tools they need to cope with what’s in front of them.
“If we can provide these coping skills, the next hard, overwhelming, scary thing – whether it’s a spelling test or trying out for the volleyball team – they’ll be able to look back and draw from these skills.”
– By Maureen Gilmer, IU Health senior journalist
Photos by Mike Dickbernd, IU Health visual journalist