Abstract
I
It was my good fortune to shadow a very seasoned child life practitioner. This particular experience occurred early in our time together and stands firmly in that select group of formative experiences which shapes both our practice and our person. In my mind, its power to do so lay in the mystical quality which seemed to suffuse it. I had the sense I had entered an altered, almost enchanted world and was witness to an ancient art, so fluid in its execution that it seemed choreographed. This memory has stayed with me through the years, consistently evoking a kind of grounded and energized state upon its recall.
Our patient was a nine-year-old Laotian boy with a terminal brain tumor. He was ambulatory, with good functional status, but he had become withdrawn and essentially mute in the preceding weeks. The parents were anxious to find someone who could help him communicate his feelings. His mother worried that his behavior might represent depression and disappointment in her and his father. As the only child of his immigrant parents, he had been very vocal about his desire to have a brother, his comments becoming more frequent as his disease progressed. Thus far, the parents had been unsuccessful in becoming pregnant again, which weighed heavily upon his mother.
I followed my colleague and our patient into an empty playroom. After introducing myself to the child, I sat quietly in a corner, watching from afar. A conversation ensued (she talking, he not) which involved a decision to make a picture. Every step of the process seemed intentioned and each flowed into the next. What size picture would he like to make?—and various sizes of paper were offered. Would white paper or colored paper be best?—and various colors were offered. Which way should the paper lay, vertically or horizontally? Should we cut the paper with scissors and have a clean edge or tear it so it is jagged but appears softer? What material would he like to use?—and colored pencils, markers, paint, crayons, and chalk were offered. For each of these decisions he would point or nod and she would continue on seamlessly asking questions and offering choices. When the conversation was complete, he sat in front of a 20 by 30 inch, clean-edged, white piece of paper with a set of colored markers. “I can tell that you have something to say,” she said, “and maybe it's hard to find words right now. Making a picture sometimes helps us to tell a story. Start by drawing the first thought that comes to you, you don't need to share it with me. Maybe it's something you want to say to your mom and dad.” And then she was quiet and left him alone, busying herself in another part of the room.
He did draw a picture. Two small red hearts, each about two inches high, in the very middle of the paper, each with tears falling down. They seemed very small and very alone in the middle of this big white space. He did not talk in that session, at least not in words. But that day began a relationship that gave him a voice. And eventually he would use it to reveal that he knew he was dying, that he was sad and knew his mother and father were very sad, that he wanted a brother so that they would not be so lonely after he died, that he loved them very much.
What is mystical, you query, about helping a child to draw a picture, offering paper and markers? And, of course, you are correct to note its ordinariness. But therein lies the power of her work: the ordinary transmuted into the extraordinary…alchemy of the first order…transforming a playroom off a busy clinical ward into a hallowed space…suspending time, allowing silence…deeply respecting the power of a powerless small boy in his own process and feelings and the place to which he had retreated inside…no cajoling, no sweet inducements, only deep, deep respect.
It is a mystical world, this world of ill and dying children, with its own culture and language of play and symbol. We must travel it with persons who are fluent in the language, adept in alchemy and ancient art forms. And on occasion, for our own sake, we should sit in the corner and watch our gifted colleagues at work. From there we will surely learn new and valuable skills. But, as important, we will be reminded of a truth that can both vivify and ground us: this work we have chosen is precious and holy and true.