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This one is about: A Dollar's Worth of Ear Tubes

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by Joan McCartney

Our five-year old needed her tubes replaced. Meghan had been born with a complete unilateral cleft of the lip and palate, so even though this was a minor procedure it was her fifth trip to the operating room. With each visit she has been a little older and a little wiser about what would happen. Fortunately, she has so far taken every surgery in her stride. In fact, this time around she really seemed to enjoy it!

Her "old" membrane tubes had ceased functioning as well as they should after three years. Dr. Fieldman, Meghan's ENT Specialist, preferred to replace them with standard open tubes. Meghan accepted the news matter-of-factly, partly due to her innocence about surgical procedures, but also because she enjoys visiting Dr Fieldman (we've been there too many times to count!) As far as she was concerned, this meant she just had to come see him again.

As the surgery date neared I reminded her that we would visit Dr Fieldman at a different office (a surgicenter). I explained that both adults and children need to be very still when the doctor puts tubes in their ears, but it is very difficult to do this (probably because it tickles). So another doctor gives them medicine that will help them to take a short nap while the tubes are put in their ears. This is done with a mask (sort of like the one the dentist uses.) When people breathe the air in the mask it has medicine in it to make them sleep.

Since Meghan was going to have a mild sedative beforehand I told her that she would be given a small drink (it turned out to be apple juice with the sedative in it) with medicine that would make her feel very happy and a little sleepy. We would be with her all of the time except when she was in the room with Dr Fieldman because the room would get too crowded if everyone was in there. I also explained that she would lay on a tall bed or examining table. It needed to be high because the doctor would surely get a backache if he had to bend over to put her ear tubes in! She thought that was funny.

The night before we read Koko Bear's Big Earache, which reiterated everything I had already told her. We packed her lunch box with cheerios (her favorite dry snack), three raisin rolls and juice. (Some children are a bit nauseous or just not hungry after surgery, but our Meg is usually ravenous.) We also stuffed her backpack with books (including the Koko book), cards, coloring book, and crayons. The doctor told her to bring a special friend to accompany her into the OR, so she dressed her toy penguin in a nightshirt and added him to the top of the bag. Of course, her most beloved Bunny Blanket would be with her as well. Bunny has gone through every surgery with her. It's always next to her face when she is in recovery. Clearly, all this packing lent an air of adventure to the plans!

Meghan's was the first surgery scheduled, so we arrived around 6:30 am. ( was still dark outside! Meghan thought it was pretty neat to be up before the sun! We checked in, dropped her urine sample off at the lab and sat down to wait. Meghan colored in her new book and was opening her card game when we were called into pre-op. Her vital signs were checked and she was given her sedative. The apple juice, though only a small amount, was well received since she hadn't had anything to drink or eat since bedtime. I had thought she might complain about this but it didn't seem to bother her. She usually prefers to eat an hour or so after waking up anyway, plus the adventure and attention kept her mind preoccupied.

She was impressed when shown to a dressing room and given a "special dress", socks and a plastic bag to put her clothes in. "This is for ME?" she asked, pleased at these unexpected gifts. (It doesn't take much to make a kid feel special!) After I helped her change into the special dress her father and I read her library books in a small pre-op area. She was interested (and probably reassured) to see other people "waiting their turn" to have something fixed. When a toddler protested having his vital signs taken Meghan acknowledged, "He's scared 'cause he's just little." I nodded and asked, "Are you scared, Meg?" "Nahhh," she replied.

Our chatty daughter began to feel the effects of the sedation. The anesthesiologist had assured me Meghan would be "very happy by the time I take her to the operating room." She wasn't kidding! Giggles erupted whenever Meg leaned over to pick up a book and found herself listing to starboard on wobbly legs. She was obviously feeling verrrrry good!

When Dr Indira appeared for the 3rd time (She kept tabs on the sedative's effect) she leaned over and smiles, "Okay, Meghan, it's time to come with me." I asked the doctor if she had a "balloon" in the OR for Meghan to try to blow up. She crouched down to Meghan's eye level. "Oh, yes, I have a big balloon to show you!" she said as she extended her arms out. Meghan slid off her father's lap into the doctor's warm embrace. They posed for a picture and went off happily chatting to each other, probably about that intriguing balloon.

David and I returned to the main waiting room which was now mobbed with children. I pulled out a raisin roll but David decided to look for a place that provided something more substantial. Within 20 minutes Dr Fieldman was waving to me from the hallway. I had expected it to take a little longer, so, for a split second, I wondered if everything was alright. "She did great," he assured me as we walked into a small room next to the recovery area. He gave me a small bottle of ear drops for Meghan's ears (to be used for one week) and a small plastic container with her old set of ear tubes "for the Tube Fairy," he explained. Then he told me I could join my daughter in recovery and pointed to a paper gown to wear over my clothes.

He prefers parents to be with their children as soon as possible after surgery and we couldn't agree more. It's a strange feeling to wake up from a forced sleep. Children often cry and thrash around as the affects of the anesthesia begins to wear off and they calm down more readily when a primary caretaker is present. Meghan tossed about, crying out in angered bursts. David had returned by now (not having had any luck at finding breakfast in an unfamiliar town) and we stood on either side of the bed talking to her softly. She opened her eyes a few times, then eventually looked at me and, in an indignant, drowsy voice stated, "I'm hungry!" Typically Meggie! She rolled over, sighed and went back to sleep, resting comfortably for about 45 minutes or so.

One of the nurses gave us tea and coffee and toasted a muffin for David when she heard that he was hungry. While Meghan slept her vital signs were periodically monitored and I took photos. Yes, I received a few surprised looks, but I have learned that bringing a camera lends a positive nature to the experience and the snapshots offer the child some concreteness in understanding what took place. Besides, they're great for taking to school for show and tell (so are the ear tubes!)

Once awake, Meghan refused the nurse's offer of toast or muffins but accepted the apple juice eagerly and asked for her bag of cheerios. She smiles dreamily, enjoying her light breakfast and all the attention. Within half an hour she was more alert and we helped her change into her play clothes, took a photo of her and Dr Fieldman, and said good-bye to everyone.

We know by now that post-op instructions warn parents that children might become sleepy or nauseous on the ride home, so we put a bucket, water and toweling in the car. So far we haven't had to use them. Meghan is usually gassy for a few hours afterwards and might have a little loose stool, but, as mentioned above, she is always hungry. I try to keep her meals light but this time she kept asking us to stop and buy her "pancakes, eggs and bacon"!! (Breakfast is her favorite meal.) I suggested she order just pancakes or eggs, but good old Dad came back to the car with the works. Since we weren't far from home by then I insisted she at least wait to eat this meal until we got there! Three and a half hours after surgery Meghan ate every drop of her breakfast. She never even burped!

For about half of the day she seemed to be sleepy or mildly wobbly at times but played happily and kept up a running conversation as usual. Over the next few days she displayed some crabbiness. Whether this was a 
stress reaction from the surgery or just due to a little too much attention and a few later bedtimes I'm not sure. She was also a little more sensitive to loud sounds for a week or two afterward (a common occurrence after the ear tube surgery). For example, when the dog barked she covered her ears and stated, "That hurts my ears!"

Just the other day she was telling her little friend (who might need ear tubes) about it. "You have to take a nap because you have to lay very still." She went on in detail, mentioning the special dress and socks ("You get to take them home!") and that big balloon in the OR ("It was black!") When her friend asked her what the tubes look like I reminded her that she could show her the old tubes (we had asked the Tube Fairy to leave them for show and tell). "Yeah! and I put them under my pillow for the Tube Fairy, and the next morning I found a DOLLAR!" I guess a 
dollar's worth of ear tubes was certainly worth a trade-off for a short nap in the OR. At least Meghan has very positive memories about this surgery.

-------------------------------Joan McCartney is the mother of a cleft-affected daughter and the author of Promising Smiles, Adopting a Child with a Cleft Lip and/or Palate.

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