Photo Essay by Nick Carranza
A Minnie Mouse rattle and pager are essential tools of the trade for child life specialist Karleen Wray as she moves through her day supporting pediatric patients in the OR.
Karleen Wray’s workday starts well before most people have had their first morning cup of coffee. A child life specialist with UCLA’s Chase Child Life Program, she often is in her surgical scrubs by 5:30 am, checking the day’s roster of young patients she will help to ease through the experience of undergoing surgery.
Wray is among 18 specialists in UCLA’s child life program who give support to patients and families who are experiencing healthcare challenges. While that support, delivered through a combination of play and education, is provided in a variety of both in- and outpatient settings at UCLA’s hospitals in Westwood and Santa Monica, Wray alone works exclusively with children in the OR or who are receiving anesthesia for a nonsurgical procedure, managing an average of 200 cases each month. “Supporting them through this experience, which can be particularly confusing and frightening for a child, is so important,” Wray says. “I’m meeting the kids and families before their surgeries, helping them to understand what’s going to happen and then going through the experience with them to support both the child and the family.”
While many people might associate “child life” with fun and games — staffing the hospital playroom and joyfully delivering toys to bed-bound patients — the challenges of the job can sometimes deliver a strong motional punch. “We hear a lot, ‘You’re so lucky, you have such a fun job,’” Wray says. “Yes, it can be fun working with children and families, but the members of our child life team also are supporting them through times that can be extremely painful and challenging and that sometimes ultimately end in loss and bereavement.”
Her days begin on the surgical floor of Ronald Reagan UCLA Medical Center with a review of the pediatric surgical calendar — on some days there can be upwards of a dozen cases that are scheduled to start at 7:30 am. “I never know until I meet the patients and their families exactly what their needs will be,” Wray says. “A big part of my job is assessing each patient and family to see what their potential stressors are going to be throughout the day and prioritizing my time to be able to provide support in those moments. Every situation is different.”
It also is important in these first moments to help parents feel some sense of control by providing them with essential information about what is going to happen over the next several hours with their child. “I’m preparing the child, but also preparing the parents,” Wray says.
Wray stays with the child as he or she is prepped for surgery and, in many cases, accompanies them into the operating room to provide further comfort and support while they undergo anesthesia. Often she will be the first face the child sees when he or she awakens after surgery.
The photographs on these pages follow Wray through a typical day.
BEING HOSPITALIZED AND UNDERGOING SURGERY ARE STRESSFUL FOR ANYONE, and that is especially true for a young child. But child life specialists are trained in a technique called stress potential assessment to help them prioritize even before meeting a patient how to best give the necessary emotional and physical support to them and their family.
For 2-year-old Genesis (above), providing that support and building trust mean getting down on the floor at her level (above) and offering her a choice of what gown she wants to wear while in the hospital. It is all about giving the patient — even a very young child — a sense of control over something in a situation that is, in almost all other ways, beyond their control, Wray explains.
It also helps that Wray can speak Spanish — “I’m not perfect, but it’s ok,” she says — and provides an additional measure of comfort to both the child and her parents.
While Genesis is shy and timid at first, she quickly warms to Wray, who promises the little girl that she can watch an episode of her favorite show, Peppa Pig, before she goes to sleep in the OR.
LIKE SO MANY PEDIATRIC PATIENTS, 6-YEAR-OLD KAYLA (TOP RIGHT) ARRIVED IN THE OR FRIGHTENED AND IN TEARS. Lack of control, again, often is the root cause of such fears. “Illness and surgery can’t be controlled by the patient, but focusing on what we can do to alleviate the fear and to control the things we can control helps,” Wray says.
One way to do that is to help her young patients to understand what is going to happen as they are prepared for surgery. That may involve something as simple as explaining the mask that will be placed over their face as they are put to sleep before the operation. To help Kayla get comfortable with the mask (top right), Wray gives her a sheet of stickers with which to decorate it. Once a mask is decorated, the children get to choose a scented oil to give it a pleasant odor. Kayla chose strawberry.
Bubbles are another useful tool to both distract and delight a child (right), but sometimes it is hard to tell who is having a better time.
WRAY IS A MASTER AT FINDING INNOVATIVE WAYS TO CONNECT WITH HER PATIENTS. When one patient became upset about having to be inked with a surgical marker to indicate the surgical site, Wray began engaging the child in a calm, soothing voice, asking, Do you like to color? Do you like crayons or markers? Do you like superheroes?”
As the child calmed, Wray handed over a marker and extended her hand, on which the patient drew a happy face. What began as a moment of distress turned into interactive play, as the patient next drew a happy face on the hand of his father. Soon, the child, without tears, allowed the medical staff to make their necessary marks in preparation for surgery. Later in the day, as she does paperwork (bottom left), the happy face serves as a reminder of a job well done.
Back with Genesis (below), Wray feels that the child will be most comfortable if she is carried to the OR. It is a good time to bring out the Minnie Mouse rattle, as the little girl prepares to say goodbye to her parents before being taken inside for her surgery.
ARRIVING AT THE OR SLIGHTLY AHEAD OF SCHEDULE — set-up is not yet complete — Wray slips on her mask to distract Genesis for a few moments until they can enter (above).
For Kayla, an impromptu game of Baby Shark helps to lower the child’s pre-surgery anxiety. “Whatever it takes to make patients comfortable, nothing is out of the question,” Wray says.
INSIDE THE OR, WRAY IS A WELCOME TEAM MEMBER, as she assists the nurses and surgeons to calm and comfort the child before surgery. Sometimes that means something as simple as holding the child’s hand or playing a song the child enjoys or even arranging for the child’s parent to be there until he or she goes to sleep. For Kayla, Wray brings out a favorite stuffed toy for moral support, as the anesthesiologist prepares to put her to sleep — using the strawberry-scented mask that she decorated — for her operation. Kayla’s stuffed rabbit will reappear at her side when she wakes up in post-op.
With a break between cases, Wray takes an opportunity to review her patients’ charts. Continuity of care is an essential principal of the Chase Child Life Program, and charting ensures that Wray and other team members have the most up-to-date information about each patient as they move along their medical journey.
AS THE DAY WINDS DOWN, WRAY RECEIVES A CALL (RIGHT) FROM THE NURSES’ STATION ON THE FIFTH FLOOR. One of her patients is having a rough time and needs her. Continuity of care is a core principle of the Chase Child Life Program, and throughout the day, Wray stays in contact with her child life colleagues and nurses caring for her young charges elsewhere in the hospital.
IT OFTEN IS IN POST-OP WHERE THE RELATIONSHIP BETWEEN THE CHILD LIFE SPECIALIST AND THE PATIENT IS MOST EVIDENT — a familiar face can be a potent remedy for a distraught child as they awaken after surgery. When 2-year-old Genesis woke up in tears after her surgery, it was Wray’s gentle touch and reassurance that comforted her (above).
While she can’t always be bedside at the perfect moment, Wray tries to anticipate the needs of her patients before they wake up. Her careful planning and constant communication with the OR staff put her within a few short minutes of her patients at their most vulnerable moments. Simple gestures like gently stroking a patient’s hand or making sure that a child has her favorite stuffed animal by her side as she awakens now are instinctual for her.
ARTWORK, CRAFTS AND HANDWRITTEN NOTES — from her young patients decorate Wray’s small workspace tucked into a corner of the OR suite. Each reminds her of a patient or a moment during which she affected the life of a child and family.
Wray’s commitment to her work and patients sometimes leaves her with little time to attend to daily necessities, like lunch. “I eat like a child,” she says. “I have pouches and stuff.”
Finally, after a long shift in the OR, she hurries down a corridor (below) for one more visit with a patient to ensure that all is well before heading home to rest up for the next day.
Nick Carranza is a photographer, video producer and content strategist for UCLA Health.
For information about the Chase Child Life Program, go to:
