Medical Trauma, part 10: In the Event of Bad News

Not all medical procedures fix all problems. Sometimes problems require a series of medical interventions, and even then, the issue may not be completely resolved. And then there are problems—take diabetes, for example—that will last the child’s lifetime. In these situations, you can’t tell your child everything will be fixed and that there are no further worries.

What then do you do when the news is worrisome or even just plain bad? While the process of talking to your child is the same as above—you start with the emotions and work your way towards the intellect—there’s now the added complication of coping with bad news and a potentially challenging future. The goal here is to find a way to continue on, to keep going despite the difficulties. After all, what choice do you really have? As in the well-known Serenity Prayer, you’re trying to “accept that which cannot be changed.”

It’s important to accurately tell children what is happening to them and their body. If the news is disheartening or bad, kids still need to know what’s going on and what to expect in the future. In this case, this means the future will bring challenges, whether the child will be limited in some way or will need more medical attention and interventions. The take away is often the same: something is actually broken and can’t be completely or adequately fixed. In this case, the child will experience a sense of loss and grief. Only by expressing this grief over time will she start to accept and integrate her loss.

Let’s use an example here. Let’s say that following an accident, a five-year-old must wear leg braces which allow her to walk but with great difficulty. This is unlikely to change, even with additional surgeries. Clearly, she’ll need to mourn her ability to walk and play like other kids, but we have to consider the full range of her experience. Not only must she mourn her legs, but all that goes with their loss. For instance, she may now have trouble fitting in with her peers, fearing that they will automatically exclude her. She may feel not only different than other kids but reduced or “less than” they. In this way, her grief will extend beyond the use of her legs to include friendships and social acceptance. Whatever her experience, she will need help expressing the range of her grief in order to eventually accept what has happened, how she has changed, and how she can continue on. It’s also important to note that because kids have trouble expressing sadness and loss, these emotions often present as angry or aggressive behavior. When voicing these emotions of rage for your child, just remember that under the anger lies a profound loss and this, too, will need to be expressed.

There’s one more thing to consider: bad news for a child also means the parents have to cope with bad news. There’s a parallel process here but it’s best if you can manage your feelings separately from your child’s. If you’re sad or worried or scared or devastated, all these feelings are acceptable, and should be dealt with apart from your child. Your worries or sadness will only compound your kid’s feelings. There’s also the chance that your kid might feel she has to help you with your feelings, especially if she can see that they are intense and difficult for you to manage. Her job isn’t to deal with your feelings but to find a way to deal with her own. And she’ll need your help with this. This isn’t to say that you have to be unemotional. Quite the opposite. You can have your feelings and tell your child that you, too, are scared, but there’s a big difference between acknowledging your feelings to your child versus letting those feelings run wild. You are always modelling how to have and manage feelings. Remember, your kid needs someone who is in charge and appears to be managing things, logistically and emotionally. Your kid can’t have you falling apart. If you fall apart, your kid’s world will come unglued, and that’s terrifying for any child. You must remain intact so that your kid can fall apart if needed, and you can help her process her feelings to become whole again. You’ll also likely need help. So talk to friends, family, clergy, therapists, even strangers if that’s what works. You’re entitled to all of your feelings, but you have to be in control of them. When you’re talking to your kid, it’s all about her and her feelings.

Notice here that while there are a slew of potentially harmful narratives that could develop, many of them are not actually about the medical issue itself but are rooted in relationships. Because the medical issue creates intense, sometimes overwhelming feelings in everyone, it’s very easy for many of the child’s relationships to change which, in turn, might create new narratives. While parents can’t control how everyone deals with the bad news, they can help their child maintain healthy narratives by talking about how these relationships are changing and what kinds of relationships the child would like to create.