Medical Trauma, part 8: Building Healthy Narratives, Example 2

Let’s look at another example in which a parent elicits his child’s questions and then must figure out what exactly his son is asking and needing to know. In this case, I’ve chosen a subject that can be difficult for some parents by revisiting the boy who has an undescended testicle. Here’s an exchange between five-year-old Jamal and his father regarding the upcoming surgery.

Parent: [presenting his son with some paper and a pencil] Hey Jamal, will you do a drawing for me?

Jamal: [seems eager] Yeah, okay!

Parent: Draw you and your body and the upcoming surgery you need to have.

[Jamal looks a little uncertain, but he takes the pencil. He draws a basic stick figure. The face has a flat, expressionless mouth. Jamal regards the picture then carefully darkens in the area all around figure’s groin. He pushes the picture towards his father as if he’s finished with it.]

Parent: You done? [Jamal nods.] You drew a picture of yourself then darkened over a part of it. How come?

Jamal: Don’t want anyone to see.

Parent: To see what?

Jamal: What’s there.

Parent: How come? [Jamal shrugs.] You said you don’t want anyone to see. Like it’s private? [Jamal nods.] Okay, then. [The father lifts Jamal onto his lap.] That area you covered up in your drawing—I know it feels private. Can you and I talk about it because I think you got some feelings about the operation that’s coming up on your testicle, which is where you darkened out. [Jamal gives a tentative nod.] We’ve talked with the doctor and all that, but now this is just the two of us. Father and son. [Jamal regards his dad, then nods.] First, you got any questions?

Jamal: [shrugs and thinks for a bit] What’s a testicle?

Parent: [nodding, as if approving] All right. It’s the size of a little ball that is often inside your body under your penis. As you get older, it will come out of your body and usually hang down a little under your penis.

Jamal: But why’s it there?

Parent: You mean inside your body?

Jamal: No, why do I have one?

Parent: You actually got two. So that one day if you want a baby, they can help.

Jamal: What’s wrong with mine?

Parent: There isn’t anything wrong with it. It works fine. It’s sort of like on a string that goes in your body. Your body should be able to raise and lower the string to bring the testicle inside your body where you can’t see it. Or let it hang outside where you can. Right now, it’s only inside your body, and it should be able to come out when your body wants it to. That’s what the doctors are fixing.

Jamal: How?

Parent: They’re fixing the part that let’s your testicle come out.

Jamal: What about, you know, my pee pee?

Parent: Yeah? What about it? [Jamal just smiles and shrugs.] There’s nothing wrong with your pee pee. It works fine. And your testicles work fine. Like I said, the doctor’s fixing that little string that lets your testicle go up and down.

Jamal: Will it hurt?

Parent: You mean the surgery? No. It will feel sore afterwards. But the doctor is giving us medicine to help because he doesn’t want you to hurt.

Jamal: And they make me fall asleep.

Parent: Yeah. What do you think about that?

Jamal: [shrugs] I guess it’s okay?

Parent: Before they do the surgery, they help you fall asleep so that you don’t feel anything uncomfortable or painful. I’ve had surgery before and it’s like falling asleep when you’re super tired. Like when you fall asleep in the car at night and I pick you up and bring you to your bed without you even waking up. It’s like that.

Jamal: Where will you be?

Parent: When do you mean?

Jamal: While I’m sleeping.

Parent: I’ll be there, in a room next door for when you wake up. You okay with that?

Jamal: When I wake up, you’ll be there?

Parent: I’ll always be there. You’re not going to be alone.

[Jamal pushes himself off his father’s lap. He gets the drawing and adds a larger stick figure beside the smaller one.]

Jamal: That’s you. [Jamal then erases the darkened area about his groin. He starts to redraw his body, then reconsiders, and darkens in the area again.]

Parent: Still feeling private?

Jamal: I don’t want to see it.

Parent: You don’t want to see it? [Jamal shakes his head.] Oh, I think I get it now. So it’s not that you don’t want others seeing your testicles, it’s that you don’t want to see them? [Jamal smiles and nods.] Or think about them. [The father gives a light laugh.] Okay then. But we talked, and that was alright, wasn’t it? [Jamal nods.] Sometimes if you got someone else with you, you can talk about the things you don’t like thinking about when you’re alone. Like us talking now, right? [Another nod.] Okay, little man. We’ll keep talking about it. But for now, we’re good.

Jamal’s dad broaches talking about the surgery by asking his son to draw a picture of his body and the upcoming surgery. This intentionally vague request leaves a lot of room for Jamal to express anything he wants, though the father did ask Jamal to include his body in the drawing. In this way, the father is hoping to learn how Jamal regards his body in relation to the surgery.  Interestingly, Jamal only draws his body—partially censored—and nothing else with respect to the surgical procedure. From this, the father interprets that Jamal feels his body is private. The father appropriately both gets Jamal’s permission to talk about the surgery and reminds his son that it’s safe to talk with fathers about these sorts of things.

When Jamal first asks what a testicle is, his dad tells him where a testicle is located. This is an acceptable response, especially because the parent is sticking to the tangible stuff that a five-year-old is often needing to know. But Jamal isn’t content with this and asks, “Why’s it there?” This question isn’t clear: is he asking about the testicle’s placement in the body or its function? After helping his son clarify the question, the dad gives him some extra information that is necessary: Jamal has two testicles. When he explains the testicles’ function, he’s a bit vague but Jamal is nonetheless satisfied. For many kids, if they want to know more, they’ll ask.

When Jamal wants to know what’s wrong with his testicle, the father emphasizes that the problem isn’t with the testicle. In this way, he’s countering the possibility that Jamal might develop narratives that his penis or testicles are broken. Yet Jamal’s next question is about his penis. It’s not enough for the dad to imply that his penis is okay; Jamal needs to know for sure! It’s a good thing Jamal asks so that the dad can set him straight—not every kid will ask questions for which they are scared to hear the answer. Another child who is too uncomfortable mentioning his penis might never have his worries addressed. The fact that Jamal asks suggests that the dad should have pre-emptively addressed this concern rather than hope or assume Jamal would understand the facts.

When Jamal asks about pain, the dad reassures him, but also forewarns that he might be sore afterwards. Here the dad takes the opportunity to reinforce a narrative that doctors want to help rather than cause pain. Similarly, he accurately interprets Jamal’s question, “When I wake up, you’ll be there?” by speaking to Jamal’s fear of separation, reinforcing another narrative that Jamal won’t be alone.

At the end of their talk, Jamal revises his drawing a little: he adds the father, erases the darkened area, then has a change of heart, and shades it back in. The father interprets this as he had initially, that Jamal is “still feeling private.” But when Jamal comments that he doesn’t want to see what’s there, the father revises his assumption of privacy, now correctly interpreting that Jamal is keeping himself from seeing what’s there, thus avoiding thinking about his testicles and the surgery. The father encourages his son to develop healthy narratives here by reminding him that while Jamal might want to repress uncomfortable or scary thoughts, talking about them with others can help. The dad’s also aware of Jamal’s ambivalence—how he’d erased and then blackened out his groin—and tells Jamal that they will keep talking about the subject in the future.

Lastly, there’s something about this dad’s calling Jamal little man at the end. Sure, it’s a term of affection, but seeing as the surgery will be occurring among Jamal’s man-parts, the dad seems to be reinforcing Jamal’s male identity. It’s as if the dad were letting Jamal know that the surgery won’t detract from Jamal’s being a man. Instead, the dad is recognizing him as one, albeit a “little man,” and welcoming him to the club.