Medical Trauma, part 9: Building Healthy Narratives, Example 3

Seven-year-old Gisela needs a third surgery for a large birthmark that has disfigured part of her cheek and upper lip. She was three when she had her last surgery. She hasn’t had any questions about the upcoming surgery or shown much interest in talking about it. She now surprises her father in raising the issue. (Unlike the previous two examples, this parent makes a few blunders as he struggles to figure out what his daughter is feeling and what responses would be most helpful.)

Gisela: I don’t want another operation.

Parent: [surprised, caught off guard] You remember the last time?

Gisela: [irritated] No. But I don’t want it. It doesn’t help. 

Parent: I think you know why you’re having another surgery. Your face is growing and changing, and there’s still a bit more birthmark to remove.

Gisela: [sighs, impatient] I know. You’ve said.

Parent: [remembering to focus on the emotions] I recall the last time. It was scary for you because you were little and didn’t know what was going on or why, and we couldn’t give you a good explanation because you were too little to understand. [Trying to create a healthy narrative.] Just remember that the doctors helped a lot last time, and we think they can help you again.

Gisela: [shrugs as if this doesn’t matter] I don’t like it afterwards. It hurts and I don’t like the bandages.

Parent: [encouraging her to keep talking though he’s unsure what exactly she’s feeling] I know. It does hurt. And to have the bandages on your face. No one would like that.

Gisela: Why does this have to happen?

Parent: It’s not fair, is it?

Gisela: No.

Parent: [trying to voice another possible narrative] You didn’t do anything to make any of this happen. It’s not your fault.

Gisela: [softly, sadly] I want to look like other kids.

Parent: I get it. You want to fit in. And you don’t want them to not like you because of how you look.

Gisela: [agreeing] A kid called me ugly at dance class.

Parent: I’m sorry about that. I can tell that hurt.

Gisela: I don’t like how I look.

Parent: Because you look different or because kids say hurtful things?

Gisela: Both.

Parent: [trying to reassure] I think the surgeries have helped and they will continue to help, but the doctors have said that your lip will look a little different than other people’s. Most people have things about their face that make them look different. Someone might have a really big nose, or a really little nose. Or someone’s eyebrows are crooked. [Gisela turns away, and the father feels he’s losing her attention.] We all have things about our face that make us different, and I think that’s okay. As I’ve said before, what really matters is what’s inside us, not how we look.

Gisela: [dismissive] Okay, I know.

Parent: I know you know. [Backtracking, realizing this last part didn’t hit home, and that he hasn’t focused enough on her feelings.] What you’re mostly feeling is how other kids see you, right? And right now, you seem mostly sad about it.

Gisela: [now making eye contact] Yeah.

Parent: And frustrated that there isn’t much you can do. Except have surgery which is scary and hurts. And won’t make you look just like other kids.

Gisela: Yeah.

Parent: And even though some kids will be your friend, it feels like other kids won’t because of how you look, and you can’t do much about that.

[Gisela tears up a bit and nods.]

Parent: [pauses to collect his thoughts] Sweetie, you can’t do much about what other people think. So my hope for you is that you can feel better about your face no matter what it looks like. I think you’re beautiful inside, and that beauty comes out and shows all over your face. And I hope that you can see that too, regardless of what happens with any surgery.

This is a bumpy conversation, but it reflects many parents’ experience in which we don’t say the exact right thing every time. Because let’s face it: none of us are perfect. We all flounder and grope our way sometimes. It’s like being in a dark room, feeling our way around the walls for the light switch without tripping over too many pieces of furniture. That’s the reality of parenting.

Initially, this dad makes a common error, focusing on the intellectual facts—the why she’s having surgery—rather than his kid’s feelings. He catches himself, then tries addressing a potential, harmful narrative: that doctors hurt and don’t help. He’s jumping to conclusions here, and not ones that are based on anything Gisela has said—she hasn’t mentioned the doctors! Notice, too, that Gisela doesn’t react to the dad’s remark but instead mentions the bandages, an indication that the dad missed the mark. It’s not clear what exactly she dislikes about the bandages, but the father validates her feelings, encouraging her to keep talking.

When Gisela then asks, “Why does this have to happen?” the dad takes another stab at a potential narrative, voicing that Gisela might feel it’s her fault for needing surgery. Her response—that she wants to be like other kids—has nothing to do with her dad’s interpretation, a clear indication that the dad’s comment is off. Again, he’s jumping to conclusions without fully understanding how Gisela feels. Like any seven-year-old, Gisela herself isn’t exactly sure how she’s feeling and is using the discussion to figure it out.

Kids give us a number of chances, and here Gisela directs them both towards the root of her feelings: she wants to be like her peers. When the dad reflects back how Gisela is afraid of rejection, she confirms this in a way that kids will often do: she gives an example—a kid calling her ugly—that illustrates her dad’s interpretation.

Her dad again appeals to her intellect, telling Gisela that “most people have things about their face that make them look different” and that “what really matters is what’s inside us.” He’s trying for a new narrative here, a new way of thinking about her face. But this narrative is based on “either/or” thinking: ignore how you look and focus instead on your inner beauty. Gisela can’t ignore her appearance; even if she tries to, the bandages and her peers will keep reminding her. She’s rightfully dismissive of the narrative because it doesn’t acknowledge or help her come to terms with her strong feelings about her face.

Fortunately, her father notices Gisela’s reaction, and doesn’t press the narrative. Instead, he returns to voicing her feelings almost as if he were reminding himself what it is she’s experiencing: other kids will reject her and there’s nothing she can do. Now Gisela tears up, and her dad knows that he’s accurately described her feelings. Only with a deep understanding of her experience can he understand what the issues are. In this case for Gisela, it’s all about being accepted by others while lacking the ability to ensure it. With this in mind, a new narrative presents itself to the dad built on Gisela’s acceptance of herself rather than her peers’ approval. This narrative reflects “both/and” thinking in which Gisela can have feelings—even misgivings—about her face while also recognizing her inner beauty. This narrative allows her to have both a disfigured face and a beautiful one that reflects her inner-self.