“Ice Cream Spray”
The other day I saw a 4-year-old boy with some mild gastroenteritis symptoms and poor oral intake for about 12 hours. He was otherwise well, but we checked a urinalysis on him because he described some vague discomfort with voiding.
The urine came back positive for a surprisingly high amount of ketones, but otherwise no concern for infection. This can be pretty common in these young kiddos who haven’t eaten much in several hours, but I had to check a blood sugar to ensure he wasn’t this ketotic because of hypoglycemia.
Unfortunately, one of my nursing colleagues had gone in to attempt to get a point-of-care blood glucose but this little man was feisty and after she did the skin prick he was able to turn the room upside-down getting away from the glucometer, so she wasn’t able to get the sample. When she told me this, I went in with her so we could get the sample together.
When I walked in, little man was immediately highly suspicious.
“What are you gonna do?” he asked, eyes narrowed.
“I am going to talk to your mom a bit, kiddo.”
I discussed the urine findings with his mom, and the rationale for checking the blood glucose. Mom was completely understanding, but looked reasonably nervous about trying to prick her little guy again.
I turned to my patient and said, “Okay my friend, I know you haven’t been feeling well for a while, so there is a test we need to do to make sure you are safe and healthy.”
At the word “test”, he immediately started screaming and crying. “I don’t wanna! I don’t wanna!”
I sat in front of him and said, “My friend, I promise I would not do this test if we did not need to.”
He sniffled and nodded but was still trying to climb behind his mom.
“So I have a couple of questions for you.”
“Like what?” he asked, peeking out behind his mom’s shoulder.
“Okay, first question: do you like popsicles?”
He gave me a “meh” face and a shrug.
“Alright, do you like... ice cream?”
“Yeah!” he said, interest piqued. He clambered out from behind his mom.
“I like ice cream too!”
“So... if I do this test I get ice cream after?”
I chuckled and looked at his mom, who was laughing and nodding. “Yeah, buddy, we can definitely have ice cream after.”
He looked a little more open to the suggestion.
“So my friend, we have this special ice cream spray that feels like ice cream!”
“Yeah, can we show you?”
So we brought out the spray, but he also saw the glucometer and started losing it. We showed him what the spray looked like by spraying on his mom’s hand, but he was still crying.
“No, no! I don’t want it. I don’t want the test!”
I met his eyes. “My friend, I know you don’t want the test, but we need to keep you safe and healthy. But it’s your body, so I want you to choose, okay? You can get the mosquito bite [i.e. the lancet], or you can have the ice cream spray. Which one do you choose?” (I learned this protip from my child life colleagues during residency: you give the kids choice of how they want the test or procedure, but not whether they want the test/procedure done. It helps give them control and autonomy while also doing what’s in their best interest when they are developmentally unable to consent.)
“No! I don’t want either. I don’t want any of them!”
“I know, buddy, but we need you to pick so we can take care of you.”
He cried and sniffled for another few seconds, until finally he conceded.
“Okay, I want the ice cream spray.”
I nodded at my nursing colleague, who grabbed everything for the test. He still recoiled at the sight of the glucometer, so we positioned his ID band and let him press the scan button, which he actually kind of enjoyed (haha kids love buttons). Then I held his hands out, like he was going to receive scoops of ice cream in his palms.
“I’m going to help you hold your hands for the ice cream spray, okay? I want you to close your eyes and think of your favourite flavour.”
“I like chocolate,” he said, obediently closing his eyes tight. His mom covered his eyes with her hands.
“Me too!” I told him as I held his fingers extended for the nurse. She swabbed him with ethanol. “Keep thinking about your favourite flavour.”
“I like chocolate,” he said, sounding a bit more anxious.
“You’re doing great buddy, keep thinking about chocolate! Say it faster!”
“I like chocolate! I LIKE CHOCOLATE!” he repeated over and over as we sprayed his fingers.
“ACK! That’s cold!”
“I know, that’s the ice cream spray! Still gotta think about your chocolate ice cream, bud!”
“I LIKE CHOCOLATE!” he repeated again as the nurse lanced his finger. He squealed and tried to retract his hand but I held it steady while the nurse collected the sample.
“You’re doing so good buddy, the ice cream spray will melt off soon. What flavour are you gonna get?”
“Chocolate,” he said again. “I’m gonna get chocolate.”
We placed a band-aid and let him go. He seemed surprised.
“You’re all done, my friend!”
“Oh...” he said, looking at his hands. “You know... that really did feel like holding ice cream.”
The nurse laughed as she put everything away--glucose was normal.
“Buddy, you did SUCH a good job. I think you deserve a treat now, what do you think?”
He nodded enthusiastically.
“Let’s see what kind of treat to get you, okay?”
He nodded again. I told him, “Let me check your ears--there are clues in there for what kind of toy you might like!”
I looked. “Well this ear is a little waxy... it means you must like squishy things!”
“And this ear... wow, it’s fuzzy! Do you like soft fuzzy things?”
“Hm... let’s check your tummy to find out what kind of soft fuzzy toy. Your tummy feels pretty squishy... do you like stuffies?”
“Yes! I really like stuffies!!”
I finished the rest of my exam and told the little man we’d grab him a freezie to keep up his PO intake and also grab him a treat from our treasure box (a stuffie, of course). As I was about to head out to grab these things, he said, “Actually... I would be happy with just one treat. I don’t need both.”
I smiled. “Well my friend, that is very thoughtful of you wanting to make sure we have enough treats for all our little friends here, but I promise we can get you both and still have enough treats for everyone, okay?”
Predictably, this little man ate his freezie in record time and he really loved the teddy bear we grabbed him from the Child Life stash. After they were officially discharged, my little friend’s mom stopped me as I was about to head out of the room.
“I just want to thank you,” she said. “Your bedside manner went such a long way for him today. He has to get blood tests done at least every year for his [other unrelated condition], and I think the ice cream spray is going to make such a huge difference for him in making the tests less traumatic.”
“Thank you,” I said, a little flustered. “I’m really glad we could make this better for him in some way!”
“No, really. You were a game changer for him today.”
Little things can go a long way. If you can... be a game-changer for your patient. They might not realize it, and you may not realize it... but doing what you can to make things better makes all the difference. Anything we can do to provide the best care for our patients will always be worth it.
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