In a Pediatric ICU, Halloween Can Be Healing

Celebrating uniqueness and breaking from the norm in a place so filled with physical and mental stress 

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When I look back at my childhood Halloweens, my best memories are actually of the days that followed. As I rummaged through my surplus of sweets, I didn't think life could get any better. It was a deserving reward after hours of strategically approaching neighbors who offered candies of the highest calibre. I climbed the doorsteps multiple times of those who handed out packs of Bubblicious, and frequently rang the bells of residents who gave a medley of chocolates to each individual.

For me, as a kid, October 31st was about candy. Sure, it was fun to be Peter Pan for a few hours or chant hocus-pocus for the day. But I played pretend frequently; I did not, however, have so many sweets so directly at my disposal except for one day a year.

So I didn't know what to expect at a children's hospital on Halloween, particularly in an intensive care unit. What is trick-or-treat like when you are not capable of eating the treat? When going from door to door isn't feasible because you are bedridden or required to stay in isolation? When you're quite possibly already upset because you can't to go to school and join the ranks of your superhero and cartoon character friends?

It turns out that since these kids can't be home for the holiday, the hospital brings the holiday to them.

This was apparent on the morning of one Halloween when I looked up from assessing my patient. The sounds from my stethoscope had blocked out the footsteps of an approaching entourage of Disney characters, all dressed with impeccable detail, from head to toe.Snow White smiled at my startled look, and then held out a plastic pumpkin full of Halloween-themed stickers, stamps, bracelets, pens, and keychains -- appropriate treats for the patient I was caring for. He had complicated gastrointestinal issues, and his only option to "eat" was intravenously.

Meanwhile, my other patient waited impatiently for me to help him transform into a wrestler. The 7 year-old boy had a tracheal tube in place. It was connected to an array of tubing leading to a ventilator that helped his chronically sick lungs breathe. In order to put on the mask and costume, I arranged everything so that he was only disconnected from the ventilator for a minimal amount of time. During that moment of disconnect, I watched his vital signs to make sure there were no drastic changes. I left a small gap between his head piece and his body suit for the tracheal tube to maintain its place. Technical difficulties wouldn't stop Ray Mysterio from rearing his ugly head that day.

Another year, I took care of a child who was dressed as a flame. Red and orange spikes of fabric covered his entire body, including the port on his chest and his bare head. Every time I walked into his room, I didn't leave without sticking the thermometer under his arm and then gasping at his imaginary million-degree fever. Tylenol wouldn't be able to defeat this, I told him. He was burning up so badly that even antibiotics wouldn't overcome it. He nodded in solemn agreement as I fanned myself. I even pretended to fumble with the thermostat in a desperate attempt to cool him down. He got a kick out of it all, and enjoyed every dramatic gesture.

It surprised me that these kids never mentioned anything about candy. They had spent so much of their lives in the hospital that they accepted dietary restrictions. Instead, they just relished the opportunity to be someone else, as all children do. But for chronic pediatric patients, it's more than just a game of make-believe. As I watched minnie-Ray Mysterio clenching his fists to all who walked by, his costume drowned out the presence of the ventilator that loomed behind him. And the little ball of fire -- you could never tell he suffered from cancer because, on Halloween, hats and wigs aren't just for people who have undergone chemo. There are children I work with who know that they are not "normal" kids. They feel like they stick out and look a little strange. What better day to ease those insecurities than one that commemorates sticking out? Usually, we help these kids cope with what makes them different. But on Halloween, they are simply surrounded by things that are even more different. Patients in liver failure often have discolored skin because of imbalanced enzymes. But nothing compares to the ghastly green Shrek lurching around the hospital. A paraplegic patient once dressed as a bumblebee. No one heeded the fact that she couldn't walk when she looked like she was supposed to fly. Recently, there was a picture circulating the internet of a wheelchair-bound child dressed as an ice cream truck. It exemplifies what Halloween can be for sick kids: a chance to be something that distracts from what's already distracting about them.

It's also refreshing for healthcare professionals to don their own dress and counteract the ever-present White Coat Syndrome of pediatric hospitals. Caregivers are often greeted with cries and anxiety; younger children associate us with all things threatening -- needles, blood, medications, etc. But when you're dressed as one of the 101 Dalmatians, the threat is somewhat minimized.

In the PICU, we can never get too creative or elaborate with our attire. Emergent CPR occurs on a regular basis, and sterile procedures are done daily. We have to simplify our costumes so that they can accommodate such circumstances. But as long as our scrubs are replaced with anything silly, we manage to get some smiles instead of the usual furrowed brows.

Some physicians also partake in the festivities. There's nothing like watching the cardiology team discuss matters of life and death while dressed as the House of Cards from Alice In Wonderland. One year they paraded through the unit as a variety pack of Sweethearts. One cardiologist had "Kiss My ASD" etched across her Sweetheart body (an Atrial Septal Defect is a common congenital heart defect). She wore it proudly until someone of authority thought it was inappropriate and asked her to change. 

Others shun dressing up, regarding the entire concept as inappropriate and unprofessional. It's a valid argument in some cases. Holidays in the PICU can be tricky that way. We have chronic, acute, and terminal patients, and it's never an even split. At times there are numerous children barely hanging on to life support, and many others who are sedated or neurologically impaired. Even if the kids are not alert and oriented, their parents and families are. Nursing is a profession that delivers family-centered care. We are obligated to create an atmosphere that uplifts those who want to forget their problems and respects those who are consumed by them. So not everyone at the hospital, patients and/or providers, celebrates Halloween.

But to those who do, our hospital's Child Life team comes ready with costumes to distribute. Some parents will still dress up their child who may not be aware of what's going on. They'll put an Elmo suit on their son or throw a tierra on their little girl's head. It often serves as a comfort measure. Other times, the purpose is two-fold: it's done for comfort but also for entertainment. As is evident when the angry face is not just on the bird, but also the baby.

The PICU is a place full of physical, mental, and emotional stress. So we try to have some fun when we can, whether it's Halloween or not. Every now and then, the boy who dressed as a flame returns to the hospital for a treatment. He usually looks down and depressed to be back. Whenever I pass by his room, I say hello and make some small talk. He responds with one-word, disinterested answers, and his somber expression remains unchanged. Then I remember our little inside joke. I try to take a few steps closer to him but wince back from the fictitious force field of heat. He finally cracks a smile.

Who would have thought? A nurse perpetuating a "fever."