Hospital Memories

I was reading a book today and the author referred to a time she had spent in hospital as a child and this started me thinking about my own childhood experiences of hospital in 1960.

I was nine years old and it was a Monday morning when I was taken by ambulance from my home to a hospital. I remember the doctor was very cross with my mother. I knew I was ill; I couldn’t walk. I knew my father had not taken me seriously, had not listened to me when I said walking was difficult. It was at the end of half term and I had spent a lot of time that week reading in bed. This had been interpreted as laziness and on Saturday my father had made me walk the three miles to the library. I remember crying and on the way back my legs wouldn’t work properly and I had to crawl. My father thought I was making it up and kept telling me to stop being silly. That evening after tea I was expected to clear the table. I had to do it on my hands and knees – still they didn’t believe me.

It was on Monday morning when I couldn’t get out of bed for school that my mother called the doctor. When I got to the cottage hospital I was alone; my mother had not come in the ambulance with me and I was put me in a ward with mainly elderly women. There was no separate children’s ward. My clothes were taken away and I was put in a hospital gown. Without a word of explanation I was put in a bed and denied a pillow. I was to lie flat. I was not allowed to get out of bed or even sit up for the next two months. No-one ever explained why I was there or why I had to lie flat. My brother was not allowed to visit me. My parents were allowed to come at visiting hours only which was 5.00 – 6.00pm. My father could not get away from work and my mother would need a sitter for my brother, nevertheless she did come most days and my father came at weekends.

Apart from my family, I was deprived of the company of other children except for a short time when another child was in the bed next to mine but she was very ill and didn’t communicate very much, but I still have a vivid picture of her in my mind. I have no idea what happened to her. Each day was the same hospital routine. I had nothing to do. There was no hospital school, no work was sent from my school. I loved books but found it very hard to read flat on my back and they wouldn’t let me turn on my side.

Over the next two months I never had a bath, only a bed bath once a week. They couldn’t wash my hair so they cut it very short and I had dry shampoos. I still remember the itchiness. I tried to amuse myself by day dreaming. The highlight of my stay was when I received letters from every child in my class, they were almost identical – it must have been a writing exercise on the board. I remember longing to be back at school and so grateful they hadn’t forgotten me.

Each day I was made to eat the hospital food, which was awful, but the worst was every Friday when Coley fish was served with lumpy mashed potatoes and parsley sauce. The smell was awful – my mother always cooked Coley fish for our cat and I was convinced they were making me eat cat food. Most evening and at weekends my mother brought me food – I wasn’t hungry but she made me eat it. She didn’t trust hospital food because it didn’t have any goodness.

In fact the ward I was on was a geriatric ward and unsurprisingly people died. They never told me they had died even though, awake and scared in the night, I saw them taking the body of an elderly lady away on more than one occasion. Once I asked after her and they said she had gone home. I knew they were lying.

There were rituals in the hospital and some I never got to the bottom of. Every evening the nurse would fill in my chart and ask: “Yes or No?” I didn’t know what she was asking and never knew what to reply. It didn’t seem to matter what I said as I don’t remember any consequences. It was only later I found out that the question related to the opening – or not – of my bowels.

After two months I was allowed to sit up and for the next month I gradually learnt to walk again and was able to visit some of the other wards. I remember a strange mixture of women and men with what I now realise were mental illnesses and I was scared, but knew it would be wrong to show I found them repellant. I steeled myself to visit them and be polite but, following one horrible incident where an elderly, toothless woman grabbed me and pulled me close, made sure I stayed out of their reach.

Even when I eventually left hospital, I was not allowed to return to school for several months while I convalesced and regained my muscle power. It was then I found out I had had rheumatic fever. Later I was surprised when on returning to church I heard them say prayers for a child who had nearly died and been brought back to them. Who was it I asked, only to be told it was me they were talking about. I had nearly died – surely not, I hadn’t been that ill! I always believed they were exaggerating.  

I had put on a lot of weight in hospital and my hair had been kept cropped. There were no mirrors and I remember seeing myself for the first time when trying on the new clothes my mother had bought for me. I remember staring at a chubby girl with cropped hair and looking over my shoulder for my former athletic self with a bob haircut and ribbons. It was a shock. I didn’t recognise myself.

When I returned to school no one recognized me either, but they soon found a name for me – ‘fatty’. My former friends had found new friends in my absence, I couldn’t blame them – they probably hadn’t been told I would eventually come back. My mother always insisted I went home for dinner (she didn’t trust school dinners either) so there was no opportunity to make friends during lunchtime. My final year in primary school was miserable and made worse when I discovered I had failed the 11+ and would not be going to grammar school. I had been away from school for months but no one had thought to make sure I kept up with the preparation for the tests and not surprisingly I failed. However, I was apparently a borderline fail, and my family were brought into school for an interview. My father told me afterwards they had decided I wouldn’t get a place in the Grammar school because another girl, Jennifer, whose father was a policeman had been given the place. Apparently they thought she, rather than me, daughter of a factory worker, albeit a skilled toolmaker, would have more support from her family and so I went off to one of the very first comprehensive schools in the UK.  My school report said, “If Marilyn did less daydreaming and concentrated more she would do much better.” Daydreaming had got me through the day in hospital – I had become very good at it.

I spend a lot of my life now thinking about children’s rights and what needs to be done to persuade adults that children’s voices should be listened to and then acted upon. I have no doubt that my hospital experience was pivotal in my life; it was a benchmark, I saw my childhood in two halves, before and after I was in hospital. Some things I learned in hospital I am grateful for – I learned how to make a bed with properly mitered corners that before the widespread use of fitted sheets stood me in good stead and still comes in handy occasionally. I also learned that I was resilient, I didn’t complain, I made the best of things and realised I could cope without my family and maybe it did equip me to cope with problems in my life, I’ll never know, but learning how to daydream probably prepared me to be a reflective person. Things I am not grateful for are what I now see as my invisibility. No one saw me, I felt powerless and lonely, no one was interested in what I thought; no one considered that I should be told anything – I was only a child. To be a child in 1960 in England was to be a non-person. I had no rights. I had no power. I had no voice. I had no chance to ask questions about the things that were happening to me. I don’t remember nurses being kind to me, I do remember being made to eat my Coley fish even though I was crying; I do remember the pain of having blood taken every week and dreading the moment when the needle would be stuck in my arm and hoping the nurse would find a vein and only have to do it once. I remember being told not to be silly when I showed fear, to be a brave girl ‘for Mummy’. I remember not being treated as a person because I was a non-person – a child.

As I recall these memories I wonder what would have been different if the United Nations Convention on the Rights of the Child had been passed at that time. I think first of all my parents would have had open access to visiting and may even have been allowed to stay with me over night if I was really scared. I think my brother would have been allowed to visit me. Surely I would have been in a children’s ward with staff trained to work with children and they would have been sympathetic and explained what question ‘Yes or No’ was the answer to, as they filled in their charts and they wouldn’t have made me eat that Coley fish! I think they might have found a way to set up a prop for a book so I could read. I would probably have had a tutor and the school would have set work and I would have passed my 11+. Most of all someone would have explained what was wrong with me and why they had to make me lie flat, and why they had to take blood and why they were so interested in the workings of my bowels. They wouldn’t have cut my hair off and they would have found a way to wash it. I like to think I would have been given some choices and a chance to discuss the rules of the hospital rather than just be made to obey them. I would have been allowed to have my own pyjamas and not the silly hospital gown that was too big and constantly rucked up under me (I still can’t bare to wear a nightie in bed). My mother would have told the hospital not to feed me as she was bringing food and I wouldn’t have got fat. Maybe they would have found a way to push my bed outside so I could see the sunshine and feel the wind. I wouldn’t have been excluded from any sense of control over my life; I would have had some personal autonomy. They would have explained what death was and helped me understand what was wrong with the other patients. On returning home my mother would have let me choose my new clothes and let me grow my hair.

I see now that to be ignored as I was is the ultimate in powerlessness. I felt as if I didn’t count, worse I believed I was a nuisance because the nurses told me I was. I felt guilt for all the trouble I caused my parents in coming to see me. My mother had to catch two buses each way.

These memories were stirred as I read another account of a child’s experience in hospital and for the first time I realised that my experience was not just my experience; that other children had been treated in similar ways, that others had felt the same as I had, I felt a sense of solidarity. My generation of children were frequently treated as non-persons, were frequently ignored, were seen as not competent enough to be able to process our experiences, let alone be involved in decisions about our lives. Our voices were silenced.

A lot has changed, but not enough. The rights of the child have been recognized officially, but few adults recognize all the issues that need to be addressed to properly enact those rights. Most important of all is children’s voice. We must value children’s experiences, listen to what they have to tell us and act upon it. This means the relationships between children and adults have to continue to change; we need to pay attention to how children are treated and how they feel. We have to think about how much power children actually have in their daily lives and campaign for the social changes which will have to take place if the position of children is to get better.  Changes in the ways children are treated in hospital today compared to my own childhood shows change is possible. I hope that my grandchildren will look back at their lives and wonder at how little power they had compared to their own children – that would be progress.

The Little Boy

Once there was a little boy and when he was four it was time for him to start school. Each day when he went to school the teacher would tell him stories. He loved the stories – stories about dragons and knights, about giants and wolves, witches and fairies. Stories about goodies and baddies, about brave people and cowardly people, about greedy people and generous people. Stories of love and hate, jealousy and cruelty, friendship and loyalty, betrayal and trust. His imagination was full of places and events, of people and animals that peopled his dreams and his play. 

Every morning he looked forward to arriving at school because the teacher would ask him to choose where to put his name card ­– would he choose a witch or a dragon, a castle or a ship, a story or a poem? And each day he would think about it and put his name card beside his choice and the teacher would ask him – why do you like dragons best, or story or castles? He would think about his answer and tell her. He learnt to give reasons for his choices.

Then the teacher would ask all the children to sit on the carpet and talk about their choices. He liked hearing the ideas of the other children in his class and sometimes after he had listened to them he changed his mind and made a different choice. All together they would think of ideas for stories and then he would go and play the stories – he would dress up and play being the monster or the hero, he would take small figures of dragons or witches or Fireman Sam and create a story, he might use puppets as characters in his games, he might make props and characters from playdoh. And after he had played the teacher would bring the class together again and read some of their stories that she had written down while she watched them play. 

Then one day the teacher set up a story-telling table and said anyone who wanted to tell her a story could come to the table and she would write the story down. The little boy was excited – he had lots of ideas for stories so he went to the table and he told the teacher a story and she wrote it down. His story had a dinosaur and a boy and Fireman Sam – it wove together ideas from all the stories he had heard and played. And the next day the teacher read his story to the class and invited the children to act it out as she read it again. And the little boy looked at his words and was happy. He liked acting out his story with others in his class. 

Then the little boy was five and he had to move to another classroom and another teacher. This teacher didn't ask him to make any choices at the beginning of the day, she just read out the names from the register and asked him to listen for his name and say 'Yes, Miss Jones' when she called him. He missed his old teacher and wondered what the children in her class were doing.

Then his teacher said, 'today we are going to have new books for you to read'. The little boy was excited – he loved to hear stories and was eager to see the new books. The teacher called him up and gave him his reading book. It didn't look very exciting. She slowly read the book to him. It didn't have many words and the teacher stopped to sound out the letters in the words. It wasn't a story like he had had before where he could imagine himself as a knight or a giant slayer or a big bad wolf. The little boy was disappointed. He missed the stories he had had in his old classroom. He didn't want to take this book home to read, he longed for his old teacher who wrote his own stories down for him to read. 

Then one day the teacher said, 'today we're going to write a story'. 'Oh good' thought the little boy, he loved to write stories and he picked up a pencil and began to draw his story. 'Wait' said the teacher. 'I haven't told you what to do yet.' The little boy was full of ideas but he stopped what he was doing and listened to the teacher. The teacher gave out a sheet of paper with pictures on it. She told the children to look at the pictures and write the words to make the story. The little boy looked at the pictures – he didn't like the story they told about a boy who walked along the road to the shop to buy some something. His mind was full of tales of castles and knights, magic and mystery, but the teacher didn't ask him about his ideas. She sat all the children down and asked each of them to tell the story to go with the pictures. The little boy wondered why they all had to write the same story, but he didn’t say anything. He sat there and looked at the pictures, but he didn't want to write the story.  

And pretty soon the little boy stopped telling his own stories and learned to do what the teacher asked him to do.  He stopped looking forward to having his stories written down for him, he forgot how he loved to act out his stories with his friends; he got used to the reading scheme and learnt to do what the teacher asked. He read the books in the reading scheme and wrote what the teacher told him to write about.  

This story was inspired by the work of the late Patrick Whitaker, a wonderful educator, Sara Stanley, an inspirational early years practitioner and Vivian Paley, the renowned American kindergarten teacher, now retired.  

What did you learn at nursery today?

In this blog I reflect on four incidents in the life of Jack, aged 2 years and 4-6 months and raise important issues about how we engage with small children.

Incident 1: Jack aged 2 years and 4 months comes home from nursery.

Hi Jack, how are you?

I sad. 

Why are you sad Jack?

No see Janey no more.

Janey has been Jack’s key worker at the Sure Start Nursery he has attended two-three days a week since he was six months. Local authority provision of childcare for babies and small children is no longer statutory, and the local authority in question decided to close the nursery.  The quality of provision had been outstanding. Jack loved Janey, his key worker, and now he couldn’t understand why he wouldn’t see her anymore. 

Jack had brought home a book which recorded highlights from his experience in nursery.  He sat with his mummy and looked through the book.  She didn’t want to make light of his sadness, she explained that the nursery was closing and Janey had a new job to go to.  Jack would be starting a new nursery and it was OK to feel sad.

Incident 2:  Jack, aged 2 years 6 months seems to be settling well into his new nursery, which is based on the site where his daddy and mummy work. He particularly enjoys putting on his helmet and cycling to and from nursery each day with daddy.  He’s stopped talking about Janey and his old nursery.

One day when he was dropped off at nursery he burst into tears as his daddy left.  “Don’t cry Jack”, said a nursery worker, “if you don’t cry, I’ll give you a sticker.”  Jack’s parents were very unhappy about this and let the nursery know they didn’t want this kind of response to his distress, they didn’t mind if he cried, they knew he would soon settle as he became distracted by the activities on offer, but in that moment of tears they wanted his feelings validated. 

Incident 3: The next day Jack’s daddy was getting him dressed for nursery and Jack said, “Go to Janey nursery today, daddy.” His daddy told him that Janey’s nursery was closed and so he couldn’t go there, he would be going to his new nursery.  “No” said Jack.

That day Jack’s mummy took him to nursery in the car. On the way he was chatting happily, then just before they arrived his voice reduced almost to a whisper, it was impossible to hear what he was saying.  “You’ll have to speak up Jack, we can’t hear you when you whisper.”  He carried on whispering. Finally on being asked again to “speak up”, he said, “Not cry at nursery Mummy.”  His mummy reassured him, “I don’t mind if you cry Jack, it’s fine to cry if you feel sad. I cry if I feel sad.”  They arrived at nursery and Jack ran to look at the guinea-pigs and then outside. He began to climb up a small A-frame climbing wall showing dexterity and confidence.  It was something he had done a number of times before and he clearly enjoyed doing it.  The nursery worker came over and alternatively commented, “be careful Jack,” and “brave boy, Jack”.  Why did she say this? He was not in any danger, he clearly didn’t feel scared and he certainly wasn’t being brave. 

Jack got off the climbing frame and the nursery worker smiled at him.  He didn’t smile back.  “Oh come on Jack, you promised me you’d smile today.” Jack burst into tears.  She scooped him up and took him over to another play area to distract him and his mummy said goodbye and left. 

She both felt very unhappy with what had happened and in telling me about it, I wondered what Jack was learning from the nursery’s response to him:

1)    If you are sad you mustn’t cry.

2)    If you don’t cry you will be rewarded with a sticker.  

3)    If you do something that demonstrates your physical agility you will be praised for being ‘brave’, even though you were clearly not afraid.  

4)    Mummy says it’s OK to be sad, but nursery workers don’t agree – they want you to pretend to be happy when you are feeling sad.

What does a parent who wants her small boy to be able to express his feelings and have them validated do when faced with this situation?  I told another mother with a two year old and she didn’t understand why I was upset.  She said parents don’t want their children to cry when they leave nursery and want the workers to have strategies to stop this. She also thought that her own daughter copied other children who cried and pretended to cry when she left because she thought she was meant to cry, she was only pretending to be sad. This led me to reflect on the situation over the next few days. 

What provision do we want for our youngest children?

We know that a child’s experience in their early years is fundamentally important for their flourishing, so in providing care for small children we expect much more than provision of a service so that parents can go to work. The central focus of a nursery is to meet the needs of the children through offering appropriate activities and ensuring a safe, caring environment. The relationship between a small child and the adults at nursery is central. In providing care the attitudes shown towards children will influence the building of relationships for their whole life and it is ethically important what the quality of those relationships are like.

Caring for small children is a moral activity and moral issues will be constantly raised in the practice of childcare – we have a right to expect sensitivity, trust and mutual concern.  Caring should therefore involve close attention to the feelings and needs of Jack and his parents. Validating a child’s feelings is vital for the relationship between the child and the adult caring for them – it is hard to trust someone who doesn’t validate our feelings and trust is fundamental if a child is to feel cared for.

The last thing any parent wants is hostility between them and those who care for their children.  We expect the nursery to see and to hear children’s needs and make sure they are met, the parents have their preferred ways of responding to their child – it is therefore essential there is dialogue between home and nursery.  Should they raise the issue with the nursery?

This raises some questions:

·      If they raise the issue with the nursery what should they say?

·      If, to get the kind of behaviour they want, the nursery uses rewards in the form of stickers isn’t this encouraging deception?

·      What if this induces fear in the child who knows he can't comply – the small voice Jack used in the car was in my view an expression of fear, or perhaps shame that he wouldn’t be able to comply – ‘big boys don’t cry’.

·      What kind of world are we preparing children for when adults tell them how to feel and how to behave?

Let’s consider the incident from Jack’s perspective.  That morning he had asked his daddy if he could go to his old nursery – why did he do that?  I think he had noticed differences between the way his old nursery interacted with him and the new one. The Sure Start nursery had had extensive training in emotional literacy, they often discussed Jack’s emotional reactions to his day and reference to his developing emotional literacy was frequently the subject of comment in his daily diary that was passed between home and school.  Parents were encouraged to write in the diary and let the nursery know what feelings the child had been expressing at home.  Their policy was to acknowledge and welcome children’s feelings, to believe the child’s expression of emotion was genuine and to respond with empathy and encourage each child to talk about their feelings. 

Jack’s parents made an appointment to see the manager at the new, private nursery to discuss their concerns and to raise questions about policy with regard to responding to the children’s feelings.  They had a very productive meeting, however they found out that the staff had not had any training in emotional literacy and had no strategies for promoting it.  Their focus was the parents – they were told that parents don’t want their children crying when they drop them off in the morning and so the nursery did their best to make sure this didn’t happen. It would seem that the parents’ needs, not the children’s are being prioritized – she who pays the piper calls the tune.   

Let’s consider it from the nursery worker’s point of view.  She (and sometimes he) is trying to maintain social order in the nursery where it has been decided that happiness, not sadness should be shown by children when they enter the nursery. Children who smile are given stickers – children who cry are promised stickers if they don’t cry.  This raises the issue of what kind of society will be created when children are told to pretend about their feelings in this way.

Why was Jack afraid he wouldn’t be able to stop himself crying? I don’t think it was because he wanted a reward in the form of a sticker.  I think it was because he didn't want to upset the nursery nurse.  To a small child having the approval of your care worker withdrawn because you don't smile is devastating and of course he was worried. If children are given stickers if they don't cry this will shape their emotional development. Surely using rewards to regulate behaviour when it requires a child to deny their feelings is indefensible.

What kind of environment is being created if Jack gets a sticker for not crying? The sticker represents ‘praise’ for not crying and is therefore a moral judgement: those who don’t cry are the ‘good’ children. Young children's moral learning arises from the sum total of the responses of others to what they do – this is not an appropriate response to a child’s sadness. Through her use of language, the nursery worker is imposing on Jack the identity of the ‘good child’ who is rewarded when he doesn’t cry and doesn’t show his negative emotions, so through her expectations and his need to please her, he is being encouraged to inhabit a false self.

The climbing wall incident is another example of an inappropriate response. Jack is given language to describe his actions, a very important part of language development for a two year old – but in this case the language used does not match what is happening. To be able to ensure children’s safety and yet not over-control is an important requirement for a nursery worker – taking care of a small child so that he does not hurt himself yet is not unduly fearful is a skillful job; in the incident on the climbing wall this was not achieved.  He is told he is ‘brave’ and at the same time he is admonished to be cautious – such mixed messages are not helpful to the young child and labeling his actions as ‘brave’ when he was without fear and admonishing him to ‘be careful’ when he was clearly competent, is linguistically and emotionally confusing and says more about the nursery’s priorities that the child’s.

Incident 4: The evening after this event Jack asked for a bedtime ‘knight’ story – he loves ‘Mike the Knight’, a character on the Cbeebies children’s channel.  His Mum told him the story of Rupunzel – substituting the prince for a knight. For those unfamiliar with the story it involves a prince (knight) falling in love with Rupunzel who has been locked in a tower by a witch. On finding out about the knight the witch takes Rupunzel far away and, pretending to be Rupunzel, tricks the knight into the tower. She pushes the knight out of the window and he falls into thorn bushes and is blinded.  The knight wanders the forest for some years until he is found by some children, who take the knight to their mother, who is no other than Rapunzel. She throws her arms around the knight and weeps with joy to have found him and as her tears touch his eyes he is able to see again.

A complex story for a two year old you may think. The next morning Jack asked for the story again and then made some comments.  “Don’t like knight thrown out of tower, Mummy” and then, “like it he not blind now, Mummy”.  In showing his understanding that it is bad to throw the knight out of the tower and good that his sight is restored, Jack demonstrates a deeper understanding of moral issues than most people would think a 2 year old capable of. This raises an important question: if he can understand the moral issues in Rapunzel, what is he to make of being asked to lie about his feelings?

I believe that small children like Jack are able to understand abstract concepts such as good and bad, sad and happy and can engage in exploration and reasoning about them.  After all traditional fairy tales from all cultures across the world are full of such concepts – rich and poor, brave and cowardly, ugly and beautiful, strong and weak – happy and sad.  We frequently and wrongly assume that small children can’t reflect on such ideas – so it’s OK to impose how we want them to feel, rather than help them explore how they do feel.  It follows that when a small child expresses their feelings they should not only be respected and validated, but they should have the opportunity to talk about them as well.  A child’s feelings should be treated with respect as well as kindness.  How we respond to small children will shape their understanding of themselves and their world – it is a huge moral responsibility and there should be no place for manipulation.  Manipulation is the manifestation of childism[1] and childist attitudes.

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[1] Childism is when the adults’ needs are prioritized over the child’s, when adults make assumptions they know how a child should feel at any time and take steps to manipulate children’s emotion to comply with adult expectations.