Anxious about facing that sick kid? Sing a little.
That’s among the advice from pediatric emergency physician Megan Marino, MD, who cares for the small fry in the kids’ ED at New Orleans’ Ochsner Medical Center (and as deputy medical director for New Orleans EMS). Marino has written a children’s book, Chepecho and Her Clippity Flappity Floppity Friends, aimed at helping kids accept each other’s differences, and has a second coming this year. She also sings and plays the ukulele. She sat down with EMS World to discuss the intersection of medicine and creativity in caring for our smallest patients.
EMS World: Your career has been focused from the beginning on caring for kids. What led you to that patient group?
Marino: When I was in college, I planned to go to law school and join the Peace Corps. And then my senior year, my little brother was diagnosed with brain cancer. I ended up spending 16 months with him in a children’s hospital here in New Orleans, and I really learned as much as I could about his medicine and disease and what I could do to help him. I learned a ton, reading as much as I could, and through that process I realized, Oh, this is actually a really wonderful and rewarding way to help people, and kids specifically, because all my time was in a children’s hospital.
After he passed away, I still wanted to find ways to help children through medicine, so I went back and took some science classes and went on to medical school. I started that with the idea that I wanted to find a way to take care of kids.
Working with a top EMS system and in the emergency department, what do you see as the big care issues for kids, both in emergency care and for their overall health and well-being? What are New Orleans kids facing?
I think access seems to be the biggest issue, and for the EMS system giving our providers access to educational initiatives and opportunities on caring for kids. That’s something I’ve been focusing on for several years, not just in New Orleans but when I was in Houston at Texas Children’s Hospital and with the Houston Fire Department. We worked to help improve EMS education for pediatric patients.
Finding care providers with the appropriate training here is really difficult. There aren’t many pediatric emergency medicine subspecialists in the country, and New Orleans doesn’t have enough of them. The majority of pediatric patients seen in Louisiana are cared for by adult emergency medicine physicians, and in the prehospital setting paramedics who maybe have just a limited amount of pediatric training and very infrequently care for pediatric patients. I think the biggest obstacle is getting good pediatric training to providers, both prehospital providers and adult emergency medicine physicians who care for most of these patients.
Tell me about the creative interests, the writing and singing and ukulele, and how Chepecho came about.
I’ve always loved singing and music. My grandfather started Preservation Hall, the jazz club in New Orleans, and so when I was little I was very much surrounded by music. And I always loved writing; if you’d asked me in high school what I wanted to be, I’d have said a writer. It’s definitely something that’s been a part of me for a long time, but with my career in medicine, it’s taken a backseat.
Between fellowship and starting my job here in New Orleans, I went to Italy with my family. And while we were there, we kept seeing this animal in all the art. It had two legs like a horse, two wings like a bird, and a fish tail, and it’s called a hippocampus, and we saw it everywhere—it’s even on the Trevi Fountain. And I kept thinking, This is such an amazing creature—why wasn’t this in my story books growing up? And I started creating this story: This animal looks a little bit like all the animals, and it can bring everyone together and teach everyone that they don’t need to be afraid of each other.
That was in August 2017. Then some really terrible things happened in Charlottesville, Va., and a woman was killed. I was heartbroken at that and also just kind of sad about this wave of hate we’ve seen come across the country in a way I don’t ever remember seeing before. I couldn’t sleep, so I stayed up all night and wrote this story about this animal that brings all the other animals together and teaches them to accept each other’s differences.
Then a few weeks later we were in Israel, and I went to Yad Vashem, the holocaust museum in Jerusalem. And there I saw this Nazi-era propaganda in the form of children’s books teaching children to hate people who are different. I thought, Oh, my goodness, we need books that teach kids how to love and accept those that are different! I’d just written this story, so I e-mailed it to my mom and sister and best friend from fellowship and told them, “This is what I’m working on, and we’re having a wonderful trip!”
I’d known my best friend’s mother did programs with reading and refugee children, but what I didn’t know was that was through the foundation arm of her children’s publishing company. And so when I got home I got a call from the publisher saying, “We’ve read your manuscript and want to publish it.” And it wasn’t even a manuscript! It had been taken from the notes section of my iPhone! But 12 months later it was available for sale on Amazon and in independent bookstores.
And somewhere along then I started playing the ukulele and writing songs that reinforced the messages of the book. And so it turned into an opportunity to go to schools and read to kids and talk to them about inequalities and bullying and being friends with people who are different. The kids seem to really like it.
How do the creative and caregiving sides of what you do complement each other? Do the writing and singing help you as a physician? Does the medical background help you communicate to kids through the art? How do they work together?
I didn’t realize this until people started asking me about it, but I actually sing all day while I’m at work! Whenever I’m doing a painful procedure or something unpleasant, the first thing I do is I ask the kid what their favorite song is, and we pull it up on YouTube, and, with the parents, we all sing it together. Usually it’s a song I don’t know, to be honest, although for a while it was Frozen’s “Let It Go.”
I haven’t been able to figure out how to play my ukulele for the kids at work because I usually need both hands for whatever I’m doing. But I’m always singing with them, and I grew up in a house where my mom was always singing, so it just seems like a natural thing. If you’re doing something a child doesn’t like, you sing at them, and things are a little bit better.
I think being able to find ways to develop rapport or make the experience a little bit easier for pediatric patients is worthwhile. It doesn’t cost anything. It’s doesn’t really take any more time than you’d spend otherwise. And I think it actually saves time because if I’m able to move thing along with a little song and dance, the parents are less stressed out, the kids are less stressed out, and I’m less stressed out.
What other kinds of skills or techniques can field providers use to help put kids at ease and maybe communicate some of those big or difficult messages?
I think the biggest thing—and this is what I practice in the emergency room and tell the prehospital providers I work with—is to just explain what you’re doing: “I’m going to put a straw in your arm.” “You’re really sick, and I’m going to help you breathe by putting this mask on your face.” Just talk to them like you’d want to have something explained to you. Often I think providers both in the emergency room and the ambulance are so stressed about caring for kids that they don’t take the time to just explain what’s happening. It goes a long way to getting a child or a parent to calm down.
Sometimes we don’t have time for that. But it can be as simple as singing a song or asking mom to pull up a YouTube video while you’re doing things. Everyone knows some song they could sing, and it will make everybody feel better. I know I’m more comfortable. If I’m singing a song, that’s a second to pause and think about what my next steps are. So it can definitely make a difference.