It’s just after 7:45 in the morning on a weekday in early June and seven-year-old Maxime Li calmly enters the operating room (OR) with his mother Jessie in the Day Surgery Unit at Scarborough and Rouge Hospital’s (SRH) Birchmount site for dental surgery.
After some final preparations and checks, Maxime lies down on the operating table and – with Jessie right by his side – Anaesthesiologist Dr. Malcolm Tai-Pow gently places the mask to sedate Maxime over his nose and mouth. A few moments later, Maxime is asleep and Jessie departs for the procedure to begin and to wait to see Maxime in the recovery room.
Like thousands of children and parents before them, Maxime and Jessie participated in SRH’s Til I Sleep program, which allows parents to accompany their children into the OR until the child has been anaesthetized, or ‘falls asleep’.
Introduced 20 years ago at the Birchmount site, SRH was the first hospital in the Greater Toronto Area to implement such an innovative program. The General site followed not long after, and the Centenary site has also offered the service for almost a year and a half.
“This program has truly been a success and one of the most important things I have ever done in my career,” said SRH Anaesthesiologist Dr. Alan Tallmeister, who was instrumental in helping to launch it.
“Although many physicians were skeptical in the beginning, once they saw how much the program improved our efficiency, helping to put kids asleep with virtually no tears or struggling, they came to accept and value it.”
It’s an observation shared by Dr. Tai-Pow.
“Til I Sleep is a very useful program, which puts the parents at ease and, in turn, makes the surgery easier for the child,” he said.
“We’re so fortunate to have had ongoing support from our physicians, nurses, and hospital administration,” added Michele Clark-Ward, a Child Life Specialist at SRH’s General site who also helped to start the program.
“And now that we’ve been providing the program for so long, it’s just something everyone expects will happen.”
“Til I Sleep is part of a larger Pre-Operative Teaching program the hospital runs to help reduce anxiety for paediatric surgery patients and familiarize children and families with the hospital environment,” explained Sue Regan, a Child Life Specialist at SRH’s Birchmount site.
Alexandra Frankel, a Child Life Specialist at SRH’s Centenary site, added that “in the Pre-Operative Teaching program, children and their parents or caregivers meet with a Child Life Specialist one to two weeks before their surgery where they visit the Day Surgery Unit, OR, and the surgical waiting room. The Child Life Specialist is also there on the day of surgery, providing important continuity of care for both the parents and children.”
SRH Surgeon Dr. Chi Tai, who conducted Maxime’s dental surgery, echoes Alexandra’s comments, explaining that “for children 12 and under the concept of going to a hospital can be nerve-wracking. So having this hospital tour, and giving kids a chance to come into the operating room, have a look at what’s going on, be prepped with all the different modalities of monitoring equipment and noises is key to having a successful anaesthetic induction.
“Plus, surgically, when you have a happy child coming into the operating room, they usually wake up happier.”
Jessie admits she was “so pleased with the entire process, which introduced me to everything. As well, being in the OR with Maxime was very important to me. My one-year-old daughter recently had surgery at another hospital to repair a hernia. The nurse came and took her into the OR and I waited and cried a lot.
“Here with this program I felt so much better. I would’ve stayed with Maxime for the whole procedure if I could.”