‘Tails’ – A fairy tale on furry tails: A 15-year theatre experience for hospitalized children created by health professionals

Abstract

OVERVIEW

The present article describes an innovative theatre production that has been running in The Hospital for Sick Children in Toronto, Ontario, for the past 15 years. It is directed at, and created for, hospitalized children and their families. The effects of hospitalization on children and their families are reviewed, and the benefits of humour and support during the stressful time the children have to spend in the hospital is highlighted. The play and its message, as well as possible health benefits, are also described.

PRACTICAL IMPLICATIONS

Theatre productions may help ease the anxiety felt by children and their families concerning illness, hospitalization and the associated medical procedures. Theatre may also assist in increasing patients’ compliance with medical procedures and follow-up.

ORIGINALITY

The play described is the first regular children’s theatre created by medical staff for hospitalized children. It is valuable because it may result in other hospitals following this example, and because it may generate research on the effects of theatre on patients and their families.

THE IMPACT OF HOSPITALIZATION ON CHILDREN

Hospitalization is stressful for adults and even more so for children. Sick children who are hospitalized are usually taken away, often unexpectedly and unwillingly, from their home, family, school and friends into an often frightening hospital environment (1,2).

The stresses imposed by hospitalization may precipitate uncharacteristic behaviours and emotions in the children, which, in turn, may become a major source of stress for their parents. There is extensive evidence that the whole family may be adversely affected when a child is hospitalized, especially when it is for a lengthy period of time and/or for a serious or life-threatening illness (3–5).

THE ROLE OF HUMOR IN PAEDIATRIC HOSPITALIZATION

The idea that humour, laughter and play exert positive health benefits has become increasingly popular in the past decade (6). Research has demonstrated that humour that provokes laughter has both psychological and physiological effects. It has been shown to reduce the levels of stress hormones, lessen depression and improve mood. Humour involves cognitive, emotional, behavioral, psychophysical and social aspects (7). Hockenberry-Eaton et al (8) found that a positive self-perception of “being like my friends, fitting in with the group, and not being different” is of utmost importance in assisting the child during hospitalization, and, later, in re-entering the world of the healthy.

THE BEAR THEATRE AND ‘TAILS’

With the growing awareness of the ability of theatre to support and help patients endure medical procedures, as well as the hospital’s alienating and possibly frightening environment (9), a theatre was erected at The Hospital for Sick Children in Toronto, Ontario. There, among the murals on the walls, the colourful pictures and the funny creatures made out of wood, the theatre production was created. The play combines storytelling, humourous insight and a message for the sick children. It aims to empower and encourage them to face their ordeal, in and out of the hospital, with courage and self-acceptance.

To the best of our knowledge, this is the first and only regularly performing company of health professionals based in a paediatric hospital. By staging a play, Dr G Koren, the paediatrician and scientist who created and staged the play, wished to share the nonmedical and professional personalities of hospital staff with paediatric patients and their families to help humanize the hospital experience. Hence, “Tails: A Fairy Tale on Furry Tails”, an original comedy musical about being different, was created.

Every Thursday evening since 1992, upon entering the Theatre, the children and their parents receive a pair of animal ‘ears’. The play starts with Quincy Taylor handing out and tailoring tails to members of the audience and the cast, creating an atmosphere of a magical forest filled with animals (Figures 1 and 2). Only the rabbit, Honey Bunny, who arrives too late, does not get a tail. Eagle Joe, a space pilot, arrives looking for someone to accompany him on his flight to Venus. All the children who, naturally, want to accompany Eagle Joe, fill out application forms, with the help of the cast. But Eagle Joe can’t take just anyone, proclaiming that:

Figure 1.

On stage is Quincy Taylor (left), who comes to town and gives everyone a tail. In the middle is Tough Luck, who, despite Honey Bunny’s pleadings, refuses to share one of his two tails. Tough Luck answers every request with the phrase “tough luck”. On the far right is Teller, a Penguin, who is the narrator. The threesomes lead the audience in singing and dancing to the ‘Tails’ anthem

Figure 2.

Eagle Joe, the space pilot, is selecting the winner of the ‘Tails’ book and poster

My shuttle is small,

and everything is so tight

there is no room for a pilot with a tail

So this is a tail-less flight!

The children then remind the narrator that Honey Bunny does not have a tail and may thus qualify for the flight to space. To his great surprise, Bunny is chosen precisely because he does not have a tail. Bunny then addresses the kids and points out to them that he feels special (going to space), but so are they, despite whatever may differentiate them from other children. The Teller Penguin reiterates this message:

Honey is special! He always was!

He simply didn’t know it!

We are all special.

We just have to accept ourselves

the way we are

and not to try to be ‘somebunny’ else.

The musical ends with the song, “Everyone is special in his own way”. There is considerable audience participation: singing, dancing, waking up Honey Bunny and filling applications to fly to space. Humour and puns are rampant throughout the show. At the end of the show, one of the application forms is drawn, and the winner receives a copy of the book ‘Tails’.

TAILS: A SHORT HISTORY OF THE PLAY

The first show was staged on July 6, 1992. Dr Koren assembled a cast of approximately 20 ‘actors’ who all volunteered to participate in the play. The actors and the support staff (eg, ushers, sound ‘technicians’, etc) were recruited from among the hospital workers and the community-at-large. Since 1992, ‘Tails’ has been performed without fail every week to an audience of up to 40 hospitalized children and their families. Since 80% of the hospital’s children change weekly, the majority of children and parents are new to the show. Yet the children who experience long hospitalizations have seen the play as many as 30 times. (The ‘application forms’ help the team trace who has seen the play previously). These children know the text and songs by heart, recognize all the characters, and correct them when they make ‘mistakes’.

THE IMPACT OF TAILS

Although we have not yet found a way to scientifically assess the overall impact that the play has on patients and their parents, we describe the following two anecdotal observations, which illustrate the huge impact reported in specific cases.

Ben’s story

Four-year-old Ben was a liver transplant recipient. Due to rejection of his new liver, he had to undergo various treatments over prolonged periods of hospitalization. He used to sit in the front row of the theatre and dance with the team. When the music tape of ‘Tails’ came out, he received the first copy, which his mother said he cherished and listened to many times per day. Ben died during surgery to replace his failing new liver. When members of ‘Tails’ attended his memorial service, they were moved to hear the happy music of ‘Tails’ in the church. Ben’s mom explained that “this is the music he wants to listen to now”.

Mother X’s story

One Thursday, a woman attended the show by herself, participating in all the dances and singing. She was visibly tearful. At the end of the show, she was overcome with emotions. Her child died of cancer at The Hospital for Sick Children, and thereafter, the family fell apart and the mother moved west. As part of the mother’s therapy, her therapist instructed her to revisit five places where her daughter was the happiest. ‘Tails’ was number one. In a personal communication, Dr Koren remarked, “This story culminates for me maybe the highest achievement of my career ... I touched a dying child and made her happy”.

Quite often, the children recognize their nurses, physicians, social workers or child life specialists on stage. The response is overwhelming. Children and their parents meet their health professionals in a more intimate, humanizing way. The program also reinforces the hospital’s reputation as a caring place, where staff members perceive their young patients as individuals rather than simple ‘cases’. Last, but not least, participating regularly in the play has turned cast members of ‘Tails’ into more complete human beings. The team expresses a sense of catharsis and happiness during and after the show. The contact with very sick children and their struggling families is, for many team members, an almost sacred experience (eg, a young mother smiles for the first time since the diagnosis of her son). It is not unusual to see parents in tears during the performance of this upbeat musical, when they fully identify with the theme of finding happiness in who we are, and not trying to be someone else.

It would, of course, have been advantageous if we were able to conclude this paper with methodologically sound research on the benefits of ‘Tails’ on the outlook, stress level and coping skills of the young patients and their caregivers. However, because the children remain hospitalized typically for one week or less, and because it may not be possible to conduct a ‘follow-up’ at home, this is not the case.

Instead, we have gathered several additional anecdotes suggesting that the play is indeed beneficial and has positive effects on:

• The children. Verbal feedback from nurses in the various departments confirm that after children watch the play while they are hospitalized, they seem less lonely and more comfortable in the hospital surroundings. A child of a medical trainee in the hospital attended the play numerous times. His father later told us that the child had a learning disability, and the play (which deals with the notion that being different is okay and not shameful) helped the youngster and his parents cope with his learning disability. Moreover, the book and videotape of the play were used to deal with the child’s special challenges. Remembering this context, ‘Tails’ is a modest attempt to remind the children and their parents that the staff are not prison guards, but rather compassionate and caring people.

• The parents. They consistently express gratitude and appreciation for the play and its message, indicating that it is needed and beneficial. This has been conveyed both directly to the actors and in their written input at the end of the hospital stay.

• The actors. They related to the authors that they benefit by staging a play for sick children and are rewarded by the enthusiasm with which their work is received.

CONCLUSION

Theatre in Education originated in British schools in the mid-1960s as an attempt to “harness the techniques and imaginative potency of theatre in the service of education” (9). Following that example, Theatre in Health Education (THE) aims to empower children by providing them with information and opportunities to examine their attitudes, beliefs, values and lifestyle (10). ‘Tails’ is geared toward empowering children who, because of their illness and hospitalization, are often perceived by their peers to be disadvantaged, weakened and dependent. It attempts to help them to realize their personal and social potential, despite their illness and its ramifications. It also transforms the hospital into a place where good people try to create fun for hospitalized children.

However, there is a significant lack of scientific evidence concerning the effectiveness of THE (9). As Ball (11) so poignantly indicated, “it is important to recognize that scientific evaluation methods, with their tight controls and systematic objective-oriented procedures, may be appropriate for testing routine operations of a cognitive nature but are unsuited to the complex human interactions inherent in a THE programme”. It is hoped that future research may come up with an appropriate design to quantify the often subtle change in those who participate, as an audience, in a Tails-like production. In the meantime, the creator of ‘Tails’ is pleased to share the production with colleagues everywhere – a gesture that has already been adopted in Tel Aviv, Israel, and Long Beach, California, USA.