1. Osterlund, Hob MS, RN, CHTP

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It's not your fault.


You can't catch what they have.


Someone will be there for you.


For Pauline King, MSN, RN, these three simple statements have the power to change lives-her own and those of the children she works with. As director of children's programming at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at the Ohio State University Medical Center in Columbus, King has reached thousands of children who have lost loved ones and might not otherwise have found a way to handle their pain.


"When I first started working in adult psych-oncology in 1992, I saw what happened to the children of our patients. There was nothing for them," recalls King. She did a literature search and came up with almost no information on programs for children's expression of loss.


King sees grieving as "a social skill that needs to be learned." Children are often assumed to be doing well but are actually deeply hurt and frightened, she says. Once she realized that, "I was like a dog with a bone," says King. She found money to fund programs, and gradually established what would become a national model for helping children who have been exposed to the life-threatening illness, suicide, or murder of people close to them.


King's programs have helped children like seven-year-old Melinda Patterson, who said to her, "I felt better when I found out someone else's daddy died. You are not the only one whose daddy died," and 10-year-old David Richardson, who drew a weeping willow that is "sad because it lost someone. It never wants to blow in the wind any-more. All it wants is to be alone. Still, it wants someone to be around."

FIGURE. Pauline King... - Click to enlarge in new windowFIGURE. Pauline King, surrounded by "her kids" at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at the Ohio State University Medical Center in Columbus. At a Family Love and Strength Celebration, adults and children involved in the medical center's programs for grieving children gather together. King began these sessions after one girl said to her, "Mrs. King, I can't be hurting all the time."

"The children taught me what they need," King says, and in turn they help one another. When the father of one of the boys in her program died, a girl in the group said, "I know what Clinton needs. He needs a big hug." She then lay down on the floor and the group sketched around her outstretched arms. They folded up the hug and sent it to Clinton. King reports that "he still has that drawing on the wall above his bed."


When King got her bachelor's degree in nursing from Salve Regina University in Newport, Rhode Island, and her master's degree in adult mental health nursing from Boston University in 1976, she intended to work with adults, but over time she was drawn to develop services for children.


One program she launched at the Ohio State University Medical Center, Hand in Hand, helps children ages two through 19 years to deal with the serious illness of someone they love-from diagnosis to death. Another, Good Grief, is for children who are coping with the death of someone close to them, whether it resulted from illness, accident, suicide, or another cause.


Each program, split into groups according to age, meets one evening a week for six weeks. "New kids are amazed by the kids they see laughing and playing, kids who have lost someone. They see that it didn't destroy them," says King, whose programs include support groups for adults. "The kids actually drag their parents here," she says, with a laugh. And because it's possible for the kids to return to the support groups after completing the six-week program, they learn they don't have to grieve the loss of the new people they meet. "People create their own rhythms," King has observed. "I thought at first they'd come for a year, to face all the anniversaries and birthdays and holidays." But some keep returning. "There are so many changes they have to face, and we help the kids with the transition," she says.


One young boy watched his mother date seriously after she had been a widow for four years. The group helped him find what he wanted to say to his deceased father. "Dad, I love you," wrote the son, "and no one will ever take your place. But Brian's a great guy, so don't worry about us." What the children have to say about grieving has filled a book, Honoring Pain, written and illustrated by the participants of King's programs.


And to help adults, King and her team created The Little Book of Love, a workbook for parents and children. King tells this story: "One dad had a wife with breast cancer. He was always upbeat. Then one day when he realized his wife was really dying, he held his girls on his lap and started to cry. One of them looked up and asked, 'Daddy, you're sad too?'"

FIGURE. This drawing... - Click to enlarge in new windowFIGURE. This drawing was done by a nine-year-old whose mother had cervical cancer and has since died. From

King identifies goals for her career. First, she'd like an endowment for continued support of her programs. The James Cancer Hospital's children's programs received a five-year, $500,000 Battelle Memorial Institute challenge grant in 2004 -a big step in that direction.


Second, she'd like to research the emotional and spiritual pain of children. "It's only been recently that children's physical pain has been recognized. The psychosocial pain needs to be seen and treated," she notes.


Her third goal is to offer formal training to nurses, art therapists, social workers, and other professionals. In 2003 she presented the Mara Mogensen Flaherty Memorial Lecture at the Oncology Nursing Society's 28th Annual Congress. "I'd like nurses to gain the confidence to start their own groups," King says.


Despite the fact that she has reached more than 5,000 children, King sees herself as the primary beneficiary of her own work. "I'm not a religious person, but I feel like I'm God's tool. When a little child who's drawn a picture of her grief tells you 'I feel like a bowling ball left my stomach,' you know you're on the right path."