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How a Stuffed Toy Changed Every Paediatric Case That Came After

E — Examine The Habit That Turns Experience Into Learning

 

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Appu was a stuffed toy elephant. About as big as a football. Rounded at the edges the way only a well-loved toy is.

We were about to anaesthetise a six-year-old. His parents were standing just outside the theatre — anxious in the way that parents are when their child is going somewhere they cannot follow. That anxiety doesn't stay outside the door. It travels with the child. It was written all over him.

He wouldn't look at us. Wouldn't speak. He had come from the ward with a cannula already in his forearm — placed by a nurse he didn't know, in a moment he hadn't chosen — and somewhere between there and the theatre, something had broken. Trust, gone. We were strangers to him, and we had the same uniforms as the last stranger who had hurt him.

So we showed him two toys and let him choose.

He picked Appu.

Within two minutes he was smiling. Then talking. The tension in the room — in the child, in the team, in the air itself — visibly eased. We wheeled him into the OR, induced smoothly, operated successfully. He woke up. He went home. He was fine.

Afterwards, I gathered my team.

What worked? The toys. Specifically — letting him choose. Giving a frightened child one small thing he could control changed the entire trajectory of that induction. Not the monitoring, not the technique, not the drug selection. A stuffed elephant and the words you pick.

What didn't work? We almost skipped the debrief. The case was smooth. The list was long. It would have been easy — natural, even — to move straight to the next patient.

What changes next time? Toys available at every paediatric induction. Not as a backup. As part of the setup, as standard as the laryngoscope.

Appu is in our theatre now. Every paediatric case.

That is what a debrief does. It takes one good moment — a small, human instinct that worked — and makes it permanent.

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The Simple Debrief Structure

 

A debrief doesn't need to be formal. It needs to be consistent.

Three questions. Five minutes. That's it.

What worked? "The pre-briefing helped — everyone knew the plan when blood pressure dropped."

What didn't work? "The first medication I asked for wasn't ready. We need to anticipate vasopressor needs better."

What changes next time? "For patients with cardiac disease, vasopressors drawn before induction, not after."

That's the debrief. Not a committee. Not a report. Three questions, spoken out loud, before the team disperses.

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Why Debriefing Matters

 

Without debriefing, you repeat the same mistakes. With debriefing, mistakes become learning.

The anaesthesia resident who forgets to check the backup airway equipment once will forget again — unless the team names it, talks about it, and makes it part of how they prepare next time. Debriefing creates that moment. The naming, the talking, the deciding. Eventually it becomes automatic.

But debriefing isn't only for mistakes. The Appu story was a success. Nobody was harmed. No crisis was averted. And yet the debrief after that case changed how we set up for every child who came after.

Debriefing after disasters is damage control.

Debriefing after ordinary cases is how ordinary becomes excellent.

When you debrief consistently, you start seeing patterns — what predicts problems before they arrive, what conditions reliably produce good outcomes, what small adjustments compound into safer care over time. You adjust your pre-briefing. You modify your checklists. You evolve your protocols. The team gets incrementally better with every case, not just after the ones that go wrong.

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Creating a Debriefing Culture

 

The hardest part isn't running the debrief. It's making it routine.

If debriefing only happens after disasters, it becomes associated with failure. It becomes something people dread — a post-mortem, a reckoning. Nobody wants to call for a debrief because doing so implies something went wrong.

If it happens after successes too, it becomes about learning. It becomes neutral. Normal. Expected.

In our operating theatres, we debrief after every complex case and every unexpected event. Not as a formal exercise. Not as documentation. As a conversation between people who were in the room together and have two minutes before the next case starts. Three questions. Spoken out loud. That expectation — that we will always pause, always ask — is what makes it work.

The same principle applies beyond clinical settings.

After a major project: thirty minutes. What worked? What didn't? What do we change for next time? Document the answers. Reference them before the next project starts.

After a difficult conversation: a few minutes of honest reflection before the memory fades. What landed well? What triggered defensiveness? What would I do differently?

After a presentation: How did the audience respond? What questions caught me off guard? What would I adjust?

The pattern of asking these three questions — consistently, after successes as much as after failures — is what transforms experience into expertise. Years of practice without reflection doesn't make you better. It makes you more entrenched. Reflection is what converts time into skill.

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E is the seventh element of the SCRIPTED framework — a system for communication under pressure that I have developed across twenty-seven years in the operating theatre, military medicine, and hospital leadership.

Appu still sits in our theatre. He has helped dozens of children since that first day. Not because I was clever. Because my team paused, asked three questions, and made one good instinct into a permanent habit.

Five minutes. Three questions. Every time.

 

 

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