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Alexander Gref Larissa Sokolova

DOCTOR-PUPPET

The Program of Psychological Help to Children with Oncological Diseases in Hospital and in Hospice

1st edition, 1999 translated to English by Konstantine Kiryanov-Gref and Bob Black

This booklet describes a program, called About authors: "Doctor-Puppet", concerning psychological help to children with oncological diseases Alexander Gref. being in hospital or hospice. The program Candidate of science, docent. was elaborated by "The Vagrant Booth's" Art director of the puppet theatre "The collaborators and was implemented from Vagrant Booth ". May, 1995, to May, 1997, in the hematologic department of the Morozov's Larissa Sokolova. children's clinical hospital of Moscow; and Psychologist, actor and musician of the also from September, 1999, in the First same theater. Hospice for Children with Oncological diseases of Moscow, and from September, 2002, in onco-hematologiacal department of Russian Children's Clinical Hospital. tel: 343 9592, 417 6303 E-mail: [email protected]

We are grateful to everybody who helped us to realize our difficult program.

Moscow 2003

CONSTRUCTION OF OPENLY CONTROLLED, MIMICKING PUPPET

Eyes with movable eyelid

Opened mouth

Movable neck 90 cm

Movable articulations of hands

Glove for hand manipulation

Movable articulations of legs

For our relatives Authors

The Work Experience by L. Sokolova Comments by Alexander Gref

For two years of work – from 1995 to 1997 – in the hematological department of the Morozov's children's clinical hospital of Moscow more than 120 children from 1,5 to 15 years associated with the doctor-puppet Lucka Lukich, and 70 people of them - are more than 2 times. The intercourse with the puppet doctor in majority had individual pattern. (1) From September, 1999, more than 20 children in Hospice was visited by Lucka Lukich, 10 of them – are more than 2 times. From September, 2002, to May, 2003, more than 50 patients from 7 months to 17 years associated with Lucka Lukich in onco-hematological and marrow transplantation departments of Russian children's clinical hospital. Practically, all children were visited more than 2 times..(2)

The Child’s Initial Arrival at the Hospital

The unexpected change of circumstances and environment, the fear of uncertainty, the strangers surrounding the child, as well as the painful procedures, all these ingredients produce feelings of danger and helplessness within the psyche of the small patient and contribute to their psychological defenselessness. As a result of the child’s initial stay in the hospital, restraint,

(1) The individual or group dialog between the puppet and children depends on the working conditions. As for us we prefer the individual one, as – according to our experience – the group of children gets too excited during the communication with the big puppet, occasionally reducing the positive effect of puppet-therapy to zero. Furthermore, in the hematologic section of the Morozov's hospital children live in the isolation wards with their moms or grannies, and under these conditions the individual communication between puppet doctor and child is natural.

(2) The psychological correction of the behavior of ill children is traditionally directed toward the reduction of stresses, anxiety or aggressiveness that appears during the traumatizing, severe treatment; it is also directed toward the creation of positive motivation toward the recovery. During our work, we have discovered certain novel, features of the therapeutic device we used (large, openly controlled, mimicking puppet), which until this time had not been described. This new manifestation is the puppet’s seeming ability to become the steady object of the child's attachment, an object of attention and concern. The proximity of the doctor-puppet to the child, its nearness, during the child’s initial arrival to the hospital is critical, because the child is caught in the middle of much uncertainty and turmoil. During the child’s arrival, he experiences a lot of stressful commotion; during any preparations for operations or immediately following a medical procedure, during the feeding of the child, all these moments it is critical that the child receives comfort to alleviate his fear and uncertainty. The doctor-puppet is able to calm the child, to reinforce his self-worth, which is one of the most important tasks of psychological support. Moreover, it was discovered during the course of our program that the doctor-puppet was able to provide academic and pedagogical lessons to the child; similar to those he would receive in school. This will be detailed further below.

4 anxiety, aggressiveness and sadness begin to manifest within the child, which is often immediately reflected in their expressions. The patient’s eyes reveal, quite palpably, the degree of psychological support, during these initial days, that the child requires.

It is precisely at the moment when the child experiences fear, isolation and alienation, that he meets "the doctor." The child quickly discerns, through his interaction with the doctor-puppet, that the doctor will not harm him nor does he wish to medically “treat” the child in a painful manner. The puppet is perceived as a benevolent doctor and fosters comfort concerning the environment in which the child finds himself. In other words, the doctor is viewed as someone who has brought the child a gift, or plays with him, as if the child were on holiday rather than staying in a hospital. Over time, we worked out and perfected some specific first-encounter conversational topics and banter as of way of comfortably, and in a relaxed manner, acquaint the child with the puppet. Almost all of the children were introduced to the puppet in the same fashion. But first I will describe some general procedures of the therapy.

To begin with, the artist-puppeteer asks the parents for permission to visit the child.(3) “Dr. Luckich” greets the child using mimicry and playful gestures through the window of the ward, which looks upon the corridor, attempting to engage the child. This behavior is critical to gain the child’s trust, because the child learns that the doctor will not enter the room unless the child acknowledges and “gives him permission.” Once the child’s attention and trust is gained, the door to the room is opened. . "Hello, how do you do? Let me introduce myself: I am your new doctor, the most important and the kindest doctor of all time! May I sit down?"

Usually, the puppeteer will sit down on the bed, near the child. Most frequently, the doctor will sit on the bed in such a fashion as to allow the child conveniently to control the manipulations of the puppet and to participate in the “game” (the therapy), while still allowing for the puppeteer to have enough space for remain mobile so as to provide free motion for the puppet. The most effective way is to hold the puppet on the lap. If the child agrees with the conditions of the game, the doctor should not hide behind the puppet but remain in full view. This is to ensure that the presence of the puppeteer does not interfere with the conversation the child has with the puppet.

"Hello. My name is Lucka Luckich!"

The puppet stretches out its hand. The puppets eyes must be directed toward the child, to establish direct eye contact, so that the child is engaged with the puppet, and not with the puppeteer. When this direct eye contact occurs, the child feels engaged, as if he were having a conversation with a real person. This skill, to hold the child’s eye contact and attention, is the primary, and most complex, of the puppeteer challenges. The ability of the puppeteer and his craftsmanship to engage the child as if the puppet were a living being is paramount. It is important to acknowledge that not every child answers the puppet immediately or stretches out his hand to greet the puppet... However, for description’s sake, let us assume the initial contact and bond between the child and puppet has been established.

(3) The parents’ permission for the doctor-puppet visit is critical. During the two years of the therapy’s trial, there was only one instance in which the child rejected interacting with the puppet. However, it is imperative that the parents be notified before the actual doctor-puppet visit, particularly because the therapy requires the collaboration and participation of child’s parents. However, we must note that the interaction and relationship between the parents of ill children and individuals outside the immediate family are complicated. Even the relationship with people, such as health care providers, who are attempting to help the child, is considerably complex. But that's another difficult digression in itself. 5 The puppet continues speaking. "I will meet and chat with you while you’re staying here. And now, I'll open my magic handbag, and take a look to see what’s in there. Ah, yes, I think we can now begin an examination. What do you think?"

Lucka Luckich busies himself with his trunk - the main object of the performance is to capture the child’s imagination. The puppeteer opens the bag with a snap, sorts through his instruments. There! He has selected something. He removes the instrument from the bag, looks at the child and shows the instrument to the child. Each gesture of his hand is initiated by deliberate gestures and tender, affectionate eye contact: eyes looking at the retrieved object, then toward the child, returned to the object; then the therapist removes the object and shows it to the child. During the entire time of the interaction, the doctor’s motions are leisurely and clear. (4)

(4) The technology behind the manipulation of an openly controlled puppet is both simple and complex. The puppeteer holds the puppet before him, manipulating the hands, legs, and head, through the technique of mimicry. The special feature of openly controlled puppets is their extraordinary plasticity, which is similar to that of a person. Minding the infinite variety of puppet designs, we understood that the motion of puppets is, as a rule, schematic and caricaturish, which is basic nature of puppets! Gabriadze, the noble artist, said that the gait of the marionette is like a drawing of human's gait. But large, openly controlled puppets are authentically able to become a human. And the main secret for success is not the mimicry itself but the accuracy of the mimicry. The puppeteer must manipulate the puppet so that it would gazes into the eyes of the child-in this instance, the puppet magic is prodigious! The most difficult task for the artist is to attain consistency between the puppet's gestures and gaze. A well-known mechanism of clownery - tracking the movement of each significant gesture - becomes the basic method of the game while manipulating by puppet. For example, a clown if a clown offers a pencil to someone, he carries out the gesture in several, articulate steps, like broken line: he raises his head, pause, examines the pencil, pause, picks it up, pause, looks at the person, pause, hands him the pencil, pause, smile, --the end of banter. I will describe in detail, for those who want to learn more specifically about this technique, below. You have mostly likely noticed when a child, deep in some activity, suddenly notices another object and instantly forgets about his previous occupation? That's the feature called “primitive;” i.e.; primary, naive consciousness. Children perceive the world as they see it, relying on their sensual experience. In this instance, the child is a pure empiricist and he discovers and learns via experiment, probing each feature, each relation of activity or object. A clown is a mask, the personification of the naive consciousness: he discovers every feature and every object he encounters as if he were seeing it for the first time. Therefore, some discrepancy is possible between what an object actually is, and what it appears to be. One example is the "wooden thermometer," which looks like a toy–the study of an object removed from its inherent function. For example, Larissa Sokolova takes the child’s temperature or measures the width of the child’s smile with it. The clown, similar to a child, studies the construction and properties of objects, not only their "function." They examine the purpose of the object, and not simply take it for its face value, because it is “new” to their experience. First of all, the artist-clown must find this quality of naive vision in himself – in order to be able to see an object, as if he were seeing it for the first time. This is a difficult talent, as its almost antithetical to our consciousness. But the pragmatic, mature consciousness, in the instance of the clown-actor, must be freed from this habit. Frankly speaking, this “transcendence” requires a great effort. Moreover, the actor must know how to describe his relation to the object by using plastic, free gestures. The foundation of the clown’s plastic gestures is rhythm. When, as human beings, we want to be understood, we speak articulately: gesture - pause - gesture. The listener, expecting articulated information, pays attention to this clear, linear approach. 6 Below is an approximate set of responses by the children, as detailed in diary form, of their interaction with the doctor-puppet during the first medical examination:

1. Measuring the length of the child’s smile by using a “thermometer” (a large, and wooden one).

*** From the diary: September 4, 1995, Olya S., 12-years old.

Lucka Luckich measures the smile from one ear to another. Signs with Olga an agreement that the smile will not shrink. Olya pencils her signature in agreement.

September 18, 1995, Alesha K., 12-years old.

The length of his smile is 36.3 “degree’s” long. Lucka Luckich explains that the length of his smile must not shrink. It must grow. Alesha tries to smile even harder: "Hey, look! My smile just grew!" That's true – it’s not 36.3 but 36.5f degrees long now!

It's interesting that conventional units of measuring a smile can be quite paradoxical: cubic meters, spherical centimeters, Celsius degrees by cubic millimeter, etc.

2. Measuring the child’s temperature with a thermometer under the arm, under the knee and even under the child’s pillow.

*** From the diary: November 2, 1995. Irina L., 6- years old.

If a clown intends to take a pencil, we the audience do not know this initially. The clown turns and stops. We follow his gaze intensely and wonder, will it be a pencil? Yes, a pencil! Then, he stretches his hand, he removes the pence - pause. For a moment, he examines the pencil, and again stops, and we are struck and we admire the movement, sharply delineated! The clown sets his eyes on the person for whom the pencil is intended and then, viola, the miracle - the person one, to whom this small, simple object was given, believes that he has just acquired a great treasure! This experience is passed upon the slow, rhythm that the clown has used to build up the person’s expectation. The luminous moment, like the beautiful moments of dance. (See previous page) In general, pencil was necessary for the drawing, and entire exchange lasted but a brief moment. Now, let us note that it is just the same with movement and discipline of the clown is required for the puppet. The only difference is that the work of the puppeteer requires a greater accuracy of motion. "Staggering", uncertain motions of puppet turn the spectator’s attention away. Moreover, the artist must always be the shadow of the puppet because it is critical that the audience perceive that it is puppet who is moving and not the puppeteer. The puppet's movements must be the activity, which engages the audience. And the puppet's sight is also crucial. It is necessary that the puppet looks directly at the hand, at the pencil and, most importantly, into the eyes with whom person he (the puppet) speaks! Larissa Sokolova merged with her puppet – so that often during her conversation with even adults, they would address the puppet rather then Larissa. It was even more pronounced with the children. Simply, they addressed her as Lucka Luckich and not Larissa! 7 The initial visit. Lucka puts down the child’s name, surname and birthday in his notebook. He takes the temperature under Irina’s arm. He shakes thermometer and puts it under her arm again, and begins: "One, two, three, four! The kitty is learning to count. Five, Six, Seven, Eight The kitty forgets the amount. Nine, Ten, Eleven, Twelve She searches throughout the house Thirteen, Fourteen, Fifteen: Hey! What happened to the…”

Ira: "Mouse!"

Lucka looks at the thermometer: "The temperature has also disappeared! Thirty six point five (36.5)!"

September 4 1995. Nastya Sh., 5-years old.

Lucka Luckich: "How are you doing?" Mother: "She has a temperature!" Lucka: "Now we'll blow that temperature out." He folds a piece of paper into a fan and begins to wave: "Cooler?" He places the thermometer under her knee: "Thirty six and six degrees long! Shall we sing a little song?" Nastya begins singing joyfully: "Parrot's singing in her cage, and in the forest she is silent."

While taking the child’s temperature with the wooden thermometer, it is more effective to accompany the activity by reciting poems, singing songs and dancing some dances: "Thirty five and five degrees long – that's fine, let's dance for a bit!"

Lucka dances, the child manipulates the puppet's legs while it sits on the chair. If the child is able to leave his bed, he is invited to dance as well.

At this time, the doctor can continue to wave the fan so that the child’s temperature is “cooled down” and “blown out.” Soap bubbles can also be used to “reduce” the child’s temperature. With the mother, the child and Lucka Luckich, they blow the bubbles and breathe on them, which drives the temperature away.

Ironically, in the case of Nastya, when the doctor was speaking with her, and “fanning away” her temperature, her temperature was actually reduced from 38.4 to 37.9. However, this was the only instance where this physiological changed occurred.

3. The measuring of growth by thermometer.

*** From the diary: November 16, 1995. Serega T., 7-years old.

The child’s growth is 5 thermometers. "Write this down!” – Doctor Lucka Luckich says. "Chin up! Look! You’ve have just grown by a half a thermometer! Please, keep growing like this." – Serega is laughing. 8

4. Pulse. The doctor takes the child by the hand and feels the pulse and recites:

"One, two, three; one, two, three! I can feel it faintly! Count the holes in the cheese, But be very patient, please. One, two, three. You’re pulse is chasing your knees.”

Lucka begins to count, quickening his rhythm: "One, two, three." Dependent upon the child's individual behavior, the pace and the rhythm of counting poem can vary. Various poems are told.(5) "Hey! I can feel a very happy pulse, indeed! Let's write it down: "The pulse is very happy, can you hear him?"" Puppet doctor writes the child’s pulse down in his notebook: "The pulse is very happy indeed!"

5. The search for a smile.

(5) The banter between doctor and child is very simple and the child or the circumstances of their hospital life prompt the majority of the interaction between the two. Each banter parodies and translates the doctor’s actual behavior into a humorous situation. This allows the child, through humor, to identify with the doctor and to successfully adapt behavior (the activities of doctors and nurses) within the stressful situation (hospitalization). Using the lexicon of psychology, the banter and play between doctor and child fosters an adequate behavioral model for the child to cope with his traumatic circumstances. The task of providing an adequate behavioral model for the child to use to cope with his hospitalization is critical, for it supports the pedagogical task of allowing the child to learn some of the basic concepts of his illness and the treatment through the use of games and role-playing. Occasionally, Luckich was asked questions by his small patients, which involved covering and explaining broad questions about medicine itself, beyond the specifics of the child’s illness. However, we need to offer children their due. They are not simply docile creatures constrained and manipulated by the strings of our didactic theories. Children are willful, independent creatures, not puppets. Moreover, they were thoroughly up on medical sphere better than Luckich was… According to game/role-playing therapy, children relate their feelings and ideas about their world and circumstances through action (games) rather then through verbal cues and expressions. Action/playing (games) is the primary means of expression and interaction for the child. Playing is also the primary manifestation of the child’s inner world and experience as well. Game-therapy procedures consist of the methods of interpreting what the child wants to express about himself or the world and must be the focus of the doctor’s behavior. In other words, the games are often metaphors for the child’s emotional and intellectual experiences. But also, through game-therapy, the child is capable of formulating a behavioral model, which adequately helps him react and adjust to the stressful and changing circumstance of the world around him. Moreover, let us not forget the powerful phenomenon and benefit of game-therapy: it fosters positive emotions in the child and diminishes his negative feelings and experiences, which are often difficult for the child to express. This primary benefit can often be a significant factor in the psychic health of the child (the ability to replace negative emotional experiences with positive ones) who must often live in the hospital wards for months without any valuable, positive communication during the serious, often traumatic, treatment. 9 If a child is still in low spirits after the above-described play activities, the doctor then suggests searching for a lost smile by means of the “magic buzzer-hammer.”

***From the diary: December 11, 1995. Zhenya. 4-years old.

Today is the second day in the hospital. The child's mother, father and grandfather are in attendance. "Where is your smile? Is it lost? Where has he disappeared?" Searching his trunk of toys, the doctor takes out the magic buzzer-hammer to begin the search for the lost smile. The doctor retrieves the hammer, and begins gently “hammering” the child’s heel. The hammer remains silent. The doctor hammers another spot, and then suddenly, the hammer “bursts into laugher”. Lucka Luckich stops hammering, but the magic buzzer-hammer "tries to say something,” continuing its “laugher”. “Oh! Here is the trick! We need to turn it upside down,” twists the lilac cap off the hammer’s handle and…”blow!”

"Blow! And try to catch the bubbles with your hands! The smile will be return!" Zhenya and the whole family are blowing and catching the bubbles with their hands. Laughter is everywhere, and most importantly, laughter has return to the child. The lost smile has been found.

Lucka Luckich’s hammer is not a simple device, for it has both a buzzer (which produces the “talking”) and also soap bubbles as well. (6)

Other props, which may be used to “find a smile”, include a clown nose, foam-rubber ears, glasses with eyes, cap and mirror, any prop which infects the child with humor and promote the desire to interact with the doctor. Often these types of props remain with the child in his room, as a Pavlovian reminder of his positive experience “searching for the smile.” (7)

( (6) The expressions used by the doctor are critical and a fundamental element of clowning. We gathered and collected these expressions, one by one, often through the observation of profession and amateur clowns. We observed clowns at fairs, penny whistles, and circuses and in theatres. We made some of the toy instruments ourselves: – the wooden thermometer, for example. Some of the tools we obtained from children, some were purchased in stores, some were we ordered abroad. The society of Korchak acquired a Dictaphone to use for the analysis of the conversations with the children. The beautiful black trunk was given to us by a TV-station in Warsaw- "a serious trunk," as the station operator explained. I spent quite a long time trying to create a cup with the Lucka’s portrait imprinted upon it. Each piece is a treasure! The primary characteristic of clowning involves the use of counterpart. For example, many children do not know how to tell time by looking at a watch. Thus, Lucka Luckich obtained a real pocket watch! For children, often the size of an object matters, as does their approximation of the “essence” of the object to the way they interact with it and the way they interact with the world!

(7) At the beginning of our work, we decided to offer a gift to every child after each visit. However, we did not offer the gifts as a programmatic scheme. A gift is of great importance to a child, not only because the act of giving/sharing pleases the child, but also more importantly, fosters a special atmosphere of mutual bonding. The child begins to develop a personal bond with the doctor. The gifts, as well as the clown props, become material mediums for a sense of place and worth for the child: he finds himself no longer surrounded by soulless medical objects, but by dear and valuable ones. Furthermore, the gifts are magic! What child would refuse to drink from a cup with Lucka Luckich’s portrait on its side, especially if this cup is present by Luckich himself? 10 The game playing used during the initial visits are often used to further communication as the therapy is extended over time. Often, the child initiates the play, asks to find his smile or have his temperature taken. But also, the child’s parent may repeat some of the game playing. It is very interesting to observe the child mimicking the initial clown banter with the doctor’s toys. (8)

The preparation for operation and return from operating room (9)

In this instance, it is quite efficient to use the props which imitate medical implements and equipment: small and big syringes, wooden thermometer, stethoscope, beakers, tubes, hammer, forceps: props which approximate actual medical devices.

Lucka Luckich demonstrated to the child – using toys as an example – how to behave during the actual medical procedure: how to lay down; how to place his hands, legs and head. "Have a look! The mouse has placed its tiny feet flatly and he doesn’t swing his tail. He lays still and is quiet; he does not shake or make a peep; he closes his eyes, dreams of the delicious cheese waiting for him after the job is done."

Lucka Luckich demonstrates the operation or procedure: takes a blood test, gives the child an injection; changes the catheter, at the same time, the child helps Lucka Luckich with the procedure. The child, through play activity, experiences the feeling that the procedure is not as horrible or frightening as he had feared, because the funny doctor-puppet showed him everything and explained to him how to behave. Because the child internalizes the procedure as fun and enjoyable, he will be better prepared to experience the ensuing difficult, medical procedure.

This game is very useful before the procedure as well as after it. Often, a child was observed, “curing” the toys himself and explained to the toys the game-procedure he was performing. What is also accomplished by this play procedure is that the doctor-puppet has taught the child about a complex matter (the medical procedure) which corresponds to the human body. The doctor explains the complex procedure (and illness) to the child by means of drawings or fairytales: what actually occurs inside the child as a result of the disease. The doctor explains how the body fights the disease and how the medication aids the body in battling the illness. Lucka Luckich prepares the child for the changes to his body, which will occur as a result of the operation or medicine, as well as the change in his appearance during the long and painful aggressive treatment.

***From the diary.

(8) The repetition of a type of clown's banter with the child is the most important and interesting element of our work. On the one hand, by repeating the playful activities, the child’s traumatic medical therapy is lessened, but also, the repetition allows for observation of the child: we can conclude, over time with repetition, how the child thinks and feels about the behavior. This allows the clown activities to be refined and improved over time with the child. Thus, the repetition allows the therapy to be tailored to the specific needs and behavior of each child. Strictly speaking, observation of the child's game, and the results, is the only opportunity for the doctor to determine how effective his clown banter is: as if to watch himself from the side.

(9) The fear induced by trauma has been described many times. Fear is humiliating. Therefore, one of the main motives of the therapy is to help the child transcend their fear.

11 November 9, 1995. Vika G., 8-years old.

She prepares herself for her first needle puncture. She embraces her toy rabbit and does not lift her head.

Lucka Luckich: "You’re cuddling your bunny. Is something worrying him? Is he scared?" Vika nods. "We can help him: We have everything in the trunk which he might need." The doctor- puppet opens the trunk: "Let's put this towel on the bed and lay your bunny rabbit on his tummy" – Vika lays her stuffed rabbit on the towel. – "Let's pet his back, and you'll put some healing oil on him." – The girl rubs the toy rabbit’s back. – "We need to find out why your pet became sick. Hmmm, let’s see. I know, we'll do some SPECIAL analysis. You rub and pet the bunny rabbit and I'll take out the smallest syringe from my trunk. Here it is. Listen how the syringe is singing." – Lucka Luckich turns to me, the puppeteer, and asks me to play a song on the syringe. The New Year song is playing. – "Now, take the singing syringe yourself and give your bunny an injection so he’ll feel much better. Don’t worry, he won't feel a thing. See how calm he is as he lays quietly with his legs and paws straight, and he doesn't even move his ears, he’s so calm. Right here." Vika gives the stuffed animal an injection."

Vika: "He didn't cry…" Lucka Luckich: "Are you surprised? But you were able to do it without hurting your bunny! Now your bunny needs 2 hours of rest and a good, deep sleep. After his nap, you'll see him jumping again, slapping his ears, clattering his feet, sniffing the air, twitching his whiskers, looking for carrots! Lay him down on his back, this way."

Vika covers the toy. "Lucka Luckich, will you come to me when I'll be lying for two hours?" Vika asks. Ninety minutes later, the doctor returns. Vika waits to brag: "Bunny is jumping again!"

Her mother: "We were not crying at all!"

September 7, 1995. Nastya Sh., 5-years old.

Nastya: "Lucka Luckich! My parrot has gotten sick." This exchange takes place in the corridor. Yana and Olya are also here. The girls begin to bandage up the parrot. Lucka Luckich and Nastya go to her ward. They take the parrot's temperature. Nastya gives her toy parrot an injection with the syringe from Lucka's trunk. Takes the tourniquet off the parrot's head and places the thermometer under its wing: "Cheers! No temperature!"

January 15, 1996. Olya S., 12-years old.

She “cured” her toys. Her mouse had an I.V., soar throat and its left eye ached. Olya bandaged the toy's throat and eye. Lucka Luckich gave the doll a massage, removed a style from the toy's eye with a cheesecloth napkin that Olya had prepared.

March 31, 1996. Zhenya. 5-years old.

You wouldn’t recognize Zhenya today. Instead of his typical responses, punctuated by “eh's” and “don't know's,” we have performed a full plot-and-role game replete with the vocalization of all the activities.

Recently, the boy received a present—a rubber-ducky named Tim. At the beginning, Lucka Luckich introduces himself to the rubber-ducky and asks Tim about Zhenya. Zhenya does not 12 respond to the question. He simply responds with his usual phrase: “So? What are we gonna’ do?"

Lucka Luckich does not answer Zhenya’s question. Instead, he opens his trunk and says: "It seems to me your new friend has a fever in his feet."

Zhenya: "Maybe he's sick? Let's check him, okay?"

The boy takes the wooden thermometer from Lucka's trunk: "Yeah… He's got temperature alright… What, Timmy? You need some medicine?"

Then Zhenya "takes leukocytes" from the duck’s feet using wooden figures from the counting set. His leukocytes are red circles. "Now, dear Timmy, we'll give you a quick shot", - and then using the counting stick performs a "procedure" on the back of the rubber-duck. "So, Timmy…"I guess you need an operation,“ Zhenya tells his rubber duck.

He lays the duck down on its back and "cuts" its belly open with a throat depressors usually used for throat examinations, cleans the press with cotton wool, takes a green square out of the duck’s belly: "That's a microbe," Zhenya says, and then pretends to sew up the duck’s belly with a suture.

Once he finishes with his duck, Zhenya next “cures” a toy bear.

During the procedure games, Lucka Luckich acts as a helper and colleague. The crucial element for us is that Zhenya not only played out his specific medical ailments but that he revealed his feelings. It was apparent that it was most important that he comforts his toys; protect their feelings by looking after and helping them. The comfort and care he displayed to his toys brought him joy and relief.

Among all the props used in doctor-puppet games, which prepared the child for an operation or procedure, the one with the most significance, was the “CAP AGAINST FEAR”. This cap is an ordinary, three-penny clown cap, which the doctor-puppet wears. The cap is transformed into the "cap against fear.” The genesis of the idea for the “Cap Against Fear” happened accidentally. Once, we were at a loss to comfort 4-year old Lena Strahova who was endlessly crying before each simple and painless procedure – the changing of her catheter tube. Lucka Luckich placed his clown cap on her head and, suddenly, viola. Lena reacted instantly. Lucka said: "A present for you! You must wear the cap before every procedure…and your fear… will evaporate into the hat!" (10)

(10) During our childhood, each of us has owned a magic amulet or talisman. My own was an army buckles. It saved me during my own experience in a hospital. Once, as I lay on the operation table fixed with a catheter during a direct blood transfusion, I held onto it tightly with my small, white fingers believing that it would save me from the danger of the operation. I recall my father's great, large hands swollen with veins and that quivering medical hose extending toward me like an ominous finger. Once my father lost this precious belt-buckle and after searching his pockets for some replacement, handed me his precious pen. He told me that the pen had been "blessed" by magic earlier that day. It cracked in my hands, like a fragile bone – oh, precious Parker pen. After this episode, the power and necessity of the belt buckle failed. A small girl, leaving for kindergarten, presses in her fist the spool from her mom's sewing machine, as believed that as long as she did not lose this precious talisman, she would be protected from her fears and anything bad. I do not believe that the power of the magic charm for the child is merely an attribution of autosuggestion. For in this relationship between person and their charm, lay an ancient 13

Since that moment, the clown’s cap has become the most important instrument in doctor's work! After some time, Lucka Luckich checked up on Lena prior to a similar procedure, which earlier had frightened her tremendously. He found Lena in the corridor and she was walking around and wearing the cap waiting for a nurse when and she exclaimed: " Lucka Luckich! See, I'm not afraid. I’m wearing the magic hat!"

***From the diary. February 13, 1996. Zhenya G., 5-years old.

He has just been admitted today, straight from the clinic, without even wearing sneakers. His mother is distraught. Lucka Luckich measures the width of Zhenya’s smile. The boy does not smile. Fear embosses his face. With the hammer, the doctor locates the fear in his knee. Now it's time to put on the magical cap. Close your eyes. In unison with the mother, we say: "Fear, fly away into the cap!" All of us repeat the chant several times.

Suddenly, Lucka Luckich locates, with the magical hammer, the fear hiding in the cap: "Dear mother, remove off the cap and with it, all the fear that is hiding inside it—then shakes out the fear into the bathtub, and pours some water on it, some more water! – so that the fear will disappear and run away forever!"

The mother begins to play the game. It appears that the game playing is also soothing and calming for her as well.

There's a smile on her face: "Well, Zhenya, we won’t be frightened anymore, will we?(11)"

Now Zhenya begins to smile as well. They need to leave so Zhenya can be weighted. "Mom! The cap!" – Lucka Luckich walks with them. "No fear, see?" – Zhenya’s mother says. – "Lucka Luckich, please, leave your cap with us!"

February 19, 1996. Yana F., 8-year old.

Her temperature is 38.7 C°. She is unwilling to communicate. Sitting in her bed, she’s quiet and sad. The doctors can't find the reason why her temperature continues to rise. "All her tests indicate that she’s fine, and yet" Mother says that she has to have a blood test. Little Yana nearly cries: "Please, do not do it! It will hurt! Who will come help me? Gala? Mom! Call her!"

The nurse, Gala, extracts some blood for the tests. Yana wails: "Mom! Oh mom, it hurts, it hurts! Oh, I'm unhappy Yana! Ah-a-a! Oh, they’re hurting me, they’re hurting me…ohhhh… Where, where is the cap?" and mysterious mechanism: the power of a bond, to heal, to transcend our mortal coil.

(11) Focus your attention to "WE'll not "! The phenomenon of maternal identification, maternal empathy, when the mother experiences the same emotions as the child is experiencing them, as far as I know, has not been properly described. In the majority of the literature, the researchers concentrate on the reduction of contradiction between the parent and child, or they focus on the search for a compromise in interests, a bridge between the two, and so on. As for our work, we regard the mother’s selflessness, her empathy, and her ability to identify psychologically, emotionally, with the child as akin to the vast potential of psychotherapy. Or more precisely, the opposite: psychotherapy is akin to the maternal quality of empathy. 14 I wince and begin to cower: Lucka does not have his cap with him! Yana cries.

I cannot answer reasonably the question yet: "How should I behave when a child experiences pain?"

Doctor-Puppet – A Patient

Let us examine now the form of the communication between the child and the doctor-puppet when the doctor-puppet becomes the patient, and the child, using doctoral procedures, plays the role of doctor in order to treat Lucka Luckich. This form of play is possible only after prolonged communication between the doctor and patient, and after a succession of relationships: first the doctor-puppet treats the child, then the doctor-puppet with the child treats the toys, and finally the child treats Lucka. Thus, the relationship is brought full circle.

During the entire month the puppet-doctor was treating and interacting with the children, Lucka treated more than thirty children with great zeal and joy.

Over the weeks, Lucka Luckich came to the children, asking about their health and suddenly he was confronted with the anxious words of the children: "Hey Lucka Luckich, why do you look so unhealthy? Your nose is yellow! Open your mouth and let me look at your throat, please!"

In the cases where the children attempted to examine or heal the puppet, usually they performed those operations, which were well known to them. In other words, they were reenacting their own experiences; only they were reversing the reality by reenacting their experiences upon Lucka. - - Taking blood-test from the finger, - Measuring the temperature, - Measuring the length of the smile and its growth, - Inspecting the throat, ears, nose and eyes, - Administering injections, - Proscribing tablets, - Installing catheters and the replacement of catheter tubes, - Performing operations, - Quite frequently the child used real force when performing these procedures, and their behavior was occasionally too aggressive.

*** From the diary. March 15, 1996. Nastya V., 6-years old.

Almost immediately upon entering the room, I heard: "Lucka Luckich has a yellow nose! He needs 100 injections to the nose!"

She removes a big syringe from Lucka's trunk and begins to administer very "painful" injections to the doctor-puppet nose. She is consistent with her injections, but with each new injection she becomes more and more aggressive! Her face reveals her intensity and tension. She cannot 15 count to 100, but when, according to her counting, she reaches the final injection – her body is exhausted: "Oh-o-o! That's it! Ugh!" – and she sighs with relief.

Actually all the children gave Lucka injections. Occasionally, it occurred in the same fashion as with as Nastya—increased aggression until physical exhaustion, followed by relief.

***From the diary. January 29, 1997. Nastya R., 7-years old.

She does not feel well and does not speak much. She treats Lucka. She treats the doctor-puppet puppet very gently and accurately. With a tender touch: wipes the finger with cotton, slowly fills the syringe, softly injects the puppet, bends the finger, unbends it, wipes it again… The soft rhythm of her gestures acts as a lullaby. Probably, she is now soothed by her own rhythmic procedure—and possessed with inner silence.

September 6, 1996. Vitalik B., 11- years old.

Today, we met after a little break. During the visit, we only had time to exchange notes: he had undergone a serious part of his treatment.

As always, Vitalik is full of joy and energy: he smiled and waved to Lucka Luckich through the window even during the effusion of blood… He hugs Lucka as an old friend and in doing so, discovers that is friend is ill. After his discovery, Vitalik performs an operation on Lucka, precisely and professionally, using a real catheter: "I'll be an anesthesiologist," Vitalik tells Lucka. He writes a prescription: "Laughter – 1 kg, 2 times a day."

Feeding Children

As a consequence of general weakness and apathy, which is often the result of the aggressive treatments that induce nausea and vomiting, the children experience a profound loss of appetite. This absence of appetite is commonplace. Often, neither mom nor doctor is able to encourage the child to eat. However, what is sometimes beyond the efforts and capabilities of the parents and doctors in these circumstances is quite possible for Lucka Luckich.

The procedure of feeding is a delicate and complicated one: beginning with a story concerning the solitude of "the poor lonely stomach" and progressing with stories, culminating with the puppet and child eating together at the same table.

Thus, using the familiar magical buzzer-hammer, it is possible to find (as with finding the smile or fear described above) the hunger and to return the appetite to the belly.

The soap bubbles can also be used, and become like balls substituting for the appetite: child blows out bubbles and catches them with his hands and by mouth.

Lucka Luckich listens with the stethoscope to the stomach to see what has remained in the belly after dinner.

Nastya Sh., 5-years old, has "hungry macaroni in her belly which chase each other while the tea sits and cries for bouillon and bread." 16 Zhenya E., 4-years old, has a poor appetite. Lucka listens to him and discovers there is a lonely rissole in his belly: "Ah, rissole! He has no friends in your belly! No one to speak or dance with down there! No bread or cucumber. Zhenya, you have no mercy for that poor fellow Rissole..."

Zhenya nods and smiles. Lucka Luckich promises to pay a visit again later and to check to see if the rissole is doing better in his belly. But after a while, Lucka meets the boy in the corridor and Zhenya shows Lucka his belly for inspection! That Rissole found friends to dance with in his stomach.

Eventually, the puppet-doctor reveals the cup with the portrait of Lucka Luckich. This cup is quite useful, for the children can drink bouillon or juice from it or use it to wash down tablets.

The children often say: "After swallowing the medicine tables, all the food is perfect for our belly." - and the feeding methods used to help the child overcome their aversion to food are based on the children’s understanding that the puppet can also swallow the food.(12)

For example, Lucka Luckich is treated with "artificial" food: a child sets a table with paper plates, and knives and spoons – and makes with sandwiches from the wooden toys shaped like a circle.

Dolls, bunnies, elephants are all invited to sit at the table, with Lucka Luckich occupying the seat of honor. The atmosphere of joy that the child provides to others (even if they are only toys) is very important to their self-esteem and feeling of well-being. Hence, with the toys sitting near him, the child has acquired a positive motive to eat as well.

***From the diary. May 13, 1996. Zhenya G., 5-years old.

"Poor appetite," – his mother says. We begin to play. Open the trunk. Lucka Luckich takes out a counting kit, opens the top. "Let's build a house?" We build a house. Lucka: "Who will live here?" Zhenya: "You." Lucka: "And what will I drink?" Zhenya concocts something using blocks and explains: "A well." Lucka: "And what will I eat?"

Zhenya begins to create "garden beds". Lucka Luckich does not interrupt the game. Zhenya plants potatoes and onions. He, plants an apple-trees and an orange tree. And when everything

(12) This the most important characteristic of the puppet, which serendipitously appeared: the hole in the puppet. The hole for the mouth simply was a place on the puppet’s face, which had worn out. This, ironically, was great fortune because, as a result of this worn area, the puppet now had a mouth. As a result, Lucka Luckich, by chance, acquired the most important property of being alive - ability to eat! The puppet is not merely a puppet—but a living being. Lucka’s ability to swallow overwhelms the child, and completely transforms the puppet from toy to living person, that the child, after seeing the puppet swallowing candy, ask if Luca is also able to "pooh", and after that the children are convinced of Lucka’s "reality"! The child believes that Lucka is a living-breathing creature, nearly a living Person! And this actualization, by the way, is justification for the high costs of the puppet and of the complexity of work with it, for it is this critical transformation which allowed the success of the puppet-therapy: the child has found an actual “living” friend with whom he can experience and share his trauma with during his illness. 17 is “harvested,” he begins to cook soup for Lucka from the ingredients he has gathered from his garden. He pares the potatoes with a wooden rod-knife, cuts vegetables, mixes everything in the doctor's cup and boils, mixes, salts all the ingredients, saying: "Now the soup is ready."

He feeds Lucka Luckich, and actually the "potato" and "beets" actually disappear into the puppet's mouth and the boy is certain that the food was swallowed. He hums with great admiration: "Phew!" After that he notes surprisingly, "I also put some chicken to there. But you did not eat all of it, please leave something for the kids." Zhenya carefully covers the cup with a napkin, places it in the trunk and says: "Here, please give some soup to the kids."

After two hours, his mother greets the doctor in the corridor: "Thank you, Lucka Luckich. Zhenya ate very well today."

It is more difficult when the puppet is given real food to eat. This often happens when Lucka is invited to have lunch with a child:

"One spoon for Lucka Luckich and one – for you." Or: "Lucka will eat if Dima eats"…

***From the diary. November 27, 1995. Yana P., 3 ½- years old.

She does not eat. Her mother sits with Yana at the table and cuts her sausage: "Don't you want any sweetheart?"

Mother: "You sit here, and I'll leave you by yourself for awhile." Mother leaves for another part of the ward. Lucka Luckich sits down with Yana: "Mom's gone. Let's surprise her. We'll eat that sausage TOGETHER! You – a little bit then I’ll nibble a little bit, then you, two bites, and then me, two bites."

We begin to eat the sausage. Lucka Luckich heartily chews the bread, which he is able to do, Conspiratorially, Yana eats the sausage.

Mom returns: "Hey, what an odd silence over there! I'm coming!" Yana leaves two bits: "The rest is for you, Lucka Luckich." Mom: "Here I am." Yana neatly puts the sausage into her mouth and shows that her plate is now empty. Mom is surprised: "Where's the sausage?" Yana: "It ran away!" Mom: "I know, I bet Yana ate it, right?" Yana is grudgingly finishing wit her sausage – her eyes are leery! Lucka: "Yes, sure! Yana has eaten her sausage—and she shared some with me too."

The mom speaks with Yana, and Yana whispers in Lucka's ear: "The sausage was delicious, wasn't it?"

Besides the methods described above, more complicated ones are possible which enable the child to eat. For example, using the elements of art-therapy can be successful.

***From the diary. March 4, 1996. Tamara D., 4- years old. 18

"Lucka! Let's sing about herons!"

Tamara loves to sing songs about everything. Today is no exception, so we sing. Sometimes she interrupts the song and tells Lucka that her catheter was removed and that she was "not afraid at all". We also discover that she has eaten everything except the chocolate. Lucka Luckich takes out some “magic pictures” from the trunk.

Today is the first time I try this game: "If you take a pen, you can transform those pictures into anything you would like." Tamara: "I want the circle picture!" Lucka: "What would you like to turn it into?" Tamara: "Into a ball!" We transform it into a man. Lucka: "Can you transform the ball into a plate?" Tamara: "Yes! You draw it!" Lucka: "I'll draw a plate and you'll draw what’s on the plate." Tamara: "An egg!" – Drawing… Lucka: "And next to the plate?" Tamara: "A spoon! Your turn to draw!" We draw a spoon: I draw a circle; she draws a "stick". Tamara: "That's a sausage!" – Not finished, she takes a new piece of paper and draws a plate with an egg and a sausage on it. She does it silently then suddenly asks: "And a man?" Lucka Luckich: "We'll draw him Tamara?" Tamara: "Yes."

I draw a head she takes exception to the curly hair I’ve drawn and she shows her long hair. She draws legs, ears, and arms. Tamara: "What about sharvarik?" – "Sharvarik" the Armenian word for pants. We draw a pair of pants; the girl finishes the drawing by adding a couple of shoes. Lucka Luckich: "And the spoon? We need to draw a spoon so that Tamara will be able to eat." –

Tamara draws a spoon.

Lucka Luckich examines the picture in his hands and places it next to his ear: "What on earth is it saying? Here, Listen!"

Tamara listens to the drawing and suddenly she pronounces loudly: "I want to eat!" "And what would you like to eat?"

"Fried eggs with sausage!"

It seems that we’ve won the day, but there is some failure – her mother had only soup to give her. Tamara’s mother had brought the soup earlier, which Tamara had refused to eat before my arrival. What should we do? So, we begin to draw again: "open space" and "cosmic soup" with fried eggs and sausage. The girl ate everything--all the time regaling Lucka, of course.

Teaching Under the Conditions of a Long-Term Hospitalization. (13)

(13) Teaching seriously ill children represents one of the most complex and individual problems faced by the therapist. Today, the hospital staff solves this problem in the most moderate way and often with poor results. 19

In this complicated endeavor, full of specific and unique problems, we set ourselves a modest task: to keep the children interested in learning for as long as possible. (14)

Puzzles, banter, riddles, jokes, paradoxes are the main tools of the clown's repertoire in educating children. At times, Lucka Luckich even asked the children themselves to invent “catchy” games to play.

Parents basically determine the child’s attitude toward education during the hospital stay as well as after the child have completed his treatment. Some parents shelter the child completely and prevent them from any kind of schooling during their disease. Other parents encourage the child to continue with their schoolwork, including helping them with their addition and subtraction exercises, their Russian language recitation tasks, as well as reading books with them. But these attentive parents are rare.

Generalizing Lucka Luckich’s experience as a "teacher", we observed that the puppet is especially good in aiding children in those circumstances where the application of play as a means for pedagogical instruction is particularly critical:

1. Studying the alphabet, practicing numbers, learning geometric figures, color, seasons, telling time by clock - all deal specifically with the child’s world. 2. Solving riddles, uncommon puzzles, puzzles with matches, tags, different geometric figures, "mobiles" and others - problems traditionally directed at schoolboys. 3. Conducting games/lessons in mathematics using objects. (15) 4. Russian language word games lessons: "city" games, dictation. 5. Studying Russian words with children of other nationalities: the child teaches the doctor- puppet new words and reciprocally, Lucka teaches the child new words. 6. Lucka draws and teaches the child; sometimes drawings form the basis for long discussion or correspondence. 7. Correspondence with children can also be instructive – the rules of language, teaching them the skill to elucidating and articulating thought and learning courtesy. (16)

Our interaction with the children attempts to entice them, to stir their innate hunger for knowledge. Children confined for long periods of time hunger for knowledge, for information about things outside of their immediate surroundings. Under any circumstances, a child is, by instinct, intensely curious.

(14) A specific nature of the doctor-puppet therapy should be noted as well with regard to instruction. Children are adverse to overly didactic instructions given by the puppet. A child needs to feel that the interaction and games with the puppets to be free and spontaneous; therefore, systematic studies, tasks and other attributes of highly defined interaction (such as the form of interaction found in a classroom) are not effective in the relationship with Lucka Luckich.

(15) The puppeteer must always keep in mind the general rule of the puppet theater: a puppet acts naturally with the objects. I am eager to remind prospective puppeteers again – a break in the rhythmical motion of the puppet is essential, for puppets must appear to dance around, a pirouette if you will, and hover momentarily above the object before addressing it. Think of it as a puppets natural gait, the way each living creature has its own specific way of walking or meeting another creature.

(16) It is possible to offer a Russian language study program in the process of correspondence. The most important ingredient is the correspondence itself! 20 8. Lucka Luckich often taught songs to the children, and after would sing with them— occasionally with the parents as well. While playing the guitar, I placed the puppet by my side. The puppet often kept the children’s attention rapt: the puppet sitting on my laps while I held the guitar with my left hand. With the strings bound at the frets, the child would strum the strings according to their own rhythm. It appeared as Lucka himself was playing the guitar. Often the child would accompany me using another musical instrument, such as a maracas, a rattler or the box I always bring with me.

9. Lucka Luckich teaches the child about the human body, the structure and make up of cells, bone and blood. He draws pictures with children and speaks to them about their disease in the gentlest way possible.

***From the diary. September 4, 1995. Lisa S., 4-years old. Lucka Luckich tries to find out what season of the year it is: "Is it winter?" "Yes." "Is it snowing?" "Yes." Mother: "Does anybody ski?" Lisa: "No." Lucka: "Are the leaves becoming yellow?" Lisa: "Yes." Lucka: "It means…" Lisa: "Summer!" So Lucka Luckich describes autumn for Lisa.

September 4, 1995. Nastya Sh., 5-years old.

Lucka takes out his watch. (17) Nastya remembers what she is supposed to say: "Watch, open Sesame… please!" And after that she listens with interest to the ticking and reads the time, following the numbers clockwise as she learned last time.

September 21, 1995. Igor I., 10-years old.

Lucka Luckich brought a riddle about two riders. Igor prepared a riddle from "Donald" magazine.

(17) During this process we confront the vexing problem: children do not want to let Lucka Luckich leave. We had to buy another puppet for Lucka himself. Lucka pivots and looks at the other puppet: "Oh! They’re waiting me! I have to go now!" – And what do you expect? It worked marvelously! 21 September 25, 1995. Zhenya G., 11-years old.

Playing with jigsaw puzzles. Some difficulties with the "house". But in spite of these difficulties, he asks Lucka to bring more.

September 28, 1995. Sasha B., 10-years old. Preparing a surprise his for mother: to learn the multiplication table by using his fingers.

November 16, 1995. Zhenya K., 9-years old. Playing with jigsaw puzzles calms her. Practiced two math problems from a third-grade textbook. It's quite amazing that she performs multiplication and division much easier and more quickly than subtraction. Lucka Luckich explains the principle of "price-quantity-cost".

November 16, 1995. Ira S., 8-years old. Feels better. Jigsaw puzzles. Too sluggish. When she succeeds – she smiles. Lucka Luckich teaches Irina how to make a paper star for Christmas. The girl looks with interest and softly smiles. Overt time, many stars and other paper ornaments will appear on her tree.

November 30, 1995. Timur I., 5-years old. He knows the alphabet letters very well, but cannot seem to remember "W", "Y" and "B." Luckich draws a big "W", "Y" and a "B". Timur repeats and traces the letters.

December 4, 1995. Discovered that Timur had forgotten everything he had learned previously. Lucka teaches him how to write "W". From his trunk, the puppet-doctor takes out a very small wooden top: "Who can write as many “W’’s as possible while the top is spinning?" – Timur wrote 3 letters, Lucka Luckich – 2. For the victory, Timur gets to keep the top.

December 4, 1995. Zhenya G., 11-years old. Zhenya: "Did you bring any new puzzles with you?" Lucka: "Do you remember the old ones?" He solves the familiar match puzzles. Luckich brings a puzzle about ships: preparing to sail, how many boards are needed for construction, how much fabric is needed for the sails and clothing, how much food must they stow on board. Lucka: "And now what we need is to draft…" Zhenya: "A route." Lucka: "Here is your task: find on the map the routes of circumnavigation."

May 15, 1995. Tanya V., 8-years old. She has been sick for more than a year. She still feels ill, but she feels better than during the last visit. Lucka Luckich shows her a card as if it had been mailed to her. The card contains some words, which are legible.

Tanya fills in the gaps.

"WHAT'S THE REASON FOR YOUR GLOOM COULD YOU TELL ME, DEAR …(MOON)?" "SEE THAT LIGHT IN OLD OAK'S CROWN? LITTLE STAR HAS FALLEN … (DOWN)". "DON'T WORRY, DEAR MOON! I SHALL HELP YOU VERY … (SOON) 22 OLD OAK IS NOT SO FAR, I SHALL FIND HIS LITTLE … (STAR)."

"Lucka Luckich, I’ve finished the rhyme. Next time, I’ll help some more."

September 14, 1995. Mariam G., 4-years old. Andrey Mihaylovich, the department director, asks to attend to Maryann, since Mariam does not understand Russian, and cannot understand what the doctors explain to her.

In the morning, after injections, Mariam’s mood is melancholic.

Lucka Luckich acquaints himself with Mariam by initiating some clownish banter. Most of all, she is pleased with the balloon. The balloon suddenly begins to deflate and whistle as it loses air-- Lucka accompanies the sound of the deflating balloon by whistling a simple melody. The girl smiles. I blow up the balloon again (without real success, for I need a small pump). Sometimes the balloon escapes from my hands and "dances" upon the air. The dancing balloon reminds Mariam of something and she begins to whimper. Lucka puts on his cap and tries to pierce it. Several times the balloon deflates, buzzes around the room and flies away. Also, Lucka sketches silly faces on the balloon using a felt-tip pen and gives it to the girl. She is very happy. The acquaintance occurs without using a single word, and a bond is formed.

Lucka Luckich leaves the ward, calls her mom and whispers something to her.

September 18, 1995. Mariam sees Doctor Lucka through the ward’s window. She smiles. She is in great spirits: no medical procedures today. Lucka greets her in Armenian: "BARIVDIZ". The girl recognizes the word. Lucka Luckich draws a dog, a cat, and a cow. Mariam. Accompanied by her mom, teaches him the names of animals Armenian. A dog – "Shoon;" a cat – "Katoo;" a cow – "Kov".

Lucka gives her a felt-tip pen, asks her to draw the sun and clouds. Mariam chooses yellow, then blue, and then draws.

Mom: "Doctor, she is tired". We leave the two of them: Mariam waves and smiles to Lucka as he departs.

September 21, 1995. The mother asks if we can sing. I place Lucka Luckich near Mariam, take out my guitar and sing a song about little herons. The girl sings with me, forming a heron’s beak with the palms of her hands. Then we sing another song entitled "Wonderful Horse".

Mariam takes out a drawing she made during the last visit. Points to the dog with a question in her eyes. Lucka names the animals in Armenian, then asks her to repeat the word in Russian. She is confused. Then he asks: "What is "sun…a cloud? …a bird?” Mariam answers, looking at the picture: "Ampech", "Arev", and "Terchoon".

He shows her the book "Turnip." Lucka reads, shows her a picture from the book. It is clear that the mother has already read the book to Mariam.

September 28, 1995. 23 I was quite surprised to see how easily Mariam has learned Russian words, by looking at the pictures in "Turnip". Lucka Luckich teaches her: "eyes", "mouth", "back", "stomach". He asks her mom to prepare a surprise for him: to the words for " hand", "leg", and " arm".

Mariam leaves the hospital for outpatient treatment before we had the opportunity to see if she had learned these new words.

September 14, 1995. Yana F., 8-years old. She is hooked up to an I.V. She shows me her wonderful drawings. Squirrels are running to each other with umbrellas – it is raining. Mushrooms "are wet beneath the branches". There is a kangaroo with its joey. Nearby is a palm tree with bananas. The kangaroo is embarrassed. Why? "Cheburashka and a puppy from another cartoons pays them a visit, but Kanga does not know who these fellows are". There is a frog with a top hat sitting under a tree. There is a tiger with umbrella sitting under the tree.

Yana explains the stories of her drawings and asks Lucka to draw something. Lucka draws. Yana promises to make up new stories and pictures.

January 27, 1997. Nastya R., 7-years old. There is a copy of a picture on the window Lucka Luckich drew during his last visit: a bright rainbow above a river and garden. Nastya tried to enlarge it with paint.

December 30, 1995. Olya Zh., 13-years old. He has a very high temperature. His mother is very sad. "Please, just sing for awhile." We sing for about an hour.

January 15, 1996. Tamara D., 4- years old. She asks immediately: "Let's sing". Surprisingly, she remembers the song about “Do-Not-Want" almost by heart—although this is our third visit with her.

January 15, 1996. Manuk T., 10-years old. "May I play guitar?" He plucked the strings for a long time.

February 5, 1996. Sasha S., 13-years old. These are his final days, as tomorrow or the day after he will return home. He is in a cheerful mood. He wants to learn to play the guitar: he has one at home. We place Lucka Luckich on the chair, and I show Sasha the first three cords of "Seryoga Sanin". He picks up on it very quickly. He gives me his address, says good-bye to Lucka. Lucka presents Sasha a photo of himself and kisses him on the nose.

February 15, 1996. Nastya Z., 5-years old. "I want to sleep, Lucka Luckich! Sing me a lullaby." Lucka sings "Green Coach". Nastya closes her eyes. Suddenly she opens them, searches under her pillow, takes out a chocolate and gives it to Lucka: "Please, sing some more". She lies down and falls asleep while listening to the sweet song.

November 20, 1996. Ira S., 9-years, and Igor K., 3- years old. Igor smiles widely: "Sing us a song about a horse!" I sing a song. Ira smiles. Ira's mom speaks: "Oh, that's the first smile of this week!"

February 19, 1997. Vitya N., 10-years old. 24 "Hi! What will we sing today? May I play the guitar by myself?" The guitar is resting on Lucka's lap. I hold the strings with my left hand; Vitya strums the strings with his right. We sing “Amazon” together.

March 27, 1997. Kostya N., 9-years old. "Lucka Luckich! Look what I’ve made!" He shows me a Pepsi can. "Please sing "Puss-puss, meow" for me.

I begin singing. As I am singing, Kostya plays some maracas: Lucka told him last time about filling a can with grain to make a maracas. Kostya also sings while shaking his homemade maracas: "Puss-puss, meow", what glorious music!

May 12, 1995. Zhenya K., 8-years old. Lucka Luckich takes out the sketchpad. He tells Zhenya about a special, magical kingdom. The kingdom has many roads and strange creatures that inhabit the kingdom’s weird buildings. I show him a map of the kingdom. Along the road, Leukocyte-peacocks squawk, Thrombocyte-whirly-birds speed, and Erythrocyte-yaks delivered balls with oxygen ice cream to different ends of the kingdom. Zhenya: "They deliver oxygen ice-cream balls on roller-skates!" She draws roller skates for the Erythrocyte yaks. Slowly the paper on the sketchpad fills up. This way Lucka explains the structure of blood system using the actual cells as the names of the imaginary animals. I ask Zhenya to draw the beautiful town Hemato-land for my next visit.

May 20, 1995. Marianna I., 10-years old. We talk about the story of microbes and the immune system, which protects Homoto-land. On the sketchpad, we draw the Leukocytes-policemen: this one has noticed a microbe-spy and so he gives a signal to his colleague. With the leukocyte-policemen in tow, the spy cannot escape: he will be caught and eaten. And there, look, there’s a Thrombocyte-bricklayer. He fills in the holes of Hamoto-land: so no more microbe-spy can enter the kingdom.

June 15, 1995. Sasha T., 10-years old. Lucka Luckich tells Sasha about blastoma. In the kingdom of Homoto-land, the children are called blastoma. They go to school. When they grow up, they will become Erythrocytes and will provide everyone with oxygen. And there are the Leukocytes, who when they finish school become guards ensuring the kingdom is peaceful. And here are the Thrombocytes-bricklayers. And who is over there? Those guys didn't want to stay in school and study, so they dropped out and are now good-for-nothing, useless globs. . Worse then that, sometimes they run around the kingdom vandalizing places and bothering everyone. Look, there is a Erythrocyte with a green hat; he’s fallen and now the oxygen ice cream balls are scattered everywhere. And a policeman lost sight of microbe.

The Cases of Difficult Communication.

We want to be cognizant of those circumstances when mutual understanding between doctor and child does not materialize during the first visit: when the child remains silent and does not even shake the puppet-doctor’s hand. The child simply cowers. 25 I have ten cases of this kind of difficult communication. However, even in these difficult cases, my experience revealed that communication was achieved, just not orally expressed.

***From the diary. February 14, 1997. Alyona V., 4-years old. During the first two visits she did not look up. However, today Lucka Luckich found her smile with his magical buzzer-hammer. The smile had been hiding in her heel-houses. Lucka begins speaking with Alyona's feet, directly looking at them. And the feet reveal Alyona's reaction to all jokes and questions. "Yes" and "No" were understood without any mistake. The girl quickly became happy and began to speak.

The experience with Zhenya G., 5-years old, assured us that the puppet-doctor does not necessarily have to be active. In fact, occasionally over-activity on the part of the doctor-puppet reduces his effectiveness. For example, Zhenya remained closed during his first encounters with Lucka Luckovich, answering questions only with “don't know". Then Lucka Luckich sat down beside him and slowly SILENTLY emptied his trunk of the toys. Little by Little, Zhenya began playing with the toys – but only by him. Then suddenly he asked the doctor to treat his Ducky Tim! Contact was made. 26 Lucka Luckich – The Object of Love. (18)

The amazing feature of the therapy is that gradually over time Lucka Luckich becomes the object of the child’s love. This love often manifests itself through physical expression: children caress Lucka, brush his hair, feed him, cure him, draw for him, sit him on their lap, give gifts to him, embrace and kiss him.

It appears, based on our observations, that the love expressed for Lucka differs from the affection the children direct toward their "ordinary," favorite toy or pet. To the child, Lucka Luckich is "almost" a person to a child. It is difficult to articulate, but I believe this is how the children

(18) It was not immediately clear which characteristic of the puppet had the greatest impact on the children. However, over time, it became clear. While we kept the idea that the children simply enjoyed playing with the puppet on the periphery of our pedagogical plan, at did become apparent. Children connected with the puppet simply because liked to play with it! Although we could not have predicted the outcome, as we were partially blinded by the light of our dreams, this puppet who was the same size of the children simply became a friend to the children. This big beautiful living puppet became the object of their love. But this love is not the love the child directs to the toys they possess and want to protect, nor is it like the love they feel toward a patron or guardian, which is often characterized by aggression. It is similar to the one feels toward a real living being, a close friend.. Their love is for a most unusual creature, who posses near-human characteristics and absolutely intelligible behavior, the puppet appears to the children to actually be alive, and yet also, simultaneously fantastic. And that the puppet is not some fantasy, is not some interior love that the child feels, as with a make-believe friend, but is in fact real, exterior, a part of the child’s life, a friend. And still, nevertheless, the puppet is not a Man! It is a puppet! The fact that Lucka Luckich is not a human being but something else opens the child to express emotions and communicate in ways that previously he had not been able to accomplish. New means of communication have been invented by this new, fantastic relationship. This is true in even the most simple of emotions: aggression or love. Show me a person who, under the enormous stress and difficulty and pain of the medical treatment themselves would be feeling to give another an injection, or any kind of medical treatment, and yet to Lucka, the child can mimic the procedures he is undergoing. Whom can we embrace with the entirety of our being? When we suffer, it is intensely desirable to embrace, to touch, to be held…but when suffering, do we feel capable of this, are we able, under such stress and physical and emotional pain reach out? And yet, for the children, it is possible to nestle up to and hug Lucka, hold his entire body, to embrace the complete puppet! With Lucka, it is possible, for he was created for such a moment. And in doing so, is not the child embracing himself, fully, as well? My heart slipped and broke a bit when I first watched the children embrace Lucka with such passion and abandon. How they clutched his precious red “lamp”-nose, as one child described. As to my fear that the children’s intense grapping and squeezing of the puppet, and that such intense expression might damage the puppet for other children, Larissa simply admonished me with a reminder: “What else is Lucka for?" I apologized over this simple fact. That amid the entire serpentine and complex system of psychological rehabilitation, that ultimately, success appeared be reduced to a simple game? Was the essence that simple? Was it simply a matter of affection and game playing which helped these children? Or was the over simplification a defect in the system itself? I could not believe how simply and systematically the therapy seemed to work. Other doubts crept into me. Did Larissa carry out properly the program? But no, she had skillfully and faithfully remained within the framework of dialogue, which passed to games, which passed to interaction, without any didactic task. She had performed the activities as we had designed, and yet…. She still did not perform the didactic games, instead merely playing with the children—“games for free” we called it. 27 perceive Lucka. For example, the children often used the name "Lucka Luckich" for both the puppet and for me. This combination of name use reveals unmistakably that the children associate the puppet with an actual person.

The Trunk with Tools and Equipment.

The doctor-puppet's trunk plays a key role in our work. In fact, the trunk itself possesses an autonomous role in the psychotherapy. The special quality of the truck was discovered during a moment when the puppet had to be mended, when only the trunk was left to occupy the children.. Speaking with the children who had already been acquainted for a substantial time with Lucka, I was surprised to learn that the children did not need Lucka. They were content with playing with the trunk alone. They opened it and treated their toys as they wished. In a game without constraints or parameters, the child could still declare himself, explain his troubles, and heal without direct contact with Lucka.

But the children, after some time, always asked, "Where is Luckich?". Simply, the children still wait for HIM, even if he sits alongside them and remains silent. Nevertheless children gave us the cue concerning the important methods of work: after that Doctor Lucka often just sat down on the bed of patient, opened his trunk and waited.

***From the diary. January 4, 1996. Kirill Ch., 4-years old.

At first it was difficult to me to agree with the course of events (overlooking the didactic games); I persuaded, exhorted, even quarreled with Larissa, and she drooped guiltily but continued to do whatever the children wished for. This is what I could not break through. That the game playing, for the children, was paramount…and Larissa simply had to acquiesce. Children live within the world of games as easily as we adults live within our surrounding environment. And we, as adults, are permitted only to be present to watch, to occasionally participate in the games, their world, if we are lucky. In now way, however, are we allowed to impede, to undermine their world of games, for in fact, it is their universe, their cosmos if you will, and as essential and real as is the outside world for adults. Simply, this is the power of their imagination and their conception of things. And one additional observation, prompted by the first reader of the manuscript: concerning the solitude of someone ill. This terrible sensation, the lonely isolation, is familiar to all of us. And if solitude, as it happens, can often times profit adults, and in fact is a essential state from time to time for adults, for a child, isolation and solitude is a heavy bane. A difficult and profound experience for them to endure. The profoundly sad thing is that a sick child often "resists the entire world", even those most close to him: parents, siblings, and relatives. - I recall dramatically the hate in the eyes of the four-year old directed at her mother when she received some severe therapeutic treatment. The mother and I had, by force, to administer this treatment, and the fire and fear, which shone from the child’s eyes, was startling! Her anger was simply the intense manifestation of the child’s isolation and lonely fear.. And Lucka Luckich, possibly, happened to be sometimes the single creature from the external space that broke through the "hostile" circle and lead the child by his hand away from the infinite internal world toward outwards things. 28 He takes out the I.V. tubing and with the help of Lucka "connects" his favorite Teddy Bear to the I.V.. After half a minute, he hides the toy inside his sweater: "Here’s his home". He wants to take his toy out of his "home" but was puzzled by the sleeves. The Teddy Bear cries with Kirill's voice: "Where is the exit? Do you want me to sit here, alone and locked up my entire life?"

Lucka: "Hey, Teddy, try the neck, the door is probably there." "Oh! Yes! Here is the exit!"

January 18, 1997. Maxim K, 6-years old. He constructs a ship from the trunk and its contents. Then it turns into a flying-carpet, after that – into to rocket (a car without wheels). This rocket "with a passenger" flies and smashes into to Lucka.

It's clear Maxim needs to get rid of negative emotions.

The Equipment (toys) Inside Lucka's Trunk.

1. The Equipment for Game Therapy: 1.1. "Medical" Equipment: - Large syringe, - Small syringe, - Tongue depressor, - I.V. tubing pieces, - Bandages, some cotton, - Glass and plastic vials, - Plastic saws - Forceps. - 1.2. Clown Equipment: - Wooden thermometer, - Wooden stethoscope, - Hammer with buzzer and soap bubbles, - The cup with Lucka Luckich portrait, - Paper hat to protect the children from fear, - Pens, pencils, felt-tips, paper, - Small light ball, - Small cars, - Set of typical geometric wooden figures, - Figures of animals and people, - Balloons.

2. Pedagogical Equipment: - Blocks and other geometric figures, - Matches, - School counting set, - Puzzle kit, 29 - The set of riddles, tasks, exercises to train attention and memory, - Pocket watch of Lucka Luckich. (19)

CONCLUSION

(19) A few words in the end regarding the history of this program. We can trace the genesis of the idea to create a large, child-sized, doctor-puppet, designed especially for work with seriously ill children, to January 22, 1995. The doctor-puppet was as a result of a series of events first described in my old diary. In our small amateur puppet theater (referring to the peripatetic folk puppet-theater troupe "Vertep", the members of that theater troupe correspond to authors of this program) – The theatre troupe’s aim was to entertain people who needed comforting: the elderly, disabled and especially children, children who lived in boarding schools, orphanages or were staying in hospitals. The troupe’s expressed raison d’etre was to bring joy to those who needed comfort or were less fortunate, although there was not an expressed, written mission. We will not describe in detail the trips and charitable work of the theater nor the visits to the hospitals, boarding schools, and children detention centers throughout the many small and large cities of Russia. Simply to list five places where the theatre troupe performed will suffice to explain the wide spectrum of the theatre’s work: the boarding schools of Olonez and Myshkin, the nursing homes of Kargopol, the Petrozavodsky Republic Hospital, the Pediatric Aids center at Moscow’s Sokolini Hill Hospital But after some years of charitable work, the theater began to recognize its special role for ill children. Even with this revelation, the theatre was not yet ready for the large responsibility of maintaining prolonged communication with ill child. Our dear friend Olga Medvedeva, president of the Russian society of Yunush Korchak, helped us establish ties with Andre Puli renown for his work with children in oncological clinics in Switzerland. Through the help of Yunush Korchak, we were able to invite Andre Puli to Moscow. Puli was able to coordinate with the famous European clown from Lausanne, Jean Claude, and the two of them visited Moscow with the intent of offering their services to help the sick and hospitalized children.. The psychotherapeutic method of using clownery to help patients, first established in the United States, has spread to many countries with broad success One of the most renown practitioners of this form of psychotherapy is Paige Adams, who visited Moscow approximately 15 years ago. During his visit to Moscow, Adams successfully worked with many ill children and helping them recover from the psychological damage inflicted from their illness and hospitalization.

On January 21, 1995, Jean Claude showed performed his work routine in the hematological section of Republic pediatric hospital. Jean Claude’s work was first class. – Simply brilliant! I was standing alongside him and enjoying the sublime art of his simple and merry tricks! But while I watch him enchanting the audience, I noted to myself that something was amiss. The audience, comprised of the sick children and their relatives, smiled but as if strained. I wondered if their strained expressions were possibly a result of the conditions: the strange, noisy foreign language, the presence of a translator, the camera, and excessive sounds and gestures, together with the confusion simply created the slightly strained ambience. Still, we must give due to Jean Claude’s tenderness and to his refined technique. Once, when he sat down on the bed of tiny, prostrated young, sick girl, he created the most gentle and tender purr while carefully touching her motionless hand with the nose of “glove-rabbit”, 30 Pediatric oncology continues to confront the most dramatic regions of medicine, despite the substantial successes achieved in the treatment of malignant neoplasm in children. Painful procedures and invasive treatment, the need for which children, as a rule, cannot comprehend, fill the children’s souls with a multitude of fears. Many of these fears become so ingrained within their psyche, that even they remain and affect their mental state for years after the procedures. Moreover, many of these post-traumatic fears continue to affect the children’s development. l. It is because of this dramatic, long-term effect of the trauma that the psychotherapy developed by Alexander Grief and his assistant Larissa Sokolova is and outlined in this book is so important.

that all those who were present clenched their teeth, to hold back tears.

The current work of Swiss clowns with sick children is a quite extensive and complex program, which involves the collaboration of psychologists, physicians, parents, and multiple dialogues with the children as well as written correspondence with them. However, the Swiss model required from performers what we did not possess – the highest and most professional clown skills, acquired from years of training. As a result, we had to end our collaboration with the Swiss masters. We were grateful to Andre Puli and Jean Claude, who showed us what was possible in aiding the children through continuous and critical work, and to teach us how to organize such techniques. Furthermore, their artistic work inspired the idea which lead to the creation of the puppet-doctor therapy. The fact of the matter is that in certain instances, for example, during the direct interaction between clown and spectator, it is necessary for the artist to create the "game of space game" - to be covered with mask or puppet. Without inventing a new character, we transferred the idea of the clown mask to the theatrical puppet. Subsequently, we discovered that the puppet, created by us, possessed fundamentally different properties and possibilities then the clown. First of all, we thought that the puppet-doctor had to be proportionally sized to the child, or more precisely, equal in size to the child. We arrived at this conclusion considering the truism of the child’s ideas about the world: everything larger then yourself is assumed, to be "senior"; anything smaller than yourself is considered to be "younger." It was critical to us that the first acquaintance between the child and puppet-doctor be one of assurance and bonding. If the puppet-doctor was equal in size to the child, the child would consider him is peer, his friend who was visiting if you will.. Thus, from the beginning, the puppet-doctor was considered by the children to be someone who would understand and help them, one who were reliable. In other words, someone they could love without being frightened or intimidated by. We assumed from the very beginning that the puppet would work with the children because of their apathy toward their surroundings: in a state of pain or shock, stress, expecting an operation or children who recently entered the barren, unforgiving building of hospital, would react to the puppet-doctor as something beautiful, categorically different from the severe conditions around them. The puppet would not only be see as novel, but beautiful as well to the children! The specific design of the puppet has an essential importance: it should be light, mobile, to allow the actor to freely associate and interact with the child. In other words, to allow the child and puppet to be on equal footing. Openly controlled puppet that mimics human behavior is the standard theatrical practice for large scenes or open areas. The puppet’s complex and detailed motions are carried out through the manipulation of the puppet by several puppeteers. We transferred this puppet technique into the narrow confines of the hospital setting, where within close proximity to the spectator (the child) it is impossible to deceive by the trick of the large stage, because everything is evident because the child is so close... We did not know, and still do not know even now, about this technique being used elsewhere. From the pure theatrical point of view, our experiment was sufficiently daring, that is to be revealing to the child so closely the artifice of the circumstances of the puppet. Maybe even, this exposure of the artifice was 31 I had the opportunity to watch the puppet-doctor in the work and even to participate in some of the activities. I would like to acknowledge that that Lucka Luckich is quite kind and engaging, with the amazingly pure, naive, and penetrating contact. In other words, he makes contact with the children. Because of the skillful work of psychologist-puppeteer, the child develops, through the interaction, the strength and feeling of well-being which eliminates the child’s fears which have resulted from his medical circumstances. The key ingredient is, however, that the fears the child experiences are not relegated to the subconscious, which would affect his emotional state and entire subsequent development, but draws them out and allows the child to confront them and transcend them, allowing for a more sustained and healthy psychological growth.

irresponsibly daring. For the manufacture of the puppet, we elicited the services of the Puppet Theatre of S.V. Obraztsov’s workshop. This workshop has created such masterful puppets, such as Gerdt's Master of Ceremonies for the Unusual Concert! Masters Lucka, Mark and Luckina were all predecessors to our puppet, thus we named him Lucka Luckich. After several months, Lucka Luckich settled in our theater of the red sofa. The prolonged search for equipment and toys began, which concluded with the formation of the banter, and rehearsal of dance between puppet and artist.

We created the idea. We wrote about the interaction. On paper, everything looks good... But how can I describe to you that I simply "saw" the puppet: as it gesticulates, as it turns to the child, as it walks, as it sways and dances and “breathes?”. Simply: to perform, to give it life...

Money. How to describe the charge a fee for the activity? It is necessary to describe the transaction, to require it, but how? Indeed, I ventured into this business, in one in which no one believed, at great expensive and apprehension. The idea for the enterprise was based solely on a vision: into a room flooded with sunlight enters a man with a large bright puppet and in the glow, a child, who sits on the white bed, extends a brilliant smile... It is shameful to admit, but I deceived our creditors, marking down the prices in order not to frighten them by the cost of operation and I solicited funds from different places for the same costs.... I plunged into debt, knowing full well that I would not be able to repay. But then I gathered all the creditors, as they were my comrades, spoke frankly with them, and presented to the finished puppet. Do what you want, I cannot repay your money, but at least we can now work with sick children, I told them. They forgave me.

Arbitrarily, we selected the hematological section of the Morozov's Pediatric Clinical Hospital to perform our puppet-doctor work. We had once had the opportunity to appear there with the theater troupe. When we produced the large puppet to clinics new director, he found our proposal to work with the children very interesting and was abundantly happy to support our endeavor. However, for over a year we did not have a the trunk for the puppet, and Larissa had to drag herself the puppet, our equipment and a change clothing and foot-wear in the large, bulky bag through in the metro. In the eyes of Muscovites, Larrissa was viewed as a simple tradeswoman trammeling through the streets. The eyes of the strangers were often filled with judgment and harshness, with all the attendant associations toward a tradeswoman lugging her wares. This did not deter us. We made it as a rule to work with the children twice a week, and, in general, for two years of work we abided by this commitment.

Larissa visited children throughout the ward, introducing the puppet to them and engaging them in conversations and play from twenty minutes to hour. Over a period of six to eight hours, it was possible to visit every child in the ward. I do not know how exhausting this workload must have been, since Larissa worked without any break! There were the instances when in the evening we carried ourselves and the entire 32 Generally speaking, thought this book is brief, it is quite informative. Pediatricians, not only pediatric oncologists, will find it many constructive for addressing both pediatric psychology and as well as the psychology of sick children. But the audience for whom this book might most benefit is the puppeteer-psychologist – as the book serves as a handbook. But also, the parents of these ill children might also enjoy and benefit from reading such a book.

It is critical to note two significant areas, which the “Doctor-Puppet” program can help solve. The first area is the specific education of the child’s illness. This therapy allows, in very accessible play form, children to learn truthful information about the medical procedures involved with treating neoplasm (immunity, the effect of medicines). In other words, the therapy contributes to the formation of an "internal picture of the disease." In this case, it is understood “theater” out into the city to take breath and to eat something. Frankly, I rarely observed Lucka Luckich in the ward – because in the confined space of dialogue, the need for privacy is paramount. There is no place for a spy. But, especially in the beginning of our work, we met together in the evening and discussed each other’s results, the children’s reactions and our experience, often until late into the evening. We analyzed each conversation the children had made and their every gesture. Children and parents accepted Lucka Luckich with the great joy, practically without exception. Profound relief was instilled in the parent, for whom living in the wards with their ill children had been a traumatic experience. Many of the mothers, debilitated by the terrible misfortune of their child’s illness, often required as much nourishment and psychological aid as did their children. In fact, many of the parents suffering was as significant as the child’s, simply because the parents did not receive attention. All the while, the children, who could walk, waited for Lucka Luckich in the corridor, or they glanced out of the ward’s windows in expectation of his arrival. Patiently, we waited for the physicians to believe us and to acknowledge the benefit of our work. And eventually, they celebrated our work. Once, the moment we entered the hospital, the staff physician galloped toward Larissa with the bundle of money—the commission for our work. This was holiday indeed! We continued the work based on our intuition. In the beginning, it seemed necessary to us to listen to the advice of psychologists. Those psychologists with whom we spoke confirmed the general efficacy and accuracy of our work, but they added nothing more substantially. At that time it was important to me to obtain a professional appraisal of the program, since I myself suffer from a lack of confidence in autonomy. I wanted to be sure that my idea was not only substantial but also, psychologically speaking, proper. And I was equally hard on Larissa, insisting that her work was performed the proper way. I did not allow her very much slack in the beginning because I wanted to ensure that what we were doing was not only proper but valuable and beneficial to the children Considerable efforts were spent in finding a partner for a prolonged collaboration. Promises of potential collaborators hung in the air and then quickly fell away as autumn leaves. It is incorrect to say that no one helped us; of course, they helped. However, no one was willing to collaborate with us over for any great length of time. After the first year of work, Larissa was accepted into the staff of the Scientific Research Institute of hematology. She was hired for the post of psychologist with the responsibility of conducting the psychological support program for children in the hematology ward of the Morozov's Hospital. As a result of her hire, it is possible to say that the administrators and physicians recognized the benefit and success our program. But today the work in the ward has temporary stopped, because of personal obligations, which Larissa Vladimirovna has to fulfill.

It is difficult for me to judge the future prospects of the program. At times, the future appears iridescent, at times, how should I describe this, ... not very rosy. In the current circumstances, my guiding principle is to transfer the work the amateur sphere into professional sphere: to propose an agreement with an organization interested in a similar psychotherapeutic work, for it is necessary to understand that the artist-psychologists also needs to earn money to support himself and the program, that 33 that the brighter and more detailed that this “picture” is offered, the more active is the position the child occupies. And the second area that is enhanced by the therapy is the pedagogical enhancement. The treatment focus attention on the fact that Lucka Luckich is capable of providing schooling exercises that the child would normally not be afforded during the hospital stay. These programs are important not only for the intellectual development, but also for strengthening of the child’s motivation toward his treatment. Indeed, even very young not to mention the older ones, children, who participate in the pedagogical exercises during their stay in the clinic, exhibit positive mental faculties. Their engagement with schooling activities is irrefutable proof of the child’s strong, authentic recovery.

We emphasize that the most important function of puppet-doctor therapy is the ability for the puppet to befriend the child, engage them in conversation and games, all the while becoming the object of the child's love. This nourishes the child and strengthens their psyche and emotional development, which is often damaged as of result of their physical illness. This is the underlying essence of the effectiveness of the psychotherapeutic program. A child experiences real love because of his relationship with Lucka Luckich. Because of this love, he feels less afraid and is strengthened by this friendship and is able to cope with his traumatic illness.

Dear readers, we the authors of this book experienced this remarkable love as well.

In conclusion, I would like to add a few words about the composition of the book, which, to my mind, is original and successful.

Pediatric oncologist, Manager of the Rehabilitation Department of Scientific Research Institute of Pediatric Oncology and Hematology, Doctor of Medical Sciences - G. Y. Tseytlin.

he has responsibilities and obligations in his life. A very dear lady once suggested to me that volunteer work could also be professional. To this I reply: only partly. By the quality of the work – yes, absolutely. But, with the organization of the program, the timetable, and the resources need, I repeat: in the present circumstances – the program does not have a rosy future if it depends upon volunteerism only! It is necessary to have and create a profession, committed, financially viable, joint venture with a professional organization. This is necessary to establish the success and long-term viability of the program. Well, in general, the truth of the matter is that the importance does not rest with the logistics of the program, either someone else’s program or mine. The importance is the matter of helping to heal the children. Sick children. Large, openly controlled puppet has the rare quality of being able to communicate and interact with the children. We, of course, need the professional backing to allow for the existence of the program. But most importantly, we need an artist, someone who is capable of breathing life into the puppet, engaging the children, being a friend to help these ill children. To feed them love and hope.

So, call me an optimist. In general, I look at the world with a smile, albeit a melancholic one. The smile, which hides the gentle, tears behind the radiant light.

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