Pediatrician writes to calm kids' fears
This is a story about an earache, an elephant, and the world of managed care.
But it's also a story about a pediatrician who, try as she might, knew that the doctor's office alone can't provide enough care -- that parents needed something else while waiting for a doctor's call or struggling to explain a child's troubles in a 10-minute office visit.
"It's becoming more difficult to practice because of time pressures and the information -- or misinformation -- glut that parents bring into office visits," said Dr. Charlotte "Holly" Cowan, who has been on staff at Massachusetts General Hospital for the last decade. There's a need for ways to preempt that misinformation and educate patients, she said.
To find a remedy, Cowan plundered lessons from her own life, as well as those of her parents. "I started thinking about writing stories," she said, "so [parents] didn't feel panicked in the middle of the night."
The result is a new series of children's picture books from the Hippocratic Press, a venture begun by Cowan, a pediatrician for 20 years, and her husband, a businessman and son of a printer. The first book, published in September, is "The Little Elephant with the Big Earache," illustrated by Elaine Garvin. It is the first of an anticipated five storybooks designed to calm the anxieties of sick children and their parents.
Earaches, or otitis media, seemed a good place to start since they account for 24.5 million office visits annually and $5 billion in treatment costs, according to the journal Pediatrics. They are also, Cowan learned while writing, a focus of a Centers for Disease Control and Prevention campaign to reduce doctors' reliance on antibiotics, part of an effort to combat the growing problem of drug-resistant illnesses.
In keeping with the new philosophy, Cowan's Dr. Hippo chooses not to prescribe medicine, preferring to wait and see if Eddie the Elephant gets better.
Alison Patti, program developer for the campaign "Get Smart: Know When Antibiotics Work," said her medical director suggested that Cowan's character not use antibiotics. The book, Patti said, may assist the agency in helping parents understand that doctors are not shirking their responsibilities when they choose to let infections heal naturally.
"Parents are appalled at new guidelines," said Patti. "We're hoping the book would help them better understand what doctors are seeing."
Four years ago Cowan asked for a leave from MGH's Pediatric Group Practice to see if she could translate her knowledge into story form. She chose to write storybooks, she said, because they are meant to be read by parent and child and can be re-read, the ideal way to promote good medical education.
This bridge -- from doctor to author and teacher -- picks up several strands of Cowan's life. She is the daughter of a gastroenterologist, but medicine didn't attract Cowan in her youth. Her mother, who died when Cowan was 13, had started a children's library in the basement of a West Hartford, Conn., school. It was those influences -- "Make Way for Ducklings" and "Cricket in Times Square" -- that Cowan would carry through creative writing classes and an English literature degree from Princeton University.
Cowan's first career was in teaching and she worked for a year at Concord Academy. She then enrolled in Smith College's School of Social Work and did field work at Catholic Charities in New York. "I felt [overwhelmed] with the problems children were coming to me with, enormous societal problems," Cowan said.
She decided to pursue medicine, graduated from Boston University Medical School in 1980 and never considered any specialty other than pediatrics.
The seeds of the children's books were planted in many places, but one comes from an indelible memory: Cowan was a medical resident wearing a surgical mask to ward off germs when she approached a sick child and frightened her young patient. "I remember thinking, there must be some way to offer education, to help them understand ahead of time, relieving the anxiety," said Cowan, a mother of three.
Later she chatted with a colleague about a tale she imagined, of a little duck who needed a nebulizer treatment. The doctor suggested she start writing.
After 15 or so publishers turned down "The Little Elephant," Cowan's husband Rory, who works in global software, suggested they publish the book themselves. They invested $60,000 and teamed with Taunton resident Garvin, a widely published illustrator known for drawing books that involve the Bunnyworth family. To cut costs, the Cowans printed the book in China. Hippocratic Press was born. It was Garvin's last book; she died in June.
Cowan said she's not sure when she will return to her practice. She's caring for her children, her 96-year-old father, his wife, and his sister. And she must get to her next title, "Peeper Has a Fever."
Where to find the book: www.hippocraticpress.com, www.amazon.com, The Concord Bookshop in Concord, and Willow Books in Acton.
