Flexibility Is the Key for a Cincinnati Teacher Whose One-Room School Is Children's Hospital

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9:27 a.m.

CINCINNATI-- Jeff, a small blond child with a powerful set of lungs, does not want to go to school today. He makes his position very clear to anyone within earshot as his nurse carefully maneuvers his hospital bed into the classroom at Children's Hospital here.

"I don't want to be here," he repeatedly cries, tossing and turning on his bed.

Maria Kunkel, who runs her one-room schoolhouse for sick children with the empathy of a pastor and the adroitness of a juggler, quickly acts to defuse the situation. Motioning to Jeff's father to sit on a chair next to the large bed, she offers a Curious George picture book to the child as a peace offering. It's a deal.

"Usually, I don't like parents in the room, because without them, kids feel more free and independent," she says. "But this morning, with the kid coming in in tears, and Dad wanting to stay, I let him stay."

The ability to be flexible is the hallmark of Ms. Kunkel's job. A Cincinnati public-school teacher assigned to the hospital for the past eight years, Ms. Kunkel never knows from day to day which children or how many students she will teach.

Like other public-school teachers assigned to hospitals across the country, Ms. Kunkel attempts to provide her children with a certain sense of stability during often-trying times. But the educational program, she knows, must always take a back seat to medical concerns. Early every morning, she calls all of the hospital's wings to see if any of their patients are in good enough condition for educational services that day. Last-minute changes, she says, are common.

"Because their medical status changes, I'll never know who I will see," says the teacher, who has worked with children who have cancer, gunshot wounds, digestive disorders, and a host of other physical ailments. "For example, all of a sudden, their blood pressure will go up, and they will have to stay in their room."

"School is part of the plan," she says, "but it's certainly not the priority."

9:50 a.m.

Although she is certified to teach special-education students in grades K-12, and English and social studies in junior and senior-high schools, only on-the-job training has prepared Ms. Kunkel for days like today.

Of the eight children who have come to the classroom for the 9:30-10:30 instructional session, two are in the 1st grade and two are in the 8th grade. Everyone else falls in between.

Most of the children wear the school's unofficial uniform, the hospital gown. Intravenous feeding tubes protrude from several small arms.

Three of the students attend school in Cincinnati. They are in luck--lining the white wall cabinets is a nearly complete set of textbooks used in the local school system.

For the other students, who come from suburban Cincinnati and beyond, individualized instruction around the classroom's round, pink tables is the rule. With the aid of several long-time volunteers, Ms. Kunkel bounces between the children, trying to ensure that each has been properly placed.

Turning to Mary, a wide-eyed 1st-grade student from Findlay, Ohio, Ms. Kunkel asks her if her school uses phonetics or a whole-language approach to reading. "What kind of phonetics?" the little girl asks. "I'll show you a couple of books and you'll show me," the teacher replies.

10:10 a.m.

Ms. Kunkel's services are available during the regular school year to most school-age children who stay at the hospital, no matter how long or short their stay. A second teacher, who has been hired by the hospital, provides year-round educational services to children who are being treated for orthopedics, neurological problems, and rehabilitation.

"Education is one of a child's key developmental tasks," says Gail Klayman, the hospital's assistant director of child life. "We need to provide that normalcy. Research shows that these types of programs speed recovery."

"It's a real anxiety-producer for a child to miss school," she says. "If we can keep things normal for them as much as we can, we can reduce that anxiety."

Since the beginning of the school year, Ms. Kunkel estimates that she has worked with more than 140 students. About half of these children, she says, stay for just a day or two at a time.

"I'm always trying to build a relationship," she says. "It's like, 'Hello, please trust me.'"

A large part of her job, Ms. Kunkel explains, is understanding the emotional needs of the young patients. Today, for example, Jeremy, an 8th-grade student, sits with his head down on the desk. He says his stomach has been hurting him since last night, ever since the doctors performed a procedure. Ms. Kunkel lets him put his books aside.

Later, however, she confides, "I knew that the reason why his stomach hurts is because he was going home. For many kids, the hospital is a very safe place. Some feel so close to the nurses."

10:30 a.m.

Jells hospital bed, which is wheeled out at the end of the first instructional period, is quickly replaced by Michael's bed, which is covered with balloons portraying the Teenage Mutant Ninja Turtles and slogans like, "You're the greatest!"

Michael, a 6th-grade student, has most of his body covered with an orange and black cast, the colors of the Cincinnati Bengals football team. He says he likes going to the hospital school because "I like getting out of my room."

A total of eight new children have come for the 10:30-11:30 period, ranging from a kindergartner to a high-school sophomore.

"Where do you go to school?" Ms. Kunkel asks the youngest child. "Next to the store," he responds.

"It's not unusual this time of year for kindergartners to not know where they go to school," she says with a smile to a visitor.

11:40 a.m.

After the last of the second-period students has left, Ms. Kunkel explains that she has to be constantly on the alert for malfunctioning equipment and potential medical emergencies. "Usually, there are a lot of beeps going off," she says.

"If the [air or blood] pump goes off, I call the nurses," she says. "They do the procedures in here."

The worst medical problem she has faced in class, she recalls, is when "one time a child was playing with his central line, and it started gushing blood. I just pushed the emergency button."

Even the usually simple matter of allowing a child to go the bathroom is not that simple in this classroom, she notes, since some children come to class with medical cards that specifically prohibit them from using the toilet.

12:55 p.m.

With her lunch break over, Ms. Kunkel begins an afternoon of one-on-one work with children who cannot leave their beds or who are too medically fragile to be exposed to other students.

Her first charge of the afternoon, 7-year old Jarod Barndollar, wears a cloth mask over his mouth and nose as he is wheeled into the classroom by his mother.

Ms. Kunkel explains that Jarod, who has been in the hospital since the beginning of the summer, suffers from a rare neurological disorder. As part of his chemotherapy treatment, the boy's immune system was suppressed, she says, making it critical that he be exposed to no more than a handful of people at a time.

"You're looking good today," Ms. Kunkel tells the child.

With his mask removed inside the classroom, Jarod begins his spelling lesson. Furrowing his brow, the boy softly and deliberately spells out g-a-v-e and b-r-o-k-e.

As he continues down the list of words, his mother, Donna Barndollar, explains that the daily half-hour lesson provides the bey a welcome release in a day typically filled with medical tests and examinations.

"When school started, he was real disappointed that he couldn't go back with his friends," she says. "Having a teacher here gives him something to look forward to in the day."

1:45 p.m.

Ms. Kunkel's schedule is already falling behind. Her next pupil, a 1st-grade student named Daniel Duffy, is having is his I.V. line changed, and she has to wait outside until the procedure is done.

In the meantime, his father, Michael, says that the lessons will help his son, who is diagnosed as having acute, non-lymphomic leukemia, make up some of the school time he has lost since the beginning of the year. Over the coming school year, he says, the doctors estimate that Danny will miss at least 50 percent of his classes.

"This represents a real opportunity for him to feel normal," Mr. Duffy says. "He has a tremendous amount of energy and really wants to learn."

3:30 p.m.

After a long day of being "up"for sometimes depressed and cranky children, Ms. Kunkel acknowledges that working with sick, and sometimes terminally ill, students can be wearying. The worst part, she says, "is anytime there is a bad prognosis. The hardest thing is that you know too much."

She says that, once a quarter, she meets with other Cincinnati teachers who work in area hospitals to discuss their common concerns. But her main support system, she says, is the hospital's child-life department, which provides seminars about specific diseases and their treatments.

Although the seminars also deal with how to talk to children about illness and death, Ms. Kunkel lets hospital staff answer questions about these weighty matters.

When she first started with sick children, Ms. Kunkel says, "I cried every day. Then I began to be able to handle it. Now I'm in between."

"Without becoming a cynic, you find a comfortable place to work from," she says. "I do get down, but basically it inspires me."

Vol. 11, Issue 06, Pages 6-7

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