Laughing Banana

Niche pain relief

Neve, age 9, December 2021. Painted in Titanium Grey watercolour from The Stoneground Paint Company

I often forget that laughing fruit and vegetables are not normal, everyday entities. People look at me blankly or with a puzzled face when I casually mention these artefacts. Possibly they wonder whether I am ok. Little do they know that Laughing Bananas are what make me ok, when I don’t feel it. 

I don’t believe I had ever heard of a Laughing Banana, until the spring of 2021. Neve was already terminally ill by this point. She was suffering from excruciating head pain, which most medications just didn’t relieve. When I talk about pain, I don’t mean a minor headache. I mean a child crying, sobbing, holding her head. I vividly recall Neve on the sofa, with one of her beloved carers holding her close, in agony. The carer and I made eye contact and it was clear that we were out of our depth. This was not reasonable pain for a child to be in. Seeing this in the eyes of an experienced carer was important. This carer had been supporting children with complex medical needs for years; she had a wealth of insight and wisdom.

You might wonder where her medical team were, during this period. They were in fact there, right there. Sometimes I would google pain and children in palliative care. I would find articles and guidelines, often authored by Neve’s doctors. Suffice to say, we were not short of skilled, experienced support. In addition, Neve was lucky enough to have access to a wide range of complex specialist medication. Anything that she needed, that might help her, she was given. The NHS at its very best. 

The problem was that Neve’s pain was incredibly complex and not limited to head pain. Normal pain relief, even of the opioid variety, often wasn’t enough. In addition, she seemed to metabolise medication in her very own way, so she needed very large doses to have any impact at all. It was a constant balancing act, with the goal of comfort as our priority. 

In addition to the pain, Neve was suffering from an increase in seizures and real difficulty with her receptive language processing. It was a time of intensely complex communication needs and real frustration and sorrow. Neve was very easily confused and needed me to repeat everything I said, word for word, with absolutely no deviation, often many times. She was desperate to understand what was going on around her but her brain just wasn’t cooperating.

Her own expressive language skills were very much intact and mostly remained so, until she died. However, this only added to the confusion. It was instinctive to pitch our communication with Neve to the levels that we could see and hear. So, when her expressive language was excellent, it meant that we invariably assumed that her receptive language was on a similar level. The result was many tears and much frustration.

Language, the beloved form of communication that she had spent eight years mastering, was failing her. Needless to say, it was a heartbreaking time for Neve and for everybody around her. 

You are probably wondering how a laughing banana fits into a story of harrowing brain tumour symptoms. This next bit of the story starts on a day when Neve was in horrendous pain. She managed to tell me that what she really needed was a laughing squishy banana with a smiley face.

No time was wasted and my friends and I set to work, googling intently. But this was just not a search term that, at the time at least, came up with much of anything. I wanted to press Neve for more details, had she seen this somewhere before, where did the idea come from, etc. However, communication was a constant juggling act. Too much language could lead to severe frustration and agitation. But more information was clearly needed. I tried to keep my questions and my language as simple as possible. Neve maintained only that a laughing squishy banana with a smiley face was what would help her unbearable head pain.

It wasn’t often that the internet failed to offer up what we needed; my friends are experts in online searching. In passing, I mentioned all of this to one of the doctors from our hospice; let’s call her Dr C. At this point, we all resigned ourselves to the fact that this item, this holy grail of pain relief, just didn’t exist. Neve moved on and life moved on, though her symptoms and suffering continued, unabated. 

This was a time of at least daily phone calls with the hospice and with the community palliative care team, with constant medication changes and dose increases. At the same time, we were learning about the Biopsychosocial Model of Pain; Neve’s pain was multifaceted, influenced by biological, psychological and social factors. This was alongside trying hard to minimise the use of language, getting our heads around the complex variety of seizures that we were seeing and doing our best to minimise other symptoms, which kept appearing. 

About a month later, a parcel unexpectedly arrived in the post, addressed to Neve. This was, in itself, an exciting turn of events. You can imagine how hard Neve’s days were, at this point. Parcels in the post are always exciting. Though mostly they tended to contain syringes, gloves, masks and other PPE, much to my general disappointment. However, I could not have predicted what this parcel contained. Within the packaging was a plastic takeaway tub. Within the tub was a laughing squishy banana with a smiley face. 

Words were not needed. Neve squeezed the banana and it laughed its wild laugh. Her face slowly changed from a look of shock to a grin. She turned to me, smiled and then brought the banana to her lips, to give it a kiss. And just like that, a laughing banana entered our life. 

Press play below to hear the Laughing Banana

Neve, age 8, Spring 2021. Watercolour & Ink.

It was impossible not to smile when the banana laughed. This proved an excellent source of distraction and pain relief. Also bringing us joy and amusement was the look on other people’s faces, when they would hear and see the banana. As attested to by google, laughing squishy bananas with smiley faces are not the norm. Possibly they should be.

Of course, you may be thinking that miracles come in the form of bananas. In fact, it was in the form of creative and compassionate hospice doctors that we found miracles. It was Dr C who was the miracle worker, the creator of the pain relief that Neve so desperately needed. Hospice doctors have plenty of training in pharmaceutical prescribing but it turns out that their bag of tricks is vast and never ending. This doctor had listened, heard and taken very seriously Neve’s wish, which she had managed to so beautifully communicate to me. 

After our initial conversation, a month earlier, a squishy banana had been ordered, a laughing device purchased. A surgeon husband was tasked with surgically inserting the laughing device and closing up the wound. A smiley face was applied. A child smiled and a story was begun. 

The Laughing Banana, watercolour

This story doesn’t end here though. Through the coming months, Neve continued to suffer from innumerable symptoms. I sometimes wondered whether she had printed out a list of possible brain tumour symptoms and was working her way down that list. Some were easier to manage, others remained severe and complex. No stone was left unturned by her medical team and she was often admitted to the hospice, for a few days, to try to get something or another under control. Many of these medications have possible serious side effects, including sedation. Better to deal with this in a inpatient setting, with round the clock medical care, than at home. Though, truth be told, by this point, Neve was known as The Unsedatable One. Either way, she adored her visits to the hospice. There was fun to be had, in so many ways and at all hours; there was always chocolate to eat and a care team to love and be loved by. 

On these hospice visits, Neve and Dr C would discuss which fruit or vegetable to doctor up next. By the following visit, there would be an item to collect. Out of these conversations came a scented (very important) laughing strawberry, a laughing broccoli, a laughing carrot and a laughing apple.

Laughing (scented) Strawberry, Laughing Broccoli, Laughing (muffled) Carrot, Laughing Banana and Laughing Apple, Watercolour & Ink.

The carrot is worth mentioning in more detail, as it was the sole non squishy item. Unbeknownst to Dr C when she ordered it, this carrot was not squishy like the others had been. In fact, it was filled with sand. Sand, which poured out on to the floor when it was surgically opened. Needless to say, a new plan was needed. A veterinarian father was inveigled to join the surgeon husband and between them, the carrot was filled with cotton wool, alongside its laughing device. It was then stitched up beautifully; the stitching was admired by all who met the carrot. This gave the carrot a very different feel and a rather muffled laugh. Neve immediately declared the laughing carrot to be a bedtime item, for when she needed a smile at night. It was gently placed on the pillow beside her, ready for anything. 

Press play below to hear the Laughing Carrot

These laughing fruit and veg became a constant in Neve’s life. They were called upon time and again, when distraction and smiles were needed. On the surface, these laughing items brought Neve and all of us some much needed joy and smiles. But it went further than this. Yes, they didn’t magically eliminate her symptoms or cure her cancer. The former wasn’t easy and the latter impossible. We knew this. 

However, the laughing items helped us all to understand that pain is multifaceted and that distraction and smiles have just as important a role to play as opioids and other medications. They also highlighted the individualised nature of a hospice, where care is tailored to what a particular child wants and needs. They bring focus to the compassion and the listening, the real listening, that underlines communication in difficult times and through tender conversations. I hear so often that when people imagine a hospice, they imagine sadness and sorrow. I would like them to also imagine a nice doctor, Dr C, sitting with a child, Neve, making squishy food items laugh manically, while deciding which item to doctor next. Because this is just as much a reality of a children’s hospice as the death and dying bit. 

If we can’t do anything about the death and dying, as is so often the case with aggressive cancers and complex illness, then surely the answer is to make the most of what we can influence. In this case, the laughing fruit and veg were where the fun lay and they are something we will treasure going forward. Both the physical items and the memories of those connections, those relationships, the compassion, the creativity and the laughter. 

The banana is looking slightly worse for wear these days, however Dr C assures me that it has a lifetime guarantee. I briefly wonder whether she means Neve’s lifetime, cut short as it was. But I know she doesn’t. She means as long as we need it, as long as Neve’s memory remains with us and with those who knew her and those who didn’t.