Duly noted

When it was over 100 degrees outside and I was inside my office roasting with a very poor functioning a/c unit, I didn't consider the converse. Weather.com shows me it is 45 outside with a "feels like" of 39 degrees. It is my scientific opinion that it "feels like" 39 degrees in my office too. I'm going to have to start wearing long johns to work.

Also, just overheard in the hallway: "I farted." Kindergarteners are so cute.

TY

I've been uncomfortably surprised by the number of Christmas cards I have received at work, mostly due to their religious intonation. I work for the government, can't we keep this stuff away from work? Anyway, one in particular made me smile: "Nurse Erin - Thanks for taking care of our kids!" Signed by the principal. I don't think the principal at my middle school even knows my name, and this is the second time I've had a handwritten note of appreciation from this one. There's a reason I make an effort to be here two full days a week.

Bon voyage

My first semester as a school nurse comes to an end today, and I’m ending it sick, exhausted, and optimistic. It’s been a real shock to work with the clientele that I do, a population drastically different than anything I encountered growing up. Unlike the nurse on the good side of town, who laments to me the way parents detail the differences between tree nuts and peanuts to her, I have been yelled at for interrupting someone’s day when I call home at 10 a.m. to find out the severity of a nut allergy listed on an emergency card. I have mailed home over 50 hearing and vision referrals and have only received follow-up evaluation notice once. More come back as a “return to sender” because they’re no longer on the address listed on the emergency card (that was just filled out in August) than that. So few come back that I finally stopped keeping a list of what I’d mailed out; it’s too depressing. I’ve learned I’m expected to know everything, and I’ve learned it’s not the end of the world when I don’t.

!!!!

This morning at my middle school, the cutest little trembling sixth grader entered my office. He told me he's in the AVID program - I'm still not exactly sure what it is, but I think the "good" kids are in AVID - and they've been assigned to ask "someone like a doctor or something" to talk to the AVID class about their career. I don't have a clue what that entails or what to say, but sign me up! How sweet! 

It almost makes up for the fact that my office has an overpowering stench of dead rats in it. Apparently maintenance figured out there was a major rat problem above the ceiling and poured a bunch of rat poison. I can say it killed them for sure, and the odor is permeating the buildings while they consider how to remove the dead animals. Yay.

My reputation precedes me

This weekend, 140 miles from work, the guy at the ski rental counter recognized my address and asked what I did for a living. "I'm a school nurse," I said, "I work in the ghetto." I know there are worse neighborhoods in the world, but for most people I encounter in the real world, it's fair to say that about my schools. He asked the name of the middle school, and when I told him, his eyes lit up with recognition. He said that he got mixed in with the wrong crowd growing up, and that was the school the troublemakers attended. As he adjusted the bindings, I could tell he was still thinking about what I do and where... "So you must get a lot of fights, huh?"

Yep.

What we've got here is a failure to communicate.

Perhaps this is just a sign of my aging, but seriously, where are kids’ manners these days? When kids come in demanding an ice pack forgetting their p’s and q’s, unless there is an active emergency, I remain at my desk and tell them I can’t hear them.  Nobody’s teaching manners at home, so I try to teach them while I still can. The other day I had a sick girl already on the cot when a boy entered and I said, “What can I do for you, sir?” Suddenly the girl had energy, shot up and screeched, “You should have called me lady! You called him sir, that isn’t fair!” Excellent attention to detail, young lady, but she quieted down when I reminded her she was sick… and that she hadn’t addressed me as ma’am, either.

This week I saw child restraints for the first time. The kid was screaming so loud I began to wonder if I could later file for workman’s comp when I become hard of hearing because of it while he was being pinned by a resource teacher. Something had set him off, and after he spit in several kids’ faces and bit his teacher, they caught him for fear of further harm and destruction and brought him into my office. Twenty minutes later, he finally exhausted himself to the point of silence. All this, and the kid is only in first grade. Imagine what problems he has to come. 

You know you're a nurse when...

Having a student puking into the trash can in your office doesn't faze you - or detract from the delicious apple munching experience you're having at the moment.

What's gross anymore? I don't even notice.

All in a day's work

This morning I was called at an ungodly hour by one of my schools (okay, 7:15). It was the school I had been at yesterday, and left early for an appointment (really). I was hesitant to answer: I decided either someone was dead, or I was completely disoriented and was perhaps supposed to be at work at that time, and maybe even had the days of the week wrong and was supposed to be at that school. Nope, they just needed me to swing by on my way to another school in order to identify an assortment of pills. A student had been caught with a bottle of random pills, and they wanted to see if they were actually the allergy pills she claimed them to be. I felt like Ralphie in A Christmas Story decoding what turned out to be the Ovaltine message. One by one, I looked them up, and every single one of them was disappointing: some form of an antihistamine, an over the counter cold remedy drug; the most interesting was an herbal diet pill. It was terribly anticlimactic. Also, yes, I know anyone with the ability to type and use a search engine could have done this, but people apparently have an aversion to touching pills.

I get asked a lot what I do during the day, and the answer is I don't know. There really is no such thing as a typical day, as I'm reminded so often, and a lot of my day is hoping for and then dealing with surprises like the one above.

It's not as bad as it looks

There's a crew of substitute secretaries that fill in at the various schools when the regulars are gone. [Side note: secretaries appear to have the highest rate of absence of any position I have ever seen. Where do they even get all that sick time?] As time goes on, I'm starting to get to know a few of them, but today I met a new one. She was very sweet, your typical semi-retired elderly woman, and took a break in my office to find out my story - people are always fascinated as to how I came to be a school nurse at my age. We got to chatting about the district, and she mentioned a couple of other schools, describing them as "unbelievable" with a lot of eye-rolling. No surprise, the two unbelievables she mentioned were my two other schools. When I told her this, she just looked at me and clucked, "Bless you little thing."

And about my schools: One is an elementary school in a terrible neighborhood, one that I have specifically been told by several individuals to leave by nightfall (not that I'd have any reason to be here after dark) for fear of violence. This school has the most orderly students, and is the best performing. Another school is an elementary school in a bad neighborhood, with terribly performing and out of control students. The third is a middle school in the same bad neighborhood also with terribly performing and out of control students. What sets the one elementary school apart? Why are the kids better behaved, and why do they do so much better academically, despite being in an even worse neighborhood economically? I don't know, but it's been fantastic to have been so pleasantly surprised by the environment. Lesson: don't judge a neighborhood by its cover.

District Office, take note

"Non-health professionals are usually not effective health service managers." - The New School Health Handbook, 3rd ed.

Friday Randoms

Today I pulled up to my school and parked behind a car with a license plate holder: "My other ride is my wife." Only in this neighborhood would I consider this perfectly normal.

Everything happens to me. The number of times I tell another nurse what happened at my school that I hear a "Wow, I've never seen that before" is becoming ridiculous - and this is coming from nurses that have been in the district for a decade or longer. This week never-seen-befores included an injury necessitating a wheelchair (my second!), the bleeding eye poke, and HFMD - see below.

HFMD: Hand Foot and Mouth Disease. One of my students was out sick with it, prompting me to become an expert so I could sound semi-competent when I talk with the secretaries about it. The discussion turned into an excellent dialogue, and since it was via email, there were no ears to overhear me saying it how it is: wash your hands, don't swim in poop, and you'll be fine. Usually.

This brings me to my next point. I'm all for the good germ theory, that it takes some to build up resistance, but I am also pro-hand hygiene. And, since becoming a nurse, I've decided hand hygeine is incredibly underrated. My offices are all connected to a bathroom that staff can use. One in particular has a noisy sink and paper towel dispenser, so I always know when people have washed their hands. The number of people - adults - that leave without washing their hands is nothing short of utterly disgusting. Another office of mine has a toilet only, so to wash hands users need to come back into my main office. Further, I face the bathroom door and sink there: I know who comes and goes and it's right in front of my face when someone stops to wash their hands. Interestingly, not a single person leaves without washing. Would more people in the first office wash their hands if I turned my desk around and they had to face me as they left? I don't want to know.

One small step

It's a start. Also, how much does the kid in the picture look like the kid in A Christmas Story?

Expect the unexpected.

Today a boy came in with a bleeding sclera (the white part of your eye) after being poked in the eye with a pencil. He was walking around as though he was fine but OUCH! I've seen a lot of eye pokes, but nothing near a severity invoking bleeding. Thank goodness I've been here a few months now and can call a parent with confidence about this kind of situation; I'm even more thankful for the mother that came to pick him up. She was one of the most gracious parents I've ever encountered (not saying much, but still, it's appreciated); thanking me over the phone and even more profusely in person - just for being here! How nice.

Not coincidentally, this incident happened in a previously mentioned completely out-of-control classroom. Teachers, please, control your students.

How cute.

My middle school secretaries gave me a lanyard for my ID badge that has the school's name and colors on it, just as all the students and employees wear. I've had more than one kid at my elementary schools as if I go to school there now. Apparently to the second graders I look like a seventh grader. I'm also puzzled by the number of girls who come in for an ice pack and leave telling me how "cute" I look. Thanks?

What's going to become of a child whose legal first name is "Gangster"?

Other duties as assigned.

Today I was left in charge of a classroom while the teacher called CPS. One of her students came to class with facial and throat bruising; when questioned about it, he told his teacher it was because his dad was mad at him after yesterday's parent-teacher conference. In the words of the teacher, some people should just not reproduce.

Today marks the beginning of Thanksgiving Break, and I only work three of the next seven weeks. I'm fully aware that I am being spoiled rotten by this job.

Observations:

1. Lice is GROSS. I have seen some gross stuff in my short time as a nurse, but nothing grosses me out quite like live lice in someone's hair. I got through five periods of vision and hearing screenings and was nearly ready to jump for joy as I reached the very last group of the day when the other nurse pulled me aside to sat she heard a report that one of these last girls had lice. Being middle schoolers, I figured it was just another rumor, but when I went to put headphones on this girl, I saw I was sorely mistaken. There they were, crawling around, I didn't even have to go digging in search of them. I wanted to go take a disinfectant shower; instead, I still had a meeting and training to attend.

2. Trainings never fail to bring out the dumbest in people. What is it about those things that just make them magnets for completely idiotic questions? It's bad enough sitting through them, but listening to the questions (that I could have answered without sitting through the training) is just pouring salt into the wounds.

These are a few of my favorite things:

Putting teeth into little plastic tooth-shaped capsules for children to take home.

A certain girl at one of my schools who comes in every time I am here, always volunteering to be the buddy in her classroom to walk the ill and injured to my office in order to see me; better still is when I can make her laugh.

Curing stomachaches and headaches alike with a cup of water and some TLC.

Answering questions ranging from "How did you get to be a nurse?" to "What's a bladder?"

Hearing every facet of the children's lives while they wait in my office to be picked up.


However, my least favorite things include, but are not limited to:

Mass screenings of kids who think they're too cool to have their hearing and vision tested.

Nurses meetings where, consistently, absolutely nothing is accomplished.

Trainings, no matter what kind: MediCal billing, SEIS, Aeries. These are the most painful of all things to me, and the instructor always seems to want to go over the coursework as. Slow. As. Possible.

Tomorrow my day will include all of my least favorite things. I have been dreading the day for weeks, and my refrigerator is stocked in anticipation.

How dumb do you think I am?

(Random thoughts ahead.)

I had a kid waiting to go home for suspension walk into my office and ask if he could give me a dollar to buy him a soda from the faculty lounge. Absolutely not! Luckily, that's the only vending machine in the school.

If a student has not met the immunization requirements, or as is increasingly the case, had a waiver signed exempting the child from said requirements, we are mandated to exclude them from school. I HATE doing this. I cannot stand sending kids home from school. I had one girl who I'd called in the office to warn her there would be a letter giving a beginning exclusion date in 2.5 weeks (10 days is all that is required). I sent the letter home, and the following week had a Spanish speaker make the call for me in order to ensure no language difficulties. I was annoyed to find on her day of exclusion no updated immunization record, so I called her into my office to discuss it with her,  planning on giving her another week. But when she came to my office she claimed she never got the letter and her parents didn't know, and more than I hate sending kids home, I hate being lied to. I told her that wasn't the case, I had someone speak with her dad last week to confirm the letter, and that she needed to go home.

It reminded me a little bit of when a girl came in who had been caught with OTC eye drops. Her eyes were "dry" and she just needed something to "clear them up" a bit. I assured her she could have the eye drops, but I would need a doctor's note accompanying them. She decided to leave them with me, and the rest of the office staff laughed with me knowing I wasn't about to have one pulled on me by a 7th grader. Lay off the weed, girl.

Today I found out our third week of winter break is because so many kids go home to Mexico for the holidays, and parents don't bring them back. Rather than lose the ADA money for all those absences, they'd rather just extend the year a week and let the kids stay on break since they'll be gone regardless. Same goes for having the whole week of Thanksgiving off: parents take their kids out anyway, and the school loses money every time. At first I thought it was a tragedy to have so much time off, concerned for fitting my contract days in... But now that they're approaching, I have no problem at all with them. Happy four day weekend to begin the holiday season!

When in doubt...

All through nursing school, or any mandated reporter education, you hear "When in doubt, report it." No one tells you that there will be times that reporting might do more harm than good. What about when there are cultural differences, as was the case for one nurse who told me of a reporting dilemma. A young teenage girl was married to an adult man, custom for where they came from in India, but an atrocity here in America. What about the girl whose mom you are sure beats her but if you report her to CPS one more time, it still will do no good, and the girl will probably only get beat again because of it? (Not to mention having that said angry mother will come looking for you too.) Is it wrong to not report her mother, even if you have proof in the shoes she is neglecting her daughter, because you know if you do you will probably lose the fragile relationship you have built with her daughter? They don't teach you the fear of the nurse that parents drive into their children when they've been reported to CPS, and they don't teach you how it feels to have suddenly lost respect from that child too young to know right from wrong. I will tell you: it is terribly, terribly disappointing to start connecting with a child week after week, assuring her you are an adult she can trust, something you know she doesn't have enough of, and then have it be ripped apart because her mother thinks you reported her to CPS. What's actually worse, though, is knowing you didn't report her on account of not wanting to lose that relationship, and now you've lost it anyway.

This glass is half empty

In one of my schools, I arrive at the school breakfast time. Each day that I come to this school, I prepare to hold my breath as I cross through the cafeteria on the way to my office. The food being served is like a bad accident: I can’t help but steal glances at it, even though I know I don’t want to know what it is. Sometimes it’s cold pizza, sometimes sausage, and on a good day, it’s a sugarcoated cereal. Sure, there are orange slices available, but what child will take an orange slice if pizza is offered before that? [Truly, the way the line is formed, the fruit stand is last and most children get out of line with a tray full of junk food before they even see it.]

Whoop-ee!

Two confirmed cases of pertussis in the district, and one is at my school. Not that I know what to do with the information; the Communicable Diseases Department, a division of the county's public health department, does not have anyone manning the phones that knows what to do with such a predicament. The nurse who faxed me this information was, according to one person, "around" - but could not be reached for a live conversation. In the meantime, I should probably start becoming a pertussis expert, because I expect chaos once word gets out about this.

On the inside, looking in

It's Election Day, which I think is an appropriate day to comment on the sorry state of our schools in California. Here's what's going on:

The food served to the neediest is greasy, and generally brown, including the wilted iceberg lettuce. Cold pizza is served for breakfast, and warm pizza for lunch as an alternative to the main entree - which is almost always something fried, in addition to regular French fries. If it's not pizza for breakfast, it's a gigantic, icing covered cinnamon roll or some kind of sausage. No matter what, it will be something guaranteed to mess with the diabetics' blood sugars, as well as every child's cardiovascular health. Walking through the cafeteria is enough to make me want to lose my own breakfast.

The majority of teachers are undeserving of their reputation as lazy. They get to school long before school starts and leave long afterward, often times after required professional development meetings, and then bring homework home to grade. They sit in the lounge at lunchtime, lamenting their ever-growing holidays and the time they lose out to teach. They buy supplies out of their own pockets, even clothes and glasses. I'll be the first to admit they work far harder than I do.

Physical activity is limited to a short walk before school, a ten minute recess during the day, and then maybe a few minutes during lunch if they eat fast. I think we can all imagine what they do or, rather, don't do, when they get home too.

As far as infrastructure goes, some of it is literally falling apart. Air conditioning and heating units break regularly, phones in the portables only sometimes work, and it takes careful magic to unlock one of the cupboards in one of my offices - the one that has the epi-pens. The district recently moved to all electronic records, but did not have the foresight to update the computers. It takes 15 minutes to turn on one of my computers, which in case of emergency leaves me with the usually very limited history contained on that year's paper emergency card.

As far as staffing goes, one of my schools last week had three teachers call in sick on the same day, and could not get a substitute for two of those classes. They spread out the classes with the absent teachers among the other classes in the grade level, 4-5 students extra per class. Kindergarten classes contain 30 wild monkeys, and the district doesn't know why no one's learning. There is still a classroom vacancy at one of my schools; there have been rotating substitutes since August but it appears none of them stay for long. Then there's the office staff. The principals all get a bye, they are there dawn til dusk and are clearly passionate about their jobs. The rest of the office seems to spend a large portion of the day gossiping about one thing or another, on the phone with personal calls, or any number of things that can hardly be claimed as work. I'm trying not to implicate myself here, but if someone was detailed enough to audit the office staff, I'm pretty sure the work could get done with many fewer staff members. And the janitorial staff! My goodness, those guys sit in the lunch room longer than anyone. Granted, they're not paid that much, but wouldn't it be better to pay fewer people to do better work?

I could go on forever, but I think you get the idea. I'd say vote accordingly, but I'm not sure I have faith in any of the candidates to fix the mess: it is so messy out there.

Volume control

Kindergarteners have none. I went into a class, introduced myself, and told the kids I would be spending some time with the boys (color vision testing). One of the kids shouted to his teacher: "I KNOW HER! SHE FIXED MY BLOODY NOSE!" When it was his turn, I asked him what his name was, and at point blank range he shouted at me, "YOU DON'T REMEMBER ME?! YOU FIXED MY BLOODY NOSE!!"

It was the first time I actually enjoyed being yelled at during work.

One

There's a second grade girl I met in my office under unfortunate circumstances several weeks ago. She'd been sent to the main office after acting out and said she wasn't feeling well, so I had her lay down on the cot in my office. It was clear she wouldn't be sleeping, so I offerred her a Little Mermaid coloring page and markers. While she colored away, she shared the details of her life: she recently moved in with her aunt because her mom went to jail, but she liked it better at her aunt's house because her aunt doesn't beat her, nor whip her with her belt. She asked me questions about my life: why I don't live with my parents, how I can get to school without anyone driving me, do I go to church. The conversation was heavy and intense, especially with more details about her mom, but the girl kept me captivated for over an hour. How can a girl with one of the prettiest names ever, who thinks hard about things (she was truly blown away by the fact that I live in a town she's not even heard of - why couldn't I walk to school?!), who's got a knack for coloring Ariel, and is thoughtful beyond the majority of her peers (she was very concerned about finishing the picture so I could hang it in my office) have a future that, realistically, is so incredibly bleak? Between the mother's violence and issues, and her peers that mostly appear to be gangsters in training, does this girl even have a chance? For that matter, will any of them turn out okay?

I try to leave those thoughts at school, because if I bring them home, I'll never have the energy to converse with these kids at school. I saw this girl in the hall every once in awhile after our conversation and she always gave me a shy little wave, reminding me of what we shared in my office.

I saw her again today. I walked into the main office and I breezed past her at the "Thinking Desk." I was startled to hear, "Hello, Nurse Erin" and turned to see her giving me that same little wave. I grinned at the recognition and as she continued to stare at me I heard, "I will never forget your name, Erin." She smiled and turned back to her desk, not knowing that she just made me feel that perhaps all has not been for nought.

Age is just a number

I've had varying degrees of insulting comments thrown at me in my short stint as a school nurse so far. The vast majority have been from disgruntled parents, and I'm slowly learning ways to handle it better. (The best way is actually to avoid it completely by substituting snail mail communication for phone calls anytime whenever possible, but sometimes a phone call just can't be avoided.) Then there are the teachers that yell at me for interrupting their class, or emailing me their nasty thoughts on something I did not do just right. Then there is the aide that I encountered in the office, who, after overhearing me tell the attendance clerk how I wished I was present on the day someone broke his arm and started going into shock, asked me: "Are you qualified to handle that?"

Excuse me? Somehow, I resisted the temptation to respond with any of the sarcastic remarks that came to mind. (I'm sorry, are you a doctor? Because you're not even a teacher. Do you know what a nurse is? We hold the most positions in healthcare.) Instead, I clarified that I didn't think I was going to set a compound fracture on my own in the park, but yes, as a Registered Nurse (I made sure to throw in "registered") I am qualified to handle such an incident. Perhaps even more so than the yard duty who ended up having to handle the situation...

Sheesh. The attendance clerk mentioned afterward how much younger I am than what they expected when they were told they would be getting a new school nurse. She assured me they were pleasantly surprised to find someone young working in the office, but clearly it throws others off. And this is the conundrum of being a new nurse: at the same time you're floundering around because you are so new and un-knowing, you're trying to prove to everyone that you are perfectly capable of everything. [Tip: avoid asking questions or looking things up in the presence of non-nurses.]

Note to self

To be added to the list of things they don't mention in training: pay attention to the notes. Teachers use children like messenger pigeons, and they nearly always come bearing something about their supposed condition on paper. At first I thought they were just hall passes, but now I learned they can have very useful information on the paper, and the kids don't always offer it upon entrance. Last week I had a kid come in complaining of being stung by a bee. Sure enough, his finger was quite swollen. I started to panic: what if he was allergic, what if he's one of those kids that has an allergy but the parent is just too "busy" to bring an epi-pen in, what the heck do you do for bee stings anyway, who thinks I'm any sort of capable nurse?! I started with ice while I looked up his emergency contact information. The kid wanted to leave with the ice pack but I insisted he stay in my office while I waited for him to go into anaphylactic shock and keel over and die. After 15 minutes, I let him go and waited the rest of the day for the phone to ring and have it be his teacher saying he was dead. (When you're the new girl, you can't help but let your imagination go wild and work in sometimes paralyzing fear that the worst will most certainly happen.) At the end of the day I was cleaning off all the notes and miscellaneous scraps of paper off my desk and found the one the bee sting kid came in with: "Billy was stung by a bee yesterday. Still hurting him."

I would not have needed to go through my entire day waiting for a kid to die if I'd just read the note. Now I'm training the kids to give me the note to read before I even start talking to them.

Honesty is the best policy

I took a suggestion and asked one of my nosebleeders today if his hands were near his nose when it started. In response, I got a refreshingly honest answer: "Well, I was standing in lunch line and I was bored and then my fingers were in my nose." Not that the kid will learn - he says he has them almost everyday.

The event of the day was when a man came into the main office shouting, "Emergency!" Turns out some kids were stealing bikes from the bike racks and he happened to be walking into the school when it happened. The police were called and found the kids and the bikes a couple blocks away. The kids being middle school students. Middle school students of the middle school I work at. Reality hit: I really do work with juvenile delinquents, just as I was told I was working with at that school (by the attendance clerk, and yes, it is a full time job dealing with attendance at this school). I don't know what's worse: middle school students carrying bolt cutters and stealing bikes from elementary schools during school hours, or the scandal at my other elementary school last week, which were the kids caught with cigarettes and lighters. Oh, kids. Keep your innocence while you have it.

Quotes of the day:

One of my regulars was in the office finishing up her blood sugar duties when a boy came in for his hearing screen. I said we would wait until the regular left so the room would be silent. As soon as she did so, the hearing test boy said, "Is that your daughter?" Nearly speechless, I asked if I looked old enough to have a daughter in middle school. Totally serious, the boy responded: "Yes." I don't know if he thinks this because people he associates with do have children as teenagers, or if I actually look that old to him. As I learned as a camp nurse, children have no concept of age: I was pegged at ages ranging from 20 - 53 by them.

Later in the day, a girl came in with a terrible limp and said she rolled her ankle in basketball during P.E. The conversation was this:
Me: "Can you take your shoe and sock off so I can take a look at it?"
Gimpy: "Oh, no, it doesn't hurt."
Me: "Um... Do you want some ice?"
Gimpy: "Yeah! That's what I came here for."
And out she walked, without a limp. Another magical cure brought to you by Nurse Erin.

It's NOT a TUM-AH!

Being a school nurse can be a real test of patience, and I like to use it as my excuse for having none left for after work hours. Today was another day of screening, and not nearly as fun as sitting in the kindergarten classes testing for color vision deficiencies. (Yes, it's a deficiency, not a blindness.) I thought it would go faster and be less trying than doing mass screening on the kindergartners, but in hindsight, that was just wishful thinking. Some of the kids made me want to pull my hair out. At least when they are five years old I can tell myself they are just too young to understand how to follow a complex direction such as "Clap your hands when you hear the sound." But at seven? There are those that can't understand because they just can't understand, and those that can't understand because I am speaking English. For both camps of children, I have to wonder how much they are learning in an English speaking classroom full of 30 noisy children when they can't follow simple one on one directions in a nearly silent library. Again, this job is making me fear for our future generation.

I do realize one explanation may be that I am in an uncharacteristically poor performing school, and I found one reason why today. One group in particular was out of control in the library, so the other nurse and I walked them back to their classroom to tell the teacher in no uncertain terms that her kids were awful. Stepping foot in the classroom, it was immediately clear why. The entire room was chaos: kids running around, writing with whiteboard markers on their desks (obviously an assignment, but most were drawing their names rather than math problems), everyone talking, and objects strewn about more messily than the messiest state I ever let my own room get in (and that's saying a lot). Ironically, the CD player was playing some sort of peaceful nature music, but it was mostly drowned out by the shouting. The chaotic state was something akin to the unruly state classrooms with substitute teachers are portrayed as in the movies: sort of funny, but a total waste of every child's time and every taxpayer's penny. Sadly, it turns out there have been many complaints about this teacher but nothing can be done: tenure rears its ugly side again.

Hansel's unpublished trail

A small little boy stepped into my office complaining of a stomachache. I ran through the usual questions: did you eat (yes), have you had something to drink (yes), do you feel like you have to go to the bathroom (not sure). I asked when he last went and got "I have had diarrhea and it smells really bad." At the mention of the d word I told him to go (now!) and try again. Unfortunately, the bathroom is right there in my office. He wasn't in there for 30 seconds when the door swung wide upen. I turned to hear him - pants down and underwear up - exclaim, "The diarrhea smells really bad!" And he was right.... Despite the poor acuity of my worst sense, there was no mistaking the odor of fresh poop.

As luck would have it, he didn't know his phone number, so I told him to stay standing while I ran - literally - to get his emergency contact card. I brought it back and handed him the phone while I started dialing. It was a frantic race: me dialing, him doing an increasingly fast potty dance - more was coming! We went through all five of his contacts, including home/cell/work for two of those, and no one answered. Not knowing what else to do, I started dialing from the top again, with mom's cell. I've never felt such relief for a phone to be answered, and she said she'd be on her way immediately.

The odor was now consuming my stifling office, so I suggested he go get his belongings in class. The teacher obviously wanted him in her room as much as I wanted him in my office, because he was soon back and paced the hallway until his mom came. I opened the windows in my office (thankfully it was my office with windows), thinking I had narrowly escaped a huge mess when a teacher popped into my office to ask me to identify "something" in the hallway. Yes... It was poop. I looked up the hall where they boy had been pacing and an unmistakable trail of poop smears traced his path.

Thank goodness for janitors.

Assume nothing

I know to precede any questions about home with a "Who do you live with?" But I forgot today, and asked a girl if her mom would be home. She answered, "No, my mommy was raped and now she's dead. I live with my grandma."

H20 Power

It is amazing how many kids are magically cured with a "Would you like some water, sweetie?" in my nicest, most motherly voice. Today I cured a toothache and a stomachache in minutes apiece, and the majority of headaches are cured this way too.  This is one of those things, like asking the kid to try to go to the bathroom, that no one ever told me about school nursing but I wish someone had. The proportion of kids that go home after walking into my office is decreasing rapidly.

To be continued...

The honeymoon phase is over. I'm hoping for a refreshing weekend, because on Monday I'm planning on coming back with a vengeance. Watch out, parents, it's on.

I have things to say but the right words haven't formed just yet. They're coming.

Open mouth, insert foot

I said something today that was worse than the teacher that told the boy with the partially paralyzed arm his handwriting was too sloppy (that really happened), and worse than the teacher who was playing catch with the blind girl and told her to "focus" (that also really happened): I told a girl without toes to wiggle her toes.

I feel really, really, really terrible.

...

Today I encountered a kid whose parents' "home phone" is actually their neighbor's phone, because they can't afford a phone line; apparently it's a common thing to encounter in the school's neighborhood. Another parent listed her home phone, answered it, and said she'd be awhile because she was in the next town over. It didn't add up, and in the meantime, her daughter had a twisted or broken ankle hurting too bad to walk. The mother didn't come until the end of school. Another girl came in with a terrible cough, leading her to coughing fits that ended in vomiting. I asked how long she'd had the cough and she wasn't too sure; when I asked why she hadn't gone to the doctor the answer was that it was because her little brother had gone to get his shots and they can only take on kid to the doctor. Last week I was holding a kid's head over the trash can and he looked up at me to tell me he does the same thing to his mom; he holds her head over the toilet when she's puking due to a "baby in her stomach." I saw a girl who'd come to me last week and she told me she was staying with her aunt now, which she said was a good thing because her aunt doesn't beat her.

These kids put things in perspective. I wish I could give them the innocence they're supposed to have.

"We've got a bleeder!"

In the elementary schools, they often use the buddy system to walk each other down to the nurse's office. I knew there must be something exciting when a kid came in with two escorts tailing him. One of the girls that came in with a boy clutching a handful of tissues around his nose shrieked, "Mrs. Nurse, we've got a bleeder!" Boy, was she right. I shooed the escorts back to class, pulled up a trash can and could see the blood quickly soaking the tissues. I asked the little boy to switch tissues but he was scared to do so. When he finally did, he was not the most coordinated of children and took his time - and while he took his time, we both got to watch blood from his nose run into the trash can like a little waterfall. I was as fascinated as he was with it, except I didn't feel the need to scream excitedly, "Do you see this?!" Of course I see it kid, except the point is to contain the blood to the trash can so keep your head over it if you're just going to let it drip. I had to grab his head and hold it over the trash can until he figured out how to reach for the tissues while bent over. At another tissue exchange, he pulled out a gigantic clot and was just as excited to see this, again making sure I was watching too. I love it when kids like this come in, I think because I get to teach them something - even if it's only best practices of tissue exchanging in a nosebleed.

Lesson: Things in small places = swollen things

Today a kid came in holding his hand in front of his mouth saying his lips were swollen. I asked him to move his hand so I could see the swelling, and when he did, I saw he was right. His lips were HUGE. Worried about an allergic reaction, I asked how it happened. I almost could not contain my laughter when he told me: he stuck his mouth inside a bottle to make funny faces. I guess that kind of thing might have been funny to a 7th grader, until they came out puffier than a major Botox accident. 

Uncle Jose is coming to visit

This week was kindergarten vision and hearing screening, and it made me want to pull my hair out. I was stationed on hearing testing, and with many of the kids, it went something like this:
Me: Okay, these headphones are going to go on your ears and make a noise like beep beep beep. And when you hear the beep beep beep I want you to clap [+ demonstration of clap], okay?
Kid: Yes! [Vigorous nodding.]
Me: Okay, get your hands ready to clap! [Turn audiometer on.]
Kid: [Facial expressions clearly show sound recognition, but sits there like a bump on a log.]
Me: Remember what you're going to do when you hear something?
Kid: Yes! Clap!
Me: Okay, then, clap when you hear a sound... [Turn audiometer on.]
Kid: [Bump on a log.]

Several hours later, I was left wondering why I ever wanted to be a school nurse. It makes me fear for the next generation.

Dysfunction personified

A kid was in the office for getting in a fight, which he followed with kicking the principal. His guardian came to the office to pick him up for his suspension, apologized to the principal, and said "I know you can't  hit him but I can." She followed this with a few spanks and this: "Where did you learn it was okay to hit people?"

That quote is verbatim.

Phone home

An important part of the beginning of the year is reviewing emergency cards for pertinent health information. It's a process made interesting by the vast array of spelling of some conditions, like "ama" (asthma) and vague phrases like "unknown heart condition." The names of the children are just as entertaining: welcome Destani Unique and Nevaeh Tnes. I try to follow up with as many as I can, but the majority have listed the wrong phone number or just plain don't return my calls. Today, I managed to get a hold of a parent who had listed a nut allergy on the child's emergency card. I started out the call as I do every call: "My name is Erin, I'm the school nurse. Your child is fine and well. I am going through emergency cards and noticed a nut allergy listed... blah blah." I start it out this way so parents know their kids are fine. I just said they are fine, right? Well, today I got [and imagine this being shouted in a very... um... urban accent]: "What?! Did you give Chris a cashew?! Why would you do that?!" She then passed the phone off to a man - despite no man being listed on any of the emergency contacts for this child - who, very dismissively I might add, said no big deal if he eats one, just a little itching will come out of it.

Got to love those parent phone calls.

10/1/10 Edit: Turns out this kid also has asthma and uses an inhaler, two things omitted on his emergency card. He had an asthma attack while I was at another site and the school called his parents to bring his inhaler in. They told them to just "watch him" and call back if it gets worse, and that they were "really busy" and therefore would never ever be able to bring his inhaler in. Great job, aunt and uncle, way to be excellent foster parents.

Drink up

I got my first really, really bloody nose at a middle school. As in, dripping clotted, clumpy blood. Started spontaneously, and ended quickly. (Thankfully, because even as a nurse, watching a kid pull clumps of blood out of his face make my stomach turn a little.) I was still wiping up the blood and had the now blood-filled garbage can still out when one of my regulars came in. I thought the blood might disturb her; instead I heard: "Did someone spill Kool-Aid?"

Kids are so innocent.

This is only a test

It was my first day at one of the three sites I have, hour one. I was just finishing my tour with the one and only health clerk (or technician?), Rietta, when we both turned toward the sound of a scream. It was a sight to behold: one person carrying a child flailing around like a fish out of water, the child's face and shirt covered in blood. "Nosebleed," I thought to myself. I strapped on a pair of gloves, grabbed some gauze, and was ready for their arrival into my office.

How exciting! My first customers to this office ever! The girl was still screaming, making it difficult to think or speak, so maybe that's why no one mentioned to me she's autistic and hates both the sight of blood and being touched. She's still flopping around on the floor, swatting away from me, and I'm starting to stress about how I'm going to silence her in a timely manner. By now the main office staff had come out of their offices to see the commotion and clearly this was my chance to demonstrate I'm a perfectly capable nurse that they're stuck with. I can hardly hear myself think when I get tapped on the shoulder by Rietta: "I'll take the nosebleed, you've got chest pain." She points to the corner of my office where I have a teacher sitting tripod style on a chair, clearly an ashen gray green that until that point I'd only read about in textbooks. I pointed at a man and told him to go call 9-1-1 - this man later turned out to be the principal - while I sat with the gray teacher. The principal comes back to tell me that the 9-1-1 operators wanted to speak to me, but when I go to pick up the phone line, it's dead. So, I call them back, tell them we've already called, but rather than wanting to say anything to me, they tell me the screaming in the background (the nosebleed was still going strong) is too loud for them to hear anything and someone's already on their way. Minutes later, the firetruck arrives, soon followed by the paramedics to whisk the teacher out.

And that was that. I looked at the clock: ten minutes had elapsed from the time the nosebleed began. I don't know what happened with the nosebleed - when I returned from talking with the paramedics, there was only silence and a mess of blood on the floor. The unconfirmed report I received later that day was that the teacher had a heart attack. And I was only just getting started...