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.