One semester down...

One to go. I have three weeks off now, and it comes just as I am at my wit's end with chickenpox, lice, and  idiots. I am planning on going into full on relaxation mode so that, unlike after Thanksgiving break, I return well rested. Now please excuse me while I spend the next three weeks with my new roommate: 

As always, thanks for reading! Farewell for now, and cheers to more challenges and adventures in the new year!!

NOOOOOOOOOOOOO

These last few weeks have been hellish, to put it mildly. My life feels like it's been consumed by what is officially now an outbreak at my middle school, eating away at my patience and sanity. You can probably imagine how it felt, then, to be griping to one of my elementary schools about the mess it is making, and have the secretary respond, "Oh, I was going to tell you...someone came to school with the chickenpox on Monday."

To sum up my reaction in a three letter acronym: FML. It's always me.

The good news is that public health and I are really now BFFs. The bad news is that this is why I had to be on the phone at the park this afternoon, discussing procedure, once again, and why I was writing work emails when I should have been eating dinner. The public health nurse asked me if I switched over to this elementary school that I was now reporting from the middle school, and I explained, no, I oversee both schools...plus one. I am not sure what world she lives in, but she was quite shocked at this revelation. I decided when I am sick of dealing with chickenpox cases, I will ask her for her job, which apparently takes place in a land of roses and rainbows.

Kids are in school two more days, I am at work for one more day before winter break. It cannot come soon enough.

Lice Mom: the saga continues

I'm beginning to think I should start a new blog just on my encounters with Lice Mom. She came in for a "check" for her daughter, and in our twenty minutes together, I nearly lost my mind. I began by carefully checking the scalp, and found it to be nearly spotless with the exception of a posssible nit or two. I showed Lice Mom what I believed might be nits, and she said they were dandruff flakes. I agreed they might be, removed them, and continued my overly thorough check. I then made the mistake of saying what was on my mind: "I know you came here to pick up your daughter's homework, but I'm inclined to have her stay because her scalp is so clean." She looked at me with disgust, and said, "Are you kidding me?" I got a lecture about how if her daughter returns to school she will of course get lice again, which ended with, "If that happens, I will kill you." I let out an uncomfortable laugh, the kind you do when you're not sure if someone is kidding or not, and all I got was a nasty stare in return. 

 

There were many responses I wanted to give her, most of all, IT'S NOT MY FAULT. Also, if your daughter is so freaking knowledgeable about and petrified of lice as you have made her, and she is not sharing hats/combs/brushes/jackets/etc. with anyone at school, she isn't getting it at school. Period. Out of fear of retribution though, I kept my mouth shut in meek silence. I don't actually think she will kill me, mostly because she's smarter than that. No, she would do something worse, like find a way to sue me even if it's not for lice, or find out which car mine is out in the parking lot and have that destroyed. Regardless, I fear the day her daughter gets lice again, and rather than have the guts to talk back to this woman - and perhaps I should have - I emailed the prinicpal our conversation so it's at least on record. 

 

What really, really got me though, more than her threat toward me, was her attitude about letting her daughter be in school. First, when I found what might be a nit and showed her, she denied any such possibility. Then when I suggested she stay in school if her head was indeed as spotless as she insisted it was, she began making excuses, saying Lice Daughter was on the verge of a UTI and bronchitis due to stress from the lice. Then, she looked and looked, until she found a nit herself and proclaimed it as such - and therefore her daughter couldn't be at school. She'll take any excuse to not have her daughter in school, her daughter that is so shy and scared - of her mom, no doubt - it's pathetic. The situation is making me ill, but I can't think of anything I can do for her without putting myself or my job in danger.

Awwww

I'm taking Friday off, and I mentioned it to my little Spitfire diabetic so she could get a heads up:

 

Spitfire: What? Noooooooo! You can't be gone. Who's going to be here instead? Can I see a picture of whoever is going to be here instead?

Me: Um...Why do you need a picture of her? She's very nice, you'll just have to trust me.

Spitfire: If I see a picture I can decide if I like her, and if I don't like her, I'm just going to have to stay home that day.

 

She can be such a pain the ass, but she is just so cute I kind of want to pack her up and take her home with me sometimes. I'm pretty sure I'd take better care of her than her mom does.

 

And now I am left wondering how to break it to her that we're switching schools after Christmas break, and she should be getting a new nurse either right after or soon after we return in January. 

I am not making this up:

A parent sent her seeping, oozing, bump-covered, chickenpox-infested child to my middle school. "He doesn't have a fever anymore, so he's fine, right?"

AGHHHHHHHHHHHHH!!!!

Tip of the week: If your child is oozing ANYTHING, either cover it up completely or better, just keep them home. Particularly if it is a very contagious disease, like chickenpox.

To make this situation even more horrifically comical, this student is autistic, and while waiting for his mom, was angrily waving around yelling at everyone, "I'm fine!" I picture the virus being flung around willy nilly while he's doing this in the main office, which is what every nurse wants at their school.

Four more days of the little rugrats before three weeks of winter break. I hope they all stay home in their own houses with their viruses.

Lovely

Printed on the belt of a middle-schooler: i <3 doobies!

Return of Lice Mom

I knew this was coming, I just hoped it wouldn't be so soon. Lice Daughter came into my office around 11:30 this morning, saying her head was itching and she had pulled a couple of bugs out of it during class. I combed through her hair and found a few nits; just enough to be hemming and hawing about whether or not to send her back to class and claim I thought they were dandruff, or dare call her mom and inform her. Lice Daughter told me her mom was in the hospital last night, so I was thinking I'd send her back to class and tell her to let her mom know her head was itching, when all of a sudden she pulled out a bug: "See, I told you!"

Dammit. She was right, and it was crawling around on her fingers. I bagged it for evidence, and as she looked upset, told her she seemed frustrated. She responded, "It's not that. It's that my mom's going to be mad." :(

I told her to call her mom while I packed up my stuff to run off to check my diabetics. She dialed, and when her mom answered, shoved the phone at me and whispered with a panicked look on her face, "You tell her! I don't want her to be mad at me!" I got to be the bearer of the bad news, and Lice Mom was none too happy to say the least. She finally said she would come and get her, and I dropped Lice Daughter off at the front office to wait for her mom as I ran out to my other school.

There are eight more days of school before winter break, and I'd be shocked if she returned to school clean before then. I feel SO bad for this poor girl, being stuck home with her witch of a mother, and yet I can't think of anything I can do. Calling CPS would bring repercussions that none of us at the school want; she doesn't need a referral to Healthy Start either, because she takes her daughter into the doctor when this happens. There is absolutely nothing I can think of to do for her.

In other news, the highlight of the day was when a chocolate milk-covered first grader crawled into my lap as she was waiting for her mom to bring her a change of clothes, and we played some imaginary games I could barely keep up with. That, and the $71 in mileage reimbursement I received for October. At 55 cents per mile, you do the math: I'm spending way too much time in my car with this school schedule.

Today's waste of taxpayer money

I was assigned this Friday morning, but after the week I'd had, I had no qualms about putting it off until today: creating a timesheet. This isn't just any timesheet. Apparently my position is funded by two diffent accounts in the district, the general and special education funds. The state is now requiring that for positions funded by two separate accounts there be a timesheet accounting for how much time that employee spent working on things from each account. For me, this means on my timesheet I have to account for 20% of my time in special education activities, and 80% in general population activities, whatever that means. However, the directions are key: "IMPORTANT - each day should not look the same!  80% of your time is to the general population at each school and 20% to Spec Ed....Even tho' the "sample" shows each day about the same, we have been instructed NOT to do that, because no two days in your schedule are ever exactly the same. " 

I received this email in December asking me to backlog through August, and continue keeping these "logs" in the future, so I spent this morning making 5 monthly timesheets with random numbers. While I wouldn't say I'm a mathematical genius, I wouldn't exactly say basic arithmetic is a challenge for me either. Still, inventing my hours at random in an 80/20 fashion was not simple, and I couldn't help but wonder why in the world I was having to waste my morning doing such calculations. The list of kids I needed to check on, the list I always have and usually plug away at each week but wasn't even able to touch last week, keeps growing. This job feels less about the kids every day...

TGIF

This has been Mrs. Nurse's terrible, horrible, no good, very bad week. It is one thing, an experience I've been through many times now, to have something go wrong with your kids: pot cookies, parents that won't get shoes, doubting whether you made the right call on an asthma attack, or newly orphaned kiddos. It is an entirely new experience to have issues between professionals and be made to feel inept and worthless. The politics and bureaucracy that until now I've managed to stay relatively clear of impeded my ability to function in a capacity that I knew I needed to: as a public health nurse. You'd think it would be simple; I'm a licensed nurse, a licensed public health nurse at that, but the hoops I had to jump through this week were staggering. Trust me when I say this: you do not want to know where your tax dollars went this week.

There is good news about this experience: I became phone friends with the sympathetic county public health nurses, to start. I learned, yet again, to trust thyself: when I got a call on Thursday morning reporting a second case of the disease at the school, I knew my efforts were for a good cause (tip: contagious diseases do actually spread). Lastly, I was reminded what this job is really about: the kids. Given our system, it's impossible, I see now, to not get bogged down in the politics on occasion, but the reason I come to work in the morning is always, always, always the kids.

Vaccines are not 100% effective

These past two days and nights have been consumed by a case of a contagious disease at my middle school and the subsequent mess that is following it. Out of concern for my own job security, I'll leave it at this:
1. No, vaccines are not 100% effective.
2. Safety is a greater concern to me than money for the school, though not everyone agrees with that prioritization.
3. People don't like it when you disagree with them, even if it's your supposed area of expertise.
 a) Adding "PHN" (Public Health Nurse) to my email signature is my passive-agressive way of expressing my frustration.
 b) Calling the Public Health Department is my direct way of expressing my frustration.
4. IT'S THE PRINCIPLE OF THE MATTER.
5. If you're not going to listen to my input, leave me out of it completely and let me get back to what matters: the kids.

If our nursing staff wasn't so thinned out, I'd be sweating right now - I know I have ruffled some feathers. Instead, I expect that the imaginary performance review that I've never had and probably never will, will have a bit of a blemish on it.

What a really terrible two days this has been, so when the crazy mother/grandmother of my high maintenance diabetic boy tells me, out of the blue, how much she appreciates me and how much her son looks forward to seeing me every day, I want to record her words and play them back on repeat.

Wear a helmet.

One of my students, a young, pre-teen boy in perfectly good health will probably never be the same again. He was having some fun with friends at the skate park until he flipped over the handlebars of his bike and landed on his head. He was airlifted to a nearby hospital where he was first in a coma, and then had to re-learn how to eat and speak. I'm reviewing the notes from his doctor: he will have most likely have permanent critical thinking deficits. Furthermore, "one of the caveats of head injury in childhood is that as the curriculum evolves...the more obvious the cognitive difficulties might become."

 

There is the good news: he survived, he can walk and talk, and has a parent that cares. The more obvious sad part: this was totally preventable.

 

I can only hope that both he and his friends have learned their helmet lesson for good.

Answer: No one.

Question: Who appreciated the nurse's presence when she sent a diabetic home for high blood sugar/large ketones?

 

Yes, I've been watching a little too much Alex Trebek lately. My little spitfire diabetic came to me at lunch time for her check; her teacher called me to warn that she wasn't feeling well - but thought it was because of a math assignment she didn't want to do. She didn't look well, was acting funny, and her blood sugar was 410 (not totally unusual for her, but the way she looked and was acting was definitely unusual). I had her check her ketones, which uses a little color strip analysis: without a doubt, large. Oh yay. I sent her packing, probably to no one's surprise if you know much about diabetes. This decision was much to the annoyance of her teacher, who maintained she wanted to get out of class, and the secretary, who had to be bothered to find a way to let us into her classroom so she could get her belongings. This is high on the list of reasons I dislike my job: the feeling that you're pestering everyone else, even when you know you're trying to save a kid's health.

 

In other news on this first day back from a week off that was far too short for me:

1. Lice Mom brought her daughter in: Lice Daughter is cleared!! (I am now accepting bets on how long it is before Lice Daughter gets it again - and the hell I will have to pay when that happens.)

2. A record number of kids with wet pants came in today. Apparently they forgot how and when to use the bathroom while at school.

3. The hugs some of these kids give me just for keeping them company or giving them an ice pack makes up for teachers rolling their eyes at you when you tell them a student is going home.

Vacation, and not a moment too soon

When one thing taking up all of my time (Lice Mom this last week has been unusually silent - and Lice Daughter is still out of school, four weeks later) disappears, another always fills its place. This week, Lice Mom's absence was filled by a bus driver up in arms claiming that one of my middle school students with muscular dystrophy that rides the bus is a liability due to his inability to keep himself in his wheelchair during the bumpy ride. To quiet everyone down, I said I'd take a ride myself with him to see how it really is. That's right, your tax dollars at work: the school nurse rode the bus to school. As I had imagined, it was not a big deal at all - the .8 mile ride no bumpier for Mr. Dystrophy than it was for me, and furthermore, I believe everyone is treating the kid like an invalid when he's totally not - he is a sassy preteen boy who happens to use a wheelchair. On top of that mess sucking up a great deal of time between earfuls from the bus driver and assistant prinicpal, a nurse is leaving me, and a couple of my kids were orphaned by one atrocious tragedy. I'm leaving that mess out of this blog, but let me just say that the circumstances are terrible enought to make most rational people lose their appetite. Four children are suddenly without parents. The week has been so draining that the other night I fell asleep at 8:30 pm. Yeah, break, please. I'm going to need to come roaring out of the gates when we return on the 28th, without my favorite backup. Happy Thanksgiving and please, may all the families of my kiddos remain intact.

They speak the truth

Leave it to a kindergartener to call you out on things you'd rather not have announced. I had a little guy in my office after he got sick in the cafeteria, and as I was getting a headache myself, I reached into my purse to take some ibuprofen. He said, "I don't take pills, and if I do, I have to take water with it." Trying not to draw attention to the fact that I carry medicine, I kept my own pills enclosed in my hands. I took a swig of water as I (I thought) slyly swallowed my headache relief while agreeing with him that you should drink water when taking pills. Loudly, as all kindergarteners speak, he exclaimed, "I just saw you take a pill!" just as a teacher was walking in to use the laminating machine. Thanks, kid.

Flying solo

I usually try to leave the interpersonal stuff I deal with out of this blog, but I can't help it today: our veteran nurse is retiring tomorrow, and it is giving me a most unsettling feeling. Ms. Retiring has been in the district for nearly 40 years, and, like myself, started when she was fresh out of nursing school. She knows her stuff, to say the least, and gets her stuff done. Everyone knows if you make ten women work together they won't all get along, and as I've discovered since I started working here, Ms. Retiring has been a source of controversy. Her and I, though, get along so well and think so alike that soon after meeting, people started referring to me as her long lost daughter (she doesn't actually have kids, which makes it that much funnier). For the past year, I've gone to her for too many times to count for a second opinion. The answer, if I get one, is always the same: backing me up and reminding me to be confident in myself, and to not let others make me second-guess myself. If I don't get an answer, I realize in the end it is because she knows I can figure out the answer on my own, and I do. Though we rarely work side by side in this job, I credit her presence in the district as saving my sanity more than once. We leave for Thanksgiving break tomorrow, and when the rest of us return, she won't be. I'm very close with another nurse who thinks along the same lines as Ms. Retiring and myself, but I really do not feel ready to be left alone, as it will feel without her. Gulp.

Sirens at last

If you've been wondering where all the emergencies have been this year, as opposed to the wildly eventful year I had last year, I keep missing them. While I was out sick, an elderly substitute went down in a dramatic fashion the other week: reportedly clutched her chest, eyes rolled back, and onto the floor she went. It traumatized the students a bit, but she was okay - a heart attack, I heard. Today as I was pulling up to one of my schools to check my diabetic, I saw my normal parking space in the loading zone was taken - by a firetruck and ambulance. Lovely. Turns out a teacher called 9-1-1 for an asthma attack, prematurely so, according to the prinicipal. Though I usually like to err on the side of caution when it comes to breathing, I'd go with the principal on this one: the kid was screaming his head off. If you're screaming, you're breathing. 

However, my agreement with the principal was in stark contrast to last week, when an incident occurred that left me with such a bad taste in my mouth that I didn't even want to go home and write about it. I had a kid in my office having an increasingly distressing asthma attack. We called home, and mom contacted the babysitter to come pick him up. I'm not sure where the babysitter was coming from, but it wasn't anywhere nearby, and as the minutes ticked on his coughing was getting worse and people were staring at me asking what I was doing about it. He started sweating, but his color was still good, and he was still talking, so I sat with him until the babysitter came in. In the meantime though, the secretary came in more than once and told him "it's just a tickle in your throat, you need to stop coughing." Um, kids die from asthma, and it's not really a tickle in the throat. I was quite sickened by the comment, because although in this child's case he did turn out to be fine, I've witnessed the other direction such an attack can take. It's not pretty. Along the lines of, "If you don't have anything nice to say, don't say anything at all," I think there should be another important guideline for speaking: If you don't know what you're talking about, don't say anything at all.

Yay Monday.

By 9 a.m. this morning, I was asked to file a CPS report for a case of neglect, heard that Lice Mom is claiming she's waiting on my "okay" for her to bring her daughter back to school (um...my okay depends on whether she still has lice...we've been through this for almost three weeks now), and heard that two siblings at one of my schools were orphaned over the weekend by a murder/suicide following a domestic dispute. They're in second grade and kindergarten, and the younger still doesn't know.

 

What a lovely start to this week.

G is for (bad) grammar

"Reason for retainment" section on an actual form filled out by actual adults (parents): Due to not being unable to read on seacond grade leavel. School didn't have any Reading interventions. So they pashed her back one grade.

On a related note, I helped screen 8th graders this week. I was sharing vision duty with another nurse, her on a lettered Snellen chart, while I used a shapes Snellen chart. The choices were an apple, a house, or an umbrella the whole way through. It's actually used for kindergarteners, but I figured these kids wouldn't even notice the insult to their intelligence; I was right. The other nurse was struggling to test the kids until we realized what was taking them so long to pick a letter: it wasn't that they couldn't see it, it was that they had to recite the alphabet to themselves in order to figure out what letter it was - many, and I mean many of them, could not pick out the letter "R" without singing to themselves. Please cross your fingers for our future generations.

Cheers to our veterans and a three day weekend, signaling the start of the holiday season at school: Veterans Day, Thanksgiving break, Christmas break, etc. Cheers also to me for becoming a first-time homeowner today! (Dealing with these weirdos has to get me something, right?)

Lice Mom: the bane of my existence

I had another encounter with Lice Mom this morning, a followup to last week's encounter on Wednesday. Last week she brought her daughter in for a lice check to see if she could come back to school, and I sent them packing with what I would swear on my nursing license were nits, she took her daughter to the doctor to examine her. The doctor reportedly "flipped out," saying there was nothing in her hair but dandruff. "HE EVEN USED A MICROSCOPE, AND I HAD ALL THE NURSES AND M.A.'S AND DOCTORS IN AT ONCE LOOKING AT HER," she implored. I said okay, keeping my mouth shut from what I wanted to say, which was, "He didn't see anything because I took them out myself. You would have seen me doing so right in front of your face if you weren't such a tweaker." So I nodded, and we continued looking through her daughter's head. Lo and behold: a bug. Very dead, but a bug nonetheless. We looked again, and this time found a live one. I put them in a baggy for her to take to her daughter's doctor so he could examine them under a microscope, claiming my eyes were too bad to tell what they were.

There were a few things about this morning's encounter that made it particularly miserable. For one, when she came in at 8:45 - 35 minutes after school started, claiming she didn't think the nurse gets to school on time (thanks), I started looking the clock. I leave at 9:10 to check Spitfire diabetic, so I figured that would be my escape - until her teacher called to say she was absent. Crap: I was stuck with her, and I stayed stuck with her until 9:30 when she finally sauntered out to talk to the polling precinct people in our hallway today. You can probably imagine her reaction when we discovered the bugs, first dead, then alive: I will just say, totally inappropriate in front of a fifth grader. Then, as I had my back turned trying to get real work done, she called her doctor's office to schedule an appointment so he could examine the bugs. She was totally pleasant on the phone and then hung up, and said, "What a bitch. No, I'm just kidding." I don't care if you're kidding or not, I wouldn't say that's appropriate in an office where kindergarteners frequent. Also, when she was yakking at me about how the doctor flipped out and couldn't believe the nurse (me) misidentified lice, she said he will be "reporting me to the CDC." I have a hard time believing the Centers for Disease Control will actually care that lice exists, but she can go ahead and have my nursing license number if it helps. The worst part of all was the bugs that were found: it means these encounters will continue until no more are found, and I'm beginning to feel like I will never get her off my back - her daughter will go to middle school next year, but I'm at that one too; and still, no school for her little girl. 

Lice Daughter has now missed two weeks of school.

One for the refrigerator

It's been a long week: Lice Mom breathing down my neck, an asthma attack of the caliber that I had my hand on the phone to call the paramedics just as mom ran in with the inhaler, teachers angry about IEPs, the list goes on. So when a goofy acting girl comes in and hands me this, I smile:

Then I opened the letter:

All I did was check her eyes and send home a vision referral - not a big deal, I do it all the time. (And most kids hate it, because glasses are probably on the way.) Well, it was a big deal to someone, and she took the time to write me a letter about it. Pretty much the sweetest thank you note I have ever received.

Twilighting

We like to say we're in the Twilight Zone in the area I work in: it can be just SO weird. I was "twilighting" yesterday, big time:

1) I was stopped at a stoplight on my way to check a diabetic when out of the van next to me hopped a middle-aged woman in a bra and yoga pants to fix her wedgie. (I'm not exaggerating. Black lacy bra, yoga pants. That was all.)

2) Lice Mom returned for another lice check with her daughter. I stood up to check her daughter's hair, and as I did, she sat down in her track suit and Ugg boots at my desk. She proceeded, sitting at my desk, to talk at me for a solid twenty minutes - even answering a phone call while she sat there. When I finally got her out of my office, she asked her daughter to retrieve her purse so she could show me the prescription for some lice treatment. (Sorry parents, I don't care what chemicals you've put on your child's head; if they have lice, they have lice.) The daughter returned with it and a 6 week old kitten that apparently had been sitting in their car, and the mother pulled open her purse. She caught a bottle of marijuana buds just as they were about to fall out. (I'm in California, and they were in a presciription bottle - I have no doubt she has a medical marijuana card, so I didn't question the contents.)

3) A father came to the office wearing a bright blue suit, bowtie, and bluetooth in his ear. Halloween is over, man.

And this is why I commute.

Teacher's Notes

Teachers usually send notes with their kids to explain why they're coming to my office. Sometimes, the hilarity of them makes my day. A sampling:

"Pls give Jane ice for her finger. She doesn't stop complaining. Mrs. D."

"Throwing up" [I like it when they're right to the point.]

"Ice for boo-boo" [Maybe the kid speaks that language, but in a note to the nurse?]

"Something stuck in ear?"

"Joe is sick." Then, an hour later, "He's still sick." [Okay, fine, he can call home.]

We have a winner!

Thank you all for participating in the drug handbook lottery, but unfortunately I can't afford to give one to everyone. (Actually, it's the generosity of the publisher, Wolters Kluwer, that's allowing this to happen. Thank you, Meredith!) So, by lottery, we have a winner: Pam M. Congratulations, Pam, and please contact me to get your prize!

Happy Halloween!

First, a news articles that captured my attention: this one. I find it a tad odd that a parent can have a child taken away for forgetting to pay for the $5 sandwiches they ate while shopping, but in my experience a parent can let their kids have pot cookies, neglect them terribly, etc. and still be together. Obviously a mistake was made here, and that's why it's on the news, but still. Maybe I can hope more of my parents will shoplift with their kids.

 

Second, Halloween at an elementary school is awesome. Not only are the kids adorable, particularly in the morning kindergarten parade, but I had a record ZERO phantom or real stomachaches. Everyone was way too happy and distracted by the costume chaos to feign illness, I suppose. 

 

Stay tuned for the drug reference handbook lottery result! 

Whatever it takes to get them out of my office

I have a first grader (Head Shunt boy) who for some reason reminds me of Mario of Mario Brothers, with his tiny body and oversized head - minus the mustache, of course. He is one of the most talkative kids I have ever encountered and everything is a challenge with him because it is impossible to get him to focus on a task. "Mario" has become a frequent flier, complaining of various ailments that he can never quite pinpoint. Today he came in with a stomachache, saying he needed to call home for medicine. With some kids it's easier to just call home and let their parents duke it out with them, so as he stood way too close, spitting all over my phone (and ignoring my "see, you need to step back because you just spit on my phone" requests), I dialed home. I reached his mother, what I imagine must be the most patient person on this planet, and told her I had her son wanting to talk. After prancing around my office while I had to tell his mom, "Well, he wanted to call, but now he won't talk..." he finally took the phone. He talked with her briefly, and when I asked to talk with her, he hung up. I asked what she said, and he answered, "She said stop running around and go back to class and call me later." I told him I agreed, and asked what time she said to call back. "3:30," he replied with confidence. I quickly agreed and sent him back to class, and told him he could return at 3:30. School lets out at 2:10.

Down for the count

The germs finally got me. After feeling well since school started (an amazing track record after last year, when I felt like I woke up with a sore throat more days than I didn't), I woke up last weekend with the dreaded sore throat. Things worsened through the week, and I realized I needed to go home on Wednesday morning when my little 3rd grade diabetic told me I looked and sounded terrible. I decided I would go home after I checked my diabetics at lunchtime, and was dreaming of snuggling under my covers when, while with my diabetics, I got a call from my other elementary school. Those people wouldn't know an emergency if it was screaming at them in the face, so I answered the phone with dread: what could they possibly be calling about? They were at wit's end, and a parent was demanding she talk with me about the lice situation at our school. I told them I was trying to go home sick but fine, I would talk with this lady: I knew exactly who this was and could not in good conscience just leave them with that lady.

I met Lice Mom shortly after, and immediately regretted agreeing to do so. She launched off on a tirade about how the school is infected and I'm doing nothing about it, she has a list of 23 students that have lice at this school, and that she was thinking about reporting me to the public health department. (Ha! As if that could scare me: it wouldn't be the first time.) I had to ask her to repeat a couple of things because I was so congested I could hardly hear, and when she looked frustrated at me for having to repeat herself, I explained I was ill and how "sorry" I was that she was having to repeat herself. Apparently that was the greenlight for her to go off about her reported pneumonia and kidney infection, as well as what color her urine was that morning - which her daughter so helpfully chimed in with (why does a 5th grader know what color her mom's urine is?).

No matter that her daughter's hair had been so poorly combed through that it wasn't just full of nits, but actually had live lice too. This woman just needed someone to blame, and I suppose give me a heads up in case the public health department calls. I meet many crazy parents, and crazy in many different ways, but in all cases I mostly feel sorry for the kids. In this case, Lice Mom said she is keeping her daughter out of school until all treatments are complete, despite my repeated explanations that she can come back before treatments are finished if she is nit-free (but that would involve spending time combing through her hair instead of complaining). I don't really care if parents are crazy, but it's the kids that suffer.

Free drugs!

Okay, not really. But free information about drugs, really, in the form of a drug reference handbook: keep reading and enter to win a copy! Wolters Kluwer Health, the publishers of a drug handbook reference that I'm sure many are familiar with - past editions, if not this one - sent me a copy so I could step up on my pedestal that is this blog and write about it: Nursing2012 Drug Handbook.

It's been awhile since I've had my hands on an up-to-date drug book, and oh what fun it has been flipping through this one! Besides its bright shiny pink cover, which is a plus in any messy office, the inside is pages and pages of readable text on every drug I could think of. For every drug, there is complete information including adverse reactions and interactions, just as you'd expect in a reliable drug handbook. Equally important as the content is the fact that this is a totally readable text: a pronunciation guide for those weird looking drugs, black box warnings easily found, and, a pet peeve of mine solved, pages that are not so thin you can see right through them. Drugs are arranged alphabetically, which is my preferred way to find them, but is not for everyone. In the middle of the book is a small "Photoguide to tablets and capsules." It's not something I think I could use easily, but if you're double checking you're holding the right drug - and it's one of the 396 tablets represented in the pictures - it could be useful. As a nurse who spends most of my time in front of a computer, the most handy part of this book isn't in the actual book; it's the subscription to Lippincott's Nursing Drug Advisor that can be found online. A free one year subscription is included with the purchase, and, let's face it, Google should not be your source for drug information. The online drug advisor includes all the information in the book, is searchable, and you can limit the information you are looking for (e.g. adverse reactions), so as to not be overwhelmed. All in all, it's no wonder that this is the bestselling drug handbook for nurses.

Also, if you're wondering why the pink little bookmark ribbon, it's because the publishers are donating a portion toward breast cancer research via Susan G. Komen for the Cure. And if you're interested in updating your reference bookshelf with this book, you can buy it here, for 20% off.

And finally, if you've made it this far and want to be rewarded, here's your chance: leave a comment with how you can use a drug reference book in your life and you will be entered in to win a free copy for yourself! Contest closes October 31st at midnight EST; a winner will be chosen by a random number generator. I'll announce the winner then, and you'll need to contact me with how to claim your prize - no claim within 24 hours and it'll go to the next person by lottery, so be sure to check back on November 1st! One entry per person, and karma bites, so no cheating please.


Disclaimer: I received a free copy of Nursing2012 Drug Handbook from Wolters Kluwer Health for review; however this review is entirely my own. You can make friends with them yourself here or find them here.

The Great Divide

Most of you know that I have two schools in the hood, and another one out in suburbia. The contrast between the demographics is amazing: in one area it feels like every phone call I make is a disturbance to the parents; in the other, parents are breathing down my neck and demanding to see accident reports. In one area, a white girl like myself is like being "a fly in a bowl of milk" as my health clerk calls me, in the other, I have not once been able to practice my weak Spanish skills. But the difference between the demographics is never more apparent than during special events/days/weeks. For example, on September 11th, my suburbia school got a "field trip" to walk to the park next door to meet some firemen transporting a piece of steel from the World Trade Center. Back in the ghetto, there was nothing. It's Red Ribbon Week, and in suburbia, every child is wearing an "It's my responsibility to be drug free" ribbon, classroom doors are decorated, every pillar has a red ribbon tied onto it in a lovely bow-tie, and there was an assembly that supposedly incorporated an anti-drug message into a skateboard/bike demonstration - including a half-pipe set up on the blacktop. Back in the ghetto, there's not been a single mention of it. I know that suburbia kids need to hear the anti-drug message as loudly as the ghetto kids, but I also think the ghetto kids need to hear the message as loudly as the suburbia ones do. (Yes, I said equally loud. There was a time - before drug training - I'd have claimed my ghetto kids needed it more, but kids of all backgrounds are users, just different kinds of drugs. Ritalin, anyone?)

Just another Monday...

Arriving first thing in my inbox this lovely Monday morning: an email from a teacher, subject line "Smell from student." Yay.

Happy Food Day!

That's right, it's Food Day! Who doesn't like food, right? This isn't the first Food Day, and hopefully it won't be the last. (You'll have to do your own homework on it, because I'm too lazy to summarize it for you.) I'm excited for all the many places that are having events for the big day, unlike my own schools, and I'm going to add this to the growing list of things I would change in my own district if I had endless time and energy to make all the changes I wanted to...Yeah, I'll keep dreaming.

Crushing

A little boy came to my office complaining of a stomachache, so I told him to lay down for a few minutes on the cot in my office. After a few minutes, I asked if he felt any better. He said it was still "a little bad" so I told him we could call his mom. She didn't answer, but he decided he was well enough to return to class, and off he went. A few minutes later, his mom called to ask if he was okay. I told her why he'd been in my office, and she laughed: "You know, I think he has a crush on you...He only goes in when you're there and when he gets home he is always fine and wants to tell me about you. I'll have to talk with him when he gets home today."

Lolz. A second grader with a crush on me? It's almost cute, but also just weird. (In the lawsuit riddled age we live in, I told mom I'd be keeping him out of my office unless he was really sick or injured.)

Unrelated, we are having some personnel issues in our district with a nurse soon retiring and one soon on disability. We're being stretched quite thin, and there's a forecast for four schools in my future. While I am totally ready for it, it's mostly disappointing for the kids' sake. :( At least it's the weekend - happy Friday!

Edit: It's less than a happy Friday. No thank you to the a**hole who scratched the school nurse's car this morning. :(

Would you call a parent please?

Mrs. X called concerned about [her daughter] needing to use the restroom as needed during her cycle. [The principal] asked me to have you call her.

This is an actual subject line and email I received from my middle school's secretary today while I was at another site. Sometimes my job cracks me up. (I haven't been able to reach Mrs. X but can't wait to hear the full story.)

Screenings.

Performing hearing and vision screenings on approximately 160 eighth graders in one day is exhausting. Managing hormone crazed, know-it-all teenagers is no easy task and I'm not quite sure how teachers do it on a daily basis. But performing such screenings when your LVN (that is supposed to cover your diabetics twice during the day across town for you) calls at 8:45 am when school, and therefore screening, starts at 8:55 am to say she won't be able to help you today makes the day even tougher. Then when you can finally steal a lunch break, and you check your email to find a teacher whose classes you screened last week has sent a nasty letter, cc'ing the principal on it, complaining about how disruptive your state-mandated screenings are, that just doesn't help your day. When you just want to go home and sit down with a cold beer watching Game 1 of the World Series, and your day has been so terrible that you wonder why you even bothered to go to extra school to do such a crappy job, a parent might call you. A parent that you used to hate (Epilepsy Mom), but has since fallen in love with you, and came to drop off - albeit very belatedly - a seizure care plan for you as well as to thank you for your support - well, somehow, that makes most of the mess worth it.

Laughter is the best medicine

Today was a sad day for two reasons. My little Spitfire diabetic has a mother and a step-father - her second step-father - and spends every other weekend at her "real" dad's house. I had figured this out myself when one day her teacher told me she couldn't say the specifics, just that she knew little Spitfire would no longer be staying at her dad's, and suggested I google his name. I did, and what I found was disappointing: Spitfire's dad was involved in a high-speed chase in the wee hours of a Sunday morning, and the people involved were arrested for various things including driving under the influence and resisting arrest. Spitfire hadn't mentioned it to me until today, when she saw a newspaper. For some reason hearing her talk - brag, nearly - about her dad being in the paper a few weeks ago just made it that much worse. :(.

I also received bad news about another parent I know, and will never forget. The mother of my favorite twins is in the hospital with severe burns. (Rumor has it there was a kitchen fire and, no one else's surprise, it didn't get smothered when she poured water on the grease fire. I believe that she'd pour water on a grease fire, but I'm not convinced she wasn't concocting something illegal.) She's been in there for two weeks already, and has had multiple surgeries and is expected to have several more before being discharged for rehab - assuming she makes it. I don't know who is taking care of the little girls, but I don't know how they're ever going to make it in life. Double :(.

I was feeling pretty bummed until Spitfire interrupted my moping to ask if I had any grandkids. Never in my 26 years have I been asked about having grandchildren.

Reason #84 I like my job:

Drawings delivered to you after school, just because. :)

All in a day's work

I screened kids that were absent during last week's mass screening all morning, in between curing or sending home the miscellaneous "not feeling well" kids. There was a calm before the storm, and then lunch hit. Tetherball accidents, soccer ball accidents, zip line accidents, and more. At one point a group of five screeching children came in all demanding ice packs for reasons varying from back injuries to splinters. In the mess of things, a kid came in complaining a soccer ball hit him in the head, a student with a shunt in his head, one who though only appearing to be about 3 foot tall has a voice that can carry like a football player. Shortly after, another kid came in - escorted by a teacher, which is never a good sign - saying he "bashed his head in" after a zip line accident. His head looked mostly fine, until I took a look at his eye: it was bleeding, and he was yakking about how he just had surgery. Bleeding Eye kid also happens to have ADHD to an extent I rarely see, and absolutely never stops talking. (And don't ask him if he ever stops, because he'll ask why you're asking.) So, together I had yelling Head Shunt boy and Bleeding Eye kid in my office with head injuries. Frantically, and magically, I was able to make contact with parents in both cases and they were on their way. Still...It was a solid twenty minutes of nonstop yelling in my office, because when you get two yelling ADHD kids who just cannot stop talking, it turns out that 1+1 does not equal 2...It was more like having ten wild children in my office, all screaming about something. Head Shunt boy was picked up quickly, while Bleeding Eye kid's parents took a little longer - or maybe it just felt like it. While still being shouted at by the impatient Bleeding Eye kid, I was summoned down the hall to find a student on the ground, supposedly unable to walk. Little Ms. Drama Queen complained of not being able to feel her legs after hanging upside down on the monkey bar. By now it was far past what my stomach thought was lunchtime, and I was in no mood for this girl's antics. I told her my assessment of her injury (there was none, and she was pretending), and why, and then proceeded to give a lecture about how it can be dangerous to lie to the nurse. She broke down in tears, told me other kids were teasing her and she just didn't want to be in class (and when I asked her to name the attackers, one of them was her friend that had summoned help). I told her I'd tell her story to the principal and walked her back to class, and, after several more "not feeling well" cases, was finally able to sit down to lunch, nearly two hours after the storm hit.

 

This is a very run-on paragraph to repeat the point of this blog: school nurses do actually do things sometimes. When I had multiple head injuries sitting in my office, both potential 9-1-1 calls, everyone was looking at me to call the shots, and not a single person offered to help any of the other munchkins that were streaming into my office at the time. When I went to retrieve Drama Queen, the principal was with her, but after a few minutes of not getting anywhere with her said he was hungry and left her with me. I am not complaining about either of these things, I am just here to report that I earn the leeway in my job, because when the pressure is on, I'm standing alone.

 

Note: If you're wondering why 9-1-1 was not called for those head injuries, mother of Head Shunt boy asked that I let the emergency contact pick him up and take him to a doctor unless he was showing immediate signs of trauma, like slurred speech - he was not (and I could hear him loud and clear). Bleeding Eye's dad told me his eye was already bloody still from the surgery - but since I didn't know what he looked like before/after, and that's not really the kind of family I want to be the target of a lawsuit for, I asked that someone pick him up anyway.

Politics

I usually try to stay out of them, but this bill that was recently signed made me about as disappointed as I get when it comes to this stuff. (I was concerned enough to actually write a letter to the governor about it - a form letter suggested to me by the School Nurses Organanization, but a letter nonetheless.) There are so many problems with this, it feels a bit ridiculous. To start with, who invented a medication for grand mal seizures that is administered rectally? Has the inventor never witnessed a grand mal seizure? As someone who has, I'm not sure how this would even work. What's worse is that this is supposed to happen at school: a public setting, with children and teenagers, mostly connected to the digital age with cell phones. Can you imagine the youtube videos that would be posted when a high school math teacher has to pull down a student's pants during a grand mal seizure and poke a medication up her rear end? Or the liabilty of suggesting, say, an old man teacher touch one of his young female students, much less access her rear end? Neither can I. And yes, I may be biased, as this is just one more thing that used to be reserved for nurses and now everyone can do...But still...This just seems stupid.

TGIF

This morning a girl came in with severely chapped skin under her lip, from licking her lips and seeing how far her tongue could reach (she did a lovely demonstration). After searching my office for some non-medicated barrier I could put on it to no avail, I told her she'd have to ask her mom for lotion when she got home. Her response: "My mom doesn't have money, she can't buy anything. She works and so does my dad but they don't have no money ever." <Sigh...> Something to add to my growing shopping list.

Also this morning, a kid came in with a bloody nose. I knew it wasn't his recess, so I asked how it started. He told me he was sitting on the class rug and it started. I asked where his fingers were when it started, and he shrugged; then I asked if anything might have been in his nose when it started. With a sheepish smile he pointed his finger: this was! Well, buddy, that's what you get for sticking your fingers in your nose.

Still this morning, I received an email from a secretary at another site letting me know a parent was none too happy that her daughter came home Monday with a sprain while the nurse had only given her a bandaid. Apparently I just read the teacher's note that said she needed a bandaid and in the whirl of what is often the state in that office, didn't question her for any other injuries; later, mom ended up taking her to the doctor's and getting x-rays. There are plenty of things I can think of in my defense: that x-rays are taken for the most ridiculous of complaints as a CYA thing for the medical office, that you should stop babying your 5th grade daughter, that just because your doctor diagnosed your daughter with a sprain does not convince me she has a serious injury when the injury happened on Monday and she is only coming to the office to ice it for the first time on Friday, etc. Bottom line, still: oops, a big oops in this neighborhood, and I feel pretty crappy about it. Yay... This is perhaps the 3rd time this year that a parent has complained about the healthcare at  that school (though I believe only the first I was at fault), and it's a reminder to me that I do prefer the lower income areas where parents can hardly be bothered to clothe their children, much less complain about the school nurse. Gah.

Though I may not work the longest hours, this stuff is why I get home exhausted, especially by the end of the week. Other nurses have warned me: this job will suck the life out of you if you let it. I haven't even had the energy to touch on what happened Wednesday, but the short of it is that I had a diabetic in my office with a blood sugar of 48, and for the first time heard that this has been a pattern for the last three weeks - once reaching a low of 37 at school. You read that right: three weeks into a very alarming blood sugar pattern, the nurse finally finds out. Go me.

Edit: The mother who was complaining about me, and, possibly, might be interested in filing a lawsuit against the school about the incident, has reportedly explained her obesity by saying, "I had a C-section and when they sewed me back up they put too much air in." That statement made me feel a lot better about her complaint...

These are the people taking care of your children:

I had a full day of screening 2nd and 5th graders at one of my elementary schools yesterday. In the morning, we called a classroom and asked the teacher - a substitute - to send half of her class down to the nurse's office to begin screening. Her response: "Should I come with them?" 

Yes, and leave the other half of that 5th grade class alone in a classroom. Great idea. 

Artifacts from an archaeological dig:

I dug deep into the bowels of my office cupboard, and found these: a 14 minute cassette and film reel called, "Why Do Girls Menstruate?" It's courtesy of o.b., dated 1975. If I had a tape player, I'd totally put this in and follow along with the reel, where I see pictures of girls skipping around and lazing in the pool. I also think o.b. should probably get a new marketing department given the advertisement appears to have not changed in over 35 years.

What is not fun...

Is receiving a phone call five minutes before the release bell rings from a parent that you had called two hours earlier, when her daughter had come in complaining of something in her eye. I had her flush it well and was sure it was fine. Nonetheless, it gets your heart pounding when you have a mother questioning what exactly you flushed her eye with (does she really think schools can afford saline solution?) and for exactly how long, especially when you don't feel you should say what you're thinking: I had a child in that had fallen flat on his back and hurt his head, who was a higher priority than some dust in a clearly neglected child's eye, who was probably seeking attention (I can say this, I know this family). I wasn't about to say I had my back to her daughter as I was trying to reach a parent for head injury boy, and just kept telling her to flush without paying much attention. Instead I told mom she flushed it out for twenty minutes while she was in my office, which was acceptable until she said, "No one actually flushes their eye out for that long, come on, really what did you do?" Really, I made the girl flush it until she said it was all better, and by "flush," I knew the girl was actually just dabbing her eye while watching the rest of the activity in my office, but I also wasn't about to tell the mother that I thought her daughter was an attention-seeking freak. Somehow I managed to placate her enough that she let me hang up the phone, and as I did I thought to myself: buying that liability insurance that I just did will indeed let me sleep better at night.

Less than business casual

On the rare occasion I have to make an appearance in the district office, like when I was unexpectedly called for a meeting with my boss the other week, I always feel underdressed. For example, on the day I had to meet with my boss I showed up in jeans and a t-shirt, and although it was a school shirt, I felt tiny compared to my boss, who was in a suit.  Sometimes I want to explain to the district office people: look, I'm not wearing anything nice because I work with lice-ridden, bloody, puking kids, but I always think it'd be a little weird if I offered up such conversation.

 

Yesterday I happened to be wearing some nice sandals and left my hair down, which is well past shoulder-length. As luck would have it, a tornado of children blew through my office at lunch, including the bloodiest of bloody noses I have ever seen. The kid had dripped a trail of blood in, it was coming out his nose like a faucet running on high, and he didn't know what to do about it. (Neither did the several other kids in my office, one of whom started to go pale looking at the bloodied child.) I spent the tornadoed time cursing myself out for choosing to wear my hair down and sandals that day, just one of less than a handful of days I've ever done so in the past year. I wished I could take a picture of the floor of my office, which looked like a violent crime scene by the time it was all said and done, to send to the district office employees to show them there's a reason I wear what I wear.  

 

And in other duties as assigned: I held onto a tiny little dog shaking in my arms until my arms couldn't hold him anymore while we waited for his owner to come. He was found in the school parking lot, apparently not the first time he's come to school for a visit. To no one's surprise, I was the first to volunteer for the task; my only complaint is that it happened on the same day as the bloody tornado, the one day I wore something nice, and I got covered in dog hair.

"Walmart will never be the same,"

said the highway patrol officer as he began the two day training I attended, Drug Impairment Training for Educational Professionals. That's right: I somehow convinced my boss that I was worth $100 and two days of being absent at work to get trained on recognizing people under the influence, and that's where I went instead of to school this Monday and Tuesday. I haven't attended many similar trainings/conferences, but this one certainly exceeded my expectations. First, the food was actually decent and there was plenty of it - always key. Second, the presenter was one of the best presenters I've ever encountered: engaging, and more than that, inspiring. I have never met someone so passionate about his job. Third, the material: totally eye-opening. I don't consider myself that far removed from my kids (and some of them don't either, see previous post), but I was totally clueless about a lot of things before this week. AXE body spray? Yeah, that's an inhalant, a very widely used one. When boys are spraying each other and giggling, they're not just being boys, they're getting high. Just on the way home, I passed by a whippit in front of the high school, something I'd have thought was just weird trash on the side of the road before this training.

We were well quizzed on signs of impairment, like pupil dilation and bruxism, and while I can't claim to be a Drug Recognition Expert, I do feel these days were two days very well spent. Many props to the California Highway Patrol for presenting this training. The officers there were totally human, and from a public relations standpoint, they could not have presented themselves in a better manner: down-to-earth, intelligent, professional, and with a good sense of humor (as they munched on donuts this morning). 

**Note: this "rave" (pun intended - I learned more than I ever thought I needed to know about raves in this thing too) review is quite biased for a couple of reasons. One, I was able to fulfill my life dream of biking to work today, and unless you know me personally, you can't know just how great that was for me - flies, 90 degrees, loud trucks, and all. Two, I love law enforcement: it's exciting, it's fun, it's rewarding, and I don't think there is anything else necessary, besides nicer uniforms. In my next life, I'll be a big, burly man cop that gets to carry around a gun. For now, you say you'll pay me to spend two days hanging out with highway patrol officers? Yes, please. 

Thanks?

I was outside talking to an aide about a student when another student approached us and asked if we were in line. For lunch. For the 8th grade lunch. Because I look thirteen.

 

I am not complaining though, because I do prefer this over what the kindergartener said to me the other day. I entered the class just as they were lining up at the door. The girl at the front of the line, eye level to my knee, poked it and asked, "What happened?" I didn't see any marks, so I figured it was the freckles, and told her so. Then she pointed up at my face, and asked, "What happened to your face?" Um...I was born this way.

Growing Up Too Fast

I picked up a first grader from class to do a vision screening after the teacher reported he looks cross-eyed. I recognized him from kindergarten, and made some small talk on the way to my office:

 

Me: How are things going this year?

Cross-Eyed Boy: Not so well, I'm kind of sick.

Me: I'm sorry to hear that, buddy. What doesn't feel good?

Cross-Eyed Boy: Well, it's almost the one-year day of my uncle's death. He died in a car accident. Everyone is kind of stressed out about it at home.

Me: Oh...

 

-------------------------------------------------------------------

 

A pair of fifth grader girls were sent to the principal's office today after being caught writing "sexual notes" as they confessed to everyone who asked what they were doing sitting in the hallway. Super.

Tdap update:

I am sure everyone has been anxiously awaiting the result of the expiration of the Tdap extension. For those new to the game, this year, California required all students entering 7th-12th grades to receive a Tdap, or whooping cough, shot or else they would not be able to attend school. Over the summer, the governor signed a 30-day reprieve, a break that ended last week for my schools. On the first day of exclusion, we had 12 students still missing the shot; today it is six (after at least one student was saved from the exception to the rule - homelessness). The six can be accounted for by the following:

1. One student who only sometimes comes to school anyway.

2. One student whose parents can't be bothered to get her the shot, nor come to the school to sign the waiver, nor even come to the school to add an emergency contact - a teacher and family friend - to her card that would allow the teacher to be able to help her in an emergency, or, in this case, get her the shot.

3. One student who told me he received the shot the same time he received a TB test, except he only brought in the TB record, and would apparently rather stay home than bring in the other piece of paper that I need.

4. One student who has an appointment next week because at the one that she had before, well before the reprieve deadline, her mom brought her in late and they were forced to reschedule.

5. One student who has had the shot, and I've spoken with his mother to confirm this, but isn't bringing in the shot record. Rumor has it that he's really disliking school this year because it's hard to get around for someone of his size and this is an easy excuse to be "forced" to stay home.

    a) I believe it, because this kid is quite large and I can't imagine it's easy for him to get around; he's always huffing and puffing when I see him even if he's just standing around.

     b) What kind of parents allow him to do this?

6. One MIA that no one's sure about.

 

Several hundred down, just a few to go, but these last stragglers are taking more time and effort than all the others combined.

24

My phone rang on Wednesday at 4:15, just as I was kicking up my feet for my after-school snack. It was the district office calling, and my blood pressure skyrocketed and I anxiously waited for the voicemail. It was someone in Special Ed, calling to tell me about a student that would be starting at one of my schools tomorrow. I am not exaggerating when I say this was what she said: "This girl has something wrong with her neck and she can easily get hurt and it may be fatal, do you think she should start kindergarten tomorrow?" Great. I had a new girl who was probably going to be dying under my watch. Since I've learned it's best to collect all the information before freaking out, I told the Special Ed clerk that I'd call the mom and then decide if I thought she should start school. The clerk told me that she was leaving in 15 minutes, but I could call her in the morning about the issue. (It was not easy to bite my tongue on that note - did she realize she was calling me on my off hours, and telling me to call a parent on my off hours?) The mom answered her phone, and come to find out that the girl does have dwarfism, and does need to be careful with her neck - no trampolines - but other than that she'll be okay at school. Besides that, she had already discussed this with the teacher and principal (way to be the last to know). Disaster averted. I emailed the SpecEd clerk and told her so - email, because she'd left for the day. 

First thing the next day I get to frantic work in my Thursday school, catching up on lost time due to something that had eaten up my day there earlier in the week: first aid, denying ice packs to the frequent fliers, color vision testing, diabetic checking, the usual. I went to my next school to talk with the teacher of the dwarf kinder girl, who is totally competent and has things under control as usual. Phew. Did some hearing screenings and wolfed down lunch in between screenings. Then it was onto my next school, where Tdap exclusion day had arrived: no Tdap shot, no school. We sent home 9 students, which I think is about 9 too many, but less than we might have had to. Last was an IEP meeting for an epileptic kid. I don't often get invited to these things, but they wanted me to be present to discuss safety issues for him on the bus and in the classroom. I crammed immediately before the meeting using Google, and then went and then pretended to be an epilepsy expert at the meeting (and I nailed it, if I do say so myself)...and then sat through another two hours of having to repeat myself several times, as well as listen to totally nursing irrelevant things about his academics. Gah. 

That was more work in 24 hours than I've ever had to do for this job, and more than I ever want to again. Between Epipen madness on Monday, an incident on Tuesday that sucked up my entire day plus some of Wednesday, and then potentially dying girl and meetings that go way too long...thank goodness I'd already asked for Friday off, and I might just be sleeping in on Monday a bit too. Goodnight for the weekend!

Keep your story straight

Two girls came into my office asking for ice for their eye after a couple of tetherball accidents. I told them I didn't want them to freeze their eyeball off but that they could have a wet paper towel. I recognized both as frequent fliers and told them to get back to class. A few minutes later, one of them returned, saying again that her eye "really" hurts. Oh crap, I thought to myself, and pictured the worst-case scenario that I always do: this child's eye was ruined, I would be sued, end of my career - death by tetherball. I suggested we call home, and she stood next to me as I looked up her phone number in my computer. As I did, she took the paper towel of her squinting eye, and watched me. As I started dialing the phone number, she put the paper towel back on...the other eye. 

 

I set down the phone and told her I was onto her. I pointed out the inconsistency of her symptoms and she said, "actually, both eyes got hurt." I smiled at her, told her I knew she was lying, and to stop pretending and go back to class. In response I got an embarrassed grin, and she hurried out of my office wide-eyed. 

 

Add this to the tips I've learned from kids in how to get away with things, along with don't sign your name on your criminal activity.

Nurses in the news:

We're kind of an endangered species, so good publicity is good publicity.

Medication List of an 8 year old:

Ventolin (Albuterol) 108 mcg 2 puff 4 x daily

Miralax 17 gms 1 capful daily

Cetirizine (Zyrtec) 10 mg daily

Methylphenidate (Ritalin) 20 mg 1 x morning

Abilify 15 mg 1 x evening

Clonidine 0.1 mg 1 x evening

Asacol 400 mg 2 x daily

Methylphenidate (Ritalin) 10 mg 1 x 3 pm

Omeprazole (Prilosec) 20 mg 2 x daily

Folic Acid 1 mg 1 x daily

This kid takes more pills than many of the patients I recall when I was becoming a nurse assistant in a SNF.

A School Nurse's Nightmare

There are many, but one of them is a teacher walking into your office waving an Epipen that she found in the hands of her kindergarten student who told her to "just give him the shot in the leg if he eats peanuts."  

Noteworthy items:

Teachers v. Parents.

MRSA! Watch out, this is the kind of article that makes you think every mystery mark that appears on your body is going to kill you.

Next week, the Tdap deadline officially arrives. September 15th is D-day, and my middle school still has nearly twenty with missing shot records. That's twenty students that will be booted from classes, and if they don't bring their shot record within a few days the school is required to drop them. They'll be overflowed to another school, one without their friends and not in their neighborhood, in all likelihood. No one listened to my suggestion that we just let them all be given the "Student's wiith Missing Immunizations" report I run on my computer is a fraction of the size it was last year. [If you're new, there's a new law requiring all 7th-12th graders in California to have the Tdap shot - no shots, no school is the motto.]

Another random item, I'm tired of having things I do be questioned. If you think you know how to do it better, why don't you just be the nurse? Most recently it was suggested that I make a vision referral for low cost vision services without testing the kid on the basis they failed over a year ago. Call me silly, but that doesn't cut it for me, not with the way kid's vision can change. I was also hammered this week for sending out - at the direction of my boss - a flyer requesting volunteers for Epipen/glucagon training. Again, call me silly, but when my boss tells me to do something, I'm probably going to do it, especially if I support it. The more patience I have used up by the absurd bureaucracy that is ruining the school system, the less I have for the kids that deserve it.

And last but not least, I cured a headache today by giving the kid some snack crackers I'd thrown in a drawer. That's what happens when you don't get your kids to school on time for their free breakfast, parents.

It's all relative

When the school year got underway, Mr. High Maintenance and his mother/grandmother quickly became the bane of my existance. I was always doing something wrong, this and that weren't right, and I was being instructed by a 4th grader on how to give insulin. Little Spitfire quieted down quickly, and when I made frequent calls to mom complaining of outdated orders, she was friendly and apologetic. Part of the deal I made with her was that we could continue with blood sugar checks and treating outrageously high blood sugars, like 475, if she guaranteed her availability at that morning check via cellphone and directed us precisely. (She also asked if I needed orders for the morning check and correction dose and had to resist a hugh "DUH" that nearly came out of my mouth). Spitfire's mom did as we discussed "while waiting for the orders", and the plan had been working like a charm until the mother started school, which she failed to warn me about. Yesterday, while I was at my middle school, there was a fiasco when the staff realized mom wasn't going to be answering her phone and found out from the grandma who arrived soon after that she wouldn't be in the future either because of classes. The poor secretaries later got an earful from mom about how her daughter wasn't being taken care of properly and suggested they go get trained at the hospital on insulin. (Because that's totally in their job description.) To put a stop to the madness, I sent home a very clear letter today with Little Spitfire reminding her mom that there ARE NO ORDERS for the morning check. We can't give insulin and will not be without a parent/guardian present to do it themselves. Period. And now I dread the backlash I will get from such a direct note, which is always one of the worst parts of this job...waiting for a parent to complain about you. (As an aside, I'm not sure how this woman is going to school or found the time to complain to the secretaries yesterday. She's on husband #3, and has children from each of them so that her assortment of kids looks like the Jolie-Pitt clan seen in the tabloids.)

 

This big ol' mess has made Mr. High Maintenance, who has now become far more trusting and respectful when I see him, seem like a piece of cake.

Tuesday Morning

I think it's fair to say I can tolerate a lot of "gross" things; it's part of my job and the education it took to get me to this point really opened my eyes to what I can handle. (I will admit the first time I saw a heart beating through an open side chest wound, I needed a chair for a minute - though not the second time around that I saw it, which is why to anyone who thinks they can't be a nurse because they pass out at certain things - you can get past that! But I digress.) Still, there are a couple of things that really, really gross me out:

1. Live lice. Spiders in my bed don't even bother me as much as lice in someone else's hair.

2. Being breathed on. When I hold a thermometer and the kid is breathing out their nose, the warm air breezes over my hands and just gives me the willies. It's also a problem when kids rush into my office to tell me how sick they are, and do it from inches away breathing all over my papers and myself.

3. The sound of mouth-breathing. Blow your nose, kid, and you'll breathe easier and I won't be so distracted by the awful sound. 

I love my kids...but they can really gross me out sometimes.  

Friday Recap

Oh, what week, especially after my last one. I found success I didn't think was possible, and received a small raise, to boot. I ended the week in my "happy place" that I keep meaning to write more about: my elementary school that I'm in my second year with now. The secretaries don't do much extra here, leaving me to do everything from tying shoes to untangling hair. I plucked out stingers from scraped hands and gave handwashing lessons as I tried and failed to get work done on the computer that I needed to - but that's okay. I'd rather do what I did, which was say hi to the kids at recess, be screamed at by one ("I saw you at Kid's Corner!!"), and learned a boogey dance from a 5th grader in the 90+ degree heat. I alternate between wondering why I needed to go to higher education to do this job, and wondering how on earth I'm getting paid to do something so awesome. Happy three day weekend!

Sweet victory, at last.

It took a full year of tears, but Shoe Girl is walking tall again.  

Best. Hug. Ever.

Shoe Girl has new shoes!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

More later, please excuse me while I bask in the glory of my victory.

:) (x a million!)

Friday "Recap"

Well, despite there being no emergencies* these past two weeks, I wouldn't say this school year has been off to a great start. Out of approximately 15-20 emergency care plans I mailed home after failing to reach parents after multiple phone call tries, zero have been returned. It's a bit unsettling to have things like "peanut allergy/epipen" written on an emergency card and then have no epipen, no other paperwork, and your phone calls seem to be getting lost in outer space. My new school, in a world away of a different neighborhood than my two others, was supposed to be an upgrade with more caring adult parents, and less strung out unidentifiable relatives. Instead I have one diabetic for whom I STILL don't have current orders, and another one breathing down my neck about my care who is certifiable crazy. (She refers to the child as her "daughter's son" even though it's her name as the mother on the birth certificate, and when I asked the kid who he lives with he said his mom.) On top of it all, the principal at my middle school is hounding me to get all the TDap records in and we still have 30+ kids to chase down.

 

The saving grace this week: starting color vision testing on the kindergarten boys. It sounds twisted, but finding the color blind kids is thrilling. It's satisfying to think everyone will know this about the kid sooner rather than later, and delivering the actual test is a joy itself: I sit in the back of the class in tiny chairs I fear breaking, listening to ABC songs, and I get to meet all the kindergarten kids - they're a blast, some of them.

 

Let's hope the beginning of this year isn't an indication of what the rest of the year might be like.

 

 

*Just barely. I answered a call from my trusty health clerk on Tuesday who asked me to get to where she was in a hurry: my old elementary school, site of four 9-1-1 calls, and one of the greatest concentration of weirdos in town. I found one of my old kids in the middle of a bad asthma attack, sitting with a cracked out uncle who came without medication upon getting word of the attack, because mom is in Las Vegas doing who knows what. It was my call: ER? Nope, I dug out her old medication in the cupboard, which technically isn't allowed because new paperwork hadn't been signed for the school year. Rules are meant to be broken, and I'm not sure what kind of person I'd be if I withheld albuterol in the face of a wheezing child on account of her inept mother being too irresponsible to do the right paperwork. Disaster averted, but seriously, some people should not be parents...or in the case of the cracked out uncle who arrived medication-less and suggested we give her a peppermint, they shouldn't be guardians either.

Really?

It took three phone calls and three days to find someone who agreed that, after an accidental needlestick, I should probably go get a blood test. Am I the only one who believes in bloodborne pathogens?

A new one

There's a little girl, now in second grade, that was a frequent flier to my office last year. She made up things ranging from accidents she didn't have to saying her dad hit her and she's in pain (do not fear, we take all such reports seriously and did file a CPS on that one). For such a tiny little girl, she's loaded with mental health issues, and after almost a full school year of denial, the parents are finally getting her therapy.

Still, I wasn't surprised today when she asked to see me. The reason, however, was one I haven't heard before: the "summer diarrhea virus."

Hey kid, summer's over.

Never recap a needle.

If you're a nurse, or do any work with needles, you know where this post is headed...

Not fair

I don't understand how teachers can complain I didn't get the student health alert list to them soon enough when they send kids complaining of stomachaches stemming from anxiety to my office. Parents won't pick them up and the kids are too hysterical for me to bring back to class, much less talk to them or get anything else done while they're squealing. I'm thinking I'll be filing for worker's comp for hearing loss after this week.

Actually written on an emergency card:

Occupation: Domestic Goddess.

Also, parent of Mr. High Maintenance (we'll call her Mrs. High Maintenance) came looking for me at lunch, just as the office staff and I were saying some not so nice things about her. That was lovely. It was about as lovely as the lengthy lecture I got on taking care of Mr. HM.

Now I see why, when I was hired two weeks into the school year last year, everyone said what a relief that was for me. These first three days have been nothing but craziness, and my sanity was only barely saved today when "Epilepsy Mom" returned a phone call I'd made in hopes of getting updated information on her daughter and left a message about five minutes long thanking me over and over for making the effort to get in touch with her. (My goodness, how things have changed since our first encounter.)

I spoke too soon

Mother of Diabetic #1, Mr. High-Maintenance, complained about my log-keeping to the staff - on day two of my care - and because of it says I am now supposed to call her daily with the blood sugar. Oh, joy. (Not that anyone is interested but in my defense, but she sent some messy log forms with him that she wanted me to use, which are far, FAR, more difficult to read than the ones I make.)

She's the opposite of mother of Diabetic #2, Ms. Spitfire, who when I asked today for some guidelines - because we are still missing current orders - for the corrective morning insulin, suggested I choose the dose "based on what she seems like." Okay, I'll just pull a number out of thin air and hope it doesn't make her crash. Awesome. 

Patting myself on the back

I went in to this school year with the expectation that I would have two diabetic students at the same school, one whom was supposed to be checked twice a day and one three times a day. Three times, and at my new and far away school! Ridiculous, I'd get nothing done at my other schools. With the help of parents and teachers, it took me one day to get these visits down to once a day. Hah! Take that, attention seeking kiddies (and parents).

Unfortunately that one visit can take a very long time when the kids are uncooperative, and their blood sugars are behaving even worse. If I can't get the children and blood sugars under control, it might be a very long year.

'Twas the night before school...

Never in my life would I have thought that in my twenties I'd be too jittery to sleep right the night before school started - primary school, that is. Or that I'd peruse the back to school aisle in Target with such interest in the school planners. But, here I am, waiting for tomorrow morning with excitement, nerves, and a lot of questions about what this year might bring.

The excitement stems from the orientation night I went to last week, where the little siblings of my middle school whispered not too quietly to their parents, "Hey, that's my nurse!" The nerves stem from a project I started on Friday: making the health alert lists for my students so that the teachers know any serious (or what I deem serious) health concerns for their students. I was at an elementary school and by the time I'd reached partway through first grade I had so far found two students requiring Epipens for peanut allergies, neither of whom had brought one in. One parent/guardian said she was working on it; another couldn't be reached. <sigh.> The questions: How many emergencies will there be? How am I going to teach my diabetics to be independent? How am I going to get my remaining Tdap-less students to bring those shots in or get their parents to come in and sign a waiver? Will the dynamics of the nurses and district office change? (Rumor has it we might get a new boss.) Is anyone serious about making me coordinator? What's it going to be like in my new school?

You get the idea. 2011-2012 kicks off in T-11 hours. I don't feel ready at all, I don't think my ducks are in quite the row I want them to be, but at the same time...the kids can't come soon enough.

Culture Shock

I spent the summer in countries in which I spoke two words of the language, and, needless to say, experienced some culture shock. I was in for culture shock again as I helped with schedule distribution at the back to school orientation last night. I had, apparently, completely forgotten what my clientele are like: parents and students who appear so close in age and dress so alike it was impossible to deciper which one I should hand the schedule to, cellphones falling out of cleavage, and at least one parent slurring his words and holding himself steady against my table as he leaned over me doing his inebriated, I am sure, very best to flirt with me. Welcome back, me.

Today is Thursday, class starts Monday, and my emptied out middle school office has yet to be painted, not to mention put back together. And, so far, I have two places to be first thing Monday morning. I'll spend the weekend working on cloning myself.

Putting out the fires

With no kids, I imagined this week would be pretty slow. As usual when I make such assumptions, I was wrong.

Coming Soon!

Today marks the end of my summer break, but I think my mind is on vacation until the kids return on August 15th. A preview of the year to come: I have switched one of my elementary schools with another elementary, and having never even stepped foot in my new one I can't speculate as to how that might be; our district is rolling out a new email client, which I don't imagine will be a problem for me, but I can only imagine the fuss that will create in the less technologically-savvy school personnel; and of course, the biggie that has truly earned its nickname: Tdap crap.

I'm looking forward to setting up shop this week and easing back into the chaos before the onslaught next week. Cheers to the start of another school year - may it be less exciting than last year!

We interrupt this program:

I still have a couple more weeks of summer break but I couldn't wait to share this piece of news: the California governor signed an extension on the Tdap law. When I left for break, after months of a focused effort on collecting Tdap records, my middle school had the highest percentage turned in for the district - just over 60%. Withholding schedules for a third of the school was going to be nothing short of a logistical nightmare, as well as costing the schools money they can't afford to lose. There's still speculation the law will be extended again or even repealed because of the immense cost; for now, I'll happily take a 30 day reprieve.