My phone rang minutes after I sent a sarcastic email to my health clerk, Rietta. Thinking it was her response, I happily answered; as soon as she spoke, though, I could hear things were not right. She described one of my frequent-fliers - she's often doing business with lice - who came to the nurse's office "not feeling well." Rietta is a former EMT, and she was with me during my first 9-1-1 call - I trust her assessment, which is why I was alarmed to her her say this: "Her pupils are dilated big time, I've never seen pupils so big." We decided she would work on getting in touch with the mother, a woman I also know all too well, while I contemplated what it might be. I called our nursing coordinator to get her opinion, and she said aloud what I was already thinking: head trauma, perhaps, or drugs.
The minutes were ticking by and I called Rietta back. She answered tensely: "Get over here now." As I hung up the phone, a student with a broken tooth came into my office; I dragged him down to the secretary, told her I had an emergency at another school, and sprinted for my car.
It's barely a mile to the site Rietta had my student at, so I was there quickly, but not soon enough - mom had just arrived. Mother has an always present drugged up behavior, and I very nearly reported her to CPS months back for her repeat lice offender daughters. The first time I called 9-1-1 at school, I was petrified. The second incident, I learned how much more frightening it is when the patient is a student rather than a teacher. In this one: having the parent hover over you while you assess and decide what to do with her daughter is actually the worst.
From the moment I walked in, I could see this girl was seriously under the weather. I know her well enough to know when she's not right; besides that, her pupils were just as Rietta had described - extraordinarily dilated. Fearing the sudden onset of this - she had arrived at school just an hour earlier, and had been fine then - I wasn't about to take any risks. As everyone, and I mean everyone - secretaries, principal, mother, mother's cousin, health clerk, stared at me waiting for my direction, I said we needed the paramedics. I did this despite the fact that the hospital is literally a block down the road; the girl's a 3rd grader and was in no condition to walk, and mother in no shape to carry her. I may regret this when the mother can't afford the bill and takes it to the school, but I hope I can defend the decision.
I was put on hold while the dispatcher reached the paramedics longer than I thought possible; it was over 10 minutes after 9-1-1 was dialed before the firemen arrived. When they finally arrived, they assessed her, asking many of the same questions I did: did she take any pills? (No.) Vomiting? (No.) Headache? (Yes.) It was comforting to hear what I'd just asked, and even more comforting to listen to the firemen repeat their assessment to the paramedics: no medical history, but pupils are *really* dilated, and not reacting to light. They didn't hesitate to take her as quickly as possible, and out they went.
I wanted it to be over; instead, Rietta and I simultaneously realized that if it in fact was drug related, we needed to check out the girl's twin sister. We called her out of class, and as she looked up at me when I asked how she was doing, I saw her pupils: even larger than her sister's. Crap. I went to the principal, told her the sister said she felt fine, and looked fine other than her huge pupils. She asked what I wanted to do about it, and I said I didn't want to take chances - but since I knew where mom was, at the hospital a block away, I didn't want to call 9-1-1 and have them take 10 minutes to get there again. She gave me the okay, and I piled the girl and Rietta into my little car.
As I backed my car out of the parking space, I took another look at the girl in the backseat: her pupils were tiny. It was like out of a horror movie, really, and whispered to Rietta to look at the freaky thing sitting in my car. I don't know how her pupils could have changed so fast, but at that point, neither Rietta or I wanted to be responsible for her. We took her down to the hospital, and I explained to the triage nurse the possible drug exposure issue going on. The girl's mom took her in the back to see her sister, and said she still didn't know what was going on with the first daughter. Rietta and I said we had to go, and we couldn't get out of there fast enough.
The mess over, Rietta took me over to the coordinator's office to decompress - I needed it. Looking at an eight year old with her pupils fixed and dilated, and only semi-conscious is one frightening experience. It's even worse when you have a strung out mother on your hands asking if her daughter is going to be okay, especially a mother who appears to get more nervous when you said you're calling the paramedics, seemingly for her own sake - as in fearing the authorities - than for her daughter's.
I don't know what kinds of drugs the mother's on, but more importantly, I don't know what was going on with that girl today. It's impossible to not question your actions in these situations, because I'm going to be terribly embarrassed if it comes back as just a simple headache. I hope I did the right thing, and I hope the ambulance ride wasn't overkill, because if anyone looks at my track record, they're going to see I've called 9-1-1 approximately three times more than the average nurse - and it's only March. (But in the first, the teacher agreed to the call, and in the second - I'm pretty sure a boy barely able to breathe and turning purple is justified.) Most importantly, I hope that girl's okay; what scares me is knowing that even if she is, she's still going to be being raised in that atrocious household.
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