I'm really trying not to jump the gun...

But I may have a big success coming my way. This morning my cell phone rang: the program manager for the county physical and occupational therapy programs was calling me. I knew I'd sent in only a half-filled referral for the aforementioned girl needing shoes, but before I could explain that it was a last ditch effort/cry for attention from the county, she got it: "I can tell this is a last resort kind of thing." It worked. 

I told her everything, including the recent CPS report, why I hadn't checked the box for parental permission, and when she asked if the student thought she needed new shoes, I got the chance to let my tongue loose on how badly this is affecting her (it's recently become a bullying issue among her peers, too). She told me she couldn't do anything from a PT or OT therapy perspective - BUT - she has contacts. She assured me she has resources I don't, and in no uncertain terms, "I will be working with you on this. I will not let this go."

I hope she stays true to her word. Between that and the CPS worker - someone might actually be able to help her soon. And the other best news of the day? The girl showed up to school, which means mom didn't beat her to death over the weekend (maybe CPS hasn't talked with her yet).

Edit: I talked to the attendance clerk at the school, who said she received a nasty phone call on Thursday after school from this girl's mom - well, it was anonymous, but she knows this mom's voice. The mother's shrieking complaint: "I need to talk to the principal, someone is trying to get my daughter taken away!!" Two things on this: one, I still don't know who filed the CPS report, and if it was anyone at the school I'd be shocked if they'd not told me - which means it may be someone outside of the school, something I'm sure the mother hasn't considered. Second, I am wondering if I should start wearing a bulletproof vest to work...that's one angry momma.

An eventful day is usually not a good day...

At least that's what seems to be the case for school nurses. You can wake up, go to work, lah-dee-dah like thinking today should be nice and slow. Next thing you know, the kids have all gone home and you're sitting in an office that looks like a tornado's ripped through it, wishing you'd just called in sick. Thursday was one of those days.

You get what you give

I was talking with a teacher at the end of the day about a bizarre rash on one of her students. As she was walking out the door she turned back as if she forgot something and said, "I'm so glad you're our nurse. You rock." All I could stutter was thanks, and out she went. This isn't the first time this teacher has given me such a compliment, and it's the reason I go the extra mile for her. It's also a very pleasant way to end your week. (Yes, I have a four day weekend for Memorial Day. No, I don't know why it's so long, but it's probably part of the reason our summer is so short. No, I'm not complaining, I'm just tired of people asking why I have such a short summer - if you consider six weeks off not enough.)

No sugarcoating here

My 3rd grader diabetic has been misbehaving to the nth degree lately, abusing his standing hall pass by saying he's shaky and needs to check his blood sugar. Today his pump fell out and his mom needed to come and change the site; unfortunately, she forgot the numbing cream. His heartbreaking response: "I wish diabetes didn't exist." 


My 8th grader diabetic, the one who one day didn't eat lunch after taking 14 units of insulin, must be thinking the same thing: today she decided that she was ready to be an independent diabetic. I arrived at 12:30 to meet her at 12:40 in my office where I have her check her blood sugar, calculate the units she needs (which she has absolutely no understanding of how to do still) and then make sure she draws up the correct amount of insulin. I sent out a search party but couldn't find her until I found her on her way to 5th period, 35 minutes  later. I asked her if her mom knew she decided she was ready to be independent, she said no. Well, young lady, she's going to know. You made the nurse a pretty unhappy camper today, having to wait and worry. Not only that, but if I ask you how many units of insulin you gave yourself a half hour ago, you had better be able to tell me exactly how many and why that many. If you can't do that, you're not ready to do your insulin in the bathroom. Insulin kills, and if you're using it alone, you need to know how. Period. 


This is me laying down the law to cyberspace, because her parents are unreachable to discuss this. 

Kids say the darndest things

Third grader: "So...I started wearing deodorant two days ago."
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Me: "Is the Tooth Fairy going to come?"
Girl that lost a tooth: "Yeah, if my dad remembers to call her." 
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Secretary: "You're suspended until next Tuesday."
Disruptive kid: "When's that?"

Hear me out

I have a kindergartener with diagnoses of Oppositional Defiant Disorder, Explosive Disorder, ADHD, and a few others. When he first arrived, his mom tried to bring Seroquel and Clonidine in for him; I told her she'd need the doctor to fill out the appropriate paperwork in order for us to do that. Several weeks later, the paperwork arrived with a small hitch: the doctor wrote 1 p.m. for the Clonidine dose, and I knew mom had previously said 11 a.m. This was especially important in this case because as a kindergartener he departs the school at 11:30 a.m., so it meant the difference between us giving him the medication or not. I called the mom with the intention of clarifying what she wanted, thinking to myself I'd be okay with giving the dose at 11 a.m. if that's what mom has been doing and wanted to continue doing. When she answered the phone, I said that the doctor had written 1 p.m. and I recalled hearing her say 11 a.m. Before I was even able to finish my sentence - the one that would say we'll give it at 11 a.m. if she agreed to it - she cut me off and launched into an exasperated rant. "If you think I'm going to go back to Kaiser and have the doctor re-write that paperwork, that's ridiculous!" Etc. etc., it continued, her voice getting louder and continuing without even a break to take a breath. She hung up saying, "If my choices are to go re-do the paperwork or he won't get the medication, then he won't get the medication." Click. 

If she'd let me finish, she might have learned that wasn't the choice; instead, she decided it without knowing her options. Having been in this position for almost a full school year now, I'm tired of dealing with parents who are as atrocious as this one, and I wasn't about to call her back and tell her my offer. Yes, I feel a slight twinge of guilt as I think about the fact that since he's not going to be getting the medication at 11, and school is out at 11:30 anyway, it's his mom who will have to deal with the consequences - but c'est la vie. It still boggles my mind how awful some parents can be toward me, but I consider it a sign of growth that it doesn't rattle me like it used to. Now, I just sigh and move along with my day - it's nothing out of the ordinary anymore, however sad that is.

Preserve

A parent came in and was telling me how stressful his life has become since having three kids. I told him I didn't have any (this job is enough kid time for me) and he said "Preserve, preserve, as long as you can!" Aye aye, captain. 

:)

Left on my desk one day from an anonymous artist. I recognize the name but can't place the kid; I'll assume I made some sort of positive impression on her. This picture reminds me why my job is awesome. 

The light at the end of the tunnel...

Due to the last few weeks at work resembling an out of control circus, and impending burnout, I took Thursday and Friday off last week. I had work-related calls Wednesday after school, Thursday, and Friday; and then I returned to 103 new emails this morning. The lesson I learned is that even when you're away from this job, you're not really gone; now I'm looking forward to summer break even more than I already was. 

Spinning round

I happened to see one of my independent diabetics while helping my newly diagnosed Type I 8th grader. He wasn't sure what to do, because he thought that they got out early today (they do get out an hour early due to state testing, but definitely after lunch), so he had left his backpack at home. His backpack with his glucose meter, insulin, etc. Frustrated, I helped him get an emergency lunch from the cafeteria and told him to test when he got home; I'd rather him run high than run low. I told the attendance clerk his situation, and told her to call me if he came back feeling funny, and specifically told her I didn't want to hear from her. Not forty minutes later, just as I was re-settling into my original school, she called. I answered the phone; it was my new diabetic in the office feeling sick. She had taken 14 units of Novalog insulin to accommodate her blood sugar and 75 g carb lunch...and then didn't eat lunch. That's right, she took a whole bunch of insulin and then failed to eat. I barely contained my "WTF" reaction and told her I'd be right over, and to check her blood sugar and give her something to eat in the meantime. Eventually, her sister picked her up, but in the 15 minutes I was there with her, her blood sugar plummeted by 50 (to 140), even having eaten Jell-o in that time span. Needless to say, I racked up the mileage reimbursement sheet today: first, my original elementary school, then to my extra school that I just cover the diabetic at, then my other elementary school to pick up something from Rietta (lunch), then to my middle school to help my new diabetic with the insulin, then back to my original elementary school, then back to my middle school to lecture the diabetic about the importance of eating after taking insulin, then finally back to my original elementary school.

Also, I failed to mention that the grandma who picked up the kid who had stuck a pencil in an ear insisted on reaching into the trash can where I had disposed of it, in all it's wax covered glory, without gloves. Yum.

As I was saying...

The secretary at my elementary school stopped by my office this morning (down the hall from hers) to apologize for being so needy yesterday while they were dealing with asthma medication issues. I said no problem, and we started talking about how I've been running around like a chicken with my head cut off lately. As though on cue, a kid walked in: the tip of a pencil was stuck in his ear. Way in. The little kindergartener kept trying to stick his fingers in to take it out, so while the secretary tried to control the wild child I started dialing for a parent. I didn't have any luck, so I got a pair of tweezers and pulled the thing out. It was like a magic trick, it was so long, except instead of a colorful scarf, it was a 3/4" piece of a thick pencil covered in wax. I finally got in touch with a parent, and his live-in grandma came to pick him up. That's when I heard the background: a family in turmoil, he is bipolar (is that possible as a 5 year old?), and there is a clot of some sort in his ear. He'd spent two hours at the doctor's office yesterday with them trying to flush out his ear without success (clearly, given the amount of wax that came out with the pencil tip), and that's why he had his pencil in his ear this morning: he was trying to clean out the "rock" in there.

Kids: don't stick things in holes in your body. Not your ear, not your nose, not anywhere.

Up in arms

It really, really irks me that only some of the menu's nutrition facts are posted in the school cafeteria. The menu has a main entree that varies each day, and then several stations that have something kids can count on every day, including the salad bar. I had the misfortune of acquiring a new diabetic last week at my middle school and went to the cafeteria to ask the kind lunch lady there (who gives me crackers to keep in the office even though she's not supposed to) for the nutrition facts. The diabetics need access to the nutrition facts before they enter the lunch line so that they can give the proper dose of insulin; having the nutrition facts and menu printed on paper in my office would save precious lunch time. The lunch lady informed me, regretfully, that they do not print menus for middle or high schools, nor are there complete nutrition facts available at the ready. While I was concerned for my diabetics, she said she's embarrassed when kids watching their weight ask for them and she's not able to provide anything. Calorie counting or insulin dosing, I find it absurd that complete nutrition facts are not available. The lack of a printed menu is totally inconvenient for my diabetics, and now I understand why one of my kids has a cheeseburger every single day: he knows it will be there, and he knows how many carbs are in one.

There are a lot of changes I would like to make in the schools, especially in regards to the cafeteria, but I feel like this one is truly feasible, and totally necessary to take upon myself. Now I just need to find the time to make it happen.

I should wear skirts more often

Today I walked into a first grade classroom to pick up a kid for screening, and a girl in the back row turned around, looked me up and down, and said, "Well, don't you look nice today?"

Into pieces

There's a girl at my middle school with a club foot requiring special shoes. Her shoes are in despicable condition: holes worn, literally falling apart layer by later. She gets free shoes from the hospital, but her mom has to take her to get them. This is the same mother who once came looking for me at the school office - thankfully I wasn't there - after I called her the same day, by coincidence, CPS had showed up at her house. Mom refuses to take her to the hospital, claiming transportation issues, and the hospital can't talk to me due to privacy concerns. I can't talk to mom either, knowing with full confidence that she will beat her daughter if I do. Needless to say, this is an ongoing case that is tugging hard on my heartstrings. Hearing the girl talk about it is bad enough; hearing from her teachers and other staff - the "what are you going to do about it?" questions toward me just pour salt into the wounds. After the CPS report in the fall, she stopped talking to me - her mom reportedly told her to not talk to the nurse anymore - she's seen me twice this week. Today, she came in, in tears, saying her feet hurt and kids were teasing her. Through her tears came the worst question of all: "Can't you get me new shoes?"  

Don't judge.

It's a simple rule in life, but it's easy to forget. Several weeks ago a mother had tried to stop by my office but I was inundated with kids at the moment and asked her to return later; she never did. I was really quite content to send her away, and even more thrilled when she didn't return, hoping she forgot about me - because I didn't forget her. She was Epilepsy Mom, a woman who had ranted to me so memorably that I still refer to her when I try to explain to an outsider the parents I encounter. She found me today and my office was empty; I had no choice but to begrudgingly let her in. I could see she was holding back tears as she handed me a note from her daughter's physician describing the student's medication regime and how that is affecting her schoolwork (fatigue). Epilepsy Mom continued on, telling me the difficulty her daughter is having in dealing with this, and let on that it's not just epilepsy: "She's dealing with two diagnoses." I didn't press her for details but she opened up anyway: her daughter has a brain tumor.

No wonder when the diagnosis was fresh her mother couldn't think straight. She probably needed someone to let her anger out on, and it just so happened that I called at that time. Sitting in tears in my office today, I could see the human inside her.

Lesson #1

Destroy all evidence. A middle school student tried to hide his referrals by flushing them down the toilet...except he left some pieces stuck to the plunger. Mom was not too happy, we heard, when she made this discovery.

A day in the life.

I got to work just after 7:30 this morning, well before school started, so that I could set up in my office and teachers could come talk to me about whatever before the influx of the wild children. And that they did; as I waited the 15 minutes for my computer to turn on, I heard all about the recent lice cases and a teacher confessed her reason for her frequent bathroom trips (diabetes). At 9:00, I was summoned to my middle school to check out a kid's blistering hands to ensure he's not spreading some contagious disease. He said he's being treated by a doctor, I made sure his open sores were covered, and sent him to class just as the phone rang for me at my other elementary school. It was Rietta, needing computer help for the ridiculous Medi-Cal billing thing we're supposed to do three weeks a year - this is one of those weeks (but another story). I told her I'd stop by on my way back to the school I'd started at when the attendance clerk stopped me as I was leaving the middle school to inform me that one of our students was in the hospital with newly diagnosed type I diabetes. Oh joy - this is something that in all likelihood will require me to come by at lunch to the middle school to check on her daily, which, needless to say, throws a loop in one's schedule. I finally reached Rietta, fixed her computer and showed her how Medi-Cal billing works; by then it was time to go take care of my diabetic at the school across the freeway. Finally, nearly 3 hours later, I returned to the school I'd started at just in time to find what appeared to be a bloody massacre in my office - multiple nosebleeds and sick kids all at once. I took over for the thankful secretary and got to working on the kids; it'd be another hour before my growling stomach was finally answered. Afterward, paperwork - the paperwork I was sitting down to first thing this morning that I hadn't touched. 

The last bell will ring shortly, and it appears as though a tornado has blown through my office: trash cans piled with bloody tissues, empty glove boxes, and papers strewn around in a seemingly haphazard way that only I might be able to decipher the meaning of. A lot of people ask me what I do, and there's really no way to answer: you just never know.

Bye bye, money...

This morning I went to a meeting for my new diabetic to discuss classroom accommodations that must be made for him because of his condition. The meeting included the principal, the school nurse for that site, the psychologist, the teacher (who needed a substitute, of course, during this meeting), the mother of the diabetic, and myself. The purpose of this annual meeting was to determine if appropriate accommodations have been made, are working, and to put a plan in place for the following year. Guess how much changed from last year? That's right, none. We sat around a table for a half hour, nodding our heads that the current plan is working - e.g. student will be allowed bathroom breaks as necessary to check blood glucose level. Um...duh? Anyone with half a brain could have looked at last year's plan, seen its effectiveness, collected the appropriate signatures, and saved everyone some time. This is where your tax dollars are going...And part of my salary. Gross.

In other news, it's warming up and I almost wore sandals today to work. I was very glad I didn't when a girl came in with a severe nosebleed and no clue what to do about it, as she spilled blood everywhere. I also managed to reduce a child to tears when I walked him down to my office for a hearing/vision screen. He sat down and as I reached in my bag for my audiometer, he melted into hysteria screaming, "I don't want to do it." All I could think was, "I don't have time for this, kid" - Nurse Ratched, at the ready here.

Also, it's Teacher Appreciation Week. I'm making sure to take advantage of all the perks that I can, like free breakfast this morning, because I'm pretty sure no one is going to care when it's Nurses Week next week. In fact, on the National Association for School Nurses website, it is suggested not that school nurses should be rewarded on School Nurse Day, but that we should - to mark the grand occasion - "tell someone about the role" of a school nurse.