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...

 

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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.