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.]