Woo hoo!

I made it to winter break! Time for two weeks of R&R and sweatpants! And, being very thankful I don't work at this school: California high school to be tested for tuberculosis.

I smell a scam

The principal at the Institution stormed into my office yesterday declaring, "We have a situation." Turns out a student was injured in August on the playground. At the time, she said it was an accident, but has now changed her story to saying that someone did it to her. Unfortunately for the school, no one filled out an accident report when it happened (probably because it was pretty minor, and the student said it wasn't intentional). Well, four months later, the family has come to the school complaining that she is still suffering pain from that injury at school in August, she is seeing specialists all over the place for her condition, and there's an issue with insurance...how convenient. It hasn't happened yet, but we're quite sure they're preparing to sue for health care coverage for this leg pain. 

I was getting awfully suspicious listening as the principal related this story. I though it was odd that it took four months for them to report the injury to the school; then even more suspicious that the timing coincides with them having some sort of vague insurance/financial issue. Unfortunately for them, we also have on record a doctor's note from two years ago stating that the student has chronic pain due to a leg length discrepancy...I don't think they know that we have that. 

This wouldn't be the first time I saw a family using their child deceitfully to get what they wanted, but every time, I just have pity for the student. 

Kids got a new pair of shoes

Every year at this time, the local hospital donates pretty generously to one of my lower-income schools. Today, I got to see a bunch of kindergartners with beat up shoes be handed a gift bag with a new pair picked especially for them. Their teachers had nominated these students in particular for needing a new pair, and while I wish parents would step up and maybe postpone some cigarette and alcohol purchases in order to meet their children's needs, at least someone is watching over them. Also, watching twenty five-year-olds march down the hall in a surprise brand new pair of shoes is adorable.

Last week

It's been a disheartening couple of weeks (and months) in my district. One nurse is on paid administrative leave following...an incident...our LVN that usually fills in for diabetics when people are sick has been out for surgery, another nurse quit effective this week...In the meantime, the need for us has increased: more diabetics are spread around our schools, and we're spread so thin that for one of us to take a day off, there's a serious amount of time spent orchestrating diabetic coverage.

Following the board's decision to continue to require licensed personnel to administer insulin, as opposed to the state's ruling that offered volunteers may do so, I've been thinking the solution to our shortage is obvious: hire cheaper nurses.

I was right. Last week started Monday morning with someone commenting that I have the pregnant lady waddle (not a compliment at any point in pregnancy, but at 24 weeks, I was insulted), and ended on Thursday with a call from the coordinator: we will indeed be being replaced, slowly, by LVNs. There will be able to be more of those than there are RNs, and there won't be room for all of us to stay as "LVN supervisors" as she put it. No one is getting laid off just yet, but with my preliminary credential expiring at the end of next school year (and needing a year or two of schooling to complete the requirements for a permanent credential), the unspoken conclusion was that I probably shouldn't bother completing such a thing. There won't be room for me here in a couple of years anyway.

<Sigh.> I suppose I should be more concerned about my career long-term, but instead, I'm just getting more excited by the day to meet the baby kicking my bladder.

Yummy

This website invited high school students to upload pictures of their school lunches. I browsed enough to get the gist: we feed our children junk food, and the kids don't even like it! I've seen it myself: the garbage cans in the cafeteria are grossly filled with food every day.  

Ugh

I was out on my diabetic rounds and returned to a request from the secretary to check on a student who had been complaining of difficulty breathing while I was out, and a note that mom wanted me to follow up with her once I checked on her son. 

His lungs and heart all sounded good by the time I saw him, but with the sudden turn to cold weather, I wasn't about to rule out the potential of asthma for him, particularly as he described the problem popping up during recess. 

I called his mom, who answered the phone sounding totally bored with me before I even began. I reported that by the time I listened to him, an hour after he'd first complained, all was clear. I launched into more detail that even though they may have been clear then, after an hour of rest, his lungs may actually be having a problem in this chilly weather. Her monotone response: "Well, if he has a problem, the school can transport him to the hospital." 

What. 

Making amends

I really hoped to see Spitfire before we left for Thanksgiving break, but this week was minimum days so she didn't stay for lunch at all. I couldn't think of a reason to call her out of class, so instead I dropped this note and a few stickers in her teacher's mailbox yesterday for her, hoping she'd see that even if I'm having a baby, I'm still thinking of her. 

Spitfire came to the office this morning with a 400+ blood sugar, and the health clerk called me to let me know. She told me Spitfire asked her if she had noticed anything different about me lately, and the health clerk and I both jumped to the same conclusion: Let's let her be the one to "tell" the health clerk, who of course has known for months. The health clerk played dumb, asking me if there was anything different about me, and I asked her to put me on the phone with Spitfire. I told Spitfire to go ahead and tell her the news, and I heard her say to the health clerk, "She's having a baby!"

The health clerk did a fantastic job of acting stunned, and told me later that Spitfire was just beaming with the belief that she and I are best friends, and knew the big news before the health clerk did. Spitfire ended up staying for lunch today, I don't think any sort of coincidence that she did so after the note I gave her reached her yesterday, and she giggled to herself while the health clerk interrogated me about the "news" of the baby. It was awesome.

Less awesome was that she continued to ask if I could put the baby up for adoption, and even suggested a foster home if I just wanted to do so temporarily. (I don't even think I knew what fostering was at 5th grade.) <Sigh.>

She left saying, "I still think you should put it up for adoption," but just as soon as she was out the door, she stepped back to say, "Thanks for the note and the stickers, I liked that."

Happy Thanksgiving!

Kids are so cute.

I love it when they think they are my only student that I see. A girl was in my office for the mysterious stomachache, and asked me, "Do you remember when I was in here when I bumped my knee? It had a bruise, but now it's all better."

Of course I didn't remember her, so all I could say was, "I'm glad you're better now," but it's my favorite (or one of my favorites) thing when kids think they are the center of my world.

Randoms

Lice in the news: Q&A: MORE LENIENT LICE POLICIES BUG SOME PARENTS. Happily, there's been surprisingly little fuss that I've received (from parents, there's been plenty from school staff) about our new policy.

Our computers were down this morning, so I had to pull paper emergency cards to call home for a couple of kids. One didn't feel well, and was speaking to me in horribly structured sentences. His emergency card explained why; under "Language Spoken" someone had written "Einglish." And on another, under "Language Spoken" on the English version, someone had written "Ingles." With auto-correct on smartphones, I fear what will be happening to our written language over the next generation. (Yes, I am aware I sound about 200 years old.)

The cat's out of the bag

The secretaries at Diabetic Land had agreed that Spitfire shouldn't know of my pregnancy until she needed to. She's had a rough home life, plenty of abandonment issues, and none of us wanted her to know I'd be leaving her early this year...or so I'd thought. One secretary just couldn't keep the secret anymore, and told Spitfire today to see if she noticed anything different on me. When she returned after lunch, Spitfire began the interrogation: did you cut your hair? New shoes? New sweater? New nose? Eventually, she said, "You're having a baby."

I responded yes so calmly that she didn't believe me, and continued on with her guessing until I stopped her and told her that I was telling the truth; I'm pregnant. She didn't hide the shock on her face, wouldn't even look me in the eye for some time. I showed her the ultrasound picture and told her that it was mine; she asked if the baby had a daddy. She wanted to see a picture of my husband, and briefly giggled when she saw he has a beard before bringing us back to the subject at hand.

"Who's going to be my nurse? I am so disappointed in you. I can't believe this. I am so disappointed in you. I can't believe this. Can you give birth here in this office? I need a nurse, I can't do this by myself. I'm so disappointed in you."

I tried to reassure her, telling her the baby is still a long ways off, and promised I will be her nurse as long as possible. It did no good. In between her repeated statements of how disappointed in me she is, she asked, "Could you put the baby up for adoption so you could still be my nurse?"

She left looking dejected and continuing to repeat her disappointment in me as she left my office. The timing couldn't have been worse, either: a Friday afternoon when next week are minimum days so I won't see her unless she happens to stay for lunch (which she never does), followed by Thanksgiving break. It'll be 2 1/2 weeks before I see her again.

Ugh.

(I informed the secretary who had spilled the beans that she didn't take it well, and that was precisely the reason I'd been trying to postpone telling her. I can only hope she felt some guilt.)

Just another day...

My morning at the Institution started off helping out a vomiting 7th grader, and, let me tell you, there's nothing quite like being nearly five months pregnant and already nauseous when you need to help a sick little girl. Lovely. In seemingly no time, my diabetic was here for her insulin. Shortly after, I got a call from another nurse. She'd been on standby for jury duty and just received notice that she needed to be in court shortly, so I flew off to go cover her diabetic. While at the foreign middle school taking care of her diabetic, they asked me to do a vision check and call the parent of a student who'd been elbowed in the eye earlier in the day, plus a few small first aid issues. I finally made it to Diabetic Land, where in the few minutes I was there before Spitfire made it to the office, I was told to go get the wheelchair; a student on the playground had twisted his ankle. I took care of him, the student that had vomited on the tetherball, the girl who scraped and skinned her knee, gave out some Ritalin, after Spitfire's blood sugar check and before she returned for her insulin. Finally, two hours after I'd left, I made it back to the Institution where I scarfed down my end-of-the-day lunch while trying to input some last minute IEP information that, not surprisingly, I've been getting behind on. 

Whew. 

Putting things in perspective

I've been slacking big time on this blog this year, and it's not just because we're understaffed, I blame this little thumb-sucking cutie: 

That's my baby!! Being pregnant has been awesome (and not, but hopefully afterward I'll have amnesia about that part of it like every other mother seems to get) and exhausting, and I've been letting other things go in favor of...well, doing absolutely nothing, outside of growing a human being. I'll have to catch this up more when I'm more energized than I am now (hah! Energy is something I left behind about four months ago.), but our district appears to be gearing up to follow suit of surrounding districts and replace us RNs with LVNs. It's a move I can't argue with, it'll allow the district to hire more nurses at a lower cost, and rather than be terrified that I will surely not have this job in two years from now - and a young child - I'm finding myself quite unconcerned with the matter. Nothing like a baby inside of you to put life in perspective. 

I'm due at the end of March, and I sent an email today to my assigned HR person to ask how maternity leave works. In Exhibit A of just how inefficient our school districts are, my HR lady replied back to say that she was forwarding my email to a different HR employee, who then replied back to me to say she was forwarding my email again to a different, and finally correct, HR employee. It appears, albeit with a pay cut, I'll be able to afford to leave from birth through summer. Hallelujah. 

In the hood

Yesterday morning there was a buzzing that went on a little too closely, and a little too long: our school was surrounded by a couple of helicopters. Add that to the non-stop sound of sirens, and we all started looking around at each other. The principal asked the secretary to call the police department to make sure that we didn't need to be on lockdown. The response from the police department: "Sure, students can be outside. They're just photographing a crime scene." Lovely.

Found out later on the news it was (another) shooting. The usual around here. 

All Hallow's Eve

Ahh...Halloween...the holiday whose sole focus, let's face it, is sugar. It's not the most pleasant day to work at a school: everyone needs help with their costumes, and can only think of the classroom party they will be having in which they will consume way too much sugar. And while everyone is hyped up on sugar today, tomorrow will come the post-Halloween stomachaches, from their candy binge and staying up too late. In the words of one student today who came in for his daily Ritalin, "We're going to have a party in the classroom and eat tons of candy and then go home and eat more candy and then go trick or treating and then go home and eat MORE candy, it's AWESOME day." 

This year, though, I mentioned to a secretary that I would be off November 1st, and her response was: "Oh, why didn't I think of that?" Working the day after Halloween is that bad. But yes, I'm off to become a Mrs., conveniently timed to miss the post-Halloween illnesses that will surely come tomorrow - YAY!! 

And to give an idea of just how thin we are spread right now (hence the lack of attention this blog is getting), I asked for Monday off as well to extend my eventful weekend. I couldn't find anyone else to cover my diabetics, so I'm coming in and hoping I don't get in an accident or become deathly ill: we don't have enough nurses right now for anyone to be out. 

Lastly, your anecdote of the day: I was drawing up insulin for "The Other One" - my diabetic that I want to pack up and take home with me, she is just that darling. Another student was in the office and questioned what I was doing, "You're allowed to give injections?" Yes, dear, the nurse is allowed to give injections. 

The lunchtime zoo

I'm always at Diabetic Land during their lunch hour to take care of Spitfire, and the place never fails to feel like a zoo. Parents all seem to drop by at lunch, the kindergartners are leaving (except for the ones whose parents forgot to pick them up and now we must babysit in the office), and it's recess for rotating grades. Recess means injuries, and at that school in particular, there seems to be no screening process for whom to send to the office for an ice pack. Oh, and one of the secretaries has her lunch break, leaving the other secretary alone to handle the majority of the mess. 

Yesterday, it felt particularly busy, and I was running around like a chicken with my head cut off passing out Ritalin, cleaning up scrapes, and calling home for vomiting children, all at the same time in my office. In the front of the office, I could see the secretary having a similar struggle keeping up with everything. A yard duty came bustling in, and ordered me to grab the wheelchair, a kid was down outside. I was unable to just take off and run; I needed to lock up the Ritalin first, and in the meantime the yard duty began complaining that she'd tried calling the office and they didn't answer, and couldn't I hurry up? My thoughts accidentally spilled out of my mouth: "Oh, sorry, we're a little busy in here," I said, not actually apologizing at all. She wasn't fazed by my retort, and as she was walking me outside to where the kid was, she explained the situation: "He fell off the monkey bars or something, I don't really know, I don't know if he's hurt or anything." She had her back to me so she missed the daggers I was shooting her with my eyes. 

I reached the child, who looked happy as could be laying in the bark of the playground. I did a quick assessment, and the student said that he couldn't sit up. I wondered aloud, "Shoot, how will I get you in the wheelchair then?" And suddenly the kid jumped up, dusted himself off, and ran off to be with his friends before I could even get his name. Guess what, yard duty: he wasn't hurt. 

I've used the wheelchair at this site more than any other, and it's usually for things like this: nothing. I'd rather the yard duties err on the side of caution, but on my way out to my next site, the secretaries and I had a little chat: that school is a zoo at lunchtime, and I'd prefer it if there were some sort of screening process to separate the students that need me from those that definitely don't. 

The silver lining: I was able to get some fresh air during recess, and hear my name screamed from halfway across the playground with delight. There's a little girl that I'm pretty sure thinks she is awesome because she's on a first name basis with the nurse, and she couldn't help but show off in front of her friends. I waved back at her, glad my long trip out to the bark box wasn't a total waste. 

And this is why...

I left Diabetic Land mid-morning to go take care of my diabetic at The Institution, as I always do. When I returned shortly before lunch, the secretaries informed me Spitfire had been to the office with her usual sky-high blood sugar of 400+. They said they let her call home, and her mom had asked for Spitfire to give herself some insulin. Thankfully, the secretaries told Spitfire's mom that she would have to come give the insulin herself, and by the time I had returned, Spitfire's mom still hadn't showed up. What concerned me about all this: the secretaries and mom were all on board with Spitfire receiving a correction dose just prior to lunch. (Her doctor's orders on file clearly specify insulin is only to be received at lunchtime.) 

Spitfire's mom showed up shortly before lunch, and it turns out she was hoping to "show" me where in Spitfire's doctor's orders it stated that Spitfire could give her own insulin correction doses willy-nilly...which, of course, they don't. Spitfire was diagnosed with diabetes as a toddler, and is now in the fifth grade, and yet I found myself having to carefully explain to her mother why we would not want to give her insulin just before lunchtime, when I am supposed to then give her a dose immediately after lunch. Gaaaah. 

Lessons in this: 

A) I found Spitfire's mom's willingness to give her insulin at irregular intervals, i.e. whenever she felt like it, somewhat terrifying. I have been keeping careful records, and am having Spitfire's teacher do the same for classroom logs. I plan to send these in to her doctor's office and let them know what's going on at school. Even if I am unable to speak with them directly - because Spitfire's mother has now missed two of the meetings we set up with her, and therefore I don't have a release of information - I know I can at least fax in my logs and let them know my concerns. 

B) I found the secretaries' willingness to let Spitfire be given insulin at the wrong time not as surprising, but just as terrifying, particularly on the heels of this decision that came earlier this year: California Court Rules Unlicensed School Staff Can Give Insulin. This kind of situation is precisely why this decision is frightening to me. Secretaries, through no fault of their own, have other things to be concerned about besides insulin and just can't devote the time and energy needed to administer it safely (in my humble opinion). 

It's really a miracle to me that serious accidents don't happen more often in school. 

Spread thin

There are 29 school sites in our district with attendance numbers ranging from 50-2000+ at each of those sites. We have 9 nurses and an LVN on payroll to cover these schools, but in the last two weeks, that number has dropped. The LVN is out on disability due to surgery, one nurse is out on vacation for two weeks (do not ask me why that was granted), and one is now out on personal leave. If something happened and I wasn't able to make it in to at least cover my diabetics, I honestly don't know what would happen right now. Thankfully our numbers will start to return to normal soon as the vacationing nurse returns this week.

This article says it well: we're spread thin. Really thin. 

(And that's my excuse for the recent lack of updates.)

The Other One

I have another diabetic this year besides Spitfire, at the Institution, where (almost) all students are amazing little specimens of perfection: creased pants, polished shoes, polite manners. I don't mention her on here maybe because she is just so easy there's nothing to write about. She's an adorable little 5th grader, who arrives on time, is truthful about her blood sugars and what she'll eat for lunch, and, well, she's just a bundle of cheer. 

Even at the Institution though, kids are kids. I was talking with my diabetic about her plans for the weekend, and she told me that she'd probably have to do some chores because her mom wanted the house cleaned. I asked if she had any siblings she could split the load with, and she said no, but that she had her own trick. I asked her what that was, and she explained with a smirk, "I just go in the bathroom for a really long time while my mom keeps working on the house." 

Haha...nice. I'll have to remember that one. 

If at first you don't succeed...

Stop trying to fool me. Some kids just don't get it. Time and time again, they are in my office, telling me of a new ache or injury, and time and time again, I poke every hole I can in their story. 

At the Institution, school is taken very seriously, and I make a great effort there to not let anyone go home. (The principal's office is within earshot of mine, which helps fuel my efforts.) A frequent flyer came in at lunch complaining of knee pain, saying he "popped" it. Tip #1 to students: act like I'm watching you even when you think I'm not. The student had walked into my office limp-free, which I observed while he thought I was typing away at my desk. He said it happened three hours ago during first period; I explained he would not be walking on a dislocated knee for three hours. 

I told him I'd give him an ice pack and he could sit in my office for the remainder of lunch. The student protested, saying he didn't think an ice pack would fix it. Tip #2: If you're a frequent flyer, accept what I give you. The student then went on to complain that his knee hurt when he stretched it or sat down on the ground in PE. I replied that it was a good thing then that he was already done with PE and would be sitting in a desk for the rest of the day. He finally took the hint, and when the bell rang, he gave me a sad look and feigned a debilitating limp on his way out of my office. Another student who had been in with us serving lunch detention turned to me with wide eyes and said, "Ma'am, he wasn't walking like that when he came in." Tip #3: Perfect your acting skills before trying to use them on me. You know it's bad when another student is snickering at your futile efforts to dupe the school nurse. 

School bans most balls during recess

I'm all for making recess safer, but this seems it might be a little extreme...What happened to fun? 

Eye Rolling

Monday mornings I've been keeping myself busy at The Special Place. There have only been a few Mondays since school started, but the police have had to make a visit *every* time I'm there. (Usually attempted runaways.) For obvious reasons, every closed door at the school is locked. So, to get to a classroom, I need to have the secretary walk me out of the office (because it's locked), into the classroom building (also locked), and then let me into the classroom (also locked). It's a hassle, so I don't make house calls if I can avoid it. 

I needed to screen one of the students, so the secretary called the classroom to see if an aide would bring the student up to the office. (Because I can't call classrooms from my phone in the nurse's office. Did I mention this school is a hassle?) They said they didn't want to disturb his routine, so I offered to go out there myself. The secretary walked me to the classroom, and I met the student, who was busy arranging dice in boxes. The aide's explained that this was what he was working on and that I probably wouldn't be able to get his attention to test him - could I come back in 10 minutes? I stopped myself from asking why they hadn't just told the secretary this over the phone when she said why I'd be coming down, and went back to my office. 

Ten minutes later, the secretary walked me back through the many doors to the classroom. I started trying to work with the student again when another aide piped up, "Oh, he's too low functioning, you won't be able to screen him." They weren't able to tell the secretary this when she called to say I would be screening him, nor the first time I made time I walked out there? I don't understand some people. 

Breakfast of champions

A teacher brought a kindergartner to me this morning in tears from a stomachache. She explained: his grandpa gave him coffee for breakfast this morning. Brilliant. 

Caught red-handed

Spitfire has been coming to me at lunchtime with very high blood sugars, consistently over 300. I questioned them, and she'd tell me she'd had a juice or other snack recently after her blood sugar was low in class. Still suspicious, I mentioned this to the teacher at the 504 last week. Her teacher said she'd been taking Spitfire's word for it until then, but wouldn't be anymore after hearing what her blood sugars were by lunchtime. 

Sure enough, Monday morning, Spitfire told her teacher her blood sugar was 61 and she needed a snack. The teacher asked her to show her the meter, and at first, Spitfire tried to say that she didn't know how to look at the history. Too bad for her, the teacher is a diabetic herself, so she took it and scrolled back to find that her blood sugar wasn't 61, but 261 - only a difference of 200 (and a snack). By the time she got to me, her blood sugar was under 200, quite a feat for Spitfire, and today, it was again under 200. These were the first two consecutive days under 200 since school started. 

I had the unfortunate chore of calling Spitfire's mom to inform her of the incident, and calling a parent to tell them that their child is lying is no fun. She sounded helpless and defeated when I told her of the incident, and that I suspected that it's only the first time she's been caught; given her outrageous lunchtime blood sugars this year, she's probably been doing it for some time. Mom said she'd call the diabetes educator at the clinic she goes to for tips on helping Spitfire understand the seriousness of what she's been doing; whether she'll follow through on that is anyone's guess.  

Regardless, I'm glad Spitfire's teacher is as on top of it as one can get, and at least I was able to voice my concerns about Spitfire's carefree attitude about the whole thing to her mom. 

Parents, part 5420754

We were supposed to hold a 504 for Spitfire yesterday with her mom. Spitfire's mom had confirmed she'd be there, and I was looking forward to it. Her blood sugar has been wildly out of control this year, regularly over 350, and I wanted to talk to her about what we can do to get her to start taking her diabetes seriously. Well, mom didn't show, the meeting was cancelled, and Spitfire was conveniently absent today. She's also been ignoring our calls when Spitfire's needed her.

I will never be able to understand how a parent can not take her daughter's medical condition seriously.


Side note, my apologies for posting issues and posting late. I write them and don't always remember the "Publish" button.

Undermining

I hate being undermined by my own colleagues. I can't stand when I work with a student, convince them to tough whatever the issue is out and stay at school, and a teacher walks into my office and pours on the pity for the student, reducing them to tears, and sometimes even suggests that they go home.

Once I found the doctor's note, I told Pink Eye student's teacher (below) that he could stay at school. I explained that I knew the kiddo, and that it's a recurring issue, but not to worry unless it shows other symptoms of pink eye, which I spelled out for her. What does she do? Send him to my office to "look again" and emailed me a list of phantom symptoms I guess she thought she saw. Ugh. Why ask my input if you won't listen to it?

Then this morning, a tearful student came to my office complaining of the classic stomachache. I asked her if she'd had breakfast, she said no, I asked her if she'd be able to stay at school if I found her something to eat, she said yes. I was taking her down to the office when the psychologist intercepted us, asking what was wrong. I let the student explain, and the psychologist told me she'd go talk to her, because, "There's more to this." They had a talk in an office, and when they emerged, the secretary said she's been going home for stomachaches all the time this year. She rolled her eyes at the sight of the student, and let her call home, knowing her mom would come pick her up. The psychologist left us, clicking her tongue, and telling me, "I knew there was more to that issue." Excuse me? I take pride in how many students I can get back to class when others can't, and am totally confident I could have with this one if given the chance. I didn't bother asking the psychologist why letting her go home was better than giving her a snack and having her stay in school, or how a student wanting to go home during school becomes a "bigger" issue.

My useless memory

Two weeks ago, a teacher sent a fourth grader to my office for possible pink eye. I agreed, and sent the student home asking the parent to take him to the doctor. Monday morning I received a note from the teacher that the student's eye was still pink. I made a separate trip to that site - after hitting all three of my other sites earlier in the day - just for this. His eye was still pink, but looked better. The secretary offered to call home for me (because my Spanish skills are not anywhere near conversational levels) to follow up. Mom answered and reported that she had taken him to the doctor, and that she had dropped off a note from the doctor. After some digging, we found the note - sure enough, he'd been to the doctor. 

Then it dawned on me: two years ago, this student's teacher was also constantly sending him to my office for "possible pink eye." The poor guy has an issue with his left eye, and it is frequently red - but not actually the contagious pink eye everyone fears. I double checked this in his school folder. Sure enough, I had the right student, and knew what teacher he'd had for 2nd grade. What a useless factoid for my brain to retain. I can't remember to put the garbage bins out on the right day of the week, but I can remember what teacher one particular had two years earlier. 

Up and down

I went to the bathroom just as one of my students came in for his lunch meds. I didn't see him until after I came back, and he ran at me screaming, "THERE YOU ARE!!!" and gave me a big hug. You'd have thought I had been lost for hours. (This kid has been particularly attached to me since he noticed my emerald ring as he LOVES gemstones; in fact, I keep forgetting to inform my fiancee that one of my students is expecting him to buy him a ring to match mine.) 

That was a much happier occurence than what happened when I went to screen a kindergartner. I showed him the headphones and explained the hearing screening, and he did okay until the machine started making the testing tones. He melted into tears, sobbing, begging me, "No beeps, no beeps." He sobbed inconsolably for the entire twenty minutes I was in the classroom, and still was crying as I left. Poor kid.

Parents

Spitfire's blood sugar has been out of control so far this year. In the 300-400 range very often, and varying amounts of ketones. The other day her blood sugar dropped to 60 in class so she ate two Peppermint Patties; two hours later her blood sugar was over 400. (These numbers and times were confirmed by her glucose meter and teacher.) Her A1C has been going up and up in the two years she's been under my care, and when last year a normal insulin dose would be 3 or 4 units, this year it is 7 or 8. 

So, come Friday afternoon, when I received a call from the school secretary, I wasn't at all surprised to hear that her blood sugar was high and she had moderate ketones. She had called her mom, who was at work and told her to call her aunts, but none of the aunts answered and then her mom wouldn't pick up again. I told them to keep calling her back and had I not been at the dentist's office, I'd have taken her home myself. 

It wasn't until after I hung up with the secretary that it dawned on me that Spitfire's mom answered the first time - knew she wasn't feeling well and what her blood sugar was - and then ignored the calls after that. How can parents of children with serious medical issues just ignore phone calls from the school, particularly after she already knew something was wrong? I don't understand some people. 

McBreakfasts

A first grader came to my office complaining of a headache, and I asked my usual first question: "Did you have breakfast?" He said no, and I asked if he eats the school breakfast, as a large percentage of our students do, thinking I could get him some food from the cafeteria to tide him over until lunch. He said no again, so I asked if he ate at home. He answered no once more, and explained, "I eat at McDonald's." 

What? "Every day?" I asked. 

"Yep!" 

Ugh. 

Twins

I looked up a student in the computer only to find that he had the same last name, same birthday, same address, and same parents as another student. His middle name was also listed as the other student's first name. I pointed this out to the secretary, thinking maybe he had accidentally been entered twice into the system. I was wrong. The two boys are adopted twins; their parents named their new adopted sons after the adoptive father. One became (Father's Name) Jr. and the other was given the father's name as his new middle name, with "Sir" as his first name. I'd encountered this family before I made this discovery and I can say quite factually that they are, for lack of a better word, totally weird. 

Muhahaha...

A teacher brought a student down for a lice check. I snickered to myself as I said I'd take care of her. She certainly had a few nits, so I called home just to let mom know - and then brought her back to class! The teacher is, thankfully, one of the more reasonable ones on campus, and thoughtfully nodded her head as I explained the new policy. The amusing part: as I left school, word was spreading through the halls about the new lice policy. It is only a matter of time before it reaches Ms. Meanie, who I am sure will have something to say about it, particularly when she sees it hanging in my office with bright highlighting. (The secretary and I got a good laugh while thinking about what her reaction will be.) Sadly, Sweetie 1 and Sweetie 2 are no longer at my school site, but they are still in the district and will benefit from the new policy for sure. 

Victory at last.

The lice policy, yes, that old thing that I brought to my boss's attention eons ago, is finally in effect. The new policy reflects current recommendations by the American Academy of Pediatrics and Department of Public Health, only excluding students in cases of active head lice as opposed to our outdated "nit-free" policy we used to have. 

We received approval from our boss to enforce it yesterday afternoon, and I wasn't at work for more than 20 minutes this morning before the secretary came to me complaining about it. "Do the people that wrote this thing know everyone is going to have lice now?" I conveniently forgot to mention the fact that it was actually me that wrote it, and just pretended to sympathize with feigned disgust at the new policy, while mentioning as politely as I could that our district is in fact behind the times in adapting the not-as-new-anymore recommendations regarding lice in school. What I also definitely did not mention was what the insides of me were trying to refrain from shouting: 

FINALLY!!!!!!!! It's about damn time. 

May evidence-based practice always win, eventually. 

Other duties...

Today I spent twenty minutes fixing the lock on the medication cabinet at the Institution, because getting someone to place a work order (I can't place one myself) just takes too long and even longer to see the results. It had been broken since the day before, and I just really wanted to lock up the oodles of Ritalin and other fun stuff in there...Nurses are weird like that.

Cringe-worthy

At the Special Place, there is a severely epileptic (and also adorable and sweet) student that requires Ativan in case of a seizure. Yes, you read that right: she takes Ativan orally at the onset of a seizure so as to stop it from continuing. Apparently it is not as nutty as it sounds; she'll begin a seizure, then it will pause momentarily, long enough to have her take the Ativan. (When I was first given the notes on this student, all I could wonder was how in the world we were going to give an oral medication during a tonic clonic seizure, as it was originally described to me.) 

After much discussion with our nursing coordinator, we decided that the medication could and should indeed be kept in a locked cabinet in the classroom in case of emergency. The guardian had already dropped off the Ativan for the student, so once I had a pretty care plan all written up, I brought it and the medication to the teacher. I told the teacher what I had in my hands - he had already volunteered for it to be kept in the classroom, and knew what its purpose would be - and when I said it was the student's Ativan, his response was, "Should I give it to her now?" This as the epileptic student was quietly eating her lunch.

I think my heart stopped momentarily when I heard that, and is the precise reason I *hate* having to allow medication in the classroom. Teachers have other priorities, and health just isn't their first. Needless to say, I gave the teacher and classroom aides a LONNNNNNNNNNG lecture on when and how to give the Ativan, followed by an email with the principal cc'ed including an in depth description of Ativan, its side effects, and a note to please contact the student's guardian to directly discuss the student's behavior during seizures, just so he'd have to listen to it repeated again. Ugh. 

Clean your cuts

Sea snail hatches, grows inside California boy's knee after scrape at the beach. I should start using this as an example when kids protest my efforts to thoroughly clean their injuries.

Day 2

At The Special Place, a student escaped, but only temporarily, and a teacher was bit on the arm and punched in the face by one of her students. There may only be 40 students on site, but I think they might turn out to be an exciting bunch. A new nurse was hired to replace our retired one, and now I'm thinking I may not give back the Special Place: the office is huge, I am buddies with the secretary from a previous school, and I like the excitement that comes with working with that population.

At The Institution, my diabetic is probably going to prove to be the most compliant, easiest student I've probably ever worked with. When you've worked with some nightmare-ish families, you really notice the difference when you get lucky with an easy one.

And I will leave you with this: Avoid the 'back-to-school plague'. I will vouch for the fact that drinking fountains gross the heck out of me, particularly when kids suck on the end of them like they're lollipops...child after child on line sucking on the same piece of wet metal. Gross, gross, gross.

Back in the saddle again

I started back at work on Monday, with students returning today. With one of our nurses having retired last year, I knew changes would lay ahead for this year, but they're less drastic than I'd anticipated (phew). I have Diabetic Land elementary school with Spitfire diabetic for the 2nd or 3rd year now; Disneyland elementary school, land of happy teachers and poor students in the ghetto, for the 4th year in a row; and I am continuing with the "Institution" as it shall be dubbed, where the students refer to me as ma'am, there is NO talking in the hallways, ever, and everyone is neatly buckled into crisp uniforms. Instead of adding a high school to the mix, I somehow accidentally volunteered myself, while still waking up during our Monday morning meeting to discuss assignments, for...well, I'll just call it the Special Place. There's only 40 or so students, grades K-12, and all have severe behavioral and/or medical issues preventing them from being at any of the district's other schools. I thought it'd be a breeze, but have spent countless hours this week creating care plans for everyone, and have had to essentially neglect my other schools. Luckily, they know me, and know I'll get to them eventually. Also, someone's P.O. came to the Special Place to check up on them today, and I'm led to believe this is a normal occurrence there. (I'll be keeping my phone in my pocket at that site.) 

Having to get up in the morning and leave my comfy bed and lovable pets has been a rough adjustment, but it's conversations like the one I had with Spitfire today that eventually make it worth it: 

Spitfire (staring at a new-to-her ring on my left hand): Are you engaged or something?

Me: Yes...Is that okay?

Spitfire: What?! I didn't even know you had a boyfriend. Are you old enough to be engaged??

Me: I'm 28, what do you think?

Spitfire: Oh, okay, I guess that's okay. Weird. 

Day of Thanks

It was the last day of the regular school year, and teachers and secretaries alike seemingly spent it thanking me right and left for what I've done for them and the students. A teacher with a broken foot even hobbled over to my office just to tell me how impressed she was that I returned a student that apparently frequently screams bloody murder to her classroom in good spirits after she came to me with a traumatizing split lip. Yay: it's nice to go out on a good note, feeling appreciated.

I'm off for two weeks, and then will be back in the saddle for the third week of summer school. In between, and afterward, unlike my last two summers, I have no serious plans. I predict a rotating  combination of the following: swimming, hiking, and hanging with the creatures of my house. (The cat can finally have full time immediate room service, as she's taken to meowing incessantly if there is not enough food in her bowl, her water isn't fresh enough, or the litterbox sand isn't stroked just right after cleaning.) I can't wait to get started.

Normally I would suggest you add me to your Google Reader or whatever you use so that you can pick this blog back up again after my break, but Google Reader is being put to the grave soon. Find a new RSS reader! See you in two weeks during summer school if I'm ambitious, otherwise look for me again in August, with a major change in my school assignments likely taking place (I'm slated to take over a high school). Happy summer!

Almost

Tomorrow is the last day of the regular school year. I thought about what a year it's been last night as I cleaned out my bag. As I picked out crumbs and pieces of unidentifiable objects (I'm as bad as the students), I concluded that all in all, it was kind of a crappy year. I never want to see someone again in such a terrifying state of hypoglycemia, my phone was stolen and crushed, and I've been trying without success to become a CPR instructor since September - a monkey I'd have had off my back months ago had I had some different (read: helpful, considerate) co-workers. C'est la vie: tomorrow begins two weeks off, and then I'll be back here to work summer school, and then off all of July until Aug. 12. I really shouldn't complain. 

It was my last day today with many of the kids, including my diabetics. Spitfire was her usual independent self, waving at me to have a good summer as she left. Mr. High Maintenance, who is off to middle school next year, told me, "You're coming with me!" when I told him to have a great time as a 6th grader. (He's been increasingly resistant to the idea of a new school as this year passed us by.) I'll miss him, and as much as his mom drives me nuts, her too. When I called to let her know his blood sugar today, she said, "I don't know what I'm going to do without you." Awwww! 

And in reference to my stolen phone, the county probation office called me today and invited me to Sticky Finger's court date this coming Monday. I'm not going, but can we just take a moment to think about the fact that it has taken four months for a simple phone theft - one where the suspect confessed - to be processed? Oh, our lovely court systems. 

Until tomorrow...

Return of the Sweeties

You'd have to have a really good memory to know this off the top of your head, but I've written about these girls before. There are two sisters a year apart that I have been in close contact, unfortunately, with since I started at this job. They are constantly being sent home for lice, and the problem has grown throughout this year. Their current attendance records show they've showed up less than 50% of the school days this year, and they have recently been through the truancy proceedings so that at each absence now the family is being cited by police and the income they receive from welfare is being withheld. I've filed a couple of CPS reports on this family myself, and after I made a referral to the Public Health Department, they also decided to file a CPS report too. In short: the parents of this family disgust me. 

The little girls suffering from this are ones I know all too well now. They hang out with me each time their teachers send them to me with lice, and we've spent long stretches together waiting for one of their unemployed parents to pick them up. I have a coloring book I keep in my desk that just the two of them have nearly completed, and they often ask about my life with such curiosity. Both are bright girls that would surely excel in school, if only they were present for more of it. 

Today I sent them home once again for lice, and as Friday is our last day of school, I likely won't see them again. The girls seemed to know this as well, as I watched one of them undo this well-loved rubber duck key chain from her backpack. She asked me to take it, and wouldn't accept it when I tried to refuse.

<Sigh.> I suppose it would be illegal for me to smuggle them home.

Trip Report

Spitfire's class was going on an all day field trip, which meant I was also going on a 4th grade field trip.

Mama Bears II

During scoliosis screening last week, I screened the daughter of an employee I know at another school site. When I saw the employee the next week, I asked if her daughter had survived the screening. She said (in broken English), "Oh, yes, she said it was okay. She said you seem very nice and she wants to know you more." 

Awwwwwww! Also, phew.  

The Minds of Children

I received a call from Diabetic Land that Spitfire's blood sugar was 56. They put me on the phone with her and I told her to stay in the office,  what to eat and when to re-check her blood sugar. As she was getting off the phone with me, she told me what was really important: "Oh and don't forget, it's my field trip tomorrow." 

Yes, little lady, when you're feeling shaky and your blood sugar is in the 50's - soon to be in the 40's, as it would happen - I am concerned about your field trip.

Just another day at the office

During scoliosis screening, with intermittent breaks between class periods, I was kept busy with the following:
1. Relaying an observation from a teacher to a mother that her son has been appearing to flip a switch in terms of attention. The way he's been "spacing out" with blank stares seemingly unrelated to stress or any other sort of pattern was a concern enough to suggest he need an evaluation, which is always a pleasant thing to tell a parent. 
2. Listening to a complicated lice issue: Biological mother has recently gained visitation rights to her son, and she told me he came to her house with lice on the last visit. She wanted me to follow up with the guardian that the lice has been taken care of. Guardian says the lice were planted by the biological mother. Lovely. 
3. Sending out letters to the 120 6th graders at my school who have still not turned in their proof of Tdap immunization that is required for entering the 7th grade. 
4. Another lice complaint and request for a class lice check. 
5. An email from the speech therapist complaining some of my results were inaccurate (which I had to politely disagree with). 
6. Finding out that the P.E. teacher had distributed the scoliosis notification to parents to the opposite students I needed: 8th grade girls and 7th grade boys instead of 7th grade girls and 8th grade boys. 

Needless to say, I'm glad it's a long weekend. 

It's that time of the year...

Chaos. Case in point: I scheduled scoliosis screening for my middle school for Thursday. On Tuesday, I received a call that I needed to be at an IEP that same day, at the same time 6th period scoliosis screening will be taking place. I tried to say this politely to the big-wig district office lady that was calling me about this:
"Well, I have already scheduled scoliosis screening for that day. Also, I know the student, and know that her issues are psychiatric. Shouldn't the psychologist be the one at this IEP?"
"We need a nurse there, so if you can't make it, find someone else that can."
"Oh...okay, then..."
I did, but only after some scrambling. (If someone from the district office tells you to do something, you do it.) It's that time of year where people are finishing up business, and everyone needs me to do something immediately. It's a great challenge to please everyone at every site when you're juggling three schools. Four day weekend is approaching, phew!

Overheard in the kindergarten lunch line:

"My mommy is having a baby. She wants the baby, but she doesn't want to take care of it."

Ahh....The refreshing honesty of children.

Translators

I love translators. One of the reasons I love them is they can be messengers of my bad news, and I don't have to face the reaction. I'd been dealing with a kid with a hole in his tooth for some time, most recently requesting from his Mom that she bring me a note from his supposed dentist for his supposed treatment. To no surprise, I never received a note, so I decided to go one step further with an ultimatum: produce a note from a dentist or I will have to notify CPS. I'm not sure I'd have been able to say this to a parent so calmly if I had to say it to her face. Luckily for me, Hole in Tooth's mom doesn't speak English. I found a translator and told her the message I wanted her to relay to this parent. She raised her eyebrows at me but said she knew the kid I was talking about and hoped something would be done. As expected, the parent was quite unhappy, but not at the translator per se, as the translator was simply relaying a message. Angry parent or not, the plan worked: there was a note on my desk by the end of the next day: Hole in Tooth was finally taken to the community dentist.

Birthdays

To the parents of the birthday boy kindergartner who didn't get picked up for a full hour after school, who spent the entire hour fidgeting with his paper cone "Birthday Boy" hat, staring out the window hopeful that the next car to pull into the parking lot would be you: Why did you have children? 

I understand that people have to work or have other obligations, but to not make other arrangements for your child or answer your phone when the school calls asking someone to pick him up, on his birthday no less, I don't understand. 

Hah!

It's about as unnerving to leave my diabetics in the care of another nurse when I take time off as it is to leave my pets in the care of anyone else. After taking a long weekend, I asked Mr. High Maintenance diabetic how it went while I was gone. He's recently switched over to insulin pens, and I've also been encouraging to become more independent prior to his transition to middle school next year (he's told me before that he expects me to be his nurse when he's 30).

Mr. High Maintenance: "Oh, it went okay, I did my own shot!"

Me: "Really, why don't you do that with me then?"

Mr. High Maintenance: "Well, I thought I had to. I didn't think she knew how to do it."

Me: "It's awesome that you did your own, but don't you worry. I only let nurses check in on you when I'm gone, and they all know how to do the same things I do." 

I had a good laugh with the nurse that had covered for me, a diabetic herself, when I informed her that Mr. High Maintenance was under the impression she wouldn't know how to use an insulin pen. 

Happy School Nurse Day!

It's School Nurse Day, and one of my schools noticed it - what a pleasant surprise! It's also Nurse's Week, so cheers to all the nurses out there. :)

Mama Bears

Mr. High Maintenance Diabetic is a 5th grade boy who is so sheltered he doesn't know how to tie his own shoes. No one has taught him, and he's happy to stay as naive for as long as possible. I worry that he'll be eaten alive in middle school, but that's another story. His mother, who I think is actually his grandmother, is extremely protective. Case in point: she'll keep him home if he sneezes. I do not exaggerate, once after he was absent I asked her why he was gone, she said, "He sneezed." Literally, that was her answer.

Anyway, the mother scared my little tail off when I first got to know them; I feared she'd rip my head off if I made a mistake with her little boy. I'm far more comfortable now, but the reality I deal with every day, and with every child, is that I'm taking care of somebody's baby. (Careful, "Somebody's Baby," it's one heck of an earworm. At least for me.) So imagine my reaction when his mom decided to drop of his lunch at lunchtime, and signed in as a visitor so she could watch me give his insulin. It's something I do on a daily basis, but my goodness, the pressure is palpable when the parent is watching over you. I swallowed my annoyance and had Mr. High Maintenance prepare the shot himself, and knew he felt the pressure in the room too when he looked at me and asked, "Are you really going to make me do this?" I've had to clean scrapes and call 9-1-1 in front of parents, but there's just something about being the only healthcare provider and delivering insulin to a little boy while his mother watches that was just downright terrifying. 

As usual, I should have had no reason to worry. I played it cool, and made casual conversation with Mama Bear throughout, and she didn't look twice at what I was doing. Trust thyself, even if a Mama Bear is hovering. 

Warning

I saw an advertisement on TV for the Novolog insulin pen. It included a warning at the end that the insulin "May cause low blood sugar." Duh. Hopefully anyone using an insulin pen is aware that that is in fact the purpose of it. 

Substitutes

As a general rule, I am not fond of substitutes. Teachers know their students, they know when someone is faking it, and when they're not. So it didn't take me long to figure out that there was a substitute with a classroom of children walking all over her as I received note after note all day long with students. . "[Name] doesn't feel well," in handwriting I could barely decipher. I continually sent the students back to class - it honestly felt like I'd seen all 32 of the students in that class, but was particularly surprised (read: annoyed) when a student was sent down to the office with a note just 10 minutes before school let out: "Savannah's eyes hurt. She wants to wait for her mother in the office." What? Ten minutes before she'll see her mom anyway you will send a student down to the office just to sit, just as she'd be doing in class? No thanks...I sent the student back, and requested the secretary not use that substitute again.

Ask Questions

I walked into my office in Diabetic Land at lunch time to find a couple of students already in there resting. I let them be while I prepared for the tornado storm that arrives when both my diabetics, multiple kids demanding their Ritalin, and a variety of playground injuries all enter my office simultaneously. Once the tornado of students cleared, I noticed a little girl still on the cot, just as she'd been when I arrived 30 minutes earlier. I asked her what was wrong, and she said she had a headache. "Have you had lunch today, or anything to drink?," I asked. She said she had. "Well, what might be causing your headache, then?," I asked. She explained, matter-of-factly, "My head hurts because one of the other girls in the lunch room was calling me names." 

Ahhh, it all becomes clear. 

On a different note, the mess that is Spitfire diabetic's home life seems to be continuing, as she walked into my office proclaiming, "My family is just a mess." (She explained: her aunt's fiancee left her a month before the wedding.)

Red flags

Yesterday I was dealing with a frequent flyer in with his usual stomachache. At the end of recess, I sent him back to class, only to have him return a few minutes later. Before I could even ask why, he said, "I threw up in the bathroom and then I flushed it right away."  With his too-quick explanation, he earned himself a trip right back to class. 

Tip for kids: if you want out of class, don't raise any obvious red flags. Explaining why I can't see the vomit for myself before I even ask for it is a major one. (Having a stomachache every day during math is another one.)

Fitness testing

It's the 5th grade girls' least favorite time of the year...physical testing. There's several components to this including running a timed mile, counting sit-ups, and height and weight. The scale is in my office, so I have the privilege of recording the student's weights. I do my best to keep it totally confidential and calm as possible, but there's just no way to have a bunch of 11-12 year-olds getting weighed without being stressful for some. 

This year was just as unsuccessful as last year in attaining my "no tears" goal, as two of the three teachers came to me afterward to inform me that (through no fault of my own, they assured me), several students were in tears. In looking at the numbers, it's easy to see why: weights ranged from 62 lbs to 249.8. Do the math: there's a student four times the lightest one, and the distraught students were both on the high end and the low end of the spectrum. There's no easier bait for teasing than differences among physical appearances.

<sigh.> Sorry kiddos, the higher-ups require me to weigh you. My opinion: I'd rather spend the time actually doing something with the kids, e.g. on a nutrition lesson. The emphasis on testing, physical and otherwise, in schools is unreal.     

Sponsored Post: Uniformed Scrubs

I was asked to review a Cherokee scrub top provided by Uniformed Scrubs.  I don't always wear scrubs to work but since taking on my new middle school where the kids are in uniforms, it feels appropriate. The Cherokee scrub top I was given was a round neck, cute looking top...except it didn't fit me right. Oh well; I can be picky when it comes to scrub tops. In looking at their website, I see they have plenty of options to choose from. In being the cheapskate that I am, I went straight to the sale page and found a decent selection on sale. They carry a variety of brands but they also have a large selection of Cherokee brand scrubs, which for whatever reason, have always been my favorite. 

Uniformed Scrubs is also giving my readers a coupon code for any purchases you make. Just use "15pbrm" during checkout to receive 15% off your purchase. 

Disclosure: I received a Cherokee scrub top in exchange for this review, but the review is solely my own thoughts and opinion. 

Floss

Spitfire Diabetic, for weeks and months, had "Recess Academy." Students earn Recess Academy (RA) for not turning in homework, or assignments needing remediation. Instead of going to the classroom designated for RA after lunch, in place of recess, Spitfire began serving RA in my office after her insulin. My office isn't the somber mood of RA, and I know she was doing this to get out of a few minutes of RA. She still did work in my office, but certainly less than she would have had to do in RA. Finally, her teacher let her off RA last week. 

Come Friday, I helped with her insulin and told her to go have a nice recess. Instead, she chit-chatted and hung around my office until the secretary noticed her and told her to go "be a kid" for the last few minutes of recess.   

Come today, I had a headache. Spitfire can read me as well as I can read her, so I admitted I wasn't feeling well. She was as well behaved as ever, checked her blood sugar, went to lunch, and then came back. A friend had given her a bag of popcorn, and as I was peeling an orange, she pulled up a chair next to me. We spent her recess discussing our snacks, and when I heard her get a kernel stuck in her teeth, I asked if she needed floss. "Floss? Why would you have floss?" I told her my bag has a lot of magical things, including floss, and her eyes bugged out as I pulled some out like a magician pulling a rabbit out of a hat. 

I don't like that she's not playing around with the other kids at recess and instead choosing to hang out with the nurse, but at the same time, I can't help but want to give her the kind of attention that I am sure she doesn't get at home. As I mentioned earlier, it's a fine line I'm walking with her: being supportive and attentive without being her best friend. 

Meltdown

I call Spitfire diabetic "Spitfire" for good reason. The girl's in fourth grade but has the mouth of a sassy teenager, and a quietly sarcastic sense of humor to go with it. We usually have a good time, though I've certainly had to admonish her for various things (e.g., lying to me), and I know our time is important to her. Her home life is in a continuous state of disarray: a mother who's on marriage number three, except I'm not really sure if she's married because Spitfire's told me at various times that Stepdad's moved out and that Mom's dating her boyfriend from AA, a dad who won't go to classes at the endocrinology clinic so Spitfire can be on a pump, etc. I take that background into account when I deal with her, trying to walk the fine line of being on her side of things when I know she feels the rest of the world isn't, yet also being firm with her and not getting away with too much. 

She's a tough kid that can roll with the punches (and endless needlesticks) better than most, but I could tell immediately something was amiss when she walked into my office at lunch. Spitfire said she didn't feel well and wanted to go home; after she checked her blood sugar I told her to go to the cafeteria. She returned after lunch saying, "You can ask [the lunch lady], it's true, I threw up." 

Like most kids, she knows vomiting is her ticket out of school. I let her call home, betting that no one would pick up; I was right. I had to go back to another school site, but I told her she could stay in the office until her recess was over. I walked out to relay to the secretary that she'd be in there and explained why: "Supposedly she threw up." Even though I didn't believe she'd vomited, as soon as I said it, I knew it was a mistake. Spitfire heard me saying I didn't believe her. I walked back into the nurse's office, and she had a meltdown. The girl doesn't cry, but she did today. Ugh. I told her to feel better and that I hoped I'd see her tomorrow; then I left, feeling terrible. 

Poor baby :(

A little one came in first thing this morning complaining of a stomachache, which at that hour usually indicates one of two things: either the parent knowingly sent them to school sick or there is a quiz in class, or something of the sort, that they don't want to do. I asked his name and recognized it, because I had just met his father last week as I accepted medication for this little guy. He's new to the school, just started after spring break, and I asked him how he liked it here so far. "Not really," was his sad answer. He continued, "The other kids aren't friends with me." :(

I'm pretty good at keeping kids at school even when they don't want to be, but after what he said about not having friends here, and because I had met his father, I just let him call home. He's in third grade and his medical history includes diagnosis of a psychiatric disorder, and reportedly has hallucinations that cause him to hurt himself and others.

Names

I had to talk to a teacher about the child whose name is a letter. When I looked him up in the computer system, I found it's worse than I'd thought: he's [Letter] [Letter] [Last Name] IV. That means there have been three earlier generations of these lettered men! I can only hope he changes it for his kids. 

Soapy mouth

I had a definite "oops" moment in my office today. I've been dealing with a mess related to a training I need to take, a mess that could have been avoided if a couple co-workers were...ahem...more team-oriented, and the frustration had been mounting until I voiced it to our lead nurse. "This is bullshit," I proclaimed while on the phone to her, right in front of a student waiting for his medicine. I can only hope I mumbled it badly enough that he didn't go home and tell his parent what he'd heard. 

I am nearly positive this child is old enough to know what I said, and I say so because of a story his teacher related to me earlier this year. He's a third grader, and the teacher was discussing blue moons with the class. When she asked the students what they thought a blue moon was, this little one raised his hand and said with confidence, "A beer!" 

Back in the saddle

Whew! It's already April. After spring break, it's easy to see summer on the horizon now, the light at the end of the tunnel. During my break I was catching up on old mail, and I was surprised to see a headline on the cover of California Educator, the magazine for members of the California Teacher's Association, entitled, "A Day in the Life of a School Nurse." I've been receiving this magazine since I started this job, and the vast majority of articles are pretty irrelevant for a school nurse. In fact, the only other article I remember reading in this magazine after almost 2 1/2 years was an article debating cursive lessons in classrooms. (Call me a dinosaur, I still prefer cursive.) I opened up the article and was even more surprised to find that the nurse highlighted works at my old high school in my hometown! Weird.

Click here to read the article for yourself. She has more students than I, but the rundown of her day sounds very familiar.

On a different note, I want to take a minute to say thank you to my readers for the kind words I get - both comments and emails. Even though I often don't respond, I so appreciate the support. :)

Spring Break 2k13

Spring Break already! How strange, I feel like it was just winter break...next thing I know it will be summer. As always though, I'm ready for it. Today's sad story is brought to you by a second grader with a hole in two of his teeth. Yes, a hole, carved all the way down to his gum, spanning two teeth; it appears to be a gigantic cavity. He's in extraordinary pain, and reporting that he's not seen a dentist about it; his mom says he is under treatment. The skeptic in me called B.S. on her and told her I need to see a note from the dentist, unfortunately, the conversation was through a translator so I couldn't hear her reaction. Poor kiddo, and as I do every break, I'm just going to cross my fingers and hope that him and all the others will come back in one piece on April 2nd.

Therapy Session

Spitfire Diabetic returned to school today after being gone four of the five days last week. Her mom had taken her to her grandma's in another state (because that makes more sense than waiting until spring break in two weeks). After lunch, as always, she came to my office for her insulin. We did our routine, but I knew something was up when she then asked to stay in my office during recess, because "recess is boring." I obliged, telling her she would have to watch me eat my lunch. We critiqued my sloppily made peanut butter and jelly sandwich, and she grabbed a paper and pencil to occupy her hands while she started talking. Changing topics, she asked if she could tell me something that I wasn't going to be allowed to tell other people. I said sure, keeping my mandated reporter status to myself, and kept munching on my sandwich. She explained, "My aunt is pregnant and it's a bad thing." I asked if her aunt was too young for a baby, and she said, "No, but her boyfriend is in prison." I agreed that didn't sound like a good situation, and kept eating, until she interrupted with, "There's something else I really want to tell you but I shouldn't." I reassured her that I wouldn't say anything (except of course on my blog), and soon enough, she provided some more details: "It's bad that my aunt is pregnant because she's having a girl. Her boyfriend can't be around her...Do you see where I'm going with this?" Totally tuned in now, I said yes, but suggested she tell me just so I'd be sure we're both on the same page. "Her boyfriend is a rapist, he can't be around girls, he has a restraining order out on him." [Yes I made sure she's never been around him herself.]

This is a nine year old telling me all this. :( It's terrible she knows this stuff, and whether or not it's all true - she's been known to exaggerate - she knows enough to talk like this.

Side notes: First, those "3" and "E" looking things at the top of her picture are birds; the bell rang and she had run out of time. Second, today confirmed what I've suspected for some time: give a kid paper and pencil, and it will get them talking.

TGIF

A gift from an asthmatic student. She comes to the office to take her inhaler every day, and the one minute I make her wait between puffs is too long for her to not do anything, so she's taken to drawing a quick picture.  Happy Friday!

Baby Daddies

A mother of a first grader has sole custody of her son, but her Baby Daddy and his new girlfriend have been hanging around the school at release time to wave at his son. Duped Mom asked our school to tell her what Baby Daddy's real name is (some of the staff do know him) because he used a fake name with her and as such, Duped Mom cannot currently file a restraining order on him to prevent him from waving at/confusing the poor kid at the release bell. Yes, this woman had a child with a man whose real name she did not know. On the plus side, she showed some embarrassment at her request for Baby Daddy's name, demonstrating at least a little bit of awareness about the awkward situation. 

Whose shoes do you want?

I'll be the first to admit my job is pretty easy sometimes, but I maintain that most people wouldn't want my job at other times. Today, Spitfire diabetic was absent, allowing me to get back to my other elementary school ten minutes early after lunch. I walked in to hear the secretary call my name and ask me to step in the main office for a few minutes. I found a student I didn't recognize in a wheelchair, appearing to only be semi-conscious. She had been running outside and ran into the side of a wall (don't ask me how kids do these things), reportedly lost consciousness, and needed assistance to get to the office. Dad had been called, but he'd only said he was going to try to track down mom with no promises of someone arriving, and the secretary had told him if he didn't get here quickly an ambulance would be called. Upon seeing me soon after hanging up the phone with dad, the secretary said with relief, "I'm so glad you're here, I didn't want to make that decision." 

I tried to talk with the student, and although she was oriented when answering questions, it was a challenge to keep her awake enough to do so. Just as I was opening my mouth to direct the secretary to call 9-1-1, the student's mom walked in. Ugh. She said she had insurance but it didn't cover ambulance rides, and that she would take the student to the hospital herself. In the next town. We told her the local emergency department was closer, and that she could still go to it, but the message wasn't getting across. The student's teacher was also present, and telling me that the student's lethargy seemed out of character. So, I made the executive decision, with mom standing there disagreeing with it, for the secretary to call 9-1-1. A few minutes later the paramedics were packing her up, and they were on their way. (We acknowledged that the student was oriented, but also lethargic. Mom protested that her daughter's always shy and lethargic.) Side note, I know I've finally reached the point of being quite comfortable and feeling competent at this job because I don't think my heart rate increased a beat through any of this. Two years ago I'd have been dripping sweat. 

Later, the principal asked me if I thought she had a concussion. I told him she'll probably be fine, but I don't take chances with head injuries. "Good call" were his words on it. When mom gets the bill for that ambulance ride, she'll be none too happy with me, but I'd rather have to deal with a dispute over money than the health of a kid. Regardless of the outcome of this situation, one thing is for certain: no one wanted to be in my shoes.