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.