Confessions of a School Nurse. Michael Alexander

Illness comes in waves, and Luke didn’t disappoint. His temperature went up and down, dragging his body along for the ride, but by the following morning he was feeling good again, and after a day with no fever or body aches, he was sent back to his dorm.

      Why had I been so worried? Why had I even considered sending him to the doctor? I knew he had a simple cold, and I know that children are adept at taking onboard very high fevers.

      It was because I was the one making the ultimate decision, although it did help having two experienced colleagues to turn to. But I was the one making the decisions, especially late at night or on the weekend, and deciding if a fever was benign, or a sign of something more sinister, even life threatening, and I was the one going to sleep at night wondering ‘what if?’. There were no doctors in the background to run a reassuring eye over him, and no blood tests to see how his white blood cells were holding the fort, or inflammatory markers to see how much of a battering his body was taking. I was using my senses and basic observations to make what seemed like a simple call.

      But nothing is simple, and in medicine, the simplest decisions don’t happen without a lot of thought. This is my job now. I’m the decision maker, the responsible one. It’s terrifying.

       Learning the basics

      ‘Shit,’ I thought to myself as yet another girl burst into tears. That was three already this morning. What the hell was I doing? Am I some sort of monster?

      No, I was just doing what I had done for the last half dozen years – triaging the students as if this were an A&E department.

      ‘My nose is blocked,’ said Marie. I handed her a box of tissues and moved on to the next patient.

      ‘I feel dizzy,’ said Sarah. Blood pressure fine, pulse steady and strong, no medical history of note, but skipped breakfast – treated with banana and told to return to class.

      ‘I’ve got a cough,’ said Isabelle. Chest clear, cough non-productive, dry, had only for 24 hours, no fever, otherwise well, and has not coughed once in the last thirty minutes she’s been in the waiting room – told to take some cough syrup if it comes back, no treatment at present.

      Marie hadn’t made it out to the hallway before the flood of tears began again. I stood and watched helplessly as she sat back down between Sarah and Isabelle, who instantly put their arms around her. For teenage girls, tears are contagious, and within moments the three of them were weeping quietly, hands entwined, consoling each other with mumbled words and the occasional glance in my direction, pleading with their eyes for some sign of compassion from me.

      I’d never managed to upset three fourteen-year-old girls at once before, but I was doing a fine job of it. I’d even made it an international event, as Marie was Italian, Sarah American, and Isabelle from Russia. I’d covered half the globe.

      What the heck should I do?

      I did what any male would do when confronted with such a convincing scene. I ran for the hills!

      Not really.

      I let all three of them rest in the bedroom for an hour and made them some camomile tea with honey.

      ‘We won’t bother you again all week,’ promised Marie as she went back to class.

      ‘Thank you so much,’ said Sarah.

      ‘You didn’t forget to excuse us from class?’ asked Isabelle, making sure they didn’t get an absence marked on the computer.

      ‘You’re all excused. No need to worry,’ I assured them.

      I had just let myself be played. They knew it, and they also knew I knew they knew. I suspect they felt obliged to push the limits. They had three new nurses, completely new to the world of boarding schools, and in these first few months everyone was still figuring out their boundaries. But if I was to continue treating these students like we were in a hospital trauma centre, I was never going to come out on top. I had to come up with another strategy, because if 90 per cent of the patients I had seen this morning had turned up to their local hospital, they would have been encouraged to turn away, or put at the back of the queue and wait hours to be seen.

      Hospitals are great for treating accidents and the seriously unwell, but my role as a boarding school nurse was much more than just looking after the sick.

      I’m more than a nurse; I’m a parent to these kids, a disciplinarian, an example, a counsellor, a mentor and often a dry shoulder to cry on. It sometimes means playing along with them and their antics, their dramas, and it also means knowing when and how to set limits – you have to know when to say ‘enough is enough’.

      One moment I can be reprimanding a kid for bad behaviour, the next I’m consoling a child whose grandfather has just died. Before starting this job I had reasoned that my role would be varied and that I would end up doing things outside my job description. What I was not prepared for was to constantly be playing detective.

      In a hospital setting, you tend to believe what the patient tells you. This makes sense as most people don’t like waiting hours to be seen for no reason. But everything’s different in a school, where students are looking for excuses to get out of class or homework.

      To avoid being taken advantage of, I began to develop some unique (patent pending) assessment techniques.

      ‘Sir, I’ve got a sore throat’ was one of the most common complaints. After a quick peek at their throat I could usually tell if they were exaggerating, or outright lying. If it looked OK and they had no fever, I would send them to class with some lozenges and paracetamol. This was never the desired result, and within my second week on the job, the children had become resilient to my tactics.

      ‘I vomited during the night, and my throat is sore,’ said Marie, the very same Marie who had burst into tears only a week earlier with a blocked nose. Marie had not kept her promise about staying away, she had already become a regular.

      Every year there are a dozen or so regulars who stop by two or three times a week, and the reasons vary. They may be homesick, or it may be their first time being unwell without their mother around. Often this changes once they make friends or figure out where they fit in. Sometimes all they need is a wave, a smile, a nod of the head that says ‘I’m here for you’ and ‘you belong’.

      The problem with Marie was that she looked in fantastic health. Sure, she could have been up all night vomiting, and one symptom of a bad sore throat (strep throat) is actually an upset stomach so her history does need to be taken seriously as there are potential complications. However, while this is plausible, generally if the throat looks fine, and they have no fever, then I’m stuck with a healthy looking student, with a normal looking throat, who simply claims they’ve been up most of the night vomiting.

      ‘Your throat is probably sore because of so much vomiting,’ I tentatively suggested, ‘and your throat actually looks fine, you’re not pale, and your tummy doesn’t seem to be making too much noise …’ My voice trailed off as Marie looked ready to shed some tears, but I completed the ritual: 750mg paracetamol (based on her weight), throat lozenges, honey and camomile tea, and a late pass to class.

      ‘Can’t I rest, for just one class?’ she asked, but her heart was no longer in it. She had won a partial victory with a late pass, my kindness and a detailed explanation of what my examination had found – nothing – and she relented and left, although I did offer her a vomit bowl on the way out, telling her to ‘come back if you fill it up’.

      When they don’t get the reaction they want, occasionally a student’s mouth drops open, they pull out their iPhones and dial their parents. Others just head to class. Fortunately, this relationship had moved on from that first teary-eyed encounter, and Marie and I had come to an unacknowledged yet mutual understanding, where she got the full works – medicines, honeyed tea and a late pass – and did not cry or insist on resting in bed. She took the bowl with a sheepish smile.