Confessions of a School Nurse

by Michael Alexander

  ‘I can probably go in the spring, when it’s sunny.’ He explained that the cold gives him a rash, although he did concede that he might be able to go in the winter months if it was a particularly nice day, but not today, too cold and cloudy.

  ‘So what your mum is really saying, is that you can ski, but only when you want to?’ With not the slightest shred of shame, he said that was exactly right.

  I stayed calm … because he was going to ski.

  ‘Sorry mate, but we need to have an actual medical certificate, signed by a doctor. You’re going to have to ski.’ Caio sat there quietly, staring at me, his eyes trying to lock onto mine, but I turned to my computer to document the encounter.

  ‘OK, I’ll see you later then, and you’ll see for yourself.’ He left my office and I felt very unsure. His reaction wasn’t normal; he didn’t call his mother, and he didn’t argue. Perhaps you can be allergic to the cold.

  Michaela fared no better with Celeste. ‘I’m allergic to heights. I get dizzy when I’m at altitude.’ Michaela was trying to ascertain if she was sensitive to the altitude, or if she was scared of heights, and asked her if she was worried about going on a chairlift.

  ‘I’m not scared of the chair, it’s the altitude, I can’t be at altitude.’

  ‘But you’re already at altitude, 1600-metres altitude to be exact.’ Michaela was doing a better job of staying calm and rational than I had. ‘Why would your parents send you here if the altitude makes you sick?’

  ‘This is as high as I can go. Any higher and I get sick.’ Michaela reassured her that she wouldn’t be going any higher.

  ‘You’re a beginner; you’ll be at the bottom of the village. It’s only 1500 metres, so you’ll be fine.’ Celeste tried to protest, but she soon realised she’d trapped herself and went to get ready.

  There was no way we could see 100 children by lunchtime, when lessons started, so to play it safe, those we couldn’t get to see that day were excused, just in case their concerns were legitimate.

  1530 hours

  Caio walked into the health centre, his face and neck covered in red blotches.

  ‘They’re called hives, sir.’ He tried sounding sorry, but failed. He couldn’t hide the hint of satisfaction in his tone. ‘This is your fault.’

  It was my fault. Who the hell would have thought that someone could be allergic to the cold? If only I’d listened to him.

  He sat with me as I googled ‘cold allergy’ and found out all I needed to know about ‘cold urticaria’.

  ‘… for example, swimming in cold water is the most common cause of a severe, whole-body reaction – leading to fainting, shock and even death …’ The more I read the more relaxed and cheerful Caio became.

  Thank goodness I hadn’t made him go swimming.

  ‘So, you really can’t go out in the cold?’ Caio wasn’t vindictive, but he did relish his victory, up until the last paragraph, which said he could go out in the cold if he took antihistamines before exposure.

  ‘I don’t suppose you thought to take one before going up?’ I asked. He shrugged his shoulders and with a mischievous grin said, ‘I’m not a nurse.’

  Caio’s hives resolved with an antihistamine and warmth. He didn’t tell his mum, and he did forgive me, while I admitted defeat. From then on, Caio got to pick and choose his ski days.

  1615 hours

  I found Celeste lying on the examination table in the doctor’s office. She’d been taken there by ski patrol after falling and hurting her knee.

  ‘I dislocated my knee,’ she said as I walked in. I’ve never seen a dislocated knee, very few people have. What they usually mean is they’ve dislocated their patella, or knee-cap, which is far more common. But Celeste seemed happy with either diagnosis, just as long as she didn’t have to ski.

  The x-ray was normal, and as there was no bruising or swelling, she was discharged with a knee brace, crutches and told not to ski for the next two weeks.

  I grabbed her things as she hobbled out the office, and with no hint of guile, asked me, ‘Do you think I’ll be able to ski again?’

  ‘I hope so, Celeste. I hope so.’

  By the time I got Celeste to her dorm, she had ditched the crutches as they were too awkward, and taken off to show her friends her new brace. She also declined the analgesia Dr Fritz had prescribed.

  ‘Mum doesn’t like me taking pills,’ she added after I suggested that perhaps her knee wasn’t as sore as she made out.

  Dr Fritz saw her again after her first week with the brace, whereupon he prescribed a two-week course of physiotherapy.

  When the physiotherapist couldn’t find anything wrong, but the knee still sore, Celeste was eventually sent for an MRI; her parents had insisted. The scan was completely normal, and she finally gave up the brace. But by now she’d missed the first month of lessons, and because her parents did not want their daughter doing such a dangerous sport, she spent ski days sitting in class, surfing the internet on her laptop. Celeste didn’t ski for the rest of the season.

  Do I think Celeste was faking? Maybe. The difficulty with ski season is that you can’t really make someone ski, because it’s easy to have a fall and fake an injury, and I see this all the time. But you can never assume they’re faking, or lying about an illness, because they’ll prove you wrong, as happened with Caio.

  Unfortunately, the time and effort going into dealing with the repercussions of forcing someone who doesn’t want to ski is not sustainable, especially as there are plenty of actual injuries to keep you occupied …

  Igor

  Part one

  There are some students you wish had never laid eyes on skis, let alone strap on a pair.

  ‘He went too big,’ said some.

  ‘Such sick air,’ said others, who had caught the moment on their iPhone.

  I’ll admit, the image on the phone did look impressive, but 270 degrees is 90 short of a full 360, and the end result is always the same – a nasty landing with a bruise or break. The skier’s weight multiplied by speed and gravity meant the energy went from his shoulder and deep into his body.

  SOS called me at 4pm informing me they were dropping Igor at the doctor’s office. They suspected a fractured clavicle, or collarbone, and felt the quickest and most effective treatment could be received here in the village.

  ‘It needs surgery,’ declared Igor. He was quickly told to be quiet by the doctor. Dr Fritz could put up with long hours, midnight call-outs, indecent referrals (i.e., unnecessary referrals to specialists), a round at the local hospital and an average eighty-hour work week, but he could not tolerate disrespect, especially from rude, loud and demanding teenagers.

  ‘He can’t tell me to shut up,’ Igor said, turning his attention to me for support.

  ‘If I were you, I’d shut up,’ I recommended.

  Before he could voice a protest he cried out in pain.

  ‘Fuck, fuck, fuck … what the fuck are you doing? Find someone who knows what they’re doing. Take me to a real hospital.’ Dr Fritz was trying to remove Igor’s jacket so he could send him to have an x-ray, but he wasn’t going to argue with Igor.

  Dr Fritz’s waiting room looked sick. It was overflowing with people in various states of ski dress, clutching arms, legs resting on chairs, bandages pressed against bleeding foreheads, and even holding bowls ready to empty their stomach contents into. It was crowded, noisy, and the height of the winter ski season. Dr Fritz saw no reason to treat someone who didn’t want his care.

  ‘Goodbye then,’ he said and left the room. Dr Fritz has always been a man of few words, and it seems to work. Igor was so surprised he briefly forgot his pain.

  ‘He can’t walk out, he has to see me.’ With my patience drained, I turned to Igor.

  ‘I know you’re sore, but if you don’t show some manners, you’ll be taking a taxi to hospital.’ Igor wasn’t listening, his fingers were flying over his iPhone. I added: ‘If I were you, I’d say sorry,’ but he took no heed.

  ‘It�
�s for you,’ Igor declared, holding his phone out to me. I made no move to grab it as I knew what it would be: an angry parent or an agent. I can’t decide who’s worse, angry parents in broken English, or fluent agents paid to put me in my place.

  As if I’d wondered aloud, Igor added: ‘It’s my agent, he wants to talk to you.’ I took a deep breath, and tried to relax before grabbing the phone.

  ‘Is this the doctor?’

  I told the man on the phone that I was the nurse.

  ‘You have to take Igor to hospital now. We do not want a …’ He paused as he searched for the right word. ‘We do not want a simple village doctor to treat Igor.’ The way he stressed the word ‘simple’ was not an accident that comes from speaking a foreign language.

  It was time to take control.

  ‘Excuse me, but who am I talking to, and what relation are you to Igor?’ A reasonable request spoken in a reasonably firm tone got a reasonable response.

  ‘I’m Victor and I am speaking on behalf of the family.’

  Victor could be anybody, an agent sitting in an office in Moscow, representing many families, or someone working solely for Igor’s family. His whole life could be Igor and his clan.

  Sometimes we never have any direct contact with a blood relative, even in very serious instances – some of our children have trouble even getting hold of their mother or father. It’s not always easy knowing who to call. For all I know, Igor (if that’s even his real name) could be the son of a powerful politician or criminal mob boss, although some people might say they’re one and the same.

  ‘Igor must be taken to hospital now,’ the voice on the end of the line told me. ‘I kindly ask you to do as the family request.’

  I could put Igor in the car and take him to hospital, but that would be the wrong thing to do. He’d suffer while I drove down the winding mountain road, the combination of pain and such movement would probably cause him to vomit, and he’d get no better treatment. I tried to explain this to Victor and Igor.

  ‘Dr Fritz sees these sorts of injuries all the time. I have complete faith in him.’

  ‘I don’t care if you have full confidence. You’re not a doctor, and we want an expert. You will do something now.’

  These sorts of characters should only exist in fiction, a Bond film, but I’ve learned they are real.

  When I explained that the hospital would be busy because it was the weekend and Igor would have to wait hours, in pain, before even being seen, Victor simply requested we go to an even bigger hospital. ‘Igor’s father has ordered you to do this.’

  I don’t mind being told what to do, having worked in fast-paced medical teams you get used to it, but I don’t carry out orders that will ultimately cause more suffering for my patient, even an unpleasant patient. I ended the conversation and turned my attention back to Igor.

  Dr Fritz came back to see Igor, and the x-ray confirmed a fractured right collarbone, but he was lucky because it was a simple break, in the middle of the bone and while the ends weren’t in complete alignment, they weren’t too badly displaced. I’ve seen much worse.

  If you took a stick of celery and bent until it snapped, and then slid each end of the break up a few millimetres, it would look a bit like Igor’s x-ray.

  Igor continued his tirade.

  ‘I’m not wearing a shitty brace.’ He was objecting to the standard treatment (at least in some parts of the world) of a soft brace that pulls the shoulders back.

  ‘Fine,’ replied Dr Fritz, placing the brace back in the cupboard. He handed Igor some painkillers, placed his arm in a simple sling, and told him to leave the office.

  With breaks like Igor’s, casts are out of the question. The brace wasn’t even absolutely necessary, and some doctors never use it, but the theory is that by pulling the shoulders back, you help pull the fracture back into line. Sometimes it helps, sometimes not, but either way the bone heals by itself with rest.

  ‘You can’t throw me out!’ Igor demanded.

  But Igor’s treatment was finished.

  I took Igor back to his dorm and settled him in for the night.

  Part two

  It came as no surprise when Igor went to see a specialist orthopaedic surgeon. His parents would have it no other way, and Dr Fritz was happy to pass him on. Unfortunately I was there when the surgeon told Igor the good news.

  ‘You don’t need surgery.’ Igor couldn’t hide his disappointment and resorted to what all fourteen-year-old children say when they’re at a loss. ‘But Mum said I need surgery.’ The surgeon shook his head. ‘There’s no benefit. It will heal fine. Surgery is not only unnecessary, but risky.’ He added that when you operate in such an area there can be problems with healing, as well as the risk of causing damage to the surrounding tissue.

  ‘There’s a lot of nerves and blood vessels that could be damaged,’ he pointed to a model of a shoulder on his desk to illustrate his point. ‘In this case, surgery would be the wrong thing to do.’

  Igor’s parents were unsatisfied because it was our village doctor who had made the referral, and they wanted an opinion from an orthopaedist that they had found themselves. Victor re-emerged, in real life this time, and took Igor to the specialist the family had found. They were told exactly the same thing.

  I never got to exchange pleasantries with Victor and only managed to see the outline of a hulking frame dressed in a black suit with matching sunglasses, dwarfing the driver’s seat of a Mercedes, cigarette hanging from lower lip. He was more real and sinister than any film.

  It’s good that some people have the chance to shop around for second, or even third, opinions, but it’s a bit pointless shopping around when you don’t listen. If you’ve got enough money, you’ll eventually find someone to voice the opinion you want. I see this sort of thing a lot, and it can be dangerous. I used to think it was about culture, East versus West, but it’s a culture that transcends nations – the culture of money.

  Three doctors’ opinions in two weeks was not enough and we were told Igor was going to be flown home.

  ‘I’m going home for an operation.’ Igor still sounded angry, but it wasn’t directed at us, it was at the whole health system of this country. ‘We have proper doctors in Russia. They’ll know what to do.’ I couldn’t believe any doctor would be crazy enough to operate on him given that two top orthopaedic doctors, from a country famed for its skiing and fractures, had said ‘no’.

  Igor returned four weeks later with the scar to show where the metalwork had gone in.

  As far as medical treatment goes, anything is possible when you’ve got enough money, but it doesn’t always equate with better care. In a world where medicine is big business, it’s getting harder and harder for nurses – who work every day on the frontline – to be heard.

  The staff

  It’s not just the students I look after. Sometimes I’m a nurse for the big kids as well.

  I don’t think the average person really knows what a nurse does although that didn’t stop my friends asking how many ‘butts’ I’d wiped during my college days, and I always responded by saying I’d give them all their medication rectally, if they were ever admitted. Fortunately, the teachers I work alongside don’t ask such crude questions, but they still have a very limited understanding of what I do.

  ‘See the nurse’ they say for the most minor cut or runny nose. They say it because I’m their resident medical expert, always happy to see anyone, whether it is a student or faculty member.

  I’ve treated Mr Huang, the PE teacher, who had foot warts and had heard that I had some cryogenic therapy in a can, which I did. I offered him one course of treatment, but insisted he see the doctor for follow-up.

  Mr Sapsford, a science teacher, for a rash around his groin, upper thighs and buttocks. An intense deep red, that was itchy. I referred him to the doctor who had no idea what it was, and it took a dermatologist to diagnose scabies. I’d seen scabies a number of times, but never like this.

  Miss Crowther,
the library assistant had nits. Her dorm had been battling recurring outbreaks of head lice all term. I didn’t have the heart to tell her that her infestation was so thick she was likely the source of the ongoing problem, although she probably got the hint when I said I’d rarely seen them so abundant.

  Miss Hunter, an English teacher, wanted to know if I could give her one of our ‘emergency’ contraceptives, commonly known as the morning after pill. I sent her to the pharmacy. She was relieved when I explained you can get it over the counter.

  At the school we have 100 teachers and dorm parents, alongside another 100 support staff from builders, cooks, cleaners, receptionists, gardeners and more, and while the official policy is that I’m not responsible for them and do not have to treat them, I can’t exactly say no. It’s hard to turn them away, but sometimes when you cross the line between a friend and a nurse things can get … awkward, as I discovered when I met Claire at a staff game of touch rugby.

  Claire was sporty. She had shapely calves, toned thighs, and could bike faster and run longer than anyone else at school. She was also cute; even as a happily-married family man, I could see that. Understandably she was popular and the only reason we were playing touch was because of Claire, and because she was also from New Zealand.

  ‘Too slow,’ she called as she side-stepped my clumsy attempt to stop her, and scored her third try. She was not only fast, but like all kiwis, rugby was a large part or her DNA.

  ‘Did you play much?’ she asked as she threw the ball in my direction. I’m pretty sure every kiwi has played rugby at some stage, even if only once. ‘Yeah, a bit,’ I replied. Such a lie! Thankfully, whilst I may be the only Kiwi missing the ‘league’ gene, none of the staff – 95 per cent of whom are from America and Britain – needed to know that.

  By the time the game had finished, Claire was the only one showing no signs of suffering. But that’s because she was only 25 – at least a decade younger than most of us. At the end of the game, there were some tweaked knees, limping ankles, grazed skin and bruised egos – nothing too serious – but they all asked me for my opinion.