Confessions of a School Nurse

by Michael Alexander

  I reassured her I did like her but she was too worked up to listen. ‘You don’t give me any real medicine. Is it because I’m Russian? I know what you all think of us.’

  It would be very interesting to find out what she thought we all thought of her. I didn’t think I had anything against Russian people. I don’t consider myself racist at all.

  Instead of racism, I often see ignorance or simple inexperience: people who just don’t know. They don’t know about you, your country or your culture, resulting in some simple but painful misconceptions. Before working at an international school, I was very much one of those people who had a lot to learn about other cultures.

  I had assumed that everything and everyone from Poland eastward was the same. They all drank vodka, spoke Russian (or at least sounded like they did) and had corrupt governments, often run by the mafia. My wife has only just forgiven, but never forgotten, my offhand remark during one of our rare arguments when I’d said she might as well immigrate to Moscow. My wife is Polish; I will never make that mistake again. She has also rectified many of my other misconceptions.

  I had an idea.

  ‘You’re right,’ I said, replying to Veronika’s question. She blinked several times, slack-jawed, until it finally registered what I’d just said.

  ‘You don’t like Russians?’ she asked, awed.

  ‘I do like Russian people. I just don’t know many of them.’ I paused briefly, before carrying on. ‘You’d like my wife. She doesn’t think I’m racist, just stupid.’ This brought a smile to Veronika’s face. She asked if my wife was Russian.

  ‘Polish,’ I said, ‘but you’re all the same … right?’ Veronika was smiling now.

  ‘Can I let you in on a secret?’ I asked.

  Veronika’s attitude had completely changed. Here was someone not just listening, but sharing a bit of their personal life – a bit of themselves – with her. ‘My wife and I always argue about how to treat our kids when they’re sick. She thinks I’m crazy.’

  Veronika was dying to know the details. So I told her:

  My wife believes the cold will make you sick, and rarely lets the kids go barefoot about the house unless it’s the height of summer. But so long as there’s nothing around for them to step on, bare feet are fine by me. I said that she also believes leaving the window open at night in the winter will also make you sick. So, I secretly open the window in the middle of the night, and she secretly gets up and closes it once I’ve gone back to sleep. I told that I believe when treating cuts and scrapes, they’re better left to the open air to dry out and heal quicker and that my wife disagrees. And, finally, that I never use ‘anti-bacterial’ creams on wounds. But my wife does.

  For every opinion on medical care I shared about my wife, Veronika nodded in agreement.

  ‘I’m not ignoring your problems,’ I said. ‘We just come from places that do things a bit differently.’

  Veronika left my office and promised to try my techniques to help her get to sleep, even though I was convinced she didn’t need them.

  Veronika’s story should end here. But, as it so often does, things then got … complicated.

  Veronika stopped by on Friday to say that she had followed my advice, but had still had trouble getting to sleep the previous night. She agreed to keep at it over the weekend. I promised that I’d have some more options for her on Monday.

  No one was surprised by the sight of Veronika sitting in the waiting room on Monday morning. She didn’t look like someone who hadn’t slept. She was cheerful, playful, and vibrant. She’d also made the effort, her make-up was immaculate.

  ‘Did it help?’ I enquired. She said my techniques helped a lot, but she wanted something more. ‘Just in case I have a bad night.’

  I didn’t have anything concrete, no herbal teas or even medication, but what I did have was a simple self-hypnosis technique that a hypnotist, one who usually performs on stage, demonstrated to me. But, the more I thought about this option, the more I was reluctant to share it.

  ‘I can’t really show you,’ I confessed, ‘it wouldn’t be appropriate.’

  It’s a simple technique, which I’ve used on a dozen or so of my friends, and they swear it works wonders. But when you’re responsible for children, it’s better to avoid techniques or tricks that I’m not professionally trained to do.

  Veronika’s curiosity was piqued. ‘Don’t you like me?’ she said it teasingly this time. ‘Don’t you like Russians?’ I shooed her out my office.

  The rest of the day was uneventful, and I prepared myself for the night shift. Working the night shift meant sleeping in the health centre, with the emergency phone beside me.

  At 10pm the emergency phone rang. It was the head of the girls’ dorm.

  ‘Veronika says she has to come see you tonight,’ said Sarah, the dorm parent – the same dorm parent who’d insisted on an emergency sex talk. ‘She said it’s absolutely urgent.’ Was this another ‘urgent’ non-issue?

  I felt like Sarah was testing me. She was an experienced dorm head, and should know better than to call the emergency number for such a problem as this. ‘Send her to bed. It can wait till the morning,’ I said, then added: ‘What do you think?’

  Sarah agreed wholeheartedly, and apologised for calling so late for something so trivial.

  Ten minutes later the phone rang again.

  ‘Sir …’ it was Veronika on the emergency line. ‘Are you sure you don’t want me to come?’ Her tone was playful.

  I warned her that if she used the emergency phone again, she’d get detention.

  ‘Your loss,’ she didn’t sound exactly worried by my threat. She then promptly hung up.

  Maybe these situations shock you, make you cringe, laugh or feel angry, but they terrify me. Working as a male nurse in the environment I do makes me vulnerable. In this particular case, I think the moment I shared a little of my personal life, about my wife and the disagreements we sometimes have, was the moment when Veronika saw me as human, and someone who cared. It’s probably also when her emotions got a bit mixed, the boundaries blurred, and where she might have seen me as something more than one of the faculty members. With so many new and exciting emotions flying around inside a teenager’s head, they can be forgiven for some odd flights of fancy and bad decisions, but even to this day, these moments continue to terrify me and keep me on my toes. And I think that’s a good thing.

  Consent

  Perhaps I shared a bit much of my personal life with Veronika, but it’s a strategy my nursing tutors even recommended. ‘Sharing a bit of yourself helps develop rapport and trust’ they said. You’d think after my experiences I would have learnt to keep my mouth shut and stay out of other people’s business. But no! I still find myself poking my nose in where I shouldn’t, as was the case with Corinne and Naomi. I’m convinced I was doing it for the right reasons. What do you think?

  Corinne and Naomi shared everything, from their wardrobe, make-up and impetigo to their first hangover. Nothing could separate them, not even Luke, Naomi’s first boyfriend. ‘Chicks before dicks’ they’d say before giggling like children. But they weren’t really children, they were that complicated blend of wannabe adult and naïve adolescent … and blind to the dangers that come with that territory.

  What fifteen-year-old child really has any understanding of the risks they take when all they’re doing is having a little fun, with good people, with their friends? What harm could come from going to the city for the weekend to party with their school mates?

  Everyone – staff included – knew about the upcoming Paris party; word always gets out. The staff know the students are going to get drunk, get laid, and maybe take substances they shouldn’t, but their parents keep on sending their written consent for their child to go.

  ‘They’ll be with their father’ or ‘uncle’ or ‘big brother’ they usually say. Sometimes this is true, sometimes not. So what can I do? They’re no longer my or the school’s responsibility: they’ve been signed ou
t for the whole weekend. The school no longer has authority or power to stop them and we would be overstepping our bounds if we tried.

  But that doesn’t mean I don’t still care, because every year, without fail, I get ‘the call’.

  ‘The call’ is usually from a local hospital, and their patient is one of our students. There are no parents or other relatives to be found anywhere, and their only recourse is to call the school nurse. It’s then that I have to make my own ‘call’ to the parents (if we can get hold of them).

  It never gets easier telling a parent their child is in hospital or on a ventilator, or that the amount of alcohol in their child’s bloodstream is enough to kill a bear, let alone a human. It’s why I usually wait until I’m at the bedside and have some idea of how bad the situation is.

  If it looks like the student is going to be fine, the first words out of my mouth are usually ‘they’re in hospital, but they’re going to be OK’. Maybe I should draw out the conversation, let the dread build up – punish the irresponsible parents who happily signed their own flesh and blood over to the devil. But I don’t. I’m human, and I’m a parent.

  Naomi and Corinne were both going to the city to party with the boys.

  Twenty boys and two girls were on the trip which meant that probably, but by no means definitely, at least eighteen boys were going to be disappointed, although not Luke. He had been mouthing off to the lads that this was the weekend him and Naomi were going to ‘do it’. How did I know this? I knew because Luke couldn’t keep his mouth shut. He’d told his best friend, who’d told another friend, who’d eventually confided in a teacher, who’d told the rest of the faculty.

  Should I do something? Or should I ignore the rumours? Is it any of my business? While I have some idea of what goes on during these trips, any adult can fill in the blanks. I decided to act, but not as a nurse, as a parent, and I phoned Naomi’s dad first.

  ‘I think your daughter is going to have sex …’ is not the best way to start a conversation with a father. Instead, I asked if he was aware that his daughter was going away this weekend, which of course he was, and he wanted to know what the problem was. ‘She’s going with a group of boys, two girls and about twenty guys …’ I left the sentence unfinished, letting him fill in the blanks.

  ‘Who the hell do you think you are …’ his tirade began. ‘Are you saying I can’t trust my daughter?’

  ‘It’s not about trust,’ I wanted to say. It’s about common sense. There’s no way my parents would have let my sister go away with a bunch of boys at the age of fifteen. ‘Are you calling me a bad father?’

  I didn’t tell him what I thought, instead I apologised. Time after time I have to remind myself not to impose my values on others. But surely any father, in any part of the world, would feel the same as me. Because of those harsh words I did not call Corinne’s parents for fear of any repercussions.

  The following Wednesday, Naomi and Corinne were standing in my office, bawling their eyes out.

  The weekend had gone according to plan, for Naomi at least. She’d spent the night in Luke’s hotel room. But things had not gone to plan for Corinne. Luke had booked another room for Corinne to stay in, with a male friend of his. ‘He said it was the only room the hotel had left,’ Corinne sobbed, ‘he said it would be OK.’ Corinne had been forced to spend the night with Luke’s friend, a stranger to her. She was trying to figure out if she’d been raped.

  Corinne was confused because she had agreed (reluctantly) to sharing the room and hence the bed. She couldn’t remember exactly how or when she had consented to sex because she’d had ‘a bit to drink’ but she was sure she never really wanted to but felt like she ‘had no choice’.

  The school counsellor, doctor and the rest of the nursing staff became involved in helping Corinne and Naomi work through this problem, and thankfully, Corinne eventually came to the conclusion that she had not been raped but that she had made a mistake and panicked. In France, the age of consent is fifteen years old, making them both of legal consenting age, and the boys only a year or two older. Regardless of this, your first experience shouldn’t leave you wondering if you’ve been raped.

  Naomi also ended up seeing the counsellor. She felt guilty, and resented Luke for his part in what had happened. It’s not the way anyone dreams their first time will be, but I wonder if anyone’s first time works out the way they imagine.

  Retelling and writing this story down hurts for me – I had tried to do what I felt was right. But by thinking like a father, I’d overstepped the line as a nurse and been attacked for caring. But I’d do it again.

  A change of legislation since this incident means that I’m legally not allowed to call the parents now. Naomi’s father didn’t want my input before when I had the chance to warn him, but I bet he’d beg to hear what I have to say now if he had any inkling of what went on.

  Not calling Corinne’s family before the trip remains one of my biggest career regrets. I’d been intimidated by the reaction of Naomi’s father. Perhaps Corinne’s parents would have listened.

  Dilemma

  As you can see with the events surrounding Corinne and Naomi, confidentiality is not black and white; in fact it’s very much a murky shade of grey.

  It had seemed harmless fun at first, well, harmless to Sheryl and the rest of the kids she hung out with. But there are two types of pleasures in life: those that are free, and those that you have to pay for (in one way or another). And, this time, it was Sheryl’s time to pay.

  ‘Can I see a female nurse?’ Sheryl asked. I didn’t question why, but she felt the need to explain anyway. ‘It’s a girl problem.’ If a seventeen-year-old girl wants to see a female nurse, then I’m happy to oblige.

  I ushered Sheryl into Michaela’s office and let them be.

  What girl doesn’t love attention? Sheryl wasn’t picky in the sort of attention she got, and boys knew this about her and tried their luck. I had heard rumours that many home runs were scored, but from the look on Michaela’s face when Sheryl had left her office, I had the sinking feeling that a lot of those boys weren’t going to be feeling lucky for much longer.

  ‘What a mess,’ Michaela exclaimed once we were alone and I dutifully asked what was wrong.

  Sheryl needed to see a gynaecologist because her ‘girl’s problem’ was a very nasty case of genital warts that had become painful.

  ‘I never knew they could get painful,’ Michaela admitted, ‘so I said we’d get an appointment urgently.’

  After three months in a London walk-in STD clinic I’d seen more penises than I care to remember; small, big, crooked, two-toned, squishy, bendy, deadly, and one that rested just above the knee, but I couldn’t remember a case of painful warts, although that was probably because I only dealt with male patients. I could imagine that friction (from a lot of sex) combined with large warts could lead to inflammation, and perhaps bleeding, or create the perfect environment for a bacterial infection.

  Sheryl saw the gynaecologist the following day. It meant a thirty-minute trip to the hospital, but she was desperate to go as soon as possible, and was treated for an acute bacterial infection, after which she would eventually begin treatment for the genital warts. In the meantime she was not to have sex until her symptoms had resolved, and even then she had to use a condom, to offer some protection to others.

  Teenagers don’t do abstinence well, and understand STDs even less. I was reminded of a young couple, Camilla and Mark, who had recently fallen in love and become first-time lovers. Camilla then found out she might have Hepatitis A; she had told her boyfriend about this, and he had said it didn’t bother him because he ‘loved’ her. It was a huge relief when her blood tests came back clear, but it was a scary reminder of the way young people don’t fully understand the implications of such a diagnosis, and how powerful (or blinding) first love can be.

  Sheryl put us in a very difficult position. She was seen around campus with a new man on her arm, a young student called Paul.


  What would you do if you saw someone with an infectious disease potentially about to have intimate contact with a young man?

  I’d never come across such a situation before and I turned to my colleagues and Dr Fritz for advice. It turns out we could not tell possible partners what she had as it was non-life threatening and confidentiality was the ultimate winner.

  But we had to do something.

  In the end, Michaela spent an hour talking to Sheryl, who promised she would try not to have sex, but if something did happen, she would inform her partner before intercourse and use a condom. It wasn’t ideal, but it was the best we could do.

  We also began a series of talks to small groups of students in their dorms.

  The message was: ‘There are STDs at this school.’ I always stress this because some students think I’m kidding. Eye contact works well: ‘You could have one.’ I enjoy the reaction as everyone leans away from the person I’m staring out, and then I engage another: ‘Or you could have one and not even know it.’

  The message is simple: STDs are in our school. They always have been, and always will be – and they can happen to anyone.

  Chapter Three

  School Nursing

  Itch

  School nursing isn’t all about sex, and you must remember, I’ve been here ten years, and it’s easy to remember the most shocking or interesting cases. In reality, much of my job revolves around much more mundane problems. But the thing is, nothing ever ends up being ‘mundane’ when you’re dealing with children …

  At all costs we wanted to avoid mass hysteria, but these things nearly always get out. Confidentiality is such a fickle thing at times, especially when teenagers are involved, especially when teenage girls are involved.

  Tracy sat in my office, head bent forward, while I combed through her hair with my gloved fingers.

  ‘Do I have them?’ she asked. She certainly did have ‘them’, and as harmless as head lice are, there’s no easy way to tell a girl she is infested.