Confessions of a School Nurse

by Michael Alexander

  You’ve possibly come to the same conclusion I have. I took her to the doctor the following morning for a blood test to confirm my suspicions. However, holidays intervened. Francesca didn’t get to see her blood results before leaving for the Christmas break, and when she came back she had her own doctor’s report.

  ‘He’s one of the top doctors in the country,’ Francesca explained, handing me a prescription to fill. ‘Can you get it here?’

  She was diagnosed with Somatoform Autonomic Dysfunction and prescribed the following:

  • Ceraxon injections, daily for one month

  • Actovegin injections, daily for one month

  • Glycine tablets

  • Semax nasal spray

  • Riboksin tablets

  • Magnesium tablets

  I had to google what the disease was, as well as most of the medications.

  ‘Have you started treatment?’ I asked, hoping she had not. She shook her head. I then showed her the blood results from our recent test, which indicated she was severely anaemic.

  She agreed to go to see Dr Fritz with me, whereupon she was advised not to take the treatment from the Sicilian doctor, and instead began a course of intravenous injections of iron.

  Within one month Francesca was a different person. It’s amazing what a bit of iron does. I see many adolescent girls with low iron, and I wish I had picked up on Francesca’s problem sooner, although I am relieved that we were able to intervene before she started her bizarre treatment plan from her home doctor.

  Dr Fritz spent the following few days investigating the medications prescribed, and came to the conclusion that the injections were not only unnecessary, but in fact harmful, banned in most places, and could have caused a lot of problems.

  I can’t think of another role where I’m constantly second-guessing every medical certificate I see. The problem is not Sicilian doctors, or Russian doctors, or doctors from wherever – it doesn’t matter where they’re from as every place has good and bad medical ‘professionals’. The problem is parents who think spending a fortune means better care, or parents looking for treatment to suit their personal diagnosis.

  Some of the more memorable prescriptions I’ve seen in my time are:

  Thyroxine for a student with a normal thyroid. We became suspicious when we discovered her wearing a tight corset when running. She kept on fainting as it was simply too tight. She admitted the corset was to help keep her body in shape, and the medication to help her lose weight. A doctor signed the order.

  Protein, creatine, BCAAs (more protein) and Nitrix body-building supplements. A sports doctor had prescribed all this for a sixteen-year-old boy. We made the lad take a blood test, and his kidney functions tests were not good. But he never changed his habits. Even after the school banned body-building substitutes, the boys kept on ordering more online, and we cannot keep up, although we try.

  Ritalin – some kids on as much as 30–40mg a day. Normally 10mg of quick-acting Ritalin once or twice a day is enough to help a child diagnosed with ADHD concentrate for the duration of the school day. When we questioned the doctor over this large dose, he said the student may not need this every day, but could pick and choose. We refused to do this, and only let him have one day at a time, but he was caught selling it to other students and was ‘withdrawn’ (read: expelled) from school.

  Phenobarbital for migraines. When we researched the other drugs in his tablet, we found it was combined with a benzodiazepine – a highly addictive drug. We were unable to wean him off his daily addiction and I’m sure he’s back home with his family, following his doctor’s advice, because ‘doctor knows best’. No amount of education from any of us, including the school doctor, had an impact. I’m pretty sure the headaches were more a symptom of withdrawal.

  Antidepressants and Ritalin for depression. The antidepressants might not seem so strange, until I tell you the parents were sending their own by mail because they’d self-diagnosed their child. As for the Ritalin, we never saw a diagnosis of ADHD and there is no medical reason why Ritalin would be prescribed for depression. If he was getting Ritalin when he didn’t need it, then he was basically taking hospital quality speed. Speed will make a person feel good for a while, but then they will feel low when it wears off. It could even make any possible depression worse. This is an easy one to deal with – we don’t give it.

  I could go on for a long time, but I think you see the ethical dilemma we’re in. We try to avoid such confusion by informing parents and students that all medicines need a prescription, and that any medication, even over-the-counter medicines, need to go through the health centre. How can I give a medicine, knowing it’s wrong, when not only has a doctor prescribed it, but also the parents approve? Legally I can, but I don’t. I defer to Dr Fritz who often has a simple solution:

  • Make sure the drug is legal for the country we’re in. If not, we can’t give it.

  • If it is legal, but doesn’t make sense, request further medical documentation.

  • Consider whether the medicine is harmful or harmless – would we cause more harm by stopping its use? In the case of the girl taking thyroxine for no reason, she was devastated when Dr Fritz explained she shouldn’t take it, and even after a referral to a specialist she still wouldn’t give it up because she just wanted to do what her mum and family doctor said.

  Ultimately, as I’m the one dispensing the medicine, I’m the one responsible.

  I’m not sure who is to blame for such bizarre treatments; sometimes it’s just a case of different places doing medicine differently (which is worrying in itself as we’re all made the same), but I suspect the biggest cause is some parents will look for a doctor who will finally give them what they want, no matter what the cost.

  Break-a-bone season

  Sometimes known as ski season, an average break-a-bone season runs from November to late March and sees:

  • two fractured bones a week

  • twelve ruined knees, from partial tears to complete ligament ruptures

  • one broken back

  • one broken neck (fortunately vertebrae only, no spinal damage … yet)

  • twenty head injuries, half of whom will end up having a CT scan

  • five helicopter evacuations

  You may not want to ski after reading such statistics, but it really is a fairly safe sport.

  Nine out of ten of the injuries come from jumping. That’s why we try to discourage it, but it never works. Even the best get hurt eventually, and Danny was the best of the best.

  But he was going to kill himself. Not on purpose, but just as effectively, and maybe even more spectacularly.

  ‘You’ve got something missing,’ I said as I picked out another piece of gravel from his butt cheeks. Danny winced and told me to ‘take it easy’.

  ‘What do you mean I’ve got something missing?’

  I’d recently read an article that said that people who have no fear have a physical difference in their brain compared to normal people. It said fearless people have something missing. They were more scientific than ‘you’ve got something missing’, but it made a great conversation piece as I relayed this information to Danny – and that’s what you want when you’re picking stones out of a teenager’s bottom, something to distract them.

  This wasn’t the first time I’d had to patch Danny back together, and I knew it wouldn’t be the last, because he took everything to the max. I’d made the naïve mistake of going mountain biking with him and the boys once – never again. He couldn’t just enjoy a nice bike ride down the mountain path, through the forest or beside the stream, he had to launch off a ramp and fly as far as he could. He was the most confident mountain biker we had at the school, and landed such jumps nine times out of every ten, but that one time that you miss, that ten per cent guarantee, is when you pay the price. Even with the body armour and helmet, Danny’s body kept on getting battered. His latest injury was a graze that began at the ribs and flowed down over his
buttock and upper legs, stopping behind the knee, as if a giant tongue of thorns had licked him.

  ‘You don’t know fear, it’s not normal, it’s not healthy. You’re going to kill yourself.’

  Danny lay grinning at death. ‘I know what I’m doing.’

  ‘Jeez, I’ve never heard a teenager say that before.’ My irony was not lost on him.

  ‘Got to die sometime, might as well go doing something you love.’

  October

  The first snows had left a blanket up high.

  The question on everyone’s lips was: ‘Do you think they’ll open early this winter?’ At the first sign of snow this is all many of the students can think about and I’m inevitably asked this question multiple times every day. They ask me because I spent eight winters as a ski instructor and ski nurse.

  ‘It’s a bit early to say,’ I said to Danny and his entourage of dedicated skiers. ‘But I wouldn’t get too excited if they did open early because the snow won’t be that good.’ The boys thought my words sacrilege. ‘Anytime I can get on the mountain is a good time. There’s no such thing as bad snow as long as you can jump,’ Danny said, his comment followed by murmurs of agreement.

  The boys were referring to the local glacier. I considered an early opening a mixed blessing. While most places started operating their ski-lifts around mid-December, the glacier sometimes opened as early as the first week of November. The glacier itself was pretty flat and provided limited skiing, but it was the jump park that always had me worried. The lads pushed the limits to the max from day one.

  I used to tell the students not to jump, which had no effect whatsoever. Instead, I now try to slow them down a bit and tell them to take it easy because they didn’t want to ruin their whole season with a break in the first few weeks.

  Danny and his friends left my office, promising to take it easy. I wanted to believe them, but I suspected their idea of taking it easy was vastly different from mine.

  The first school trip up the mountain was set for first week in November …

  The fifth of November

  The news you never want to hear.

  SOS, aka ski patrol, had contacted the teacher leading the ski trip to say that Danny had been helicoptered to hospital with serious injuries.

  ‘Serious injuries’ could be anything. An image of Danny flying through the air and landing on his head kept replaying in my mind. Was he paralysed? Was he conscious? They don’t helicopter people off the mountain for nothing.

  It took me forty minutes to drive from school to the hospital.

  ‘Geez mate, the lengths some people go just for a helicopter ride,’ I said by way of greeting. Danny was lying in one of the trauma beds, waiting to go to the operating theatre. He raised his head off the bed and wiggled a finger at me as a wave.

  ‘Oh shit man, it’s bad,’ he said. It looked bad, but I was relieved when I saw him. He was conscious and could move his limbs, well, at least move his legs. The problem was his arms that were both badly broken.

  ‘Pretty sore, eh?’

  Danny managed a grin.

  ‘It was pretty bad … but they gave me some good stuff,’ he replied, referring to the morphine he’d had in transit.

  ‘Has anyone spoken to your parents yet?’ I asked. No one had spoken to them, so it would be up to me to make the call.

  Danny had crashed going off ‘The Monster’, the biggest jump in the park. ‘I’d already done it three times,’ he said, ‘… it’s just bad luck.’

  It wasn’t bad luck. His one in ten was due, except this time he wasn’t going to get away with just gravel in his butt cheeks.

  He had fractured both elbows, but his neck, back and skull were fine.

  Danny was wheeled to theatre and spent several days in hospital.

  The eighth of November

  Danny was back in the dorm, and we had a problem.

  ‘I can’t reach it,’ he said, admitting defeat, a worried frown on his face. ‘What am I going to do?’

  I thought I’d left this side of nursing behind when I left the hospital, but no nurse ever truly leaves it behind. With his elbows both in plaster, Danny couldn’t wipe his butt. I had a hurried conference with my colleagues, none of whom were eager to lend a hand.

  ‘He’s going to be in plaster for weeks,’ Michaela said. ‘We can’t go chasing him every time he takes a dump. We physically can’t be there.’

  She was right, it just wasn’t practical … not to mention being deeply embarrassing for Danny. I asked him if he had a preference: ‘Do you want me to do it, or one of the girls?’

  ‘You didn’t just ask me that, seriously! I don’t want anyone wiping my ass, there has to be another way.’

  It’s humiliating enough having to have someone wipe for you at any stage in life, but as a teenager it must be the worst. Unfortunately, the school simply didn’t have the facilities necessary to help Danny out.

  ‘I’m sorry mate, but there is no other way, someone is going to have to do it for you.’

  ‘I just won’t wipe it then.’ Was he joking?

  ‘You didn’t just say that!’ He managed a chuckle.

  ‘I know you like my butt, sir, but you’re not getting that close to it.’

  In an ideal world, someone with a serious injury should be sent home, or a parent should come and stay with them. Danny’s parents were originally from Colorado where he’d learned to ski, but they were currently in Nigeria and insisted they couldn’t look after him properly there. ‘There are no hospitals near where we are,’ his mother had said when I’d asked her about having Danny at home with her. ‘If there are any problems, we won’t be able to see a doctor.’

  The only solution was to get his mother to come and stay with him.

  At first, she explained she couldn’t come out because it was hard to get a flight and besides, ‘He’s in good hands.’ But when we told her that she either came out or we’d be sending him home, she agreed to come to her son’s assistance.

  Danny visibly relaxed when he heard his mum was on her way … well, a part of him didn’t relax.

  ‘You’re not wiping my ass, I couldn’t live with it,’ he said defiantly, and held his movements in check until she arrived, thirty hours later. I imagine it was quite the welcome present.

  Danny’s mum was a pleasant surprise. She really did want to be with her son, but the logistics of being near to care don’t always work out when your loved ones are spread over the globe.

  ‘I should have come immediately, I’m sorry,’ was a phrase she repeated often, and I can understand the guilt. It’s hard to know your child is injured and not be there in a flash. Danny and his mother moved into one of the school apartments, and fortunately the oil company she worked for was very understanding and she was able to stay with him for three weeks, after which he finally regained the use of his elbows.

  Danny skied again the following season, although he did stop jumping. He had two permanent reminders not to: a right arm that straightened nearly perfectly, and a left elbow that he was still working on. ‘It’s pretty good’ he often said as he tried to straighten it all the way out and failed. I guess ‘pretty good’ is good enough to remind him to take life a bit easier.

  Caio and Celeste

  All mountain schools boast about their ski programme; most make it mandatory, but nothing is really mandatory when you’re dealing with someone else’s children. Indeed, it’s sometimes hard to make anything mandatory when it’s your own flesh and blood.

  I feel that everyone should ski, and I like the fact the school made it compulsory. But not everyone likes to ski. At first I tried my hardest to encourage the kids, simply because it’s a great form of exercise, but after my first winter season at the school, I changed my mind …

  0800 hours

  Michaela, Justine and I were becoming more frustrated with every letter we read. Today was the first day of skiing for the kids and it was already turning into a nightmare.

  We’d spent the
last three weeks reminding students and parents that if their child was not able to ski, they must send us a letter with a doctor’s certificate. We had very few responses until the day they were due to hit the piste. Out of 400 potential skiers, 100 of them would not be skiing.

  ‘… Caio has an allergy to the cold, and cannot ski …’ I showed the letter to Michaela. ‘You’ve got to be kidding,’ she said, before handing me another letter from a parent she had received. It was from the mother of Celeste, a good-natured American girl from Florida.

  It read: ‘Celeste gets sick at altitude and cannot go up the mountain.’ It didn’t make sense. Celeste’s mum was an intelligent woman, a diplomat at the embassy. How could she expect us to believe such rubbish? Celeste already lived at a high altitude – they sent her to a boarding school in the Alps!

  ‘If they don’t want to ski, they should just say so. It’s embarrassing,’ I remarked. Skiing was a luxury I couldn’t afford when I was at school, and it felt wrong that a healthy young man or woman should choose not to ski. How could they not like it? Do they even know their parents wrote a letter excusing them? Is it the parents that don’t want them to ski, or are the children reluctant to go? I needed to find out first hand what the real story was. I chose Caio’s case, and Michaela took up Celeste’s. I called Caio into my office.

  Like all true Italians, Caio was on the football team and at sixteen years of age, in prime health.

  ‘You live on a mountain. There’s snow three months of the year and it gets cold,’ I said as I handed him his mother’s letter. It wasn’t the least confrontational way to start a conversation, but I expected Caio to man-up. Instead, he shrugged his shoulders, and said it’s true.

  ‘No one is allergic to the cold, it’s not possible,’ I said, my tone disbelieving. I was breaking one of the earliest lessons I’d learnt as a junior nurse – never say something is impossible because there are always exceptions, and never box yourself into a corner – but Caio insisted he could not ski, especially today as it was particularly cold.