Confessions of a School Nurse

by Michael Alexander

  Thankfully, for Jimmy, it wasn’t the end.

  Parents don’t want their children to go through the hardships they experienced, and as such it’s hard as a parent to deny your child the things privilege and money can buy, especially when you are denying them the things that you’ve worked so hard for.

  But that is exactly what Jimmy’s parents did.

  They cut him off, and kicked him out the house. But not before finding him a job as a trainee chef. They told him that once he finished, and was financially independent, they would consider sharing their wealth with him once again. I saw Jimmy a couple of years later when he returned to visit the school. He’d come to the Alps to ski, and he was allowed on campus to catch up with anyone who had got to know him in his short time here. I was one of a dozen or so staff who remembered him.

  ‘It’s strange being back,’ he mused. He was sitting in my office, in the same seat where I’d lectured him before, drinking in the view out my window. ‘It’s so small,’ he said, referring to the school, not the mountains around us. ‘You think you know it all. You think nothing else matters other than getting high.’

  This was a different Jimmy to the one I knew before. There were the physical changes: the work had done him good, his body had filled out, and he had muscles where he used to be skin and bone. But it was his tempered thoughts, his sharp observations that made him all grown up.

  ‘Do you still smoke?’ I asked.

  ‘Not really, not with the job,’ he confessed. ‘Pot and eighteen hour shifts don’t really go well together.’ He flashed a smile. This may be the new and improved Jimmy, but the fun lad was still inside. He explained he does still have the odd toke now and then, but the smoking is an occasional break from his reality, instead of being his reality.

  I’ll never forget his parting comment. ‘It’s good to have a clear head.’

  I think Jimmy has to be one of the luckiest guys around. Not only does he have the security of wealth, but he also has parents who are brave enough to make painful decisions for the wellbeing of their son. I wish all parents were able to do this.

  Ruben’s demons

  If we only had to worry about marijuana, things may not be so bad, but there’s a whole world of dangerous substances out there, many of which I only find out about when things break.

  He had armed himself with a frying pan and was warning me to stay away. Even unarmed, any patient in this state can be deadly, and while a frying pan might not seem like much of a weapon, it could easily fracture my skull. But I couldn’t stay too far away; someone had to keep him in sight until backup arrived.

  No one would believe me if I told them just how frightening and even dangerous nursing can be. If I was twenty years younger perhaps I would have tried something rash, like disarm the kid. He was only sixteen years old. I’m almost forty and I should be able to handle him, but with age comes caution.

  I’ve seen the boys punching and kicking the bag in the gym and thought to myself ‘I could still take him’. You remember your glory days when you felt ten foot tall and invincible. When you’re surrounded by teenagers, it’s common to think you’re still fitter, faster and smarter than the lot of them. Being clever and more experienced does count, but I was brought sharply back to reality when I saw how angry, frightened and big Ruben was.

  Ruben had only been with us for four months, but I still couldn’t believe I had not seen any signs; these types of problems usually build up over time.

  ‘They’ve poisoned me!’ he kept muttering to himself, although I suspected most likely in response to the voices in his head. ‘Don’t make me use this. Are you one of them?’ I shook my head.

  ‘I’m not one of them,’ I replied as calmly as possible. I didn’t try to find out exactly who or what ‘one of them’ was, but I delved into his delusion a little, to make sure to differentiate myself from ‘the ones’ that had ‘poisoned’ him. It could be his teachers, the dorm staff, or everyone on campus.

  I reached one hand into my pocket. ‘What you doing?’ He took a step towards me and I quickly removed my hand.

  ‘Just calling a friend, that’s all. Will you let me call a friend? I promise he’s not “one of them”. He’s a good guy.’

  Ruben didn’t respond straight away, he looked confused, he wanted help, but didn’t know who to trust.

  ‘You can trust me, Ruben. You’ve seen me before, in the health centre. Remember I helped you when you were sick.’ Ruben lowered the frying pan, and reluctantly agreed to let me make the call. ‘You promise not to bring the bad people?’ I promised him I’d only bring people I trusted.

  Soon the headmaster and the school counsellor were heading our way.

  As they approached, Mr Driscoll took one look at the armed teenager, his agitated movements, his big searching eyes, and stopped behind me, quietly asking what was going on. Cathy, the counsellor, kept calm, waiting for me to take the lead.

  I introduced the new arrivals to Ruben – ‘You remember Mr Driscoll?’ Ruben nodded his head. ‘And this is Cathy, she works with me in the health centre. They’re both good people. You can trust them.’ Ruben wasn’t so ready to trust them, but he said they could stay, as long as they didn’t come any closer. They reassured him that they would stay where they were.

  We needed the police and paramedics, but we also needed to get Ruben to a place where he couldn’t easily flee. The paramedics would be at least 45 minutes away, while the local police officer (if he was on call that night) could be another twenty minutes away. Fortunately it was a cold December night, and I decided to use the pretext of needing to stay warm to convince him to come inside.

  ‘I’m not going anywhere with you. It’s a trap.’

  To gain his trust I said I’d give him my key to the building and let him lead the way to the cafeteria. Cathy and Mr Driscoll continued to let me take the lead. Mr Driscoll probably realised he was out of his depth, while Cathy was experienced enough to sit back and let the person whom Ruben trusted continue to take charge.

  ‘There’s more than one way out of the cafeteria,’ I explained, ‘you won’t be trapped. You can leave anytime.’ I placed the key on the ground and stepped back. Ruben quickly scooped it up, his eyes keeping us in sight the whole time. We followed him into the empty dining hall.

  I used this distraction and asked Cathy to call the paramedics, while asking Mr Driscoll to get some male staff to come and stand outside the cafeteria, but to stay out of sight.

  Ten minutes later we were seated around a table, Ruben resting the frying pan in front of him.

  Should I tell him that the paramedics were on their way? He may feel betrayed and bolt, or strike, or go completely berserk. I’ve only dealt with psychiatric patients in the controlled environment of a ward, and even then I’ve seen some pretty hairy stuff, but now I was beginning to appreciate just how hard it was to remain in control, especially when you’re the one everyone else is turning to for guidance.

  ‘You think you’ve been poisoned?’ I had an idea I hoped would work.

  ‘It’s the food. It’s something in the food.’ He was eager to talk about this.

  ‘Why don’t you let us take you to hospital then to make sure?’ I explained. ‘They could test and see if you’ve been poisoned. They could help.’ To my relief Ruben agreed upon this course of action. ‘I’ll go and order an ambulance, will that be OK?’ Ruben nodded his head.

  Within the hour the paramedics arrived with two police officers. As the village only has one officer living on the mountain, they’d obviously brought backup from the valley. After a hurried conversation in the corridor the police agreed to stay out of sight while the paramedics followed me in to see Ruben.

  Ruben agreed to leave the frying pan behind, and Cathy went with him in the ambulance to the hospital.

  Ruben spent three days in hospital, where he improved dramatically. He calmed down and even said he was only joking about being poisoned – although that’s a worrying sign in itself – but his
parents had arrived to take him home.

  It was too soon for a diagnosis, and he’d have to go endure a lot of tests to rule out physical causes for his problem, before taking things to the next level. He was discharged into the care of his parents and flown back to Canada.

  Several months later pieces of the puzzle began to slot in place. Cathy kept in contact with Ruben’s mother, and we found out he’d been inhaling spice, also known as synthetic cannabis.

  It may sound an incredibly brave thing to admit to, but after two weeks in a psychiatric unit he simply wanted to go home and didn’t want to be labelled a schizophrenic or in his own words ‘a nutter’. He does not have a diagnosis of schizophrenia but he cannot touch drugs again, or he may end up with one. Spice has been the most common synthetic cannabis I’ve seen, although other brands I’ve come across are K2, Atomic bomb, Funky Monkey and 8Ball … the list goes on, as does the damage. It’s described as synthetic cannabis, but with a few extra branches attached to the chemical formula, making it unidentifiable. If a particular brand gets banned because it’s proven to be harmful, they just tweak it a little more, bringing it back into the ‘unidentified substance’ category and making it legal again.

  If you try googling the different brands of synthetic cannabis, you’ll find hundreds to choose from. From what I can see, the synthetic stuff is especially dangerous because it’s an unknown, it’s an uncategorised chemical substance of which we don’t know the exact effects – there is no way to know how someone will react. It’s also scary because we can’t test for it because the moment a successful test comes out, the manufacturers tweak the formula to beat the system yet again.

  Drug manufacturers are adept at staying one step ahead of the system, unlike our students, who get themselves into a right mess. Take Kate and Kelly for example …

  Kate and Kelly

  Kate was at least honest about being dishonest, but one day that honesty was going to get her in trouble, not to mention put me in an exquisitely difficult position.

  Kate and Kelly visited me nearly every day, usually to say hello, share some gossip, or fish for some. Both girls were sixteen, but already smart. Kate wanted to be a doctor, Kelly wanted to study chemistry and pharmaceuticals.

  ‘I’m going to cure cancer,’ Kelly had once declared. Not to be outdone, Kate had said she was going to be a brain surgeon. I wished them well.

  ‘We’re not sick, just tired.’ Kate’s confession lacked remorse, but her enthusiasm was contagious. ‘Please excuse us for one hour, just this class, that’s all,’ Kate pleaded as she dropped to her knees, hands clasped in front of her. Kelly followed her; the two were twins, inseparable. If one was going to miss class, then both were.

  ‘Up you get girls, you’ll be late for drama class,’ I mocked. The melodramatic antics were not disturbing, but the fact they really expected me to excuse them from class, was.

  ‘We don’t do drama,’ Kate replied, but quickly cottoned on when I suggested she’d do well in Hollywood.

  ‘Did we tell you you’re the best nurse?’

  Maybe they thought of me as an ally, even a friend. I knew that if that were the case, I needed to set them right. But have I mentioned what a pushover I can be?

  The girls skipped to class, with a note from me excusing them for being ten minutes late.

  It was the very last week of school when Kate sent me an email.

  ‘Urgent, please help, can you call me or Kelly?’

  They hadn’t called the emergency number to get the nurse on call, which means it’s probably something sensitive and personal, which usually translated to: pregnancy, STD, or in need of emergency contraceptive. I gave Kate a call.

  ‘We’re sorry’ were Kate’s first words. To which I said, ‘It’s OK, just tell me what’s wrong.’

  ‘Do you think they’ll drug test us?’ Kate asked, and I suddenly felt sick.

  The previous year Mr Driscoll had insisted on testing many of the seniors in their last week of school. This had come about because there had been a lot of rumours circulating about large numbers of students taking legal highs. Our tests cannot detect these, but he had wanted to set an example. It seemed, rumours had arisen that the same tests would be carried out this year.

  ‘I can’t answer that, Kate, you should know that. What have you taken?’ She confessed that she and Kelly had smoked some marijuana that morning.

  ‘Please sir, we’re really sorry, we screwed up; we won’t do it again. You’re not going to tell on us, are you?’

  I wasn’t going to tell on them, although I explained that this was not because I’m a friend, but because as a nurse I can’t discuss something I’ve been told in confidence.

  The girls were young women who would soon likely go to university, able to do what they liked, with whom they liked, whenever they felt the urge. Was this a one-off lapse? How long had they been smoking? Was it their first time? I asked Kate …

  ‘I’ve been good, I haven’t done it all year,’ she promised.

  ‘Ah, Kate, are you telling me that you smoked when you were fifteen?’

  ‘Well, um, fourteen actually, but not a lot, just a couple of times.’

  When I asked her about the risks of smoking pot at such a young age, she said it’s harmless. When I asked her if she’d tried anything else, she admitted to trying ecstasy, ‘but only once, just half a tablet’. She was surprised to hear me say that ecstasy is also dangerous.

  And these were the doctors of tomorrow, supposedly.

  Kate and Kelly needed help. They needed to be educated. They needed to know that there are risks involved, and I arranged a meeting with them and Cathy.

  It’s moments like these when you realise how powerful an influence you have on the people in your care. Why did Kate and Kelly feel they could turn to me? What was the right thing to do? At the very least I could make them educated drug users; often that’s more productive than just telling them to ‘Say no’.

  Somehow, so many intelligent, well-raised kids think that taking drugs is normal, and safe because ‘everyone does it’. That may be the case, sadly, but how can we stop this vicious cycle? I only wish I knew. My job would be a lot easier if I did.

  Chapter Six

  Counselling

  Ameena

  I’m a good nurse when it comes to the physical side of things – the cuts, bruises, breaks and illnesses. But a big part of being a nurse to so many school children is dealing with cases that are psychological, emotionally very delicate and private. We do have a counsellor in the staff to deal with these types of issues, but our roles often overlap, as our resources are stretched paper-thin.

  Most of the counselling I do is anything but specialised. But by simply being there listening and helping people get along, hopefully it all helps …

  As the only Saudi female at school, Ameena was unique. Oh, there were plenty of Saudi boys, drinking, partying and chasing women during extravagant weekend trips to the big cities in the valley, but in a lot of Saudi families women tend to be kept close to home. I suspect the only reason Ameena was allowed to come to boarding school was because she had two older brothers who could look after her.

  At fifteen years of age Ameena was not just a couple of years younger than her nearest brother, she was the opposite of her brothers. While the boys were loud, funny, flash with cash and indifferent about school work, Ameena was softly spoken, kind, thoughtful and reserved. She was near the top of her class in all her subjects. But it wasn’t this that made her really stand out.

  It was the first week back at school following the Christmas break, and several teachers had been in contact with me to say that they were concerned about Ameena. They told me she seemed sad and not her usual happy self, and when she finally broke into tears during class, she was sent to see me.

  Tearful female teenagers are not my speciality, and with her being a tearful teenage female from Saudi, I felt I was not the right person to comfort her. Whether this conclusion was right or wrong,
ignorant or intuitive, I meant well. I was just trying to take into consideration her cultural values. But I needn’t have worried.

  What does one say to a crying female Saudi teenager? You keep your mouth shut and offer her a box of tissues, and wait.

  ‘It’s not fair,’ she finally said, once her tears had dried.

  ‘What’s not fair?’

  She didn’t respond; she suddenly looked worried. ‘It’s nothing.’ I reminded her that it obviously wasn’t ‘nothing’ or she wouldn’t be in tears. I thought it the right time to tell her that several of her teachers had been concerned about her.

  ‘You don’t have to tell me. Sometimes a big cry is all you need,’ I said.

  She slowly shook her head, before seeming to make up her mind.

  ‘You won’t tell my brothers or my parents I’m here, will you?’ I said I wouldn’t tell her brothers, but said I couldn’t promise not to tell her parents if I thought her health was in danger.

  ‘Oh, I’m not in any danger, although my parents would be very angry.’

  I was trying to figure out what could be wrong. ‘If it’s about boys, and, you know, private stuff, I’m not allowed to tell your parents, so don’t worry.’

  ‘Oh my goodness’ – her face turned red – ‘it’s nothing like that. My parents would be way beyond angry if it was anything like that.’ I felt immensely relieved. A pregnant teenage Saudi was not something I would be well equipped to handle.

  ‘I do have a friend though, a female friend …’ She hesitated, unsure if she should continue. She took a deep breath, seeming to make up her mind.

  ‘It’s Adina,’ she said, as if this explained everything.

  ‘Ah … I see … And why is that a problem?’ I asked, my lips working before my mind had processed the implications of her announcement.