Confessions of a School Nurse

by Michael Alexander

  At two o’clock on a Monday morning I received a call about Celine, a fourteen-year-old girl from Canada. Celine had decided to play with a razor. Her wrists weren’t cut in the traditional manner (across the wrist) or even the more effective manner (longitudinally along the length of the artery), instead she had cut out a rectangular section of skin about 1mm in depth by about 4cm by 2cm on both her wrists. The edges weren’t ragged, but cut with clean strokes. There was plenty of blood, but no damage to the veins, or the arteries, that I could see.

  It was just as well no vessels were cut as she’d waited two hours before deciding to get help from her friend Lisa, during which time she probably would have died if she had severed something important.

  ‘Why’d you do it?’ I asked as I placed a dressing on her arm. The middle of a crisis is not the best time to psychoanalyse, but I also needed to make conversation, to keep my patient involved in what was going on. Sometimes girls shrink into themselves, and don’t say a thing. This worries me more than the ones who talk, even if it is just superficial. Having the energy to engage in your surroundings and the people around you is a good sign.

  ‘It makes me feel better.’ As far as I can tell, this seems to be true in self-harm cases. Generally, no matter what the cause, whether it is sadness, anger, self-loathing, guilt, or a combination of them all, the actual cutting seems to temporarily relieve the sufferer from their worries. The physical pain helps relieve the mental agony. Celine was content to let me dress her wound, but when I suggested that I should take her to hospital, she began to resist.

  ‘It’s not a big deal,’ she said, as if this was an everyday occurrence. ‘I won’t do it again.’ I asked if this was her first time, and she said it was. I had to be sure, but it didn’t seem that now was the time to push, so I went into the hall, leaving Celine with Lisa, while I called Cathy down.

  ‘Is she one of yours?’ I asked when Cathy arrived. She nodded. But before she got a chance to explain, Lisa called out.

  ‘She’s trying to take off the dressing. You have to stop her.’

  Cathy and I hurried inside.

  ‘I just wanted to see it again; see how bad it is. I’m sorry,’ she said, her voice cracking. I went outside to call the ambulance while Cathy stayed with her. ‘I’ll go with you to hospital, you won’t be alone.’ Cathy was true to her word and stayed with Celine until she was admitted to a ward.

  It wasn’t until she got back that I found out a bit more of Celine’s history.

  ‘They found lots of scars on her upper thighs and hips.’ Cathy was distraught, which was unusual for her because she had seen a lot of disturbing things in her time. ‘It’s been going on for some time.’

  I realised then that Cathy was feeling guilty because she saw Celine once a month on a routine basis.

  Cathy had a compulsory support group for the younger female students, the purpose of which was to stop minor issues before they became bigger problems, a sort of ‘prophylactic’ therapy. ‘We even talked about self-harm a few weeks ago,’ Cathy kept repeating.

  Along with self-harm, the group discussed boys, schoolwork, study habits, dealing with stress, sleep habits and healthy eating.

  ‘I can’t believe I didn’t see it.’

  I’m sure Celine had no wish to kill herself, and while there is a good chance she will grow out of this and lead a normal life, the scars will remain forever, a permanent reminder.

  With the help of the school and its staff, Celine stayed with us until graduation. She did not make any further attempts at hurting herself that we knew of.

  ‘How can one person be so draining?’ Cathy once asked after spending most of the night with Celine during a particularly bad time. They both knew that any further attempts would mean expulsion from school. Cathy and I both knew that it only takes one self-harmer to take up all your time, resources and energy – but there’s no other way.

  Such words may sound harsh, especially with the threat of expulsion; I have to give credit to our school for working hard to keep Celine. Many places have a zero tolerance towards such behaviour. It’s not just a matter of taking up so much of everyone’s time, there’s a fear nestled in the back of any headmaster’s mind, a little voice that asks ‘what if …’

  Girlfriend woes

  Fortunately not all problems are as complicated or frightening as Celine’s, but when you’ve got the perfect storm of teenagers, alcohol and hormones mixed up altogether, something – anything – could happen …

  When you haven’t got one, all you want to do is get one; when you’ve got one, everyone else’s seems hotter than normal; and once you’ve actually managed the task of finding a suitable partner, strange things happen, it’s almost as if a magnetic force is created that draws single women to you, and for the first time in your life you’re desirable – but attached. These laws of attraction are a source of so much trouble.

  At sixteen years of age Marcek was a handsome blend of Kiwi and Polish ancestry. ‘The doctor said it was a good thing my dad married a Pole,’ he told me once, ‘because the gene pool in New Zealand is a bit limited.’ Strange, but that was the same thing my doctor said when he found out I was married to a Polish woman.

  It was because of this international connection that I got to know Marcek’s family, and hence why I got to know Marcek better than most of the students at school.

  He was softly spoken, I never heard him raise his voice or argue with a teacher, and the few times I saw him in the health centre were when he was genuinely ill. He didn’t seem like someone who would do something rash or fall victim to the things a lot of young men do, but something happened one fateful Saturday night, and he snapped.

  Marcek came to see me in my office on Monday morning, the knuckles on his right hand swollen and bruised. I suspected a case of GDGAPW syndrome: aka Get Drunk, Get Angry, Punch Wall. Sometimes the wall is substituted for a window or a person.

  ‘What was it, a wall or face?’

  ‘Huh?’ He paused while thinking of a way out. ‘It was the punching bag. I went too hard.’

  As he didn’t have any other signs of a fight, it was probably a wall.

  ‘The wall will always win,’ I said as I placed some ice on his swollen hand, but he stuck to his story. I would need to continue my investigation. I asked if he got up to much on Saturday night.

  ‘Just a party. Was OK, I guess.’ This was not the Marcek I knew, evasive and dishonest, and although I didn’t want to know anything about the party, I did want to find out the truth. I could choose to ignore the real reason for his injury, request an x-ray and get the appropriate treatment, but what would he hit next time? The force he’d obviously used to punch whatever it was he had struck had been enough to probably break at least one bone in his hand, and next time the consequences could be much worse, for himself and for others.

  ‘You have much to drink?’

  ‘A bit.’

  ‘How’d your girlfriend like the party?’ I asked casually. ‘What’s her name again?’

  Marcek swore under his breath in Polish. I reminded him I understood exactly what he’d just said.

  ‘How the hell do you find out these things? Are there no secrets in this place?’ Of course there are no secrets at a boarding school. We live and breathe gossip in this place, it’s our lifeblood.

  ‘Just tell me the truth about your hand, and then we’ll go and get you an x-ray.’

  I would never be so pushy with a patient in hospital, as they might just push back, but young men are masters of doing silly things, things that seem harmless but have serious consequences. If I was wrong and he’d hit someone’s face, then the small laceration to his knuckle was much more serious because a tooth bite combined with a fracture around the knuckles is liable to get infected, and if not treated properly could cause permanent damage, and I told him so.

  I also told him the story of an upcoming rugby star back in New Zealand who had punched a window. He cut some nerves in his right arm, and had to
give up on possibly becoming an international rugby star. The sensation to his hand never fully returned and he had big problems catching the ball. ‘The poor guy had to start playing soccer,’ I explained.

  ‘It’s football, not soccer,’ Marcek cut in, his mood seeming to lift. He seemed ready to talk.

  ‘Let me guess, girlfriend trouble?’

  ‘This is just wrong.’ Marcek was shaking his head in disbelief. ‘You’re like a bloody detective. Anyone would think you’re the party police.’

  I’m not the party police, but I have become adept at filtering out the truth.

  ‘We broke up, over nothing—’ I cut him off, telling him I didn’t need the details, I just wanted to know what he punched. ‘I punched the wall. I was just drunk that’s all. It’s not a big deal.’

  Marcek’s x-ray showed a boxer’s fracture. This sort of fracture happens when a regular Joe lashes out and doesn’t punch correctly. A correctly thrown punch should connect with the second and third knuckles, but many people connect with the fourth and fifth (the ring and small finger) and one or both of them snap.

  I convinced Marcek to have at least one meeting with the school counsellor to talk about dealing with anger; hopefully this was just a one-off, but when there is alcohol combined with women, anything is possible.

  After my work was done, I thanked Marcek for his honesty, and told him I was sorry about the breakup.

  ‘Oh, don’t worry, we’re back together. She thought I was paying too much attention to some girls, but I told her I wouldn’t do that. We’re good now, just the alcohol I guess.’

  Fortunately fights within the school are not common, and people really do get along, with little bullying, and I’d go so far as to say that I’d feel happy letting my own children study here, which says it all. I think it’s because everyone is often well travelled, or live in parts of the world where they might be in the minority – somehow this exposure makes them more tolerant of others, it’s also because they don’t have a choice but to get on, especially in such a small community. Children can’t be responsible for the stupidity of their leaders, but they can be the future peacemakers and bringers of hope.

  Right now with Russian and Ukrainian relations at such a low, the Russians and Ukrainians get along here. Violence does happen, but the worst cases I’ve seen or heard about have occurred when our children are outside the school.

  Such as revenge beatings: one poor eighteen-year-old lad had crossed a couple of Serbians, and during a weekend trip to a nearby city, was set upon by a group of Serbs who weren’t part of the school.

  Another time, a group of students had a run in with some Eastern Europeans who were rumoured to have a diamond smuggling operation. One of the ‘mafia’ lads waved a gun around, and although this turned out to be a fake, it scared a lot of people, and ended up in a police investigation, which turned up nothing. More recently, some of the boys from a visiting French football team took a particular fancy to some of our schoolgirls and became a bit pushy. The students rallied to the defence of their women and one of our students received a bottle to the head in return.

  These outside events usually take place when the students have been excused from school by their parents. Do these parents have any idea what their children get up to? Of course not – even the well-meaning ones often don’t have a clue, they probably prefer it that way.

  Chapter Seven

  In Loco Parentis

  Naif

  I try my best, but I can’t help wonder about the parents whose children I’m in charge of, and I can’t help comparing my own actions as a parent myself, and the actions of my own mum and dad as well.

  I don’t know how I compared to Naif’s parents (he certainly never talked about them) but naturally I developed an idea of who I imagined them to be. It was clear Naif’s relationship with his father wasn’t ideal.

  It’s sad that some children don’t get along with their fathers. Of course, sometimes it’s justified, but often hormones and the nature of teenage life play a part too. I hoped Naif didn’t hate his father, after all, he’d spent a lot of money making sure his son got the best schooling money can buy. Surely that must mean he cares?

  Unfortunately, generosity doesn’t always equate to interest.

  ‘I need their permission to give you the shot.’ I was harassing Naif, trying to get him to give me a valid email or phone number, because he required a tetanus shot, and I needed written consent, but his parents weren’t responding. The tetanus shot wasn’t vital, but he’d cut his hand in art class and according to his records it looked like he had missed this routine childhood vaccination.

  ‘They’re busy people; you won’t get a reply,’ he explained. ‘I’m old enough to look after myself. You don’t need their permission. I’m eighteen anyway.’ I suspected Naif was very capable of looking after himself. He had a confident, street savvy wariness about him. He was smooth, but not in an arrogant youthful way – more like the characters from the movie Goodfellas. Naif had the greased hair, the fine clothes; he looked like a clichéd mobster, even when just going to class! School rules didn’t apply to him apparently; he had his own dress code, his own flashy style.

  I reassured his ego that ‘of course’ he could look after himself and that I only needed written consent because those were the rules.

  ‘Just give me the number in your phone, and I’ll talk to them.’ All families give the school the usual contact numbers, such as home and mobile, but a lot of kids also have a private line to yet another phone, a line that they can always contact their parents on. I’ve used this line a number of times when unable to contact a parent on the regular phone numbers they give us.

  ‘There’s no need to call them, they’ll get in touch, just give it a break. Don’t call them again, all right?’ He was trying to sound casual, as if he was doing me a favour, but why was he so sensitive? Why wouldn’t his parents respond to my calls and emails?

  ‘Let’s forget the tetanus for now,’ I said, sensing tension. It wasn’t urgent. Even the local hospitals have stopped giving the shot, as most of them have never seen a case. ‘But for future reference, I do need to be able to speak to your father. What if there’s an emergency?’

  ‘You don’t understand, sir. I’ve been looking after myself for a long time. I live my own life. I don’t need my father. I don’t want a father. You don’t need to speak to my father, ever.’ Naif was suddenly conscious of the words that had escaped against his will and began to retreat.

  ‘Just forget, it all right?’ he said, as he stormed out the room. With his usual panache, of course.

  I first met Naif when he was only fourteen years old. His first words to me had been to complain about the temperature:

  ‘It’s so cold here, this is ridiculous.’ Naif was from somewhere in the Middle East and this was his first winter on a mountain.

  ‘It’s too cold for school, sir. Let me rest in the health centre. I’ll make it worth your while.’ Naif had pulled out his wallet and begun rifling through a thick wad of notes. I took the wallet and told him to go to class. ‘It doesn’t work like that.’

  ‘It’s not fair,’ he protested as I guided him back out the door and handed his wallet back to him.

  Many kids ‘pretend’ to bribe me so they can miss class and go back to bed, although I have the funny suspicion that if I really did take the money, they’d be fine with it.

  But other than the fact that Naif always had a wallet full of cash, I knew nothing of his background. Our interactions were frequent but usually brief, pleasant but superficial. He would poke his head through the door every so often, to ask how I was, complain about the cold, or ask if there was a bed free. The answers were nearly always the same, ‘I’m fine’, ‘It’s not that cold’, followed by ‘No – now go to class.’

  Naif didn’t return the next school year, as well as the one after that. I had forgotten all about him when he came back to finish his senior year of high school.

  ‘Do
you remember me? Surely you can’t have forgotten me,’ Naif quipped, as if the previous two years’ absence were nothing. I hadn’t forgotten him; I just didn’t recognise him.

  ‘What happened to your face?’ Perhaps it wasn’t the welcome back he was hoping for, but he had changed in ways that didn’t seem regular adolescent growth could account for. ‘Broke my nose,’ he explained. It wasn’t just his nose. Naif was pale and had lost a lot of weight. Naif had never been fat, but he hadn’t filled out at all, his face looked gaunt and he looked frail.

  Naif visited me and the other nurses regularly, he continued to try and buy his way into a bed, all the while flattering us and always taking an interest. But there was something different about him that I couldn’t quite explain; a seriousness that wasn’t there before. He mingled with his peers, but didn’t participate fully in the usual parties or some of the more silly antics that senior kids usually get up to, although he still flashed plenty of cash.

  His biggest expense that term was paying the bill for the champagne shower he and his friends had participated in at a nightclub one Saturday night. The boys had clocked up 35,000 euros on bubbly they hadn’t even drunk, but shaken and sprayed on boys from another boarding school. At least three schools had been involved and each had similar bills.

  As usual, Naif couldn’t figure out how I found out about the party. On this occasion, the fools had posted a copy of the bill to Facebook and it had eventually made its way to the headmaster’s office. They’d been competing to see which school could generate the most expensive bill.

  I’d raised the story more as a matter of interest. They hadn’t done anything wrong; they were of age and had been checked out with their ‘parents’ for the weekend, but I did remind Naif that he shouldn’t drink so much.

  ‘I don’t drink, sir,’ he declared, his tone serious. Naif denied touching a drop. ‘I only sprayed it around. I don’t drink.’ I told him he wasn’t a good liar and he vehemently denied he had been drinking. ‘I may lie about some stuff, but not about that.’