Читать книгу Confessions of a School Nurse - Michael Alexander - Страница 12

I have a confession to make: before seeing the school vacancy, I had never planned on working with children. But I figured it wouldn’t be too hard. I’d learned some of the general rules during my years in the emergency room; developed the hunches that seep into the core of any nurse or doctor who spends their life looking after others.

A screaming child is a good thing, although not for one’s ears. It means a set of functioning lungs and an airway that is clear. A child that fights as you struggle to put in an IV or suck some blood is also a good sign, it means their illness hasn’t sapped too much of their life force. A child that is quiet, a child that doesn’t put up a fight, is a concern. Their illness has begun to overthrow their natural survival instincts.

Luke was quiet. He was nine years old and one of the youngest children at our school. He was also one of my earliest patients.

The junior school consists of about sixty children, an almost even split of boys and girls from ages 9–12, and while they do sometimes mingle with the high school kids, they live and study separately. They do, however, share the same nurse. I see the little ones and the big ones.

‘What’s wrong?’ I asked as I ushered a pale, sunken Luke into the examination room. He mumbled a reply and I asked him to speak a little louder.

‘I feel sick,’ he managed, his chin resting on his chest, his eyes staring blankly at the ground.

The words ‘I’m sick’ don’t really help a lot, but he wasn’t up to giving me a more useful answer. To investigate, I phoned up the people in charge of his dorm to get a bit of background.

‘He’s had a bit of a cough,’ Mrs Pierce his dorm parent explained. ‘I didn’t realise he was so sick. He was running around with the others playing football this morning. I’m so sorry.’

The people in charge of the dorms are usually a married couple of any age, but often with their own children, and they’re the heart of all boarding schools, wherever they may be. They act as a parent to these children, hence the title.

Mrs Pierce sounded defensive, but she had no need to be. Kids are renowned for bouncing off the walls one minute, then being deathly sick the next. They reach that tipping point where their reserves are finally exhausted and their body suddenly catches onto the idea that it’s unwell.

With Luke I, at least, had a starting point – a cough and a runny nose. He also had a high temperature, 39.9. I was worried, not because of his illness, but because it was up to me to make the call on what to do. I could make the five-minute drive to the doctor’s office, but Dr Fritz is a busy man. He has a whole village to take care of, and I can’t go running to him every time a child has a high fever. To help me decide, I did what I would do if triaging someone in the emergency room. I got as much data as possible.

No headache, no neck stiffness, no rash and no photophobia (sensitivity to light) plus a probable cause for his fever, that is, a cough and runny nose; probably a simple cold.

Lungs clear, with good air entry on both sides with no wheezes, crackles or signs of respiratory distress and his pulse and blood pressure were fine. But he oozed misery. His body ached and shivered. ‘I’m so cold,’ he mumbled.

It’s normal to feel cold when your temperature is up. Sometimes it’s the first sign you notice when someone is sick; you’ll find them nestled under two duvets with a hot water bottle, trying to warm up, and when you check their temperature, it’s very high.

‘You’re going to stay with us for a bit,’ I explained as I led him through to the sick bay. We have sixteen beds for 400 kids. The most sick get the beds, while the not so sick stay in their dorm where their dorm parent takes care of them. Luke probably had a simple cold, but such a high temperature needed to be monitored.

‘Please don’t take it away!’ Luke screamed, horrified that I’d removed the duvet and replaced it with a thin blanket. It was the most he’d reacted since being admitted. It’s cruel, watching him shiver, and it didn’t help when I placed a cool compress on his forehead. But he was only nine years old and did as told.

Over the next couple of hours, the combination of cooling measures, paracetamol and half a litre of water brought his temperature back down to 37.2, and his actions showed.

‘Can I watch a movie?’ is a sign that a child is getting better. I set him up with something to watch. Once the movie was over, this was followed by ‘I’m bored’. I love those words. They’re almost as good as ‘I’m hungry’. Sure signs of recovery.

All the same, I kept Luke in the health centre that night. Illness comes in waves, and Luke didn’t disappoint. His temperature went up and down, dragging his body along for the ride, but by the following morning he was feeling good again, and after a day with no fever or body aches, he was sent back to his dorm.

Why had I been so worried? Why had I even considered sending him to the doctor? I knew he had a simple cold, and I know that children are adept at taking onboard very high fevers.

It was because I was the one making the ultimate decision, although it did help having two experienced colleagues to turn to. But I was the one making the decisions, especially late at night or on the weekend, and deciding if a fever was benign, or a sign of something more sinister, even life threatening, and I was the one going to sleep at night wondering ‘what if?’. There were no doctors in the background to run a reassuring eye over him, and no blood tests to see how his white blood cells were holding the fort, or inflammatory markers to see how much of a battering his body was taking. I was using my senses and basic observations to make what seemed like a simple call.

But nothing is simple, and in medicine, the simplest decisions don’t happen without a lot of thought. This is my job now. I’m the decision maker, the responsible one. It’s terrifying.