Confessions of a School Nurse - Michael Alexander

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of all ages and sizes. The size of a person can make it difficult to tell. Often frail people don’t even need to have an accident or any overt force involved to dislocate a joint, and their statures make it hard to see if something’s out of sorts. But a seventeen-year-old boy on the basketball team is likely to be tall and skinny. The poor lad didn’t have enough flesh on him to hide anything.

      My clinic was only 100 metres away and with the help of Brian and James we managed to get Steve lying on the examination table. I tried calling Dr Fritz but got no answer. I remembered that this was one of the few weekends he had off; we were alone.

      ‘Fuck!’ Steve was trying to find a comfortable position but not succeeding. ‘Just fucking do something, fuck, fuck, fuck …’ He carried on screaming, pleading, while I didn’t have the courage to tell him that there was no doctor.

      Steve had found the best position to ease the pain a little. He was lying face down on the examination table with his right arm hanging down off the side. ‘Please do something soon. I can’t take this anymore.’

      In such instances the emergency call was directed to the next village over, usually a thirty-minute drive away. The next option was the ambulance, but the nearest ambulance was forty minutes away, which would mean at least an hour and a half before he got to hospital. My other option was to take him by car, screaming all the way. With such limited and unappealing choices, I opted for driving.

      ‘Please, I can’t move. Don’t touch me. I can’t move.’ We couldn’t get Steve to move off the bed let alone into a car. He’d found himself in a slightly less agonising position and was not going to budge. I needed some advice.

      I try to avoid calling my colleagues, Justine and Michaela, when they’re off duty because time off is supposed to be just that, and like all nurses, I know, when you ask someone for help, they will never say no. Michaela was no different and was happy to help out. In fact, Michaela relished the challenge of a decent trauma. I instantly felt reassured by her upbeat tone when she arrived.

      ‘Don’t worry about a thing,’ Michaela said and quickly began examining Steve’s shoulder. ‘I’ve put dozens of shoulders back in place.’ What the hell was she talking about? Nurses don’t relocate limbs. At least, not nurses in Britain or New Zealand. I knew Michaela was extremely experienced and supremely confident; perhaps this is what nurses did in the States.

      ‘What do you mean you’ve put in dozens of shoulders?’ I whispered, thinking I was out of earshot of our patient. ‘You can’t do that. You’re not allowed.’ I know my limits, and I know what is within the scope of my practice, and what is not. Relocating the shoulder myself had never occurred to me. Steve chose that moment to scream in pain.

      ‘Let her bloody fix it. I can’t take this anymore. Just do it,’ he managed to shout.

      Watching someone in agony never gets any easier, and it’s a whole lot worse when you don’t have an IV line to insert with a whole lot of morphine or midazolam.

      I was trying to think of what could go wrong if Michaela went ahead and fixed his shoulder. She could worsen any possible fracture or nerve damage, although there was no way to judge how much damage we could do by leaving him as he was – there were possible circulation problems to worry about – and this was without even considering the possibility of the relocation not working.

      ‘We can’t leave him like this for the next hour and we can’t take him to the hospital. We have no choice.’ Michaela was in total control, and not in the slightest bit fazed by the chaos. ‘Honestly, don’t worry, I’ve done this lots of times with the docs at work. It really does look like an uncomplicated dislocation. I know what I’m doing.’

      I stood back and watched.

      She rolled up a sheet, wrapped it around her waist and Steve’s shoulder, and gently began to pull. ‘Fuck-fuck-fuck-fuck-fuck …’ Steve’s screams reached new heights. I was just about to stop Michaela when … ‘Thank fuck for that. Oh, thank you, thank you, thank you so much.’ The relief was instant and the whole procedure over in less than ten seconds. After checking Steve’s circulation and sensation in his hand, Michaela placed him in a sling and gave him some analgesia. ‘I can’t thank you enough,’ he said repeatedly.

      Part of me felt more than a little envious, the childish part that wanted to be the hero. But that was nothing to the relief I felt knowing that he was feeling so much better.

      Steve was taken to the doctor the following day where an x-ray showed no fracture, and the doctor congratulated Michaela on a job well done. ‘You’re OK with us doing that?’ I asked. I had been prepared for him to be angry with us for doing something that was a doctor’s job. ‘Why would I be angry? You did a good job.’

      His words were not helping me to figure out what was right or wrong (if there really was any such thing), or what my exact role was. I was doing more than the average nurse, a bit of diagnosing, and administering treatments and medicines like a doctor, as well as playing detective … but nothing as practical as what Michaela had done.

      Michaela’s brave actions on that surprising Sunday night taught me a few lessons that I’ll never forget. To act or not to act? Indeed, that is the question.

       Checklist

      Generally, dealing with big issues is easier, because you know it’s bad, and you know you’re going to need outside help. Perhaps that sounds odd, but there’s no uncertainty. So much of what I see is subjective, and while kids aren’t necessarily dishonest, no one is immune to playing the system.

      It doesn’t matter that 95 per cent of our students are either very wealthy or ridiculously wealthy, because they’re all the same. They’re young, impressionable, tricky, manipulative, cocky, embarrassing, awkward, fun, scared, compassionate, and clever. They’re capable of anything, even fooling their favourite nurse, although I do try to catch them out when I can.

      Skipping class or PE is built into their DNA, and there’s no better way to achieve this goal than to pull a sickie. After my first year on the job, I’d learned, adapted, and implemented various techniques and tactics to spot the genuine from the fakes.

       1. The Positive Make-Up Test.

       2. Do they have a test in class? You need to be specific with your question: kids will say ‘No’ but get in trouble for not handing in their assignment or presentation, and when confronted with this say, ‘But you asked if I had a test, not an assignment.’ I always ask the full spectrum: ‘Do you have a test, assignment, homework, presentation, or anything else in class that needs to be done today, at this moment in time?’

       3. How do they answer question 2? If they start the conversation with ‘I don’t have anything important in class today’ I know where this is going. It sounds planned – and sick people are usually feeling too miserable to plan their escape.

       4. Check with their dorm parent to see if they really were sick the night before.

       5. Check the records to see if they’re regularly missing a particular class, PE and Maths are particularly common.

       6. Obtain as much physical data as possible. Temperature, pulse, blood pressure, bowel sounds, pallor, obvious nasal congestion, lung sounds – and document it all. By tomorrow you won’t remember if they’ve had a cold for one day or one week, because you’ve seen so many students, and kids aren’t the best historians, especially when they’re lying.

      Reading this back, it looks like I’m more of a detective than a nurse, but if that is so, then I’m the most lenient one around. It’s hard to say ‘no’ to a desperate kid, although I can and will when required. And that’s the problem with medical assessments – often the symptoms are subjective. It’s much easier with injuries; give me a simple break, cut or bruise anytime.

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