Confessions of a School Nurse. Michael Alexander
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Thankfully, Dr Fritz’s surgery is in the centre of the village, only a five-minute drive away.
Proximity and willingness alone made Dr Fritz the unofficial school doctor. In addition to running a full-time GP practice, he was also our first port of call if there was an issue the nursing staff felt needed a doctor’s opinion, and we would make an appointment at his office and send the child along. Even on his time off, it was not uncommon for him to see our students if the matter was urgent. Dr Fritz was also there if a student needed specialist help, as he knew who the closest and best experts were, and referrals were made through him.
Like all born and bred mountain men, Dr Fritz is a no-nonsense man. He’s also one of the hardest working GPs I’ve ever met. He is always there during the day or available in the middle of the night, no matter what, and it wasn’t unusual for him to put in an eighty-hour week.
He even has the ‘unique quirks’ that often come not only with living in an isolated mountain village, but being the only GP for a whole community.
He was happy to see Marcus straight away. Pain in the testicles can be very serious. Torsion (a twisted spermatic cord) is a surgical emergency. Within minutes, the doctor had Marcus lying on the examination table.
He began his assessment as all doctors do, by examining the whole person and not just the affected part, and gradually worked his way to Marcus’s testicles. I had wondered if he was going to glove-up as he doesn’t always, and in this case didn’t, although he was completely professional in his exam. At one point Marcus raised an eyebrow and gave me a worried look, but he kept quiet. It isn’t wise to question any man who has your nuts resting in the palm of their bare hands.
Once the examination was over, Dr Fritz arranged for an ultrasound scan to take place as soon as possible.
‘I do not think it is a torsion,’ he explained, ‘but we need to be sure.’ We were standing by the reception desk, as he turned the pages of his diary. He licked the index finger of his right hand to turn another page … the same hand he’d just used to feel Marcus’s testicles.
I glanced at Marcus to see if he had noticed, and saw him staring at the doctor’s hand, his mouth hanging open. He leant towards me and whispered in an appalled tone, ‘He just tasted my balls.’
Dr Fritz does wear gloves when strictly necessary, has always been proper and he did wash his hands, but not before the ultrasound had been arranged. Where other doctors usually wear gloves when examining warts, fungusy toes, and the like, Dr Fritz doesn’t. I don’t agree with Dr Fritz sometimes, but he is completely trustworthy if a little unprofessional – you wouldn’t get away with it in most places, and in a way, that shows just how unique this little community is.
This was the first of many peculiarities I would eventually come across while working with the doctor.
As for Marcus, the ultrasound showed that he had a hydrocele, or a little cyst full of fluid, attached to his left testicle, that is absolutely harmless. Marcus calmed down a great deal once he realised his balls weren’t going to drop off, and the pain settled with some ibuprofen.
As first weeks go, this was pretty ridiculous … but, as I was to find out, this was just the beginning.
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