Site Presented By
Saturday, Jul 11, 2009
As a school nurse, I see students who require way more than Band-Aids. They need emergency mental healthcare, instruction on how to brush their teeth and wash their hands, and answers to all of their questions.
Feb 5, 2004 | "How do you get AIDS?"
"Do people get cranky when they eat drugs?"
"Is it normal for one breast to be bigger than the other?"
These are some of the anonymous questions -- printed on index cards and dropped in a Manila envelope tacked to my office door -- that I have received this month.
I work as a nurse in two San Francisco elementary schools, where many of my students, ages 5 to 11, face problems more complex than adding fractions or writing in cursive. A few are hungry; some are homeless; some are here illegally. All too many have parents who must work two or even three jobs.
When I was growing up in Boston, in the 1960s and '70s, the school nurse was a uniformed woman who lived in a peaceful little office near the gym. I visited her once with a stomachache and vaguely recall a white room with a pristine cot and a scale. She was there all day, every day, for whatever was needed. That era has passed forever. Today, in San Francisco, I am considered fortunate to have only two elementary schools and about 800 students; some of my colleagues have many more. In some school districts nurses travel to as many as seven schools, each with hundreds of students. And there's much more to do now than give out Band-Aids. Families are fragile. With work hours and commutes increasing, many of my students are in school from 7 a.m. to 5 p.m. every day. I know a few who wake as early as 4 a.m. so that their parents can make it to their shift.
One of my schools draws from a nearby housing project, where Marcus, a first-grader, has already witnessed four shootings, the first at his preschool. Exposure to violence has left him tense and angry. He sits in class and glares, unable to focus on reading and counting, although his teachers know him to be extremely bright. Down the hall, his sister, who is reluctant to leave the house except for school, which she adores, hides her face and sucks her thumb. Still, for the most part, the children are surprisingly resilient and cheerful. Brianna, a tiny first-grader with golden shoes and a thousand braids, grabs at my stethoscope every time she sees me to hear her heart "beeping." Jason, an 8-year-old who is anxious about the complexity of third-grade social maneuvers, sends me notes through his teacher, addressed to "Dr. Lisa," giving me updates on his day. And Minerva, an angel-faced 9-year-old, and self-described "drama queen," regularly shows up just to chat because, as she puts it, with her winning smile, "I have issues."
The families are also resilient and cheerful: showing up in the rain to applaud the Halloween costume parade that marches around the block; snapping photos at the fifth grade graduation; picking up and dropping off each other's kids; spending hours in the evening listening to their children reading aloud and holding flashcards.
I have been a nurse for 11 years, and this assignment is the most compelling and challenging of my career. I started working in the schools on Halloween of 2002. Quickly, I became swept up into 60-hour weeks of finding emergency mental healthcare for the 8-year-old who says she wants to kill herself; teaching 50 first-graders how to brush their teeth and when to wash their hands; assuring teachers that while lice are a nuisance they are by no means fatal; and tracking down someone to bring in a child's asthma inhaler when all of the phone numbers on his emergency card have been disconnected.
"Why do we pee?"
"What do bones look like?"
"If you eat unhealthy food what will happen to you?"
As San Francisco becomes increasingly unaffordable, more children are commuting an hour or longer from less-expensive outlying cities or are boarding with grandparents in town. Many lack health insurance and depend on urgent-care clinics or emergency rooms. Increasing numbers of students come to school with chronic conditions, such as asthma and obesity. Some are not allowed to play outside their homes because it isn't safe.
The image of traveling school nurses bewilders people from my generation or my parents'. At a recent gathering, I described one of my schools to another nurse, an extremely competent woman in her 50s, with decades of patient care experience.
"Are you the only nurse at that school?" she said.
"I'm the only nurse at both my schools," I replied.
"God," she said, refilling her glass, "that sounds stressful."
Being split between schools is a bit disorienting. When Ryan comes in complaining of a stomachache I have no idea whether he shows up every day with the same ailment. Sometimes I ask the secretaries whether a student is a "frequent flier," but they are not always certain themselves. Out of necessity, sick students get squeezed into the office bustle, tucked among phone calls, discipline problems and UPS deliveries. I rarely hear about what happens on days I'm not there, except from the kids themselves, who might run up on the playground and reproachfully inform me: "I threw up yesterday and you weren't there."
