Riding the diabetic roller coaster

My little spitfire diabetic was absent today, and no wonder: yesterday her blood sugar ranged from 400+ to 60 in a matter of hours. Apparently she told her mom that her dad (they have joint custody) gave her that night's insulin, when in fact he hadn't, as the mom found out the next morning. At her morning check, her blood sugar was 260-something, and she felt ill; her ketones were off the charts. We called mom, who, to my relief, actually answered and came, and explained the insulin issue that happened last night. She said she was just off the phone from their doctor, and gave my diabetic her specified dose. An hour later, her teacher called to say her blood sugar was 60. And this was a totally normal Monday for this girl.
I don't understand how she can get any work done when she's feeling crappy all the time, and her blood sugar is flying all over the place. Her teacher said her work is suffering: in a recent test my diabetic was the only student in the class to not score in the "green" category. :( I'm not really sure what to do about the situation, and I don't understand why her mom won't realize that she's the parent and the diabetic is the child - someone needs to take responsibility and it probably isn't going to be the 8 year old. No one seems to care about the fact that there are serious long term complications of uncontrolled diabetes that this girl is headed for if things don't change.
On a lighter note, a first grade teacher relayed to me an incident during recess in which she overheard several students discussing the existence of Jesus. One pointed to the sky, and said he's up there; then another said, "Jesus died of lupus." You really never know what will come out of the mouths of children. 


Cue the "awwww"

I mentioned earlier this week that my little spitfire has been depressed lately. I've been making every effort to cheer her up, because it's been breaking my heart to see her so sad. Apparently my efforts were not as futile as I thought: she brought a little bag of dog treats for my dog, and I have never seen her as excited as she was to give them to me and discuss my dog's taste for bacon-flavored dog treats. Furthermore, she did this despite being sick. She threw up before school, but her mom was gone already and wasn't answering her phone, and her step-dad was still asleep, so she did what she knew she was supposed to and walked to school. She ended up vomiting again at school, and her grandma had to come pick her up, but to come to school - sick - and give my dog treats? Adorable. I am so proud of her today.

This small victory, along with the mother of my other diabetic randomly thanking me for teaching her son how to draw up his own insulin and being patient with him (duh, that's my job!), help me get over the other rudeness I encountered this week, including a mother talking to me as though it was my fault I hadn't done anything about her son's peanut allergy and epilepsy conditions she'd failed to mention to me previously. You can't please everyone.


Kid talk

A teacher dropped off a student in my office, telling me she found him puking into a drain outside. He was very open about the illness:

"Well I had two wet poops today, and that's a sign of sickness."
"Oh, yeah?"
"Yeah, they were wet. You know, when it's all liquid-y and stuff?" (Gestures with hands to demonstrate.)


I was leaving my elementary school when some kids - the one whose parents are routinely late picking them up after school - stopped me near the entrance. They were hunched around the globe that sits there, and pointed at the African country of Niger as they asked me:

"How do you pronounce that?"
"How do you think you pronounce it?"
"Well he thinks it's Niger, but I think it's the bad word we aren't supposed to say."

I changed the subject to the multiplication tables they're studying.


The things these kids deal with...

My little spitfire diabetic, eight years old, has been acting differently since we returned from break. She's been subdued, almost depressed, and I'm not the only one who's noticed this change. She's casually mentioned various people in her life being at court for a variety of issues, totally matter-of-fact while she's talking about it, but her overall change in demeanor leads me to believe that it's affecting her more than she's letting on. I have been trying to cheer her up by chatting with her about my dog (who she's decided she loves just based on his pictures), bringing her tangerines from my tree for her to bring home, and letting her play with my iPod. She drew me this lovely picture: my dog being attacked by spiders.

I wish I could think of a better way to cheer her up, but short of packing her in my car and bringing her to live with my dog and me, I'm not sure what I can do for her. :( 

She's not my only kid with heavy stuff on her mind, either. I commented to his mom that my other diabetic didn't seem to be being as mindful of portioning out his snack according to his blood sugar accordingly, and she said he has been being bullied at school and is afraid of being beat up - hence the distraction from his blood sugar. [He's totally justified - apparently the other kid that has been making threats toward him punched his cousin, a 2nd grader at the time, in the face last year.] Also, a student at my middle school is in the psychiatric ward of the hospital. Reason: extreme bullying caused a mental breakdown. 

What the heck happened to kids being kids? 


Reading material

There have been just so many interesting things I've been reading these days:

Twitching disorder affects 12 girls at New York high school. Um.

Allergy kills Virginia girl at school. I know I say I have nightmares about Lice Mom and such, but this is actually my nightmare. I'd have to quit.

Are schools making kids sick? They're making me sick, that's for sure. I am now, unfortunately, a pro at sinus infections and other obnoxious afflictions.

Sara Horvath Picks Out the Lice. Perhaps this will be my summer job.

Study: Don't Blame School Lunches For Childhood Obesity. Lunch alone, probably not, but it's certainly part of the bigger picture.


Making miracles

A little girl came into my office complaining that she had hurt herself outside:
"Where does it hurt now?"
"It hurts my tummy when I go like this [flaps arms frantically]."
"It hurts when you go like this? [flapping frantically]"
"Yes it hurts right here [points at stomach]."
"Okay, then don't do that."
She ran out of my office as though she'd just discovered electricity. Problem solved!
On a very different note, I was driving between schools and as I was nearing my middle school, passed by a church where a funeral or memorial service had clearly just ended. The area was crawling with unmarked (but obvious) police vehicles. Cool. 


What's wrong with this picture?

I finally got my first 9-1-1 call of the year on Friday morning, and it didn't play out the way I would have hoped.

I happened to be in the main office, two doors down from my own office, when the secretary answered a call. I could hear surprise in her voice as she said, "Yes she is, I'll let her know." She hung up the phone and turned around to tell me that the preschool needed me and that it was "kind of an emergency." [This elementary school has a preschool site attached to it, for special needs 3-5 year olds.] I jogged out of the school, across the blacktop, and through the gates to the preschool building. The rest of the kids were coming out, ushered by the adults, who directed me inside. Inside, I found the teacher and a three year old autistic boy, and the teacher told me he had just had his first grand mal seizure. I asked if 9-1-1 had been called already, and she said yes, that they had called down to the main office who then calls 9-1-1. I thought that was odd because the fire station is literally across the street from the school's soccer field, but okay. I asked when it had happened, because the boy was sitting up when I found him, and this was the gist of the teacher's description: "He went into a shaking seizure on the bean bag, which began ten minutes ago. It lasted for about two minutes, and afterward he was unresponsive and his breathing was labored. He still isn't his normal self." Sure enough, within a minute or so, the boy snapped to alertness, and I could hear sirens leaving the fire station. The teacher said that the boy's mom was on her way, and that she had called 9-1-1 because it was his first seizure of this kind - he normally has absence seizures - and I nodded in support. Soon enough, the firemen and paramedics arrived, and the mother did too - who, as she and son were being loaded into the ambulance - explained to her panicked husband who arrived shortly thereafter that teacher had explained to her why 9-1-1 was being called, giving the same reason she had given me.

Now, I am the school nurse to the elementary school, and there is another nurse - a co-worker of mine - responsible for the preschools around town. However, when emergencies happen, and I am there, I am obviously going to do what I can to help - in this case, thankfully, it only involved observing for a few minutes before the paramedics arrived. In this particular case though, there were several things screaming at me that these people need to be better prepared for future emergencies. So, without further adieu: Can you find what went wrong?

1. Why did they call down to the main office to have them call 9-1-1? The dispatchers ask questions in which it is quite helpful to be directly observing the patient in question (e.g., Is the child conscious?), and not only that, it wastes precious time. The preschool has a direct outside line, one on which they called the mother of the seizing student - but not 9-1-1.
2. Why did it take so long to call 9-1-1? I learned afterward that it took so long to hear sirens because they didn't call for 9-1-1 until AFTER they called the main office to check if I happened to be on site. (I think my blood pressure rises just thinking about it.) They knew to call 9-1-1 and why, and for the life of me, I can't figure out why it took TEN - that's 1- 0 - minutes to act on that knowledge.
3. Related to number 2, if a child is unresponsive after a seizure - his first grand mal - that would be a clue to me that if for some reason 9-1-1 hadn't already been called, now would be the time. But the teacher also mentioned to me that although he was breathing, it was "labored" after the seizure. Tip: if a three year old without respiratory issues is having difficulty breathing, please call 9-1-1. Immediately.
4. My own areas in need of improvement: turns out I don't have a health alert list for the preschool kids. They may not be mine, but they really are when I'm there, and it would be nice to know who has seizures, and who has Epipens (yes, preschool-aged kids do have them). I'll be getting that from the preschool nurse. Second, I wasn't wearing a watch, which is tortuous in case of emergency, particularly related to a seizure. No one will probably believe this, but I noticed my naked wrist on my way into work and thought that with my luck I'd have an emergency. Murphy's Law strikes again, and to heck with watch tans: I'll be wearing a watch from now on.
5. A child having his first grand mal seizure is not "kind of" an emergency. That is an emergency.

In my efforts to stay positive this semester, I'm going to see this for what I want it to be: this is a serious learning opportunity for everyone. I've already discussed with the principal the need for the preschool to make their own 9-1-1 calls - they can notify the main office after they call for assistance - and I asked the preschool nurse to do some in-service training for the staff's benefit. Unfortunately, they beat me to her with a different story - one that involved calling 9-1-1 three minutes in and the paramedics taking 11 minutes to arrive. Must...Stay...Positive...


Semester 2, Week 1: Success.

So I didn't switch schools this week as I've been being promised for months, leaving me still split between two towns. So the mother of a child for whom I have been asking for an Epipen (bee sting allergy, and there are tons of bee stings in the spring), once again did not show up to the 504 meeting that has been rescheduled twice, even though she confirmed with the school secretary that morning that she would be present this time around. So I had to send home some of my sweeties because their mom is, I found out later to no surprise, the kind of mom who takes her middle and high school-aged kids shopping on school days when she's off work - it's no wonder their house always has lice. So I was scoffed at by a teacher when she asked me how many times the aforementioned sweeties have been sent home and I answered only twice this year, knowing I had just looked at my log (insider tip: school nurses are terrible at documentation, but for these kids, I've smartened up and am logging every time they go home) and was positive of the answer. So she didn't apologize or even acknowledge I was right when the attendance clerk printed out the attendance record showing they had been sent home exactly when I'd said they were. I'll still mark this week off as a success, because I'm not going into the weekend thinking I want to call in sick next week. 

It did, however, end with a bang that's left me exhausted. Stay tuned until next week, when we'll play What's Wrong With This Picture? in regards to a 9-1-1 call I was involved in this morning - yay! 


Cute factor: 10

Yesterday I was in my office with two of my favorites, a couple of little sisters that are sweet beyond description, sending them home - yet again - for lice. They were frequent fliers last year and were doing well this year until just before break. Ugh. Anyway, I was talking about their home life and asking about who lives with them (answer: all eight kids in the immediate family, plus miscellaneous other relatives), when one of the girls added, "Well, my grandma and grandpa usually live with us but right now they are in LA because my grandma is having head surgery because she has old-timers."

We had awhile in my office together thanks to their parents that decided not to answer their cell phones (this is becoming more common: parents don't answer when they see the school calling). I suspect this was particularly true in this case because when I asked the youngest if her head was itching, she exlaimed, "I wasn't scratching, I promise!" I assured her she wasn't in trouble, but it made me a tad suspicious someone had trained her to not draw attention to herself. Finally, after waking an older sister up by calling her cell phone, the parents retrieved the poor girls. I try to make my office a happy place to hang out (but not too happy), especially for kids that are there as a result of their parents' irresponsibility, and I figured I'd succeeded when as she was walking out, the younger girl told me she was going to ask her mom if she could invite me over to bake cupcakes. How cute is she? 


Happy New Semester!

I was hanging out with my little spitfire diabetic today, and she was bragging about her new flatscreen TV she got for her room for Christmas (she's eight):

Me: "What?! You have a TV in your room? I don't even have a TV in my whole house!"
Diabetic: "Huh? How do you watch TV?"

Oh, how I missed these kids! They make me laugh. As was apparent, I had a pretty terrible first semester of the 2011-12 school year, and I'm determined to make this one better - starting with things like this, remembering how funny and fun the kids can be. I had three weeks off to reflect on how challenging my first year was in this job, yet well before it was over, I was looking forward to Monday mornings just as much as most people look forward to Friday evenings. I need to get back in that groove, because it made all the difference in the world. I need to not let certain aspects spoil it - parents, politics, etc., because what everything is really about is the kids. If I'm not having fun with them, they're not having fun with me. And no matter how frustrating other personnel aspects of this position may be, the kids are still kids, and...well, they can be pretty awesome.

Also, Lice Daughter is back! And clean! She skipped all the way down to my office, and high-fived me on her way out. For a timid little girl, being back at school is what she really needs. I'll be crossing my fingers that she stays clean, because dealing with the wrath of Lice Mom again may put a damper on my efforts to have a better second semester.