Confessions of a School Nurse

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.

The talk

With children at boarding school, we end up dealing with a lot of the issues that parents usually have to deal with, and this includes relationships, hormones and sex education. We cannot ignore these issues, or hope that when the kids get home their parents give them ‘the talk’. Even the most informed parents, even those still living with their children, probably have little or even no idea about the sex lives of their kids.

How on earth can parents be expected to know what’s going on in their children’s lives when they’re thousands of miles away? I lived at home, but I still didn’t have a sex talk with my dad. One day he said, ‘You got hairy balls yet?’ and when I turned beetroot red he handed me a book. I guess it worked for me, but I feel the kids at my school probably needed a bit more than that.

So that leaves me, your average, friendly, approachable nurse, to do the job. Am I qualified? Probably not, but I have lived. Yes, those words could certainly be taken the wrong way, but it’s true. I’ve travelled, dated women from around the world, been a ski instructor and had women throw themselves at me (it’s the uniform, not me) and even been pursued by ex-psychiatric patients. Then I got married, procreated and settled down. I also spent a few months working in a London walk-in STD clinic, so I can easily use scare tactics to terrify everyone into safe sex, even abstinence. Does this make me the best person to give our kids ‘the talk’? The teachers and other faculty expect the nurses to do this, so at least they must think so, but I’ll let you be the judge …

‘What feels better, sir?’ asked William.

There’s one in every class: someone who either knows too much, or thinks they’re being clever. William was actually neither, he was simply eager.

Next to him, poor Chen had no idea what was going on. His English was good enough to learn in class, but William’s question had baffled him.

I’d never meant for the friendly chat to head in this direction. I had been asked by the dorm parents in charge of the junior school to have a relaxed, almost informal discussion with the boys one evening and talk about growing up and to maybe, very gently, bring up sex. But I’d never talked to children as young as William or Chen before. They were both twelve years old and, along with the other twenty or so boys in the room, comprised all the boys who would be starting high school next year.

‘It would be good to prepare them a little,’ Mr Jones, the head of the junior school, had explained at the start of the year, ‘so they’re not completely unprepared.’

I shouldn’t answer William’s question. It is on my list of topics to avoid at all costs. Some of the other topics on my no-go list for talks to this age group include homosexuality, masturbation, graphic descriptions of STDs and getting in-depth and intimate about sex.

Why were these very important subjects off topic? Parents. Not all parents believe it is the school’s responsibility to educate or even discuss in the most superficial manner anything regarding sex. They’re concerned for the following reasons:

 1. They think their child is too young to learn about sex

 2. They do not think it’s the job of the school to teach their children about sex

 3. They worry that the teacher may unduly influence their child. A concern that is brought up nearly every time is homosexuality

 4. They are worried that by talking about ‘safe sex’ we are encouraging their child to have sex

 5. They come from places where sex is banned before marriage, and can result in imprisonment

 6. Their religion does not allow it

The problem is, these kids live thousands of miles away from their parents for up to eight months a year. Some see their parents even less, as they’re sent to summer school and, over Christmas, to winter camps to ski. In all the madness of such a busy life, they never get round to having ‘the talk’. Even if they do, in an ideal world, it shouldn’t be a ‘one-off’ chat, instead an ongoing dialogue – although I haven’t found any teenager yet that wants such a painfully awkward thing to last longer than necessary.

These kids are curious; they sometimes have no idea what is going on with their bodies, or can’t explain why they feel the way they do.

Today’s talk had begun with nice safe topics – ‘relationships’, ‘trust’, ways of showing someone you liked them – but it hadn’t been enough.

‘What’s the grossest thing you’ve seen?’ asked Warren, our only Australian student. I gently reminded him it was not the time or place for that discussion.

‘Can you get AIDS your first time?’ asked João the Brazilian, his question creating quite a stir.

‘Not if you use protection,’ answered William.

‘You get it from hookers,’ said Tim, clearly a surprisingly worldly twelve-year-old.

The questions were coming thick and fast, we were way off topic, and straying into dangerous territory. But this was what they wanted to know. I had to take back control. I glanced over at their dorm parent, hoping for help, but he seemed to be enjoying the show. ‘Keep going, you’re doing fine,’ he mouthed, although he thankfully did tell the boys to quiet down.

I decided to give them a choice. ‘What do you want from me then?’ I asked. ‘Do you want to know about STDs, sex, or something else?’

The majority wanted to hear about STDs, although I did notice that Chen had put his hand up for all three. I asked him how much he understood, and he just wanted to know what a ‘hooker’ was. The lads happily volunteered this information before I had a chance to intervene.

I asked the boys to list the diseases they knew about, or had heard of. They shouted out the following:

 • Warts. (William had seen one online as big as a tennis ball, and was only too happy to share the experience as well as the link to the website with us.)

 • HIV. (Everyone had heard of this, but William reassured everyone that a condom would stop it.)

 • Lice. (Enough of the kids had experienced head lice, and understood you could get a similar type ‘down there’.)

They couldn’t list any more, although they knew, for example, that there were diseases that made it painful to pee. I could have provided them with a list of diseases, but I wanted to pick up on something William had said.

‘Do condoms stop disease every time?’ I asked for a vote. William and a handful of others confidently put up their hand, while the rest simply didn’t know.

But before I had a chance to correct them, William had asked his awkward question.

‘What feels better, sir? With or without a condom?’ There was silence. They leaned forward to hear my answer. Even Chen, who didn’t fully understand what was being asked, sensed the question was a ‘big deal’ and kept quiet. Mr Jones gave me a slight nod, but this question felt too personal, so I chose to distract them.

‘I was going to tell you about the kissing disease,’ I began, ‘but if you’d rather hear about …’ I didn’t finish the sentence, everyone’s face had a look of horror.

‘There’s no kissing disease!’ insisted a suddenly uncertain William.

There were some very worried faces around the room, as well as some very confused ones.

I began to talk about herpes, otherwise known as a cold sore. Nearly everyone knew about cold sores and weren’t worried. But when I said that boys or girls with a cold sore could spread it ‘down there’ they were horrified.

I didn’t help matters when I told them that condoms are not perfect. ‘They reduce the chance of infection … but nothing is 100 per cent.’ The poor kids were never going to kiss a girl ever, let alone have sex. It was time to ease their suffering. I began to talk about what I had planned to discuss all along: relationships, friendships, getting to know someone, learning to trust.

‘If I went to a bar in town and kissed every girl in the bar, would I have a good chance of catching something?’ They agreed that the chances would be high.

‘Whereas if I met one girl I liked, and spent time getting to know her, came to trust her, and I kissed her, then I’d probably be OK. The most important advice I can give you is this: it all comes down to knowing someone, and eventually trusting that someone special.’

I’ve since learned from attending sex education courses that it was wrong of me to impose my values on the kids, but with them still being so young, it’s better to instil the ideal of having one committed relationship than multiple uncommitted ones. I assumed they’d want to kiss girls, and I didn’t mention same sex attraction, but I still don’t know that I would bring this subject up. It’s not because I think it unnecessary, but with half a dozen nationalities in the class, it’s safer for the kids and for me to keep it as uncomplicated as possible … although I can’t say I’ve ever met an uncomplicated teenager.

It’s not perfect, but I feel like I’m doing some good, which is better than no good at all.

It’s a bit daunting to think that I’m one of the main people of influence at this moment in the students’ lives. Often no one else is telling them the things they need to know, answering their awkward questions or allaying their fears. For a lot of the children, the Christmas or spring break with their parents is too long to wait for an explanation because they’re experiencing things right now. They’re all growing up, some much faster than others, they’re all changing, and insatiably curious.

This was not my first, and certainly not my last awkward conversation about sex with these boys. As I watched the students grow, my role expanded from school nurse to confidant and, well, you wouldn’t believe some of the things I’ve heard! Things were about to get much stickier …

Girl talk

When it comes to sex education, I am mostly enlisted to talk to the male students, which is probably good as I have a habit of saying the wrong thing. But sometimes I don’t have a choice …

‘You have to see them,’ insisted Sarah, the dorm parent of the senior girls’ dormitory. I turned to my colleague, Michaela.

‘Does it have to be tonight?’ Michaela asked. She wasn’t eager to talk to the girls either, it was Friday evening and we both had the night off. Sarah was adamant that her dorm desperately needed our input, she even used the term ‘emergency’, but I still wasn’t convinced.

I have lost count of the many ‘emergencies’ I have been in; some were real, some imagined, and some just plain ridiculous. I think interpretation of an emergency comes down to the various life experiences of the people involved.

My problem is that I don’t like saying ‘no’. In this case, I tried to come up with a semi-legitimate excuse. ‘We’ve been drinking,’ I said, indicating the half-empty bottle of red on the table. Sure, we had only had one glass each, but I was desperate for a polite way out. Still, Sarah insisted that the matter was urgent and could not wait.

‘What exactly do you want us to tell them?’ By asking this question I had basically admitted defeat, and Sarah sensed this too.

‘Sex,’ she said. ‘They need a crash course in sex.’

I choked on my wine while Michaela laughed.

I’ve never given an ‘emergency’ sex talk before. Exactly what was Sarah expecting the girls to do that night? And what could I say that would make any difference? Was I supposed to discourage them from doing it? Was that even allowed? Perhaps I’m just supposed to encourage them to ‘play safe’.

As a school nurse, sex education is just part of the job. It’s strange how people think that just because you’re a nurse, you’re qualified to talk about anything physical. There is a difference between being a nurse who communicates one-to-one with a patient, and actually teaching a class. But I usually get by. I worked in an STD clinic before, so I did have some ‘hands on’ experience.

‘Can’t this wait till Monday?’ Michaela asked. It could wait, but non-medical people often get worried about things that really aren’t urgent, and Sarah was convinced that this was the best time; in her defence, there had been a high number of ‘incidents’ this year.

These included:

 • A complaint from some locals living near the school about a boy getting blow jobs between morning classes, on a regular basis. The couple obviously thought the bushes behind the car park safe, but they forgot that they live on a slope, and that people living above them can see everything. The neighbours were able to give a very accurate description of the boy’s face. It also explained why Johan the Swede was always late but cheerful in classes.

 • A close call with a Hepatitis C epidemic. Fortunately this was a false alarm, but while we were waiting for the blood results we did have to track down all sexual contacts. The chain of connection showed that nearly every sexually active person in the school had a sexual link to everyone else.

 • A build-up of used condoms on the terrace outside the boys’ dormitory.

 • Three boys suspended for having spent the night in the girls’ dorm.

 • A hidden ‘sex-pad’, which was discovered in the attic of the school hall. It had been furnished with mattresses, candles, refreshments and several packets of condoms.

The frightening thing was that for every problem we knew about, there were bound to be two more we didn’t, so, with a sigh, Michaela and I agreed to do the talk together.

On our way out the door Michaela grabbed some condoms and told me to bring the bananas from her kitchen.

Our strategy was simple; Michaela would talk about sex from a woman’s perspective, and I’d agree with everything she said. Nothing should go wrong.

‘What’s he doing here?’ we were asked on arrival. The voice sounded American and belonged to a blonde lass in the front row.

‘Don’t complain, this should be interesting,’ replied her neighbour.

‘Do we get to practise on him?’ said another, and the room erupted in laughter.

My face turned red. What on earth was I doing? I had walked into the lion’s den and I had nothing to appease these seventeen- and eighteen-year-old women. I didn’t feel like an educator. If anything, I was sure I was the one about to get the education. ‘I can’t do this,’ I whispered to Michaela. She’d be fine doing this with Sarah, without me.

‘No bloody way. You’re not deserting me now,’ she whispered back.

I’ve faced some pretty hairy things during my time in the emergency room, but I’ve never felt as vulnerable as I did right then. The girls were giggling, chatting, even pointing. I resisted the urge to look down and make sure my fly was done up.

‘Right ladies, settle down,’ Sarah began. ‘We’ve got two special guests tonight who have kindly given up their time to talk to you this evening. Please make them feel welcome.’ There was a brief round of applause before we got to work.

Michaela and Sarah took two steps back, leaving me stranded.

‘Right, well, so … I hear that you need some educating about boys,’ I began.

‘We know all about boys,’ said the American blonde in the front, her manner smug, her eyes searching the crowd for support.

‘Give him a chance, Skylar,’ someone from the back responded. ‘I’ve never had a sex talk by a man before. Let’s hear what men think about girls.’

I wasn’t there to tell them what men think about girls, or was I? ‘You want me to tell you what guys think about?’ I asked. That was exactly what they wanted to know. This was an easy one to answer. But should I give the truth, or the watered-down version?

‘Men are simple creatures,’ I began, my mind suddenly blank. I paused and looked over at Michaela and Sarah, and they nodded at me to continue. They seemed as eager as the girls to hear what I had to say.

‘Men are simple creatures,’ I started again. ‘They only ever think about one thing, and will tell you anything to get it. They’ll tell lies, and they’ll even tell lies honestly believing that what they are saying is the truth.’

Skylar, the blonde in the front row, interrupted. ‘What do they want? What exactly is “it” you mean?’ She was enjoying every minute of this.

I suddenly felt shy saying the word ‘sex’ in front of them. It was irrational, but I feared my voice would crack, my face turn even more beetroot, or even giggle.

‘You know, they’ll say anything to get you to play …’ I was about to say ‘play around’ but that was too ambiguous. There was a long pause as I thought of a harmless way to say sex.

‘They’ll say anything to get you to play hide the sausage,’ I blurted.

Sarah’s mouth dropped, along with everyone else’s in the room, but I ploughed on.

‘Perhaps that was a sexist thing to say,’ I said, my tone apologetic. ‘I hear women these days are just as aggressive at pursuing men.’

‘He didn’t just say that.’ I overheard Sarah as she whispered in Michaela’s ear, but it was too late now.

‘Maybe I should tell the boys that you’ll say anything to get what you want. Perhaps I should be warning the boys to stay away from you lot,’ I said, deliberately making eye contact with Skylar. By this stage Michaela and Sarah were in an agony of laughter, along with the rest of the room. I wanted to hide, but I couldn’t stop.

While many of these girls were already sexually active, they weren’t adults. Just because they’d had oral sex or regular intercourse, they still had a lot to learn. Being able to physically do something has nothing to do with being mentally prepared, and especially nothing to do with being safe.

It doesn’t help that the school doesn’t want to deal with sex education, although that could be a good thing. When Michaela had suggested that we stock some condoms in the health centre, the headmaster had initially said ‘Why? They’re not having sex.’ This may sound unbelievable, but sometimes it’s easier to deny there is an issue, because then they don’t have to deal with it.

Other than what students learn in biology class, there is no plan, no policy or goal when it comes to educating them about the birds and the bees. It’s easier to leave it to the nurses, because – apparently – we know best!