Confessions of a School Nurse

Teaching the teachers

We needed some guidance. After my first two sexual education talks, I had many unanswered questions:

 • What is appropriate for a ten-year-old versus someone sixteen years or older?

 • Should we even be offering sex education to everyone?

 • Do we talk about homosexuality? And how do we handle such a sensitive subject given the backgrounds of some of our kids?

 • Do we need parental consent?

 • Could we get into trouble?

 • What should you expect ten-to sixteen-year-olds to know? Is there a baseline of understanding, a bare minimum they should know?

 • And how much is an average teenager exposed to, compared to when I was at school? Do they learn it all on the internet?

To help us in our quest to provide relevant, age appropriate, unbiased information, we went on a research trip to London. Britain has had boarding schools for hundreds of years, and, I like to think, pretty much have them sorted. These institutions have heaps of resources for matrons, nurses, dorm parents and teachers. Our brief was three-fold. Michaela, Justine and I went to a conference all about sexual education; we invited a sexual education specialist to come to our school and educate us about how to teach; and we invested in pamphlets, booklets, questionnaires, DVDs and online resources to make our lessons more interesting and, as far as possible, more ‘hands on’.

With all this new material, I now felt better prepared, but it wasn’t until my second year that I got to do another sex talk, and it happened to include some of the boys from my first: William, Chen and João. They had made the transition from junior school to high school, and the powers that be felt it a good idea to follow up from the previous year’s talk. They set aside the boys’ common room one evening for me to do my thing.

This time I was armed to the hilt. I had a questionnaire, a five-minute video on dating and even props.

‘What’s in the box, sir?’ William asked, as eager as ever. I wanted to keep the props for the ‘hands-on’ part at the end, but the boys were too distracted for my quiz, so I popped the lid and delved inside.

‘Contraception is all about correct technique,’ I said, handing the first penis to William.

‘No way, that’s disgusting,’ cried João.

‘It’s a bit small, sir,’ William observed.

‘Nah, that size seems about right for you,’ said another boy.

According to the guidelines, we’re supposed to teach proper technique, and make sure the boys know how to put a condom on, take one off and dispose of it.

I reached down to pick up another prop.

‘Get it out of my face, you homo,’ shouted João as William tried to insert his prop into his friend’s mouth.

‘You seem to be enjoying playing with that, Will,’ I observed, before admonishing him for his choice of language, and he quickly cut out his antics.

I handed the next penis to João.

It would have been better if they’d sent us penises all the same size. João’s was a good two inches bigger than William’s.

‘Now you’re talking,’ he crowed. All twelve boys doubled up with laughter.

I’d started so well, and now it was a circus.

‘What about me, sir? You got one big enough for me?’ said Nnakeme. I knew this would happen – boys will be boys – but I was committed now and ploughed ahead.

‘Who knows how to put on a condom?’

João volunteered, and he didn’t do too badly.

After showing them how to put a condom on and remove it properly, they all had a go, no one was exempt, whatever their background.

It was a fun way to start the session, but now it was time for something a bit more serious, and I handed them the test I’d borrowed from the conference I’d been to in England. They said it was ‘age appropriate’ for 3rd form boys and approved for use in British schools. I was doing everything by the book. Nothing could go wrong.

The Test

The boys needed to answer ‘True’, ‘False’ or ‘Unsure’ to the following statements:

 1. A woman can’t get pregnant the first time she has sex

 2. A woman can’t get pregnant if the man pulls out before he ejaculates

 3. When a girl says no, she doesn’t always mean it

 4. You can tell if someone has a sexually transmitted disease

 5. Only gay men are at risk of HIV

 6. If you love someone you shouldn’t have to use a condom

 7. Girls can’t get contraception until they are sixteen years old

 8. If a girl is on the pill it means she’s easy

 9. Two men or women can be in love with each other

 10. It is better to wait until marriage before having sex

 11. Someone has to sleep around to get an STD

 12. Someone can get an STD from oral sex

 13. Using a condom can protect against HIV and STDs

I struggle to think what I would have answered when I was thirteen. We certainly had nothing like this test when I was a boy. But the results of this test, and the many times I’ve conducted it since, make me think that perhaps students do need such information at such a tender and impressionable age.

1. Three boys said you can’t get pregnant the first time, and in every group I’ve since asked, there’s always one or two that get this wrong.

2. A woman can get pregnant if the man pulls out. On average half the class get this wrong.

3. No means ‘No’. Worryingly, on average 3–4 out of twelve get this wrong. I use this opportunity to talk about rape, statutory rape, and problems with consent when alcohol is involved, and knowing the laws of the country you are in.

4. You can’t always tell if someone has an STD. Nearly everyone gets this right.

5. One or two will say ‘true’ and a few will say ‘maybe’. They really do think HIV is a ‘gay only’ disease.

6. The majority get this right and say ‘false’.

7. Most get this wrong, and don’t realise someone under sixteen years of age can be on some form of contraception.

8. Being on the pill doesn’t mean she’s ‘easy’. In one class, half the kids answered ‘true’ or ‘maybe’. I also explained that not all people who take oral contraceptives take it for that purpose.

9. There are always, at least, two or three who say two men or two women cannot love each other.

10. Even those from stern religious backgrounds often feel that you shouldn’t wait until marriage before having sex. I do say there is no right or wrong answer for this.

11. There are always some ‘maybes’ and the occasional ‘true’, but they were shocked to discover that people can have HIV and have never slept around.

12. A lot of kids think oral sex is safe; often over half the class answer ‘false’ or ‘maybe’.

13. While condoms do protect against HIV and STDs, a lot of it comes down to good technique. None of the kids knew that nothing is 100 per cent.

I had some very interesting results. The information gave me some idea of what they needed to know, and in some cases, showed me how they might need to change their attitude. Of course it’s not for me to unduly influence, but boys who genuinely believe a girl doesn’t always mean ‘no’ when she says it, could end up in a lot of trouble one day.

Kurt and Rachel

Rachel burst into my office, gasping for air. She had run all the way from the school theatre to get here. It’s not far, but it’s uphill.

‘Sir, you have to come quick, please, it’s urgent.’

I asked what was wrong, but Rachel just grabbed my hand and began pulling me out of the office. ‘Please, sir, just come quick … Kurt is hurt real bad, there’s blood everywhere.’ I let her lead me out of the office, making sure to bring my emergency bag.

As Rachel lead me through the theatre, past the empty stalls, and behind the stage, I wondered where the hell I was going to end up, and what they’d been doing. I’d never been backstage before, but Rachel knew exactly where she was going. She lead into the boys’ changing room.

Kurt was in a bad state. He was lying on the floor, next to the sink. His pants were down around his ankles, and there was blood on his head as well as on the floor, although I couldn’t tell exactly where all the blood was coming from. There seemed to be more than one source of bleeding. Fortunately Kurt was conscious, although as pale as a sheet.

‘What’s wrong, mate, what happened?’ I asked as I knelt down beside him. He lay still but turned his eyes towards me.

‘I feel shit,’ he croaked as he tried to sit up, but I told him to stay lying until I’d had a chance to examine him.

He tried to pull up his pants and I helped him cover himself, while Rachel looked away, her face reddening. ‘I was standing up, then woke up on the floor,’ he said. I asked what he was doing at the time, and he glanced at Rachel and gave her an almost imperceptible nod.

‘We were …’ Rachel stuttered, ‘we were doing, you know … it. And then he screamed, and there was blood, down there. His … his dick was bleeding.’ Kurt was feeling a bit better and again tried to move to a sitting position. I told him to lie back down as I needed to make sure his head and neck were fine but he sat up anyway. ‘It’s so fucking sore.’ I assumed he meant his head, but he very slowly put his hands in his pants and gently cradled his penis.

‘Mate, what have you done?’ I managed a quick glance and it looked a mess.

‘She broke it.’

Rachel began sobbing.

‘I’m sorry, I never meant to, I’m sorry.’

‘Is it gonna be OK, Doc?’ asked Kurt.

I imagined saying ‘No’ to make sure Kurt got the most out of the experience, but my usual kidding around didn’t seem the best course of action. There was a lot of blood down there and while I couldn’t make out what exactly was wrong, I felt sure it wouldn’t be serious – simply because I didn’t have the imagination to come up with something overly worrying that could have happened.

In hindsight he could have had a fractured penis, something I’d only read about being possible, and had no idea what such a thing would look like! With all the blood I felt certain Kurt’s problem was probably more superficial.

Kurt denied any neck or back pain, although he did have a three-centimetre laceration above his right eyebrow. I wrapped a bandage around his head and walked him slowly back to the health centre whereupon I received the whole story.

‘We didn’t warm up, it’s my fault,’ Rachel began while Kurt lay back on the couch, still cradling his manhood as he moaned in agreement.

‘Yeah, it’s her fault.’

They’d snuck off to the theatre changing rooms for a quickie between classes. ‘The floor was so gross,’ Rachel said, ‘so we did it standing up.’

‘She split my dick in half,’ Kurt cut in. I hoped that wasn’t the case. It was time to take a proper look at it, so I gloved up and shooed Rachel out the room.

‘Softly, Doc. Softly.’ Kurt gently lowered his pants and tenderly laid out his willy. The poor thing looked like it had been through a war, blood and all, but I could see the problem. I breathed a sigh of relief.

‘It’s OK, you’ve only split your foreskin in half.’

‘What do you mean only split it in half,’ Kurt exclaimed, his voice cracking, close to tears. Perhaps I shouldn’t have said ‘you’ve only’, as I’ve never had such an injury, especially considering the pain had been so bad that he had a vasovagal episode, which caused the faint, whereupon he hit his head against the sink on the way to the floor.

Most fainting by young healthy people is vasovagal. The vagal nerve runs from the head through the middle of the body. When this nerve is stimulated, as it was by the pain from his split foreskin, it slows the pulse down – a lot – from 80 beats per minute to zero beats per minute. Only briefly, of course, otherwise you’d be dead. But the subsequent drop in pressure allows gravity to take effect, and your blood pressure ends up in your boots. The good news is that when you hit the ground, you end up in a lying position, which helps the blood pressure return to normal. There are many things that stimulate this nerve, and pain is a very common one.

Poor Rachel had received such a fright at the suddenness of Kurt’s collapse that she thought she had ‘shagged him to death’.

Kurt’s mood slowly improved, although he still spent the next two hours cradling his penis. He was nauseous, pale, and would need four stitches to his forehead.

We eventually had him reviewed by the village doctor. His bleeding parts were patched up and he was kept in the health centre for the night for observation.

While Kurt may not want to speak of his experience for a few years … I’m sure when he’s older both he and Rachel will relish retelling the story of how he was almost shagged to death. Men enjoy these stories of past and mighty conquests. And of course, as the saying goes, if you’re going to die, you might as well go out with a bang …

Night-time wanderings

It’s not just the kids that have a hard time finding privacy. Young, free and single faculty members have to be careful as well. Sean’s story was a lesson to us all.

The witching hour is usually considered midnight, but it’s more like 5.30am at boarding school. This is when all manner of creatures emerge from their dens of sin and scuttle home to hide their shame just before sunrise. It’s the time that Sean deemed it safe enough to risk an escape and make a run for it.

It never looks good for a male teacher to be seen leaving the female dorm area in the middle of the night. But what else could he do? He’d met the woman of his dreams, Sasha, a pretty maths teacher. He wouldn’t have been in trouble if his budding relationship had been public knowledge, or even for staying the night, they were both adults. Sometimes I think it’s simply because there are no secrets in boarding school that people try to keep them.

Marco also thought 5.30am was a safe time to escape the girls’ dorm, taking the above-ground path to safety, walking somewhat dangerously across the rooftops.

Stephanie chose the same route but was leaving the boys’ dorm, coming across the roof from the east, while the two males were coming from the west.

Their paths inevitably crossed: one teacher, two students.

There would be repercussions for everyone.

Marco was suspended for two weeks, Stephanie for one. Sean was more fortunate; in fact, it got their relationship out in the open and, many years later, he ended up marrying Sasha.

Marco’s punishment was more severe because he’d stolen a dorm key to enter the building, while Stephanie had been smuggled into the boys’ dorm in her boyfriend’s suitcase. The staff had even helped enable this feat by letting the boyfriend use the elevator. If only kids used these smarts in the classroom!

Sean did admit that he was very briefly tempted to pretend he’d never seen the others on the roof that night, especially when Marco offered him a deal: ‘You don’t see me, and I don’t see you,’ but he made the right choice.

It wasn’t all bad for Marco and Stephanie. Few escapades gain such instant fame amongst peers as rooftop wanderings in the dead of night.

The sex side of things

For both the staff and the students, it’s hard to have a private life at a boarding school – you really have to make an effort to be alone.

For staff, being ‘off duty’ doesn’t mean a thing to the kids when you live in the same building, the same floor, the same corridor. Whether it’s a harmless secret, or something more interesting, you’ll eventually get found out.

For the students, finding a place to have some one-on-one time is never easy. I have to hand it to the older kids, they are certainly creative in finding solutions:

 • Renting a local apartment for the year to use as a party, sex, smoking and drinking pad.

 • Building a forest hut, able to withstand the rain, but not the snow; great for the summer months.

 • Visiting the local cave – a thirty-minute hike, but that’s nothing for two lusting teenagers!

How do I find these things out? I don’t go looking, and I really don’t want to know, but I don’t always have a choice.

The crush

It’s nice to feel appreciated; it only takes a kind word or gesture to transform an average day, or even an awful day, into a bright one. Something as simple as a kind note left on your desk can work wonders. But things can often turn complicated when dealing with adolescents.

Chocolates are a relatively simple gift (as long as they’re not Russian, they taste awful). Chocolates are my go to present when I want to make a gesture of appreciation.

Alcohol is a common gift to staff from students – each nationality brings me their country’s best. From any student from Eastern Europe, vodka is the weapon of choice, with every vodka-producing nation naturally insisting its product is the best. From the Mexican students, it’s always tequila; cachaça from the Brazilians; and single malt whisky for most of the Western nations, as well as, perhaps surprisingly, the Saudi students.

Usually parents buy the gift and send their child to school loaded with hard spirits. The gesture is always appreciated, and the child is proud to show off the finest alcohol their nation can produce.

But sometimes people want to give more.

Teenagers are spontaneous, their emotions high one moment, low the next. Their feelings are intense and these little gifts of appreciation are sometimes just not a big enough gesture.

How can they find a way to express their gratitude to the person who changed their failing grade from a D to a B, especially when school is not just the biggest thing in their life at that time, it is their whole life? How can they thank the person who comforted them when they were homesick, or helped them fit in and make friends?

‘I can’t thank you enough. You’re the best’ – the note was signed ‘Priscilla’. The letter was for my friend, Brian, a maths teacher.

‘She worked for it,’ Brian said. ‘She went to every extra help session I gave, and still wanted more.’ Brian explained that she had been willing to pay for private lessons on top of the regular after school group sessions, but he’d refused. ‘You turned down 100 euros an hour?’ Maths and physics teachers were always in demand, and tutors could get away with charging such a heavy fee.

‘That’s actually why I’m here,’ Brian said. ‘I wanted your expert opinion.’ I motioned for him to continue. ‘Is she ADHD or something?’ he asked. ‘Or seeing the counsellor for any issues?’ I asked him why he thought she might have ‘issues’ and to tell me exactly what she does that makes him think so.

Many teachers have concerns about their students, and often say things like ‘she’s ADHD’ or describe someone as ‘bipolar’. Even the most well-meaning people throw these terms out there, and nearly every time it’s wrong, but labels can stick. I need to find out what the student is actually doing that is causing concern.

Do they talk non-stop in class? Do they interrupt others? Are they aggressive or act like a bully? Do they do their work? Do they say strange things?

Priscilla, Brian explained, did all of the above, particularly constantly talk in class, disturb others, and struggle with work – hence the extra help to enable her to pass Maths. Like many fifteen-year-old girls, she lived her life as if on a permanent emotional rollercoaster. Fortunately for her, and us, it was a rollercoaster with peaks of pure joy, and not particularly deep lows.

But it wasn’t this behaviour that bothered him, as it’s pretty normal.

‘She follows me … everywhere,’ he added. Priscilla had changed her activity from volleyball (which she loved) to hiking (which Brian led). ‘She won’t stop staring at me in class, and is always the last to leave. She’s even got her mum on her side, insisting I continue with her private lessons. She’s obsessed. She’s even said she’s got a surprise for my birthday next week.’