# Confessions of a School Nurse

Michael Alexander

From the people who brought you the bestselling Confessions of a GP.After sixteen years of high-pressure nursing, Michael Alexander has traded in his hospital uniform for the fresh air, comfort and routine of an International private school in the French Alps. Bliss! But it’s not long before he discovers that school nursing is not all permission slips, sniffles and gift baskets. Disastrous school trips; after hours dorm sleepovers; awkward sex education classes; culture clashes; swine flu panic; and kids with six-figure bank balances and a taste for bribery. This is nursing as you’ve never seen it before.What goes on behind the gates of one of the world’s most elite boarding schools? What happens when kids from all over the world – Russia, Africa, America, Saudi Arabia – live, learn and grow under one roof? What happens when it’s left to school staff to teach children the facts of life, and lust?Following on from the hugely successful Confessions of a Male Nurse, Michael Alexander is back with more touching, shocking and often laugh-out-loud funny tales of nursing. In Confessions of a School Nurse, Alexander tells all on boarding school life – as a nurse, parent, and Average Joe, he offers a unique perspective on this strange world.

MICHAEL ALEXANDER

### Confessions of a School Nurse


The Friday Project

An imprint of HarperCollinsPublishers Ltd

1 London Bridge Street

London SE1 9GF

www.harpercollins.co.uk

This ebook first published in Great Britain by HarperCollins Publishers Ltd 2015

Copyright © Michael Alexander 2015

Cover design © HarperCollinsPublishers Ltd 2015

Michael Alexander asserts the moral right to be identified as the author of this work.

FIRST EDITION

A catalogue copy of this book is available from the British Library.

All rights reserved under International and Pan-American Copyright Conventions. By payment of the required fees, you have been granted the non-exclusive, non-transferable right to access and read the text of this e-book on screen. No part of this text may be reproduced, transmitted, down-loaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins.

Source ISBN: 9780007586424

Ebook Edition © April 2015 ISBN: 9780007586417

Version: 2015-04-30

To Mum and Dad

Contents

Cover

Title Page

Copyright

Dedication

Disclaimer

PROLOGUE

A Taste

The first day

Marcus’s jewels

Chapter One: The Transition

Luke

Learning the basics

Agent trouble

Taking the lead

Basketball

Checklist

Chapter Two: Sex and Education

The talk

Girl talk

Teaching the teachers

Kurt and Rachel

Night-time wanderings

The sex side of things

The crush

Using your assets

Long weekends

Veronika

Consent

Dilemma

Chapter Three: School Nursing

Itch

Sores

The real deal

Parents’ worst nightmare

Type I

Gravity

Breathless

Francesca

Break-a-bone season

Caio and Celeste

Igor

The staff

Foodies

Priorities

Payback

When the fun goes bad

Chapter Four: The Internet

Swine Flu

Google

The Iliac Crest?

Reply all

Freddy

Electric friends

Chapter Five: Drugs

Getting your buzz on

A testing time

Jimmy

Ruben’s demons

Kate and Kelly

Chapter Six: Counselling

Ameena

Rocket man

Niko

Celine

Girlfriend woes

Chapter Seven: In Loco Parentis

Naif

David

Edward

Rich personalities

Expulsion

Maria

Enrolment by default

The Ivan effect

Fun in the sun

EPILOGUE

Graduation

The grand finale

Acknowledgements

Confessions of a School Nurse is part of the bestselling ‘Confessions’ series.

About the Author

Also by Michael Alexander

About the Publisher

## Disclaimer

The stories described in this book are based on my experiences working as a school nurse in boarding schools over the past ten years. To protect confidentiality, some parts are fictionalised and all places and names are changed, but nonetheless they remain an honest reflection of the variety and crazy goings-on witnessed during a decade’s worth of school nursing – surprising as that might come to seem!

PROLOGUE

## A Taste

Marcus made sure no one was sitting near the door before closing it.

‘It’s really personal,’ he whispered to me over his shoulder.

‘It has to be a guy,’ he’d insisted when he arrived at the bustling nurses’ office. Most requests of this nature are girls asking to see a female nurse; though this was only my first week in the role, Marcus was the first student to ask to see a man, so my mind went into overdrive imagining the ways in which I could impart my knowledge in a reassuring, helpful manner to a young man in obvious need.

As Marcus turned from the door to face me, his hands delved into the front of his pants. He wasn’t in uniform; he wore loose track pants instead. I got the feeling than an inspection of that area was on the horizon. He refused a seat, so I asked him what the problem was.

‘You won’t tell anyone?’ he answered.

‘Of course I won’t tell anyone, just explain what’s wrong.’

‘They’re sore. My nuts are sore. And the left one seems bigger.’

Ah!

I could either take a look at Marcus now, or wait for him to be seen at the local doctor’s office. I chose the latter. There was no need for the poor lad to be exposing himself more than necessary. It’s not that Dr Fritz wouldn’t have trusted my judgment, but there’s more to feeling someone’s nuts than the average guy thinks. Is there a lump? Does it move freely? Is it attached to the testicle? Is the spermatic cord twisted? It would be up to Dr Fritz to decide what to do – whether it would require an urgent scan today or was something that could wait – so he would need to examine the lad properly. And besides, this environment wasn’t ideal for an intimate examination; the south wall of my office was made of glass, a window that looked out upon the mountains and a large terrace … a window with no curtain.

But Marcus was too quick for me.

‘You have to see them,’ he declared, whipping his pants down. Looking up, he gave a short scream.

No students were on the terrace, but Mrs Driscoll, the headmaster’s wife, was there with what looked like a prospective family … admiring the view.

Despite the incident, the prospective girl did enroll. Rumour has it she insisted.

Now don’t worry, I’ll get back to Marcus’s nuts in a minute, but before I do, let me tell you how I came to be here on this snowy mountain.

## The first day

Why did I become a school nurse?

At the age of 32, I was a skilled professional with more than ten years’ experience working in England and New Zealand. I was a highly trained emergency specialist, who had worked in some of the biggest hospitals and busiest departments in the world, and the money wasn’t too bad. Why would I leave all of that? At that time, school nursing didn’t even seem like real nursing to me.

But, I needed a healthier lifestyle. Thirty pounds an hour sounds great at first, but the irregular night shifts – one on, one off, two on then one off – it ruins you. That’s what temp or agency nursing is about in London; you take the work when you can, even if that means spending your weekends with a bunch of drunks, dealing with abuse and violence, as well as the two-hour commute to and from the hospital. I’d chosen that life, but it’s not doable long term, and besides, there was a much bigger factor at play. My partner and I were expecting our first child, and I wanted a safe, healthy environment in which to raise my family.

My choice seemed simple, go back to my homeland, New Zealand, and get my old job back, or find work somewhere in Europe that had regular hours, no drunks, no night shifts, no underground and clean air. I didn’t feel that going back to New Zealand to work in a regular ward or a small emergency department was right for me, especially as my partner had never even been to my hometown, and we both wanted to stay close to her family for our first child.

So when I saw an advert for a nurse to work at a boarding school in the Alps, I thought all my wishes had come true. It not only seemed to fit all my requirements, they also even offered me a chalet in the middle of a ski resort. What more could a nurse with half a dozen ski seasons behind him ask for?

I applied and after a phone interview, background and police check (I’d be living and working with children, after all) I was offered the job.

Walking into my new office on that first day with Mr Driscoll, the headmaster, made me forget about big city life almost immediately.

The southern wall of the school consisted of a window looking out onto towering peaks over 3000 metres, the highest already capped with snow, despite only being late August. I felt a pang of guilt thinking the view was even better than what I was used to back in New Zealand.

Yes. I knew I’d made the right decision for me and my budding family. I felt this could be home.

‘You’re free to do as you see fit,’ Mr Driscoll said as he showed us around the clinic. My colleagues in crime, Justine and Michaela, glanced at me in surprise. None of us had ever worked in a boarding school before; we had all come from the frontline of the nursing profession, used to being surrounded by large teams. We had taken the leap from the Accident and Emergency to an elite boarding school. We had a clean slate.

Justine was from Alaska. She had spent the last ten years in emergency medicine and had come over with her husband who had a job as a maths teacher at the school.

Michaela was from Minneapolis and specialised in paediatric emergency medicine. She had also come with her husband; they had always wanted to live in Europe.

‘With your combined experience, I trust you’ll do a great job,’ Mr Driscoll added. And with that, he left us to it. The school was to be our playground.

On our first day at work, we found out that we were alone; alone and in charge of 400 students, some of the world’s most privileged children. There was no on-site doctor lurking in the background who we could turn to for help; no alarm button to press when things turned sour; no oxygen, no intravenous access, none of the equipment that I’d gotten used to having on hand, ready for instant use.

The 400 children came from over fifty nationalities, and while the majority spoke English to a high standard at least ten per cent knew little or none of the language. Other than English, the next most common tongue was Russian.

The other nurses and I were to be responsible for keeping the children healthy, taking care of them when they were ill or hurt, helping them to get along with each other, counselling them through life’s hurdles, and arming them with the knowledge that comes from being an ‘old woman’ or ‘old man’ who has made it this far in life without too many major screw-ups (the fact that we’re not even grey doesn’t seem to matter to the kids).

I was looking forward to the challenge. No longer would I have to deal with shootings, stabbings, heart attacks, strokes, violent drunks or demented, incontinent or suicidal patients. Instead, I was going to be looking after fit, young, healthy teenagers. How hard could that be?

The parents had spent a fortune to send their kids here: 100,000 euros per child per year. I assumed they would be hardworking, motivated, intelligent, considerate, good-natured, balanced individuals …

However, as you’ll discover over the course of this book, I’m not always great with assumptions.

## Marcus’s jewels

‘Why didn’t you tell me?’ Marcus cried, whipping up his tracksuit bottoms to hide himself from the family crowd gathered outside.

I bundled Marcus out the office, into the car and off to the local doctor’s office. 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.

Chapter One

## Luke

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 as ‘I’m hungry’. Sure signs of recovery.

All the same, I kept Luke in the health centre that night. Illness comes in waves, and Luke didn’t disappoint. His temperature went up and down, dragging his body along for the ride, but by the following morning he was feeling good again, and after a day with no fever or body aches, he was sent back to his dorm.

Why had I been so worried? Why had I even considered sending him to the doctor? I knew he had a simple cold, and I know that children are adept at taking onboard very high fevers.

It was because I was the one making the ultimate decision, although it did help having two experienced colleagues to turn to. But I was the one making the decisions, especially late at night or on the weekend, and deciding if a fever was benign, or a sign of something more sinister, even life threatening, and I was the one going to sleep at night wondering ‘what if?’. There were no doctors in the background to run a reassuring eye over him, and no blood tests to see how his white blood cells were holding the fort, or inflammatory markers to see how much of a battering his body was taking. I was using my senses and basic observations to make what seemed like a simple call.

But nothing is simple, and in medicine, the simplest decisions don’t happen without a lot of thought. This is my job now. I’m the decision maker, the responsible one. It’s terrifying.

## Learning the basics

‘Shit,’ I thought to myself as yet another girl burst into tears. That was three already this morning. What the hell was I doing? Am I some sort of monster?

No, I was just doing what I had done for the last half dozen years – triaging the students as if this were an A&E department.

‘My nose is blocked,’ said Marie. I handed her a box of tissues and moved on to the next patient.

‘I feel dizzy,’ said Sarah. Blood pressure fine, pulse steady and strong, no medical history of note, but skipped breakfast – treated with banana and told to return to class.

‘I’ve got a cough,’ said Isabelle. Chest clear, cough non-productive, dry, had only for 24 hours, no fever, otherwise well, and has not coughed once in the last thirty minutes she’s been in the waiting room – told to take some cough syrup if it comes back, no treatment at present.

Marie hadn’t made it out to the hallway before the flood of tears began again. I stood and watched helplessly as she sat back down between Sarah and Isabelle, who instantly put their arms around her. For teenage girls, tears are contagious, and within moments the three of them were weeping quietly, hands entwined, consoling each other with mumbled words and the occasional glance in my direction, pleading with their eyes for some sign of compassion from me.

I’d never managed to upset three fourteen-year-old girls at once before, but I was doing a fine job of it. I’d even made it an international event, as Marie was Italian, Sarah American, and Isabelle from Russia. I’d covered half the globe.

What the heck should I do?

I did what any male would do when confronted with such a convincing scene. I ran for the hills!

Not really.

I let all three of them rest in the bedroom for an hour and made them some camomile tea with honey.

‘We won’t bother you again all week,’ promised Marie as she went back to class.

‘Thank you so much,’ said Sarah.

‘You didn’t forget to excuse us from class?’ asked Isabelle, making sure they didn’t get an absence marked on the computer.

‘You’re all excused. No need to worry,’ I assured them.

I had just let myself be played. They knew it, and they also knew I knew they knew. I suspect they felt obliged to push the limits. They had three new nurses, completely new to the world of boarding schools, and in these first few months everyone was still figuring out their boundaries. But if I was to continue treating these students like we were in a hospital trauma centre, I was never going to come out on top. I had to come up with another strategy, because if 90 per cent of the patients I had seen this morning had turned up to their local hospital, they would have been encouraged to turn away, or put at the back of the queue and wait hours to be seen.

Hospitals are great for treating accidents and the seriously unwell, but my role as a boarding school nurse was much more than just looking after the sick.

I’m more than a nurse; I’m a parent to these kids, a disciplinarian, an example, a counsellor, a mentor and often a dry shoulder to cry on. It sometimes means playing along with them and their antics, their dramas, and it also means knowing when and how to set limits – you have to know when to say ‘enough is enough’.

One moment I can be reprimanding a kid for bad behaviour, the next I’m consoling a child whose grandfather has just died. Before starting this job I had reasoned that my role would be varied and that I would end up doing things outside my job description. What I was not prepared for was to constantly be playing detective.

In a hospital setting, you tend to believe what the patient tells you. This makes sense as most people don’t like waiting hours to be seen for no reason. But everything’s different in a school, where students are looking for excuses to get out of class or homework.

To avoid being taken advantage of, I began to develop some unique (patent pending) assessment techniques.

‘Sir, I’ve got a sore throat’ was one of the most common complaints. After a quick peek at their throat I could usually tell if they were exaggerating, or outright lying. If it looked OK and they had no fever, I would send them to class with some lozenges and paracetamol. This was never the desired result, and within my second week on the job, the children had become resilient to my tactics.

‘I vomited during the night, and my throat is sore,’ said Marie, the very same Marie who had burst into tears only a week earlier with a blocked nose. Marie had not kept her promise about staying away, she had already become a regular.

Every year there are a dozen or so regulars who stop by two or three times a week, and the reasons vary. They may be homesick, or it may be their first time being unwell without their mother around. Often this changes once they make friends or figure out where they fit in. Sometimes all they need is a wave, a smile, a nod of the head that says ‘I’m here for you’ and ‘you belong’.

The problem with Marie was that she looked in fantastic health. Sure, she could have been up all night vomiting, and one symptom of a bad sore throat (strep throat) is actually an upset stomach so her history does need to be taken seriously as there are potential complications. However, while this is plausible, generally if the throat looks fine, and they have no fever, then I’m stuck with a healthy looking student, with a normal looking throat, who simply claims they’ve been up most of the night vomiting.

‘Your throat is probably sore because of so much vomiting,’ I tentatively suggested, ‘and your throat actually looks fine, you’re not pale, and your tummy doesn’t seem to be making too much noise …’ My voice trailed off as Marie looked ready to shed some tears, but I completed the ritual: 750mg paracetamol (based on her weight), throat lozenges, honey and camomile tea, and a late pass to class.

‘Can’t I rest, for just one class?’ she asked, but her heart was no longer in it. She had won a partial victory with a late pass, my kindness and a detailed explanation of what my examination had found – nothing – and she relented and left, although I did offer her a vomit bowl on the way out, telling her to ‘come back if you fill it up’.

When they don’t get the reaction they want, occasionally a student’s mouth drops open, they pull out their iPhones and dial their parents. Others just head to class. Fortunately, this relationship had moved on from that first teary-eyed encounter, and Marie and I had come to an unacknowledged yet mutual understanding, where she got the full works – medicines, honeyed tea and a late pass – and did not cry or insist on resting in bed. She took the bowl with a sheepish smile. She was ‘well enough’ to appreciate my wry stab at humour.

I’m usually vindicated by lunch break when I see the kids who were supposedly up all night vomiting disregarding my advice about avoiding fried/heavy food, eating fries and hamburgers at lunchtime with no obvious ill effects.

Of course, I did get it wrong sometimes, and continue to do so even now from time to time, but I was adapting. I’d sussed the kids out – who were the ones to keep an eye on – and in turn they were beginning to work me out too.

## Agent trouble

‘You will let her rest now,’ demanded Mr Kowski. My finger itched closer to the ‘end call’ button, but I controlled my temper and my ego. Mr Kowski is far from the first, and will definitely not be the last person to have a go at me. The skill is in keeping your voice steady and calm.

Mr Kowski was calling from Moscow and was Irina’s agent.

Irina had just turned fifteen, but was already a regular in the first couple of months of school; at least two to three times a week. As far I could tell she had received great care – the camomile tea, late pass to class, the full check-up of subjective symptoms.

She’d come to the health centre this morning at two minutes to eight, right before the bell for morning class.

Irina claimed she was up all night vomiting, and had not slept, and was having to constantly run to the toilet. But I didn’t believe her.

Why didn’t I believe her?

Everything was normal. Her stomach was quiet, her temperature fine, her pulse and blood pressure normal, her lips and tongue moist, with none of that furry ugliness you normally get when your stomach contents are forced up and out. But people can have normal observations and still be sick. What they don’t do is look so great.

Irina’s eyes weren’t tired, they were lively, and she smelled good, of quality perfume, not the stench of recycled acid and dehydration. She’d also waited until the last minute to see me as well. When you’re that sick, you can’t wait to get someone to help. I find the genuinely sick waiting for me to open the door at seven in the morning still in their pyjamas.

After an examination I had tried to send her to her lessons, with no success. Instead of tears, she chose a more formidable weapon. She pulled out her iPhone.

Irina’s parents were furious, and like many of our students from non-English speaking countries, they had someone else speak on their behalf. Saudi and South American families usually have a secretary, a family friend who takes care of business, while the Eastern European families have agents. They use an intermediary either because their English is not good enough, or because they’re too busy to deal with minor issues like a sick child.

The family secretaries tend to be nice, while the agents are rarely so friendly. ‘I’m paid to be angry,’ one agent even confessed. ‘If a parent shouts at me, then I’m to shout at you.’ But I wasn’t going to ask Mr Kowski if his bravado was just an act.

I’m convinced yelling is a cultural thing. In some places, to yell at those under you, especially if you’re the one paying their salary, is normal, and I’ve even had students admit that if their fathers didn’t yell at their employees, nothing would be done. ‘They expect it,’ they explained.

I told Mr Kowski that, from my medical experience, Irina appeared well. ‘Are you saying she’s lying?’ His tone had quietened, but the threat no less.

‘Yes, she’s lying,’ I wanted to shout. Even good kids try to pull a fast one sometimes.

‘I’m not saying she wasn’t sick. What I am saying is that physically she seems well, and seems to have made a fantastic recovery.’

‘That may be so, but you make her rest, or else.’ Some battles are not worth fighting; they’ll cost you too much.

Irina spent the morning asleep. She had no further vomiting and I did not see her get up once to go to the bathroom.

I had to find a better way to get to the truth.

To aid me in my quest for certainty, I developed the PMU test. If a female turns up to the clinic in the morning, claiming she has a sore throat and has been up all night vomiting, but her make-up is immaculate and she looks great, then she has failed the Positive Make-Up test, and I am less likely to believe her. Obviously, this test is only applicable to girls.

Take Sara. Sara couldn’t see: ‘Sir, my eyes, everything is blurry,’ she insisted. She actually reached down, feeling for the chair behind her. This was one of the more unusual presentations, but I wasn’t concerned. She’d not only navigated her way out of her dorm and into the health centre, but her eye-liner was straight and her mascara not too heavy or too light, but just right. Her eyesight improved dramatically when I volunteered to be her guide and walk her to class. She nearly missed her English test.

Whereas Angela hadn’t slept an ounce. ‘My diarrhoea has been non-stop.’ She limped in with the assistance of her roommate, because that’s what diarrhoea does I guess. Both of them had perfect make-up. Obviously the bathroom didn’t smell bad enough to keep them away from the mirror, but I kept Angela for one hour during which I saw no symptoms. After forgetting to limp around my office, she made her way back to class having missed her PE class.

I can’t remember any patient in my twenty years of nursing putting on make-up after a miserable night spent in the loo emptying the contents of their stomach. I’m not talking about a touch of lippy, or a brush with some colour, I’m talking about the sort of make-up you use when preparing to take on the town, the complete works.

This was a breakthrough: a simple positive or negative test, which would help me sort the real from the fakes.

But unfortunately, it was only a matter of weeks before some of the students figured this out.

I’m not sure how they cottoned on to it, although I suspect Irina was the first to make the connections. A month after my run in with her agent, Irina turned up again with the same stomach problem, but this time without the layers of make-up, no perfume, a nice bedhead of hair, and wearing pyjamas.

Now I was stuck with a healthy looking patient, with no symptoms, no make-up, claiming she had a sore throat and had been up all night vomiting.

‘Who are you?’ I said when I first saw Irina in such a state. Oddly, without her make-up she actually looked healthier and brighter, more natural.

‘Sir, I’m sick, don’t make fun of me.’

It was at this stage that I gave up. If a child is so determined not to go to school, my job is not to figure out what is fact or fiction, but to go by their history. So I let her go to bed, but I made sure she had a bowl to throw up in, and told her I expected to see some vomit, or else.

After nearly ten years looking after school children, I’ve learned to pick the genuine from the not so genuine, but my greatest fear is missing the one child who looks only mildly unwell and sending them on their way with something major. This problem is exacerbated by the fact that on a day when there are activities, such as skiing, hiking or swimming, I can easily see up to fifty kids, all trying to get a medical excuse. Everyone loved such activities in my time, but this generation is different, delicate even.

But back then, I was still finding my feet. I had to rethink my strategy as to how best to manage the children.

## Taking the lead

I could no longer just take patients at their word, especially when all their symptoms were so subjective. And I clearly still had a lot to learn.

‘I have a migraine.’

‘Are you sure?’

‘I have a migraine – a headache.’

‘There’s a difference between a migraine and a headache, do you have any symptoms?’

Chrissy sighed and rolled her eyes as if speaking to a simpleton. ‘My … head … is … sore.’

The ‘migraine’ sufferers are the easiest to catch. A real migraine sufferer looks absolutely miserable, and just wants to lie down with a pillow over their head and a bucket beside them. Not only did Chrissy look fine, she also had the energy to be sarcastic and roll her eyes. But knowing someone’s lying doesn’t necessarily make it easier to catch them out.

‘How do you know it’s a migraine?’ I asked.

‘Mum has them, and she said I do as well.’ So many people have no idea of any of the symptoms of a true migraine. But perhaps Chrissy had the beginnings of one.

‘Do you feel like vomiting?’ She nodded her head.

‘Visual disturbance?’ Another nod.

‘Dizziness?’ Of course.

I naïvely asked her to rate her pain on a scale of 1 to 10, with 10 being the worst pain she could ever imagine.

‘Nine or ten.’

She seemed prepared to say yes to every symptom I described. She should be curled up on the floor, her arms wrapped over her head, pleading for us to put her out of her misery.

‘It sounds like a real bad one, you’ve probably got some diarrhoea as well.’ Chrissy thought over her response, unsure if I was testing her (which I was) before suggesting that things had seemed a little ‘looser’ than normal that morning. I gave up. Two 500mg tablets of paracetamol, one hour rest, and she went back to class, symptom free. I found out later that she had missed her Maths test because she was resting in the health centre.

What did I learn? I learnt to keep my mouth shut, which is quite different to what I’d do in an emergency room. When you’ve got a forty-year-old man with chest pain, you question their symptoms because it helps define the problem, and may just save their life. Questions like ‘Does the pain go down your left arm?’ or ‘Do you have pain in the jaw?’ are absolutely vital.

But at the school, I didn’t want to ask them if they had any visual disturbance, nausea, vomiting, aura, pins and needles, as the moment I gave them some symptoms to choose from, they usually chose the lot. Without fail, those who have real migraines know their symptoms and do not hesitate to let me know.

## Basketball

I like Sunday nights at the school, because they’re usually pretty quiet nights to be on call. There are no activities, no drinking (that we know of) and usually little chance of the kids getting into trouble because they’re back in their dorm preparing for the week.

But when the phone rang at 8pm one Sunday I received a rude awakening.

‘You have to come quickly, there’s blood everywhere. Come now, quick!’

The line went dead. I was about to press redial when the phone rang again. ‘Sorry, it’s me, Brian. I’m in the gym; you have to come quickly, Steve’s real bad.’

Brian was the coach of the school basketball team. He was normally a level-headed guy, but like many people involved in nasty looking accidents, when the adrenaline kicks in, they’re not the most coherent. I told him to slow down, take a couple of deep breaths, and tell me what happened.

After a pause: ‘We were playing basketball, practising for the tournament next weekend. Steve took a fall. It’s his arm. There’s blood everywhere. I don’t know what happened; it’s real bad.’ An arm injury with lots of blood didn’t sound good at all. The worst-case scenario I could think of involving bones and blood was a compound fracture, that is, a broken bone that is also poking through the skin.

I could hear screaming in the background and grabbed my first-aid kit and car keys and headed out the door.

I walked into chaos. There were two adults with Steve, and a horde of boys surrounding them all offering advice at the same time. Yet through all this noise I could hear Steve screaming in agony.

I was the only medic on the scene and it was up to me to do the right thing.

‘Don’t move him.’ As I pushed my way through the crowd, the kids were yelling their diagnoses.

‘It’s his back, he’s broke his back.’

‘Oh shit, there’s blood everywhere, I think I’m gonna puke.’

As I reached Steve and knelt beside him, I grabbed the shoulder of James, the assistant coach, and ordered him to remove all the boys from the gym. Some resisted, determined to help, others were happy to be led into the foyer, speechless, helpless, but grateful for some direction.

In any situation where there’s a crowd, the best thing you can do is to have someone remove the onlookers. I’ve seen a lot of people with what initially appears to be a serious injury calm down and walk away without any problem once the jittery, frenzied bystanders have been removed. It’s also impossible to do an assessment with a screaming horde of onlookers.

Steve was sitting on his backside, clutching his right arm, the front of his shirt covered in blood. I breathed a sigh of relief when I realised the blood wasn’t coming from an open wound on his arm but from his nose.

I imagined myself back in the triage room. One of the basic rules of triage is the ABC:

A – his airway was clear, although his nose still had a trickle of blood coming from it.

B – judging by the groans of pain his breathing was fine.

And as for his C – well, he hadn’t passed out and he was able to sit so he had an adequate circulation.

Clearly something was wrong and causing a lot of pain, but it was probably not life threatening just yet. I asked him what had happened.

‘Please just do something … it’s killing me.’

I promised Steve I would do something shortly, but stressed that I did need to know what happened.

Steve had been jumping for a shot when he received an elbow to the nose and came down on his right shoulder. He said he hadn’t hit his head or lost consciousness.

It’s tempting to tackle the most obvious injury first, and while I could see him clutching his arm, I wanted to be doubly sure to rule out any possible head injury and anything more substantial than a bleeding nose. Alongside the A, B, C is an often unknown little addition, another C, for C-spine.

C-spine, in other words, the bones that make up your neck, should always be checked for injury before moving a patient. The problem is, I’ve only ever assisted the doctors when they do such things. I’m the one who leads the ‘log-roll’ when turning patients with possible back injuries. I’m the one who holds the neck still while the doctor gently prods his finger around the back of the neck. If I stuff up and make a sudden move, it can mean a patient is paralysed for life. But now it was up to me to decide the best course of action.

‘Is your neck sore?’ I asked.

‘It’s my arm, please just fix the bloody arm, please do something,’ he begged. But I didn’t get a definitive ‘yes’ or ‘no’, and I had to be sure.

‘I’m sorry mate, I’ll get to the arm next, but I have to know for sure. Were you knocked out at all, and is the back of your head or neck sore?’

‘Geez, they’re fine, the arm, please …’

To be 100 per cent confident, I placed my fingers on the back of his neck and he denied feeling any pain when I gently pushed. I moved on to the arm.

I asked Steve to sit up straight and he tried, but he wouldn’t let go of his right arm. ‘It’s too painful, I just can’t.’ He had straightened enough for me to see that his right shoulder was not the same as the left. It was obviously dislocated. I checked the pulse on his right wrist and felt his hands. His pulse was strong and his hand warm. No circulation problems there … yet.

Not all shoulder dislocations are obvious, especially in the hospital setting where we see people of all ages and sizes. The size of a person can make it difficult to tell. Often frail people don’t even need to have an accident or any overt force involved to dislocate a joint, and their statures make it hard to see if something’s out of sorts. But a seventeen-year-old boy on the basketball team is likely to be tall and skinny. The poor lad didn’t have enough flesh on him to hide anything.

My clinic was only 100 metres away and with the help of Brian and James we managed to get Steve lying on the examination table. I tried calling Dr Fritz but got no answer. I remembered that this was one of the few weekends he had off; we were alone.

‘Fuck!’ Steve was trying to find a comfortable position but not succeeding. ‘Just fucking do something, fuck, fuck, fuck …’ He carried on screaming, pleading, while I didn’t have the courage to tell him that there was no doctor.

Steve had found the best position to ease the pain a little. He was lying face down on the examination table with his right arm hanging down off the side. ‘Please do something soon. I can’t take this anymore.’

In such instances the emergency call was directed to the next village over, usually a thirty-minute drive away. The next option was the ambulance, but the nearest ambulance was forty minutes away, which would mean at least an hour and a half before he got to hospital. My other option was to take him by car, screaming all the way. With such limited and unappealing choices, I opted for driving.

‘Please, I can’t move. Don’t touch me. I can’t move.’ We couldn’t get Steve to move off the bed let alone into a car. He’d found himself in a slightly less agonising position and was not going to budge. I needed some advice.

I try to avoid calling my colleagues, Justine and Michaela, when they’re off duty because time off is supposed to be just that, and like all nurses, I know, when you ask someone for help, they will never say no. Michaela was no different and was happy to help out. In fact, Michaela relished the challenge of a decent trauma. I instantly felt reassured by her upbeat tone when she arrived.

‘Don’t worry about a thing,’ Michaela said and quickly began examining Steve’s shoulder. ‘I’ve put dozens of shoulders back in place.’ What the hell was she talking about? Nurses don’t relocate limbs. At least, not nurses in Britain or New Zealand. I knew Michaela was extremely experienced and supremely confident; perhaps this is what nurses did in the States.

‘What do you mean you’ve put in dozens of shoulders?’ I whispered, thinking I was out of earshot of our patient. ‘You can’t do that. You’re not allowed.’ I know my limits, and I know what is within the scope of my practice, and what is not. Relocating the shoulder myself had never occurred to me. Steve chose that moment to scream in pain.

‘Let her bloody fix it. I can’t take this anymore. Just do it,’ he managed to shout.

Watching someone in agony never gets any easier, and it’s a whole lot worse when you don’t have an IV line to insert with a whole lot of morphine or midazolam.

I was trying to think of what could go wrong if Michaela went ahead and fixed his shoulder. She could worsen any possible fracture or nerve damage, although there was no way to judge how much damage we could do by leaving him as he was – there were possible circulation problems to worry about – and this was without even considering the possibility of the relocation not working.

‘We can’t leave him like this for the next hour and we can’t take him to the hospital. We have no choice.’ Michaela was in total control, and not in the slightest bit fazed by the chaos. ‘Honestly, don’t worry, I’ve done this lots of times with the docs at work. It really does look like an uncomplicated dislocation. I know what I’m doing.’

I stood back and watched.

She rolled up a sheet, wrapped it around her waist and Steve’s shoulder, and gently began to pull. ‘Fuck-fuck-fuck-fuck-fuck …’ Steve’s screams reached new heights. I was just about to stop Michaela when … ‘Thank fuck for that. Oh, thank you, thank you, thank you so much.’ The relief was instant and the whole procedure over in less than ten seconds. After checking Steve’s circulation and sensation in his hand, Michaela placed him in a sling and gave him some analgesia. ‘I can’t thank you enough,’ he said repeatedly.

Part of me felt more than a little envious, the childish part that wanted to be the hero. But that was nothing to the relief I felt knowing that he was feeling so much better.

Steve was taken to the doctor the following day where an x-ray showed no fracture, and the doctor congratulated Michaela on a job well done. ‘You’re OK with us doing that?’ I asked. I had been prepared for him to be angry with us for doing something that was a doctor’s job. ‘Why would I be angry? You did a good job.’

His words were not helping me to figure out what was right or wrong (if there really was any such thing), or what my exact role was. I was doing more than the average nurse, a bit of diagnosing, and administering treatments and medicines like a doctor, as well as playing detective … but nothing as practical as what Michaela had done.

Michaela’s brave actions on that surprising Sunday night taught me a few lessons that I’ll never forget. To act or not to act? Indeed, that is the question.

## 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.

Chapter Two

## 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!

‘Who’s had herpes before?’ I asked the girls. No one was really sure. I asked if any of them had had a cold sore, and most of them raised their hand. ‘Well don’t kiss your boyfriend down there if you’ve got one, he won’t forgive you. He’ll have it for life.’ There were gasps of disbelief. ‘You’re telling me you didn’t know that? It works both ways, except it’s usually worse for the women if they get it down there. So watch out.’

Due to the previous Hepatitis C scare, most the senior students knew about that, as well as Hepatitis A and B.

I asked them about syphilis, warts, HIV, gonorrhoea; they knew nothing, and they began to realise that they knew nothing. When I told them that we were down to the last antibiotic to treat gonorrhoea, and that pretty soon we’d have nothing to treat it, they were ready to listen. Even Skylar managed to keep her mouth shut.

I told them about my experiences working at a London STD clinic. The biggest lesson I learned from that place was not to judge anyone by appearances. In the waiting room you’d see the most sophisticated, beautifully dressed men and women, sitting next to someone more used to sleeping on the street, and they usually had something in common – an STD.

I was surprised when one young teen said that we didn’t need to worry about STDs so much in our village, because we lived in the Alps. She seemed to think that our location was some protection from STDs. I soon explained how wrong she was; ski resorts have a disproportionate number of STD cases. ‘And besides, I see cases from school every year with STDs.’ There were horrified gasps alongside demands to know who they were.

Another girl thought that oral and anal sex were safe alternatives to regular sex.

‘Hands up if you think you can catch a disease from oral sex.’ Only half the girls raised their hands.

‘A friend told me …’ began another. It’s always a friend, or a friend of a friend, but it doesn’t matter. I listened. This particular friend thought that anal sex meant the person was still a virgin. I’d never thought about it before, but I guess technically you could say that. ‘But bugs can spread particularly easily through anal sex,’ I explained. ‘It’s why we often give people their medicine that way.’

With my credentials established, the girls wanted to know more. They asked a whole range of questions:

> • How do you know when it’s right?

> • My friend has a boyfriend who is going to dump her if she doesn’t ‘do it’. Should she?

> • Do condoms always stop disease?

> • Can you cure genital warts?

> • Can you get cancer?

> • Is it always painful?

> • What’s a normal size? (Penis size, that is.)

> • Is anal sex safe?

> • What is dogging?

> • What is chariot racing? (I had to look this up on Google, although I advise you not to.)

Their appetite was insatiable, but finally we were finished, and we let the girls go, free to pursue or be pursued. Sarah came over and thanked us. She said that in her time as a dorm parent she’d never seen such an ‘enthusiastic’ response to a sex talk. I just hoped that I still had a job come Monday morning.

When Monday finally came around, instead of angry phone calls or vicious emails, I was approached by a group of senior boys. They asked when their sex talk was. They said they’d heard from the girls that it was the best sex education talk ever. I think they felt left out of all the fun.

As politically incorrect and potentially offensive as my tactics may sound, over the years that I’ve been a school nurse, I’ve discovered humour nearly always helps.

A lot of students come to me now, especially after I give a group lesson, to speak privately. It’s during these talks that I realise how little they truly know and how important it is that we continue to communicate.

## 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.’

I promised to pass on his concerns to the counsellor, although I didn’t think the matter urgent. ‘A bit of a crush,’ I remember saying so clearly. No one could have anticipated the surprise she had in store for him.

It wasn’t just any birthday, it was Brian’s fortieth and understandably his students enjoyed teasing him about becoming officially old (or ‘ancient’, as they called it). Priscilla didn’t join in the banter, instead she enlisted the help of her peers.

As Brian turned up to class the following week on the day of his birthday, he did what he always did at the start of a lesson and took the register. Everyone was present bar one. When he called out ‘Priscilla’ the music began.

Priscilla entered the room, dressed in a flimsy white dress, and began to sing happy birthday. It wasn’t your typical ‘happy birthday’ where everyone joins in. Priscilla must have seen Marilyn Monroe singing happy birthday to a naughty president at some stage, and thought Brian would appreciate the gesture.

What does one do when confronted by a flirtatious teenager?

You politely interrupt, say ‘thank you’ and explain that the classroom is not the right place for such behaviour.

Of course, it’s not always that easy. ‘She was so serious,’ Brian described later, ‘it would’ve crushed her if I’d made her stop straight away.’ Instead, he ended up saying things like ‘it’s unique’ and ‘unforgettable’ while trying to avoid actual words of encouragement.