I’ve been a school nurse in Philadelphia for almost 25 years. I’ve seen lots of blood and a finger almost amputated by a door accidentally slammed. I’ve seen head injuries, seizures, and high and low blood sugar levels in diabetics.
The very worst moments I’ve experienced as a school nurse, however, are those that were spent with children who were having an asthma attack.
Asthma is a sneaky, dangerous disease. It can emerge full-blown in a child who never before had an asthma attack. It can resurface after years of quiescence. It can occur in a child whose disease has been well-controlled until their insurance is dropped and parents can’t afford to pay for inhalers. We know that asthma affects almost 20 percent of Philadelphia’s kids. We now know, from sad experience here, that asthma can kill an otherwise healthy, active child.
Once a girl – I’ll call her M. – came to see me during her 9th-grade year and told me she had a bad cold that made her feel awful. She had trouble, she said, “catching her breath.” Although she denied ever having asthma and her school health records corroborated her assertion, when I listened to her lungs with my stethoscope, she was wheezing. I called her father and advised him to seek immediate medical care. When he tried to tell me that M. had a “little cold,” I responded by saying that if she were my child, I would take her to the doctor’s and failing that, to the hospital.
The father called the next day to thank me. His daughter had been admitted to the hospital, diagnosed with asthma.
Aside from M.’s comments about feeling “awful” and saying that she was having trouble catching her breath, she looked like a child with a bad cold. I see children like that every flu season and all they have is a bad cold. It was only in my training as a nurse, where listening to a child’s lungs is part of the physical assessment, that I knew there was something wrong.
We don’t know the particulars of 6th grader Laporshia Massey’s attempt to communicate her distress to an adult who would know what to do. We don’t know whether she carried a rescue inhaler to Bryant Elementary every day, which is permissible according to District regulations. We don’t know the severity of her illness. We also don’t know what time on Sept. 25 Laporshia first reported her symptoms or to which adult she spoke.
We do know, however, that there was no nurse in the building that day – a nurse who, if aware of Laporshia’s condition, would have known to listen to her lungs with a stethoscope and take appropriate action based upon what was heard.
The District would have the public believe that a “plan” developed by the nurse should suffice for emergencies like Laporshia’s illness. Even the most carefully orchestrated plan cannot take into account the staff’s lack of assessment skills that are part of a nursing practice. A plan is not a substitute for the expertise of a certified school nurse.
The “doomsday” budget did not just remove nurses from what should be an encompassing web of caring adults. Schools have lost counselors, vice principals, and secretaries. These key personnel do not have the training to determine whether a child is having an asthma attack. But each would have provided another set of eyes, ears, hands, and brains to consult in an emergency. Sadly, Laporshia became ill in a school where there simply were not enough adults to help her.
Significant numbers of our students with asthma – and other serious health conditions – attend schools staffed by skeleton crews. Each of these schools is a mere step away from a potential disaster. The hardest-working principal, the most caring teacher, and the most dedicated nurse cannot hope to make up for the fact that all of Philadelphia’s schools are dangerously understaffed. There are huge holes in our children’s safety net, gaps in care put there deliberately by adults who pretend otherwise. How many more children are going to fall through those holes?