Photography courtesy of Debbie Glen
When Susie Killian became a school nurse 20 years ago, she worried that once she’d stuck on the day’s Band-Aids, there wouldn’t be anything else to do. As it turns out, she sees 40 or 50 kids every day, some who have multiple disabilities, two who use feeding tubes, a kindergartner who’s diabetic. Others, perfectly healthy but a little stressed, just feel a need to come see her. “I don’t turn anybody away,” she says. “I get to know them all.”
You work at Iveland Elementary School, in the Ritenour district. All grades?
Kindergarten through fifth. They walk in at [age] 5, and they are so cute, and by fifth grade, I have to remind them how cute they were. I’ll get out the yearbook and say, “Oh, I remember you then!” And they’ll roll their eyes.
What are the usual problems?
Allergies—this year was much worse, lots of asthma. We have kids with severe peanut allergies, kids with ADHD, kids with autism. One student’s just sensitive to loud noises—at the season’s first fire drill, he was uncontrollable for an hour. I said, “Why don’t I take him out ahead of time?” So now that’s what we do.
What about nutrition?
Quite a few are overweight, but it’s very difficult to bring up. I won’t talk to the child. I’ll maybe call the parents and say, “He is short of breath when he goes outside. You could maybe talk to your doctor about some different choices?” But if the parent is overweight, you have a very difficult time broaching the subject. And my population can’t afford to eat healthy. There’s lots of cereal, lots of mac and cheese. We had a free lunch program this summer, which I was excited about, and we have a community garden.
What helps you most with your work?
Getting to know the families well. If a child’s coming in frequently not feeling good, I start to see a pattern, and I give the parents a call. Do they have headaches and stomachaches at home? No. So is there something here at school…? Pretty often, it’s psychosomatic. But it’s real. They really throw up, and their head really hurts.
Is stress usually the cause?
[She grins.] A few years back, we were going to have awards day on Wednesday, and this little boy came in Monday with a severe stomachache. Tuesday morning, his mom said he was fine, and all of a sudden he gets a terrible stomachache again. On Wednesday, which was awards day, he’s on the cot in my office just doubled over in pain, and all of a sudden it occurs to me that maybe he thinks he’s not going to get any awards. I went to his teacher, and she said, “Oh, yeah, he’s getting a few.” So I went back to my office and said, “I hope your stomach starts feeling better because I know you are going to get an award.” And it was like Lazarus rising from the dead. He sat up, gave this slow stretch, and said, “I think I’m feeling better now.”
What else do you do to ferret out the truth?
This is giving away trade secrets, but especially now, because glasses are so popular, I have a hard time telling whether somebody’s faking their eye test. So I got a pair of glasses with plain glass and said, “Is this better?” and they’ll say, “Oh, yes!” I have to turn my head so they don’t see me smile. Then I tell them, “You don’t need glasses right now—congratulations! But you could go to Claire’s and buy some plain-glass frames…”
What’s changed about kids in your 20-year career?
Impatience. They have grown up with instant technology, fast-food, movies on demand. They just Google their book reports; they don’t have as much time invested. And in conversation, they just react; they don’t stop and think.
Is attention deficit hyperactivity disorder over-diagnosed?
I don’t have any scientific evidence for this, just what I’ve observed. But I think chronic stress can sometimes create what looks like ADHD. On September 11, how engaged were you at work? If kids are preoccupied, scared, or worried, it can definitely distract them and lessen their focus.
What about more severe mental illness?
There’s a lot of controversy about early diagnosis and medication. I have seen an increase in certain disorders that technically you could not diagnose until age 18, like bipolar disorder, and they do put them on meds. And many of the meds that are used by adults have not had long-term clinical trials for children. They just use a smaller dose.
How are the students’ health habits?
Dental care is probably the least followed up on, and it’s so important. And I don’t think the kids get adequate sleep. Even just an hour a night, the cumulative effect is overwhelming. I’ll say, “I think you are crabby because you’re tired!” I’ve had kids sleep on my cot for just two hours, and then the rest of the day is productive for them.
You can’t diagnose, but you can at least warn, right?
A third-grader was sitting outside my door waiting, and he was jaundiced and had petechiae—little red dots—all over his thighs. I took one look and called his mother, and they hospitalized him that day. Another day, a first-grader came in from PE ashen and lethargic, and I thought diabetes. I called the parents and said there should not be any delay. And yes, it was a rare form of diabetes.
If you could change one thing…
I wish there were better liaison between pediatricians and school nurses. Some pediatricians are actually surprised that I got a release to talk to them—but every time I have, there’s been a good outcome. I am there; I see these kids five days a week. And what I see is sometimes different from what their parents see.
Is your care free?
Oh, no. I have to charge them for my services. They need to understand that everything comes at a cost. So I’ll say, “That will be $10,” and they will say, “I don’t have any money,” and I will say, “You can pay me with a hug or a smile or a thank you.” They nearly always pick the hug.
You can probably read kids easily by now.
One thing I’ve learned is that if you ask them a question and they shrug their shoulders, it doesn’t necessarily mean they don’t know. It means they prefer not to answer the question. And I’ve learned there’s a story behind every child. A lot of great things and some you would never even think they would have to endure.
How do you handle the behavior problems?
I had a meltdown a couple of weeks ago! I never take an actual lunch break—someone could be throwing up or have a playground injury, and I’m not going to say, “Oh, I’m on my 10-minute lunch break.” But my daughter had brought me a burger and fries for lunch as a treat. It always takes me two hours to eat lunch because there are always interruptions. So I left for a minute to go to the office, and when I came back, two first-graders and two third-graders were there, and they said one of the kids had touched my French fries with his fingers. I said, “What about my cheeseburger?” And they nodded. That, too. And he had this icky cast on. So I threw the food in the trash can with a little flair, and they could tell that Susie was upset, which they don’t usually see. His mom made him write an apology.
Any discipline tips?
If a student is disrespectful, you get them to say “Yes, ma’am.” They won’t do it at first. You’ll ask, “Do you understand why this was wrong?” and they will just keep saying yes. But when they say “Yes, ma’am,” they have admitted that they have to show me respect, and I know we won’t have any future trouble. People don’t even use “ma’am” anymore, but it works. I’m patient until they say it, and then I say, “Thank you.”
Courtesy makes a difference.
Oh, my gosh! Please and thank you! Politeness is not innate. It has to be taught. And I tell the kids, what matters most is the tone, because you will always remember the way somebody made you feel. That’s what I live by. Except that day with the French fries.
