Nursing Dectective

Hmmm, immaculate make-up, not good.
"You look well for someone who's been sick vomiting for four days" I said.
"I haven't eaten a thing for four days. I feel sick still now, but I'm trying to eat" said Sarah as she took a bite of her Snickers bar.
Hmmm, Snikcers bar, not good.
"Why didn't you call me then? I was on-call all weekend"
"I didn't want to bother you"
Hmmm, birthday party on saturday night, Sarah was checked out of dorm. Was seen at party. Not good.
"Your symptoms seem a bit odd Sarah. Vomiting for four days, no diarrhoea, mild stomach ache. I'm surprised you didn't go see a doctor then."
"Oh, I wasn't vomiting... Well, a little bit on friday night, then just some nausea."
Hmmm, story has changed. Not good.
Patient looks well, skin turgor good, lips not parched, immaculate make-up, smiling and energetic.
"You had a major assignment due this morning that you've missed."
"But I was sick. I still am stick, but getting better." It was the first time Sarah had raised her voice to me. "Are you calling me a liar?"
I raised one eyebrow "Are you?"
Sarah stormed out my office in tears.

Could I have handled it better? Maybe. Probably.
Every single day it's a battle of wits. This job isn't about medicine. It's about filtering the exaggerators, the liars and the truly sick. It's about looking at the whole picture, from school grades, school behaviour, discipline issues and absent parents.

I'm told not all school nursing jobs are like this. I'm also told that I should treat the patient, the symptoms, the signs of illness. I do this. But not all the times the symptoms add up.

But any nurse knows what someone looks like who's been vomiting for four days, oh, that's right, the story has changed, vomiting a little on friday and a little nausea for three more days.

I could be wrong.
But I'm not.
This time.