Out of Darkness
By Kimberly Toole, RN, MSN

As supervisor of a school nursing program and a former school nurse, I am fortunate to work with some of the finest school nurses in the country. Within the public school district that employs me, I hear about or witness extraordinary feats of compassion and mercy on a daily basis. The following is a story about a nurse named Linda who has gone well beyond the call of duty on behalf of children.

Linda is a school nurse at an inner-city elementary school with an overall poverty level of 90 - 100 percent. The children she serves usually come to school with a whole array of problems and Linda always considers the whole child. She considers not only their physical complaint or ailment, but also what may be going on at home with the rest of their family. The school's principal once said, "Linda practices holistic nursing, always considering the child's physical, emotional and psychological well-being, as well as their academic success." I couldn't say it better.

A couple of years ago, a child moved to this city with his mother, two older siblings, his grandmother, his aunt and his uncle. The grandmother was the head of the household, but was morbidly obese, very ill and unable to leave her home. She ruled the family from a bed, was very argumentative and difficult to communicate with. Nobody could convince her to obtain medical care for herself or the children. She and the other adults in the family were illiterate, mentally challenged, very low functioning and very suspicious of outsiders. With extreme patience Linda gradually developed rapport with the family and was finally let into their home.

While the older siblings were enrolled in school, the youngest child was kept at home. He was extremely hyperactive with dysmorphic features and was not potty-trained. He was ill kept and seemingly alienated. It was evident that the family treated this child differently than the others. During Linda's home visits, the child sat alone in a dark back room. Very concerned with this situation, Linda contacted children's services with the hope of bringing the child aid. When help was declined because the child's situation was not considered severe enough neglect, Linda decided to take matters into her own hands.

Linda convinced the family to allow her to enroll the child in kindergarten. She managed to find a developmentally handicapped classroom for him, which happened to have a very loving and patient teacher. Linda also assisted in getting the child a wrap-around instructional assistant for one-on-one assistance with toileting and hygiene. The child grew to love school and blossomed. He was still not treated right at home, but always looked forward to going to school. School was his "safe haven," and he knew he could always count on his teacher or his school nurse, Linda.

Linda also made referrals to the Bureau for Children with Medical Handicaps (BCMH) so that the child could get a thorough diagnostic evaluation from both a genetics clinic and a pediatric gastroenterologist. The geneticist said that the child should have been seen years ago and found that he had a rare genetic disorder. Linda also made sure that the child had regular care at a nearby health center. Although he had lice and toilet accidents, she drove him and his mother to all of his appointments and served as interpreter for the mother. The physician put the child on medication, which helped his hyperactivity and behavioral problems. Linda also helped the family apply and obtain public assistance, medical coverage, homemaker services, and services from the Department of Mental Retardation and Developmental Disabilities (MRDD). Since the family was illiterate and distrusting of strangers, all appointments, applications, information, and other paperwork had to go through Linda or the mother would not follow through. Linda made numerous home visits and even helped the entire family eradicate lice. She also helped one of the siblings who had chronic throat infections, enlarged tonsils, and sleep apnea by applying to BCMH so he could have a needed tonsillectomy and adenoidectomy.

Linda gave this family, like others, her all. It is difficult to say what would have happened to this family, especially the youngest child, if Linda hadn't intervened and been his advocate in almost every aspect of his life. If not for Linda, he may still be sitting in a dark corner somewhere in his grandmother's apartment.