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How to Recognize the Fakers

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“Nurse Kevin, I am so sick...I think I am having ‘ana-pol-axis.’ I am very allergic to killer bees...and marinara sauce. Can I have a mint?”

Little Jenny has some very concerning “ailments.” She has managed to articulate her reason for coming to see the nurse, clearly...and without pausing...and while suffering from a very subjective case of anaphylaxis, hypoglycemia, and, more importantly, having to suffer through life without enjoying Italian food.

During our eye-to-eye, she hangs her head low and ‘suggests,’ “I told my daddy, but he said that I had to go to school.” Then come the magic words, “But, he said if I get to feeling worse-er, that I could go see the nurse.”

Nonetheless, I happily start my assessment process and find that my objective findings do not support the child’s subjective complaints. But, why is she here? Why is Little Jenny in my office with these (what we grown-ups may consider to be) exaggerated complaints? I turn to document my findings on my computer and ask Little Jenny to sit on the bunk near Little Jimmy. Soon they start to chat. “What are you here for? I have ‘ana-pol-axis,’ and this is my 30th time to be in Nurse Kevin’s office this week.”

Little Jimmy is quick, “I broke my arm when I was four, and now I have a really bad mosquito bite.”

“I had a broken arm once,” Jenny is working hard to top Jimmy as they back-and-forth with ailment comparison, until a little girl who had been lying on the other bunk listening to the exchange between Little Jenny and Little Jimmy pops in, “Oh yeah. Well, I have cancer!” Little Amy is in the office taking a rest after a rough week. The other two sit there...quiet now...at least for a moment. Little Jenny breaks the silence, “Nurse Kevin, are you going to call my mom? She’s home today doing nothin’.”

Is Little Jenny seeing the school nurse and making up her ailments? Could she be considered a “faker?”

First of all, what’s a “faker?” How do we, as school nurses, recognize a “faker?” And, what do we do when we encounter a child that is telling us school nurses information that may describe an emergency situation yet without any emergency-level symptoms? And if you are kinda, sorta, maybe feeling “offended” over my use of the “faker” term...read on, and let’s see where this article takes you.

“Fakers,” “Frequent Flyers,” “Little Hypochondriacs” — the child that has somehow, someway gotten past the first line of “defense” — the teacher — and has found his or her way into your nursing office. They may present differently each time. One may enter with a zip and a skip in their step, only to lower their head and frown as they unload the plethora of symptoms that even the hurtest-of-hurt or the sickest-of-sick would struggle to keep up with. Another will come in and be dragging their left leg behind them as if they were trying out for the part of Igor in the next Frankenstein movie. You know who I am talking about...tell me “that child” hasn’t come and seen you today (or is planning to see you later [and likely before you finish reading this article]).

When I pick up the phone to give Little Amy’s mother an update, Little Jenny pipes in, “Nurse Kevin, are you calling my mom?”

After the phone conversation with Little Amy’s mother, I start documenting on the computer. Little Jimmy is puzzled by the method of “texting” and asks, “Are you texting my mom?"

Why are two of these children in my office (Little Amy has a clear and concise reason to “go see the nurse”)? Are the other two really suffering from ailments that would warrant a reason to “go see the nurse?” Why did the teacher allow them to come down to the office? Or maybe...they do not deserve the label of “faker.” Maybe...just maybe...there’s a reason for every child to “go see the nurse.”

Let me pause a bit here. I had another 4,000 words written, with the tales of six different accounts that may indicate that a “faker” is not really faking. I thought about publishing all those words but...well...you know that I’m happy you’ve made it this far. So...let me minimize my jabbering down to little synopses:

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A child is sleeping soundly in class and eventually finds himself asleep on the bunk in my health office. Maybe he was up playing video games all night? Maybe…or...maybe he is having to share a bed with a restless 2-year-old.

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A little girl reports, “I vomited two times in the bathroom, and there was some red stuff, but I didn’t have anything red to eat.” Maybe the child has had an incontinent-of-stool episode and is ashamed to say.

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“My head hurts really bad, and I’ve already had a lot to drink.” (I love it when the children are pre-emptively prepared with all the answers to the questions before I have to ask them). When asked how many times she has pee-pee’d in the bathroom today (now 2 o’clock in the afternoon) and she reports, “None,” then maybe she has a “water deficiency” (dehydrated) rather than a “Tylenol deficiency.” Note to self: Lots of sips from the water fountain does not constitute “a lot to drink.”

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“Nurse Kevin. My stomach hurts really, really bad. My mom said that if it keeps hurting that I could go home. Oh, and I’ve already tried to go to the bathroom, but nothing will happen.” After finding a temperature of 97.4 and, during the “rest” period, finding out that her brother, who has been serving the past year in Afghanistan, is on a short leave and due to return in just a few days, I start to understand the “why” for the “stomach ache.”

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I am the school nurse for two of the best schools in the district (no...I ain’t biased or anything). My kids are wicked smart with genius teachers that should all have PhDs. Well, maybe I am exaggerating a little (but only a little). The point is: most all the kids can do the tasks and work they are assigned. But some (like I was) are fearful of presenting their knowledge to their class. Maybe it’s about to be their turn to read out loud, do a math problem on the board (I almost said “chalkboard” and aged myself), or to participate in a group function. Maybe this is when the “worstest stomach ache ever” occurs.

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In order to ensure the sanity of the teacher (and to secure a great Christmas gift from this teacher before we leave for break), sometimes it’s just easier on the teacher to tell that child to “go see the nurse.” Truth be known (shhhh, don’t tell my teachers), it’s better to have the child “go see the nurse” and spend five minutes in Nurse Kevin’s office as a “validation visit” rather than spending the next three hours in the classroom repeating, “But it really stings!” or, “But I feel like I am going to throw up!” or, “I am going to bleed to death!”If this is a daily thing, I encourage a scheduled time for the child to “go see the nurse.” This venture out of class will give the child something to look forward to and set limitations on the child’s repetitive complaints. Hey! What can I say? They love Nurse Kevin...and I am sure...they love you, too!

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A fifth-grader reports, “I got hit over-and-over by my 6-year-old cousin. Well, she’s not my cousin, but I think of her as my cousin because we are close friends. Anyway, she kept hitting my leg with her skateboard, and just now I was out at recess playing football, and I fell, and my leg hurts really, really bad. Can you call my mom and tell her I got hurt?” Often I will call the parent or guardian AFTER I send the child back to class if there are no supporting objective findings.

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When the child was instructed to return to class, the child left with a limp that appeared to “improve” a few feet from the front door of the office. The mother wanted her child to stay in school.

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Sometimes the child just wants to go home. We school nurses have had those days...and so do the children. We just have “off” days sometimes. Now, that’s no reason to call home and have the child picked up, but sometimes a child wants to go home simply because they are not “into” school today. As a catch-all to any of the many “faker” excuses, the reason for the visit may just be simply an attempt by the child to get back home into their comfortable PJs and “call it a day.” Hey! I know just how they feel...but...if Nurse Kevin’s gotta stay at school...so do they.

Often the children will press until their parent is called. And, as soon as the child realizes that their parent is en route to the school, they TOTALLY “forget” that they are sick or injured and start dancing around. This is when I plead with them, “Child...please! At least ACT sick when your mamma shows up! She’s gonna come at me like a tornado with teeth and fingernails (figuratively speaking) when she realizes that you tricked Nurse Kevin, and she had to leave work early.” I don’t like getting fooled. But, worse than getting fooled is missing an actual injury or illness that a child may be suffering from. So, I sometimes will give in to the cases where the “subjective complaints are not supported by the objective findings.” But then again, when do they always?

So, who are the “fakers?” What child seeks the care of the school nurse, yet really does not have a problem or condition that needs taken care of? Well, the answer to that question is just as good as mine...who in the world knows? We never know who-with-what is going to walk through our office door. We do know one big thing: They come to see Nurse Kevin for a reason; there are no “fakers” (per se). My job is to figure out what they really want and determine what they really need, despite what they are telling me they believe they want or need. They may want to go home; nonetheless, they may find themselves back in class. And, believe it or not, sometimes they are sent to the health office needing to go home, but they really and truly want to stay in school.

Final Thought:

Years ago, I had a little girl who had hurt her leg at home. I’ll call her Little Trish. She had come to the office three times before noon for little more than validation visits. There was nothing that I, the parents, nor the doctor felt she needed other than to stay in school. During my after-lunch-trauma-rush, Little Trish showed up for a fourth visit. I was on the phone with another child’s parent, who was giving me the what-for over her child “catching lice at school.” That fourth visit by Little Trish was...well...it did not please me (to say the least). I gave her “the look” and an abrupt “point” to go out and back to class. She left a note on my desk and hurried...as well as she could with her hurt leg...back to class.

After the lunch rush and the anticipation of the 3-o’clock bell, I saw the note sitting on my desk. It was still all folded up just like Little Trish had left it. I opened it, “Dear Nurse Kevin. Thank you for taking such good care of me.” Ouch! I sure learned a lesson from that little girl.

Every child coming into my office is looking for something. They may have a bump, bruise, or scratch that I can plainly see. Or maybe they have a “stomach ache” because they know that their turn to read aloud in class is coming up, and they fear not doing well. Every child has something they are experiencing when they “go see the nurse,” and it’s my prayer that their need is fulfilled when they leave the nurse. Even my “fakers” get a peppermint when they “Go See The Nurse.”

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Nurse Kevin
Nurse Kevin is a school nurse who takes care of school children in Southwestern Idaho. Nurse Kevin authors content for many different websites including goseethenurse.com, licebattleplan.com, backtothehomestead.com, jesusbuiltonechurch.com, idahoismyhome.com, nursekevinhomes.com.
http://www.goseethenurse.com

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