When Virginia Krejci pulled up to her usual spot in the carpool pickup line at Lake Highlands Junior High, she had no idea what was happening to her son. It was just after 3:20 pm on a Tuesday. She expected to see Joe, her 13-year-old, trudging up to her Honda Pilot. She expected to give him a smile and quick hello, just like she always did. Virginia, an interior designer, pulled out her phone and tapped through emails as she waited. At one point, she got a call from the school but figured it was probably some sort of fundraiser. She sent it to voicemail. At that point, everything still felt normal.
Joe’s last period is athletics. That day, a clear, sunny afternoon in late November, the seventh- and eighth-grade boys of Lake Highlands Junior High were running sets of 100-, 200-, and 400-meter laps. Craig Titsworth—called Coach T by the students—stood at the starting line, clad in a short-sleeved shirt and khakis. He watched the first group thunder around the track and readied the second group to follow them. His wife had brought their two young children to the field to watch their dad work, and he smiled at them from time to time.
You expect a few tumbles and scrapes anytime you take a mass of gangly adolescents and send them hurtling across an old cinder track. That’s why Coach T didn’t panic when he noticed that one of the boys had taken a dive about 10 meters shy of the 100-meter finish line. But as he squinted across the rough, red-tinted lane, something looked wrong.
He’d seen plenty of kids fall. They wriggled, they rolled around, they made a fuss, they tried to bounce back to their feet. They moved, at least. But Joe Krejci was still and silent. He lay flat on his back, his hazel eyes open, the black-and-red “LH” of his white gym shirt facing the clear sky above.
As other runners slowed down and a small group gathered around Joe, Coach T figured he should investigate. He broke into a run.
One of the boys suggested that Joe had fallen and hit his head. Another insisted that he’d heard Joe laughing after he fell down. He couldn’t be too hurt if he was laughing, right? Coach T found no sign of bleeding or injury; no sign of a seizure, either. As he stood over the boy, trying to elicit a response, he wondered if he should start CPR. He decided against it when Joe gave a harsh, heaving gasp—a sign of breathing on his own, the coach thought. He felt for a heartbeat, and found only the faintest hint of one.
At 3:05, he dialed 911 on his cellphone and ordered a student nearby to tell the operator what had happened. Next he snapped out his ID badge. By chance, the two fastest boys in Richardson ISD—one had placed first in the district 200-meter dash; the other had placed first in the 400-meter—were standing nearby.
He tossed them his badge and said, “Go get the nurse.”
Before she started at Lake Highlands Junior High, Annie Young, the school nurse, thought the job would be laid-back. She was fresh out of the world of labor and delivery, and compared to the fast-paced 12-hour shifts she’d spent on her feet, school nursing sounded like a breeze.
Young’s first degree came from Baylor, in business, which landed her a job in human resources. But she found the corporate world soulless and unfulfilling, and soon returned to Baylor. In 2006, she graduated from the Louise Herrington School of Nursing and started a new career at Parkland Hospital. But with a young daughter and a husband who traveled often, her intense schedule became difficult to maintain. In 2013, she started as a school nurse in Richardson ISD. That’s when she learned the job is much more than most of us think.
A school nurse’s typical day consists mainly of slapping on Band-Aids, doling out maxipads, and sending fakers back to class, right? “At the junior high level, we have kids who are cutters. We have anxiety disorders and depression,” Young says. “There are kids with severe allergies, with asthma, with seizures. The school has 800 students, and during the day, I’m responsible for them.”
She sees 20 to 30 kids a day. In addition to treatment, she has paperwork and charts to fill out. There are doctors and speech therapists and administrative personnel to consult. There are prescriptions to keep track of. There are care plans to create, conditions to monitor, and screenings to organize. There are tough talks to have—like explaining periods to giggly girls, or discussing kids’ unstable home environments.
But at 3 pm on Tuesday, the office was quiet, and most of Young’s work was done for the afternoon. She was logging information for the students she’d seen that day and thinking about the evening ahead: a girls’ night spent with her 6-year-old. They might go out for dinner, paint their nails, or watch a movie.
At 3:08, the two runners from Coach T’s class came flying into the school clinic, yelling about a collapse, talking over each other, gasping for breath.
The nurse’s office is situated on the far west side of the building. The track is on the opposite side. Young started for the door, then turned around. It was partly due to that word—“collapse.” A collapse lacks the triviality of a “trip” or a “fall”; a collapse is serious. Too, it was the panic in the boys’ faces. Panic in a junior high setting, without the slightest hint of teenage facetiousness, should not be taken lightly.
She went back and grabbed the AED—or automated external defibrillator, a user-friendly machine that administers shocks to stabilize heart rhythm. In the hall, Young met with two members of the school’s emergency response team (Richardson ISD mandates a trained emergency response team for each of its 54 campuses). With the boys in the lead, Young, an office aide, and the assistant principal rushed out into the sunlight and toward the field.
Healthy people 2020 endorses a 1-to-750 nurse-to-kid ratio for the “healthy student population” (i.e., not counting students with chronic illnesses). In May 2016, the American Academy of Pediatrics recommended that every school have a nurse on campus. These recommendations might seem obvious, but according to a report from the National Association of School Nurses (NASN), only 45 percent of public schools employ a full-time nurse. Per the Texas Department of Health and Human Services, there’s no requirement for Texas schools to even have a nurse, and what that boils down to is this: districts in affluent areas, like Plano and Richardson, can afford to assign a nurse to each of their schools. But in poorer areas, nurses are often shared between campuses.
And it’s not just about student health. Kids don’t perform well in school when their health needs aren’t met. Some students don’t receive medical care beyond what they get from the school nurse. And when there’s no nurse present at all, the decision to send a kid home is left up to nonmedical personnel.
“Last year, of my 3,200 visits, only 10 percent went home at the end of the visit,” Young says. “I kept that many kids in school.”
By 2030, 20 percent of the projected demand for nurses won’t be met. This is according to the Texas Center for Nursing Workforce Studies, which also estimates that 2020 will see an 86 percent rise in the demand for RNs. And in coming years, a nurse shortage could send school nurses into more lucrative positions.
“Nurses take a pay cut to be a school nurse,” says Dr. Shelley Conroy, dean of Baylor’s Louise Herrington School of Nursing. “School systems say they don’t have the funds, so if they’re lucky enough to have a nurse, the pay is very low compared to hospitals.”
When a school is looking to make budget cuts, the full-time nurse might be an easy target for the chopping block. But what would you pay to have a nurse on your child’s campus when a student goes into cardiac arrest during gym class?
Coach T saw Young and the other women running toward the track, and he sprinted toward them. He jumped the fence enclosing the practice field and grabbed the AED. Then he ran back to Joe and ripped the AED package open, sending the contents spewing all over the track. Young, panting hard, made it to the coach’s side in time to help him place the shock pads on Joe’s torso. The AED machine analyzed the boy’s heart, found it floundering inside his chest, and told the gathered onlookers: “Shock advised.”
At 3:11, Joe’s arm twitched as the AED delivered a shock strong enough to force his heart back into a normal rhythm. Young began chest compressions while the office aide started mouth to mouth. “Not many people are willing to put their mouth on a person who might be dead,” Coach T said later.
The women performed CPR until paramedics showed up, a few minutes later. Coach T watched the ambulance speed off to the hospital, dread in his heart. He felt certain it was too late.
Virginia Krejci listened to the voicemail message that popped up on her phone, puzzled that the vice principal would want to speak with her. But after that brief, frantic talk, Virginia was speeding through school zones on her way to Presbyterian Hospital, her hands clenching the steering wheel.
Joe had no medical history, nothing that foreshadowed an abnormal heart rhythm. He’d never been to see the school nurse, so Young couldn’t tell the paramedics anything about him. He was just a normal kid, an energetic young man who loves fishing. He’d just pushed himself a little too hard, Virginia hoped.
She knew it was serious the moment she saw him. Joe was unconscious, there were tubes down his throat, and his white gym shirt lay crumpled in a heap on the ground. But he was alive. That was enough, at first.
Doctors at Children’s Medical Center, where Joe had been transferred later that afternoon, warned that he might never be the same again. Joe had gone without oxygen for six, maybe seven minutes—enough to severely damage his brain. It was too soon to say, and all they could do was wait. Young, who’d been calm and controlled during the ordeal, rolled the events over in her mind. Friends, family, and acquaintances offered prayers on Virginia’s Facebook wall.
Coach T hadn’t shed a tear in nearly 20 years. But he found himself crying on and off throughout the days that followed. He feared that Joe might have brain damage and blamed himself for not acting faster.
“I couldn’t eat, I couldn’t sleep,” Coach T says. “I googled everything. He’d gone so long without oxygen, there was no way he could be normal.”
By Wednesday, Joe had a glazed-over stare and spoke gibberish. His parents and older sister, Sara, wondered if this was the way Joe would spend the rest of his life. But that morning, as Virginia was using a sponge to wet Joe’s lips, he moved a little and said, in a distinct agitated-teenager voice, “Stop it.” Virginia felt relief wash over her.
A little later, Virginia got another indication that she hadn’t lost her son for good. During family vacations, Joe’s father, Mike, often grows a beard. And Joe, a tactile kid who enjoys strange textures, loves touching it. As Mike sat by his son’s hospital bed, Joe put his hand out and touched his father’s face—right where the beard would’ve been. Mike wept.
On Friday morning, doctors implanted a pacemaker and defibrillator to monitor Joe’s heart, and conducted the long-awaited MRI to find out the extent of Joe’s brain damage.
The results showed that Joe had lucked out again. As soon as he felt better, he’d be his usual self, doctors told the family. Virginia smiled—in her heart, she’d known this since the moment he’d snapped a surly “stop it” at her.
But as she sat by her son, knowing that he’d managed to emerge from all of this unscathed, she couldn’t help but let the what-ifs creep into her mind. What if this had happened while Joe was out fishing? Or if he’d just been at home? What if it had happened at school, but there’d been no nurse?
At some point, a doctor walked into the hospital room and told her flatly: “He should not be alive.”
Lest you think these sorts of life-and-death-and-school-nurse stories are rare, a different family experienced a similar near-tragedy just two weeks before Joe’s. Less than half a mile north of Lake Highlands Junior High, Wallace Elementary school nurse Jessica Haas and her husband were fresh from a parent-teacher conference. Haas emerged from the school just in time to hear someone shout: “This woman needs help!” A woman had fallen face down on the sidewalk.
“That’s when 20 years of nursing and CPR took over,” says Haas, a graduate of Baylor’s Louise Herrington School of Nursing.
The woman lying on the sidewalk was Sarah Maupin, a mom who’d come to the school for a parent-teacher conference. Haas rushed to her side and began issuing orders. She told one person to call 911 and another to fetch the AED from the front office. With help, she rolled Maupin over and looked down into her gray face.
The AED machine came quickly. Haas slapped the pads to the woman’s chest and pressed the flashing button on the AED to administer the shock. The automated voice then instructed her to start CPR. After a full minute, Maupin was breathing on her own, and Haas could hear the distant wail of a fast-approaching ambulance.
Maupin’s husband drove up just in time to hop into the ambulance with his wife. Later, he called Haas to ask what had happened—specifically, he said, the doctors had told him someone at the school had given his wife “one shock.” Haas explained that she was the school nurse and that she’d administered the shock.
“Thank you very much,” he told her, after a pause, “because I think you just saved my wife’s life.”
Both Maupin’s and Joe’s cases involved an irregular heart rhythm. The heart rhythms were slightly different—but neither, as Haas puts it, were “compatible with life.” And without the AED machine, neither the teenage boy nor the mom of three would have survived.
Later that evening, Haas went up to the hospital to visit the woman she’d saved. When the nurse came into her room, Maupin started to cry.
“You’re my angel,” she told Haas.
Joe is a little more aloof about his own incident. Both Young and Coach T feel a connection with him now, but he was unconscious during those moments they spent saving his life. He jokes about the ordeal and laments the fact that his mother didn’t take a video of his incoherent babblings at the hospital.
“This is serious,” Virginia scolds him. It’s hard for her to explain how close she came to losing him. How coming face to face with a parent’s worst nightmare changed her. “I hug him tighter, kiss him more, stare at his incisions, cry at crazy times,” she says. “It’s nothing short of a miracle.”
A defibrillator and pacemaker are sewn up inside him, but otherwise Joe Krejci is exactly himself: a happy, funny kid who makes good grades and loves the outdoors. And one week later, he was back at school. He was dressed in his white gym shirt with the black-and-red “LH,” in his usual spot, on time, and ready to run laps.
Write to [email protected]