Infirmary staff juggle influx of patients

For Diane Knowles, of Northfield, VT, pajamas are the dress code at her place of employment. Her eight hour night shift begins with a list of the people sleeping in the same house as she and usually ends with a waiting room full of college students.

Carla Asaro, of Barre, VT, comes to work never knowing what to expect. Some days there will be no one when she walks through the door, other times there will be so little room she has to step over students laying about the floor.

Deb O'Hara, of Warren, VT finds her job a great step after serving as a medical service corps officer for eight years and serving active duty in the army for two.  She sees an average of forty students a day and is always hoping to reach more.

These three women—House Resident, Registered Nurse, Physicians Assistant—make up part of the staff at Norwich University's Health Services who work together to provide complete high quality healthcare for the student population, according to the mission statement seen on the medical form, http://www.norwich.edu/admissions/newstudentinfo/medicalform.pdf.

At most universities, the cold winter months are what fills the waiting rooms at their infirmary. At Norwich University, the winter months are slow compared to the first three months of school, according to O'Hara, the Physician's Assistant at the infirmary.

Going from high school immediately into a military lifestyle, the first year rooks are the most frequent patients that make the walk across the street from campus, up the wooden stairs and find themselves an empty spot in the waiting room, according to Knowles, one of the house residents at the infirmary.

The house resident has no medical background, but "I have raised kids—I know when someone is really sick," Knowles said. After being informed of the nightly patients, Knowles heads to her bedroom where "I sleep, but I don't. It's sort of a subconscious feeling," Knowles said.

"Students have difficulty adjusting," O'Hara said, giving reason for the tireless amount of fall patients. The nurses are in frenzy as well, "just trying to get through the day because there are just so many coming through the door," Asaro said.

The corps of cadets presents a unique challenge to the infirmary because of its strong tradition. "With the corps, there is so much emphasis on if you are not 100% you are sent to the infirmary. That is difficult because you're not always going to be 100%. It would be nice for them to just be able to go back to their room and rest, like a normal college student," O'Hara said.

            Not a moment passes at the infirmary where someone isn't on call and available to its patients. The Infirmary staff includes three doctors, a physician's assistant, four nurses, a medical secretary and a house mother, which is still not enough support to efficiently make it through the hectic fall, according to O'Hara.

            The cadre leadership is responsible for the well being of the rooks they train. "A lot of the kids we see are sent to us by the cadre," Asaro said.

            "We really only need someone for the first few months, but that is nearly impossible to find," O'Hara said. They had a medical assistant in the fall that "was fantastic for us when we needed extra hands," O'Hara said.

"It would be nice to have cadre use their own discretion, but theROTC needs a doctors signature,"Catherine Flores said, a senior political science major from Houston, Texas. Flores was a cadre member and is currently the executive officer of a freshmen battalion, dealing a great deal with the infirmary, but "never having any problems."

The first few months bring in a range of injuries, "from simple things like needing a bag of ice to the mental issues," Asaro said, "sometimes we don't even address the medical issues such as bumps and bruises because that is just their way to get here to deal with their mental issues."

With all 16 beds filled, students sleeping on the floors, the pull-out couches in full use and a waiting room full of patients yet to be seen, "the fall gets crazy, but it makes for a cool job," Asaro said.

One of the house residents or house "moms" as the staff refers to her, Knowles arrives at 11 p.m. and stays overnight until 7 the next morning. "The doorbell starts to ring around 5:15 every morning—especially in the beginning of the year," Knowles said, "making the beginning of the year the busiest."

"Within the first week, we really know who those ten frequent fliers are who [and if they] are either not going to make it or struggling. Sometimes we have a couple that have surprised us and have made it, which is really cool to see," Asaro said.

"The freshmen that end up ‘living' at the infirmary end up not really making it back," Flores said, "It becomes a holding place until they decide to leave."

The goal at the infirmary is to try not to keep the students there too long because the longer they are separated from their company; the more they want to go home, according to Asaro.

O'Hara has been working for Norwich University for three years and is making strides to increase the amount of educational involvement the health services provide for the students, according to Asaro. "We really want to prepare these college students for the real world," O'Hara said.

The accessibility of the infirmary is seen as both a positive and a negative aspect to the staff. "All they have to do is walk in and be seen," Asaro said, "and it's free."

 "We strongly urge students to make appointments because in the real world they shouldn't think that they are going to be able to just walk in and get seen. They may have to wait a day or two," O'Hara said.

"We want it to give us more validity because we are as accessible as they can just walk in. An appointment based only system with vitals done may allow people to realize that this is actually a medical center," O'Hara said. The infirmary is run by Central Vermont Health, but they are "so much cheaper than the ER and have everything the students need," Asaro said.

"Sick call has been going on over 100 years," O'Hara said, as she expressed her need for change. "It will be a slow process, but we will get there."

The change has to start with the corps because it is hard to focus on upperclassmen and civilians when there are so many issues coming in that could be cured on their own, according to Asaro.

            "The corps needs to evaluate and let students lay down," Asaro said, "That has to change before anything."

As posted on the university's medical form, "many health services are available at no cost to students" which will be a hard thing to find once the students leave Norwich, according to Asaro.  

"It's hard for the infirmary because we would rather be doing more preventative tasks and educational services," Asaro said.

"The past two years we have been seeing fewer students because of Norwich University Emergency Medical Services (NUEMS), now that they have their own supplies on campus, they are doing foot checks every night with the rooks," Asaro said, "they can take care of all of the miniscule cuts, bruises and bangs."

With help such as NUEMS, this provides the infirmary with extra time that they can dedicate to education items, which "should be 50% of their job on campus," according to O'Hara.

We are skilled to do much more and much better than what we are doing," Asaro said, I sometimes feel like an elementary school nurse, handing out Band-Aids, ice, Tylenol."

There is a possibility that there will be a change in the infirmary hours, to allow for Wednesday nights to be open to see a doctor, according to O'Hara. "I want to be giving classes on campus also," O'Hara said.

"Medicine is so unpredictable," O'Hara said which is what keeps her around. For Asaro, it's the laid back setting that working with college students provides. For house "mom," Knowles, she comes in her pajamas with a cup of coffee and a book in hand, ready for anything.