A Report

“Mommy, what happened to this girl?”

I turn around to see my 7-year-old daughter sitting on the floor with the latest issue of Rolling Stone. In less than 30 seconds, she’s managed to flip from an innocuous cover featuring Dave Grohl’s uncontroversial face to the image of a girl, looking at the ground, her body covered in red handprints.

“Why is she sad?”

Do you remember where you were the first time you read the story about a University of Virginia student named Jackie? I do. I was sitting on the train, heading home from a long but mundane day at work. When the issue first showed up in the mail, I remember seeing something about “sexual assault” and “college” on the cover and thought, well, obviously, I’ll need to read that. I mean, it’s sort of one of my things.

But when I finally opened to the story later that day, I wasn’t expecting what happened next. I mean, besides nearly missing my stop.

Now, I work in a college health clinic. I’m one of the people that sexual assault survivors on a college campus might find themselves talking to, after. The fact that sexual assault is happening on our college campuses is not news to me.

But I don’t work in an emergency room. I don’t even work in the campus urgent care clinic. I’m the clinician you might see in a routine visit days, or weeks, or even months after it happened. When you finally muster up the courage to see a medical provider in the hopes that they can run a few tests and tell you that physically, at least, you’re okay.

What this means is that most of the time, before they even end up in my exam room, my patients have usually decided that they don’t want to file a formal report against their assailant.

When I first started working in college health, honoring this decision was hard for me to accept. Really hard. But prevailing wisdom won me over. We want survivors to feel comfortable coming forward to access all of our carefully planned support services, right? Wouldn’t mandated reporting and the specter of unsolicited disciplinary action serve to silence, to an unknown degree, those survivors who need help, but haven’t yet found the courage – and believe me, it takes serious courage – to enter into the unknown and very scary legal side of their already traumatic experience?

So instead, I would be a sympathetic ear. I would help them give a name to their experience, using the words “sexual assault” or “rape” if they hadn’t yet used it themselves. I would slowly and thoroughly walk them through all their options, from the medical side to the administrative side to the legal side. I would give them lists of phone numbers, or call them myself if they’d let me. I would tell them that, legally, I had to file a report (check out the Clery Act if you’re not already familiar with it), but that if they so chose, the report could remain anonymous.

The day after I read the UVA article for the first time, I found myself waking up in the middle of the night, unable to get back to sleep, unable get the story out of my head.

At first, I wasn’t entirely sure why. I mean, Jackie’s story is, without question, horrifying, and really hard to read. If you don’t find it affecting you in some way, well, no offense, but you’re probably kind of a bad person. Just saying.

But there was something else nagging at me about the story. And then I realized what it was.

That administrator that the author calls out, in no uncertain terms, for her – and by extension, her institution’s – inaction after Jackie came to her for help? The one that you, as a reader, find yourself condemning for being part of the system that fails to protect and seek justice for Jackie and other UVa survivors? The one that, for some reason, is seen by survivors as such an ally on campus?

I saw myself in that administrator.

Well, I mean, to a point. There are pretty strict confidentiality rules that limit what information medical providers are legally able to share with others. Even when it comes to discussing patient information with other university officials outside the clinic’s walls, signed consent on the part of the student is needed. But still. I bought into the spirit of the law here, not just the letter.

And then, a few months ago, I moved to another state. One of the only states in the country that mandates that health care providers make a formal report to local law enforcement (I’m talking the real deal, not the campus PD) every time they’re made aware of a “suspected violent injury”.

At first, I complained. All the native Californians I now work with, who never knew any differently, were a little baffled. Um, hello, it’s a crime, right? Shouldn’t we let the cops know? But this idea, that the best way to honor the survivor was to honor their wishes when it comes to reporting, was lodged in my brain.

And beyond the theoretical, I was afraid of what this would look like in real life. What about the patient who decided that morning that the most she was up for was a quick visit to the campus clinic to get STD testing? What would she say when her profoundly difficult – but clinically relevant and necessary – disclosure was met with the news that a full, non-anonymous report would be filed with the local police, with or without her consent? Would this idea of a mandated report deter survivors from accessing the care and services we might be able to provide?

And then, I started seeing patients. And guess what? So far? Not even remotely an issue, as it turns out. Every patient I’ve had to have this discussion with has completely, 100% understood. Even, almost, as if there’s a sense of relief in the decision being out of their hands. As if it clarifies the fact that it was, in fact, an actual crime that took place.

So that’s the me that read this article. The me that had already started to come full circle on the idea that initial university respondents to reports of sexual assault should be required to, at a minimum, formally report every act of suspected sexual assault to come to our attention to local law enforcement.

And that’s the me that found herself trying to figure out how to answer a first-grader’s simple question about a magazine article.

After giving some half-assed answer, shoving the Dave Grohl issue to the back of a tall dresser, and wrapping up bedtime posthaste (parenting fail, probably), I found myself thinking about the big girl my little girl will someday be, and the world she’ll be living in. Would I want the school staff tasked with keeping her safe and healthy to turn around and dump the decision of whether or not to report a potential crime back in her lap? Hell no. That’s their job.

If we, as university administrative and clinical staff, aren’t doing everything possible to protect the survivors, and ultimately, other students, under our care, then we’re not doing our job.

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The beginning of the end/the end of the beginning

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The same thing happens to me every year.

I’m heading to work in the same sleepy way I start pretty much every day. (I wish I could say I WAKE UP EVERY DAY READY TO TAKE ON THE WORLD! but that would be a dirty lie. Plus, annoying.)

So there I am, riding the train with all the other groggy commuters as we all zone out, staring at the free paper the guy pushes in our hands on our way in, or at our various depersonalizing digital devices, or at nothing at all, eyes unfocused until the conductor calls out our stop.

Eventually, my stop is called. I get up, moving forward slowly with the zombie-walking masses onto the platform and up the escalator.

As I emerge on to the main level of the station – which just so happens to double as a footpath through campus – I remember that it’s not a routine, mundane day at all.

It’s graduation day.

And every year, the sight of those no-longer college students, those-not-so-young-anymore young adults, dressed in their grown-up best with black polyester gown flapping open in the late spring breeze, gets me.

Now sure, I may also have been known to tear up at a really well constructed Coca-Cola commercial, BUT STILL. It’s a pretty amazing sight.

I mean, think about everything this moment – wearing the respectable yet still-uncomfortable heels Mom insisted you’d need for job interviews and carrying the mortarboard hat you stayed up until 2am decorating with scrapbook material from Target – represents.

It doesn’t only represent the end of your childhood. It represents the beginning of the rest of your life – the part where you start down the path you’ve chosen over the past 4-6 years, and continue down that path until…maybe…forever? AND EVER? Let’s hope you made the right choice (nervous laughter). BUT NO PRESSURE. Enjoy your day!

Oh right. That’s where that glint of terror in their eyes comes from. It’s hiding behind the breathless anticipation of all the pomp and circumstance, sure, but it’s there.

There’s an exuberant finality to this Hallmark-approved milestone that makes graduation both really, really exciting and really, really scary, all at once.

When I was a kid, I always thought of adulthood as this time where you’d become A Thing – a doctor, a lawyer, the president, a rock star – and then you did that Thing for the rest of your life.

But speaking as a Certified Grown-Up (GU-C) myself, I think we need to rethink our thinking on this. Mentally committing yourself to one profession for the rest of your life at the age of 22 feels a little like preparing for years to climb Mt. Everest, finally making it to the top, and then pitching a tent (presumably a very small one) and staying there FOREVER.

Yes, graduation day is exciting. But it’s really just the beginning of the rest of your life – just like every day is the beginning of the rest of your life. (Except this one comes with a really good party and thirty years of loan repayment.)

I guess what I’m saying is that if you’re not sure you’ve found your Thing by the time you’re standing there with that heavily decorated cardboard square on your head, don’t let it get you down. Even those of us who thought we’d found our Thing by the time we graduated from college, or grad school, or insert-milestone-here, later realized that the person we’d become wanted to do another Thing altogether.

Because that’s life. Life is evolution. The person we are at 22 might not be the person we are at 30, or 40, or 55. Each of those people has learned some new stuff about themselves and the world, and the super fun thing about all of this is that each of those people gets to decide to change course and start doing a completely different Thing if they feel like it. It might not be easy, or cheap, but it’s your choice to make.

So with that, here’s to all my soon-to-be-former patients: enjoy the party, tell Sallie Mae I said hello when she comes calling, don’t forget to get that repeat Pap in 6 months – and in the meantime, just do the Thing you think you’re meant to be doing, right now. The rest will sort itself out in the end.

Dear too-many colleges: here’s why you’re next in line for a Title IX suit

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Another week, another famous institution of higher learning in the news for mismanaging cases of sexual assault on campus.

This time, it was Harvard. The most common response, from what I can tell, seems to be summarized thusly: “Oh myyyyy – even at Hahvahd?” (eyebrows raised in surprise, mouth forming a delicate “o” of prim concern).

The morning the story broke in the local news, I happened to be having lunch with these two guys who work in administration at a nearby college. Guy #1 says to me, “So, have you heard about Harvard? And the sexual assault case?” Why yes, yes I have. Guy #1 continues, in a voice of genuine concern: “So, what can we do to keep people from drinking so much?”

Guy #2 murmurs in agreement, eyebrows knitted with empathy.

LADIES AND GENTLEMEN. EXHIBIT A. This, right here, is the crux of why colleges keep finding themselves in trouble when it comes to dealing with sexual assault.

I know, I KNOW. It’s not like Guys #1 and #2 are alone in their thinking here. Just read the comments section of any article on the college-sexual-assault topic for a primer on the latest and greatest in victim-blaming. The idea that intoxication negates one’s ability to provide consent seems to be a logical stretch for quite of few of the world’s armchair analysts.

But here’s the thing. I don’t really care if some random dude with a laptop disagrees with whether rape is rape when alcohol is involved. I mean, I don’t like it, but one guy with an opinion just doesn’t matter all that much. The extent of his power ends once his opinion’s been expressed.

However. If you’ve made a career for yourself in college administration or college health, and you continue to think that the epidemic of sexual assault on college campuses is really about excessive drinking and morning-after regret, don’t act shocked when your school is next to hit the news with a Title IX suit and a bunch of unflattering media attention of your own.

Yes, you could be the next Harvard. Or Dartmouth. Or Mizzou. Because sexual assault is happening on college campuses EVERYWHERE. It has, without question, happened on your campus. And if this common-yet-ultimately-wrong-minded perspective frames how you choose to respond to a sexual assault survivor’s case once it’s been brought to your attention, there’s a good chance that survivor will feel justifiably wronged. And, if they’re feeling brave enough, they just might decide to take this dissatisfaction with you and your colleagues public. Very, very public.

Don’t misunderstand me. I’m not denying that there’s a problem with binge drinking on college campuses that we need to address. But it needs to be addressed as an issue that’s separate and distinct from that of sexual assault. After all, just because it might be easier to mug someone who’s walking home late at night after they’ve had few drinks with friends, it’s not like the mugging itself isn’t still a crime.

I mean, someone who’s been attacked and robbed isn’t told by the authorities that their mugger didn’t REALLY commit a crime, because, y’know, you WERE pretty wasted, after all, and maybe sorta kinda asking for it by walking down the street in the middle of the night. I mean, who’s to say you didn’t HAND that aggressive stranger your money when he asked nicely? Who knows? He said, she said. You know what? Let’s just chalk this one up to youthful indiscretion and a lesson learned.

Hell no. Safety bulletins are sent out, city and campus police start patrolling overtime, and no one rests until the assailant’s been caught.

Intoxication may make a predator’s job easier. But it doesn’t make them NOT a predator.

In a perfect world, everyone would GET THIS, and this tortured public debate over what-is-or-isn’t-rape would cease to exist. I’m not naive enough to think that sexual assault wouldn’t still happen – because some people are terrible human beings – but society would deal with it the way it does any other violent crime. Meaning a) those who choose to commit a crime are consistently removed from the community for the safety of others, and b) the threat of criminal charges and incarceration might make some of the would-be assailants of the world think twice before committing assault. Both of which would result in less sexual assault. And I’m pretty sure we can all agree that less sexual assault = GOOD.

Those of us who work on college campuses need to be held to a different standard than Random Laptop Guy. You can’t hold regressive and harmful views on a topic as important – and yes, public – as sexual assault, with those views shaping your institutional response to individual reports of rape, and NOT expect that it might come back to bite you someday.

Unless, of course, you’d been hoping to end up on the front page of the Globe someday. In which case, vaya con Dios, my friends.

The luxury of time

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I have had a lovely week.

Really. I mean that. I’m not just talking about the perfectly-grilled steak I had for dinner last night, or the fact that I’ve been lucky enough to find Girl Scouts selling cookies at my subway stop, even though those were definitely highlights.

No, this week was something special. This week, I was able to be the health care provider I always want to be, the kind I always aspire to be, the kind I hope I’ll be able to be on any given day. With every patient.

Except I typically have at least 3 patients waiting and OH WAIT another double-booked emergency visit between me and this shining ideal. But not this week!

Why? Because as a grown-up woman, I’ve found myself once again completely, swooningly in love with that unique college tradition known as Spring Break. While most of my patients spend the week in exotic locales, enjoying all-inclusive cocktails and remembering what it feels like to experience above-freezing temperatures (MUST BE NICE), I get to stay behind inside the endless polar vortex, holding down the clinic-fort and taking care of the students who are opting out of paradise in order to spend their week sleeping in and catching up on House of Cards.

But that’s okay. My week may not have involved jell-o shots, but it did involve something even more delicious: time.

The clinical schedule was relatively light, but steady. Functionally, this meant that I was able to spend about twice as much time with each patient as usual.

Functionally, this meant that when I thought this one patient and I had reached a decision point, only for the patient to stop and ask to explore, from the beginning, a completely different possible option, I didn’t internally groan and look at the clock.

Functionally, this meant that when another patient continued to send me wordless signals that she was still worried that Something Serious might be going on beyond being unlucky enough to catch a third cold this winter, I dug a little deeper and asked, and listened, and talked until the signals indicated relief.

Functionally, this meant that when a different patient decided to “oh, by the way” me as our visit was ending with a completely unrelated, and much more complicated, symptom of concern, I asked her to tell me more with a warm smile. And I meant it.

It made me fantasize about an alternative reality: one where I’m empowered to spend as much time with each patient as the patient needs – as much time as we both might need – to feel confident that I’ve done everything I can do on that day, in that moment. Fewer patients might be seen. Which means the clinic might need to hire more providers. Which, I’m quite certain, won’t be happening any time soon.

Spring Break can’t last forever. The party has to end sometime.

But the memories last forever.

When “good” isn’t good enough

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Dear parents-of-college-students: before you decline your kid’s college health insurance plan because you have “good insurance”, please check to make sure that “good” will be good enough.

Recently, a patient came to see me with a history of recurrent ovarian cysts. She presented her story like it was old news, since this has been happening to her since she was 14 – or in other words, since well before she left the comfort of her parents’ home for the big wide world of college.

Her issue is that three or four times a year, she experiences what she describes as several weeks of progressively intense unilateral lower abdominal pain, culminating in severe pain (which she assumes is from a cyst rupturing) that eventually resolves on its own, with the help of lots of pain meds and missed class. 

Generally speaking, she manages things on her own, but yesterday, the pain was worse than usual. Her prescription NSAID wasn’t cutting it. She’d missed a midterm. I had a few questions: who does she normally see for this? When was the last time she’d had a pelvic ultrasound or any other imaging? Was there a plan to change her birth control pill, which she was ostensibly taking to keep things like this from happening? Was it time to dig a little deeper, to see if maybe something else was going on?

Well. It turns out that she hasn’t seen a health care provider (besides our college clinic) in years. Why? Because she grew up in New York. Her parents continue to live, and work, in New York. Their insurance allows her to be seen by providers in New York, and to have labs, and imaging, and procedures, and pretty much anything medically-related she might ever need, in New York. I’m sure it’s very “good” insurance – in New York.

If she actually lived in New York, well, that would be just fine, wouldn’t it?

BUT SHE DOESN’T.

I know, I know. Parents have a hard time thinking of their grown-up kids as no longer living with them. Sure, they’re away at school, but that’s just temporary. Their permanent address is still here with us, at home, right?

Hold up. If your college kid wants to keep listing your house as their permanent address while they’re bouncing around between dorms, sublets, and friends’ couches, living the typically transient life of an undergrad, that’s all well and good (after all, those parking tickets have to be sent somewhere).

But they need to have medical coverage in the place where their physical body actually spends the most time. If you live in California, but your daughter goes to school in Arizona, the place she needs coverage is Arizona.

You might be thinking something like this:

“I’m not worried. We just schedule her routine care while she’s home on break.”

Great, but what if she needs care that’s non-routine? What if something happens in the middle of the semester that might not meet criteria for being rushed to the ER, but really warrants being evaluated by a gastroenterologist, or a cardiologist, or whatever-ologist this week or the next, rather than months from now when she happens to have a few days off from school?

And what about that time – that not-too-distant time – when she stops coming home every summer or spring break? When she gets an internship, or a part-time job, or decides to take classes over the summer? How do you expect her to be able to get even routine, preventative health care if her insurance doesn’t allow her to have Pap tests performed in the state where she lives 95% of the time?

“Well, our insurance is pretty good. I’m sure she’ll be covered.”

Really? You might be surprised. One way that insurance companies trim costs is to limit where you can access care, so even if you’ve been pleased as punch with your plan’s low co-pays, and local provider network, and coverage for fun stuff like acupuncture, you can’t assume it covers anything beyond emergency care once you – or your dependents – leave the state.

Back to my patient from New York. Our options were limited to this: ER or no ER, since emergency care is all that her plan covers here in the state of Not-New-York. Beyond bringing her to an ER, my hands were tied – I couldn’t run labs; I couldn’t order an ultrasound.

Even though she was in pain, she didn’t want to miss yet another midterm. So against medical advice, she refused to allow us to transport her to the ER down the road, and instead returned to her dorm room, clutching her lower right side, with strict instructions to call the campus police to bring her to the hospital if things got worse overnight.

Had I been these parents, had this been my daughter, I would NOT be okay with this state of affairs. I would insist that we find a plan somewhere, somehow, that allows my daughter to access medical care where she actually lives. And I would insist a whole lot harder if she had a chronic or recurrent medical condition.

If, despite my best efforts, I couldn’t find a plan for our entire family with decent in-state and out-of-state coverage, I’d look really, really closely at the plan offered by my daughter’s college before checking the little “waive school insurance” box hidden somewhere within all that orientation paperwork.

So. My humble request to the college parents of America is this: if you’re planning on waiving out of the health plan they’re offering through your kid’s school, please, please, PLEASE read the fine print, or pick up the phone and sit through the terrible hold music until you get a human being to talk to, and find out whether your plan covers medical care – specialists, labs, imaging, etc. – in the state your child is about to move to.

Those insurance premiums aren’t cheap. So make sure they’ll pay for the care your family actually needs.

Disordered thinking

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Dear Future Teenage Daughter,

A new patient came to see me today.

She had the front desk describe the reason for her visit as “question about eating disorder”. As it turns out, the question was, Do I have an eating disorder? Spoiler alert: the answer was yes.

The shocking thing about this visit was that she had to ask the question at all. Here she was, with far too little weight hanging off her lanky frame, over 15 pounds down from when she entered college two months ago – an inverted Freshman Fifteen. She hadn’t had a period since summer. She’d been spending enormous amounts of precious mental bandwidth coming up with ways to keep her daytime calorie count below 200 until allowing herself to “eat whatever” at dinner – as long as “whatever” didn’t include carbs, meat, or human portions.

While her weight had fluctuated over time, this wasn’t even the lowest she’d been; she’d actually hit 5 pounds below this about a year ago. While she was still in high school. Living at home, under her parents’ watchful (?) eyes. Surely they’d noticed the fact that their daughter was wasting away. And, um, not eating. Two big clues that something’s wrong. Right? I mean, one would think.

Nope! In fact, dad suggested she start exercising. Because she was always complaining about feeling tired and dizzy. Surely, exercise would help. No comment from the peanut gallery over here, but… REALLY?

The sad fact is that most anyone working with adolescents and young adults will become a de facto eating disorder quasi-expert. It’s just that prevalent.

And disordered eating is a sneaky, pernicious thing, because most of the time, it’s not even named. Instead, we all talk semi-obsessively about dieting, and exercise, and ideal weight, and relative thinness and fatness and blah blah blah, being absolutely HORRIBLE to ourselves and to each other with our impossible standards of weight acceptability. That is, until someone somehow ends up with a diagnosis, in treatment, and then suddenly everyone’s all “Oh, how absolutely tragic! That poor thing. Eating disorders really are the worst!” Like it’s this thing that only affects “other people”.

So why am I telling you about this visit? I mean, I just told you about how common it is. “So then who cares, mom? Gawd, you’re totally embarrassing me. Can you just drop me off down the street and we can pick this up some other time?” (Don’t lie – that is SO future you. I can see it now, eye roll and all.)

Well, it’s a funny story. I happened to have discovered my diary from high school last week. I easily lost an entire evening escaping into the past. And in between complaining about my totally unfair geometry teacher and crushing on the boy in summer school whose name I couldn’t remember, I’d somehow found the page space to devote to bemoaning how fat I was. Good times.

It made me wonder how much of my life I’d spent being unhappy with my weight. A lot, I realized. Too much. This despite the fact that I have always been a strong, healthy, curvy, feminine and fabulous female. (WOW THAT FELT GOOD.) I may not have engaged in disordered eating – apart from that sad month in high school where I ate nothing but oranges during the day – but I have most definitely engaged in early and ongoing disordered thinking about eating.

This is Not. Okay.

So here’s what I want for you. I would like for all those brain cells that could be devoted to thinking about how fat that cupcake is going to make you to be spared for more important things, like playing, and living, and learning, and maybe saving the world (a little).

I have to be honest. I don’t even know if this is possible anymore. Society is pretty terrible right now when it comes to weight imagery. It’s inescapable, even for kids. Seriously, every girl doll on the shelf at Target has these bizarrely narrow twigs where the arms and legs should be. It’s like the toy designers looked at Barbie and thought “UGH, what a heifer.” And I didn’t even mention the everything else, everywhere else, on TV and beyond.

But I know one thing I can do. I change the way I talk about myself. I can talk about exercise making me strong, and how I like shopping for different clothing colors and patterns, all without using the words “fat” or “skinny”. I can model strength and confidence as independent of my pant size.

I can teach you to be a critical consumer of media, and celebrate what it means to be and feel healthy, and tell you how beautiful you are, just exactly the way you are right now.

If my patient’s parents had done these things, would she still be sitting in front of me, asking me whether starving herself is normal?

I don’t know. But maybe it would have at least made her parents a bit more aware and perceptive. And maybe they’d have noticed something was wrong a long time ago. Maybe they could have even answered her question themselves.

It’s a decent goal. But for you, I want more. Let’s aim for never needing to ask the question at all.

Identity crisis

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I’m pretty sure that for just about anyone who’s worked anywhere, ever, a favorite water cooler or dinner party topic is how busy everyone always is. “How’s work?” “Oh, you know…busy.” Followed by a deep sigh of exhaustion, as if to say “I DARE you to top my inhuman level of busy-ness. I mean, seriously. Most mortals would be crushed under the weight of my workload.”

So maybe take what I’m about to say with a grain of salt.

I work at a college health clinic. It’s October. It’s busy. Crazy busy. It’s pretty much nonstop busy from September through May, minus a couple of holiday-related slowdowns. And because we’re human beings and have a vested interest in preserving our own sanity, conversations among the clinicians at work frequently veer into the the realm of trying to find ways to decrease demand for clinical services. Meaning, get the students to stop coming to see us quite as often as they do now.

There are several ways to decrease demand:

1) Be really lousy at your job. Be unfriendly; give crappy advice; deliver unwarranted lectures on personal responsibility when your patient just wants Plan B. The more you suck, the more likely it is that word will spread about the poor quality of care available at the student health center, and the less likely it is that students will ask to be seen, leaving you more time to online-shop for the holidays. BAD IDEA NUMBER ONE.

2) Turn people away when your schedule is full. On the surface, sounds reasonable. This is how most of the non-ERs of the world match supply with demand. And speaking of them, there are several hospitals with high-quality ERs nearby. But take my word for it when I say that all it takes is one or two letters to the president from well-connected, pissed-off parents to make this BAD IDEA NUMBER TWO.

Now we start to veer into the realm of magical thinking…

3) Make it so that people get sick less. Aside from giving out free flu shots (done) there’s not a lot we can do here without a really fancy magic wand. The vaccines against colds, lacerations and pregnancy remain in development. Fantastic but impossible and therefore BAD IDEA NUMBER THREE.

4) Teach the students how to take care of minor complaints on their own, without coming to see us. In other words, ask them to be fully mature, self-sufficient adults, with the life experience that allows them to already know what to do when they get a runny nose, or get a little scraped up falling off their skateboard, or burn their hand on an over-microwaved slice of pizza last night.

“Can you believe the things these kids come in here with? I would never IMAGINE going to see my health care provider for something like that!”

OF COURSE YOU WOULDN’T. You’re a middle-aged adult. You have kids of your own. And you’re also a health care provider yourself, BTW, which gives you an unfair advantage.

I’ll be honest. I’m not immune. Last week a kid came in to see me because he was afraid he could have gotten rabies from eating a sandwich made with a slice of bread that shared a loaf that MAY have been nibbled on by a mouse. I’m not making this up.

But therein lies the dilemma. What is college health? Why do we exist? Are we an urgent care center, one step above advice from the CVS pharmacist (and/or Google) and one step below an ED? A quasi-Planned Parenthood, meeting all your contraception and STI-related needs? A primary care provider creating a medical home-away-from-home for young adults? Dispenser of free condoms and hand sanitizer? Host of awkward health promotion talks that nobody attends besides the health science students?

YES.

But we’re even more than that.

I had a minor epiphany a few weeks ago while I was dropping off my kid’s immunization record at the school nurse’s office. Two little girls, I’m guessing 3rd or 4th graders (which made them look like GIANTS next to my tiny kindergartener), ran into the office. One of them had fallen down on the playground. She’d scraped her hand. Classic palmar concrete burn. The nurse leans over the desk, glances at the hand, and sends her over to the sink to wash it off, then gives her a colorful band-aid and a baggie full of ice.

If that school nurse spends her days complaining about the kids coming into her office for minor abrasions, then she’s in the wrong line of work.

Your average college student may look like a fully formed grown-up, but in many ways, s/he’s not. Until now, if they’ve experienced physical discomfort, they’d go tell someone about it. That person takes care of it for them. Maybe that person is Mom or Dad. Maybe, if the discomfort happens at school, it’s the school nurse.

Our patients are really only one overly-long high school graduation ceremony removed from this earlier, easier stage of their lives. They’ve entered that awkward phase of life where technically, and according to the U.S. military and casinos everywhere, they’re adults. Yet they still have a pediatrician as their PCP. And they still need someone to help them figure out what to do when they fall down on the playground. (The playground is just a little larger now. AND FULL OF HERPES.) (Just kidding.) (Sort of.)

So the thing is, we need to be that, too. Whether we like it or not, we’re as much school nurse as we are urgent care or PCP. College health centers need clinicians with a higher level of training than your average school nurse, since our patients are also busy becoming professional insomniacs, and swimming in giardia-infested water holes in Nicaragua, and having lots of unprotected sex on spring break in Punta Cana, and spreading strep and norovirus around campus like wildfire. But at the same time, our patients still need someone to show them how to wash the gravel off their hand and cover the ouchie with a band-aid. Because next time, maybe they’ll find the sink themselves.

If we spend all our time complaining about it, we’re in the wrong line of work.