By now, Philadelphia's beleaguered public schools are accustomed to doing without things that elsewhere are givens: paper, textbooks, cleaning supplies.
But this year, some schools lack a service covering their most basic of needs: a school nurse.
Three Philadelphia School District schools have no nurse coverage at all this year, officials confirmed, not even once a week. A higher number - 16, nurses say - have no regular coverage, but do have a nurse assigned to check on the school if there is a spare moment.
School system officials, coping with the cumulative effects of years of cash shortages, say they are doing their best to remedy the situation, but those on the front lines are furious.
"This is simply ridiculous," said Melissa Wilde, mother of two children at Jackson Elementary in South Philadelphia, which currently has no regular nurse coverage.
"It's scary," said Linda Giangiordano, a district nurse assigned to four schools. She's been asked to fit Jackson in when she can. So far this school year she's made it there twice.
For those scrambling to cover caseloads of more than 1,000 students, the worry is constant. Last week, Giangiordano happened to be at Key Elementary when a second grader went into cardiac arrest.
"She fell over in the classroom; the teacher was calling me frantically. The little girl had no heartbeat when I got there, and I did CPR, and thank God, I got her back," said Giangiordano. "Everybody was so upset, and they just kept saying, 'What if I wasn't there?' "
District officials say the current staffing levels result from a higher-than-usual number of retirements, workers on disability, recent resignations, and a market where nurses have plenty of other job options.
"You've got a perfect storm," district spokesman Fernando Gallard said. "There is no lack of focus and priority in regards to the students' health in the district."
Central office staffers are working to fill 10 nurse openings, and aim to have every school covered at least part time as they make hires. Four candidates are in the interview process, officials said, and more are just waiting for background checks.
Karyn Lynch, deputy of student services, said that in schools where there is no or infrequent nurse coverage, "we're looking at the medical needs of the children in those schools constantly."
If a student in one of those buildings needs care, the district hires an agency nurse to provide it, Lynch said.
But critics say that the school system places too low a priority on students' health needs in general, and that years of cuts have resulted in an untenable situation.
Nurse Joanne Packer was supposed to split her week - three days at Wagner Middle School, two at Lincoln High. But the staffing crisis pulled her out of Lincoln - leaving that school of 1,500 students with one nurse - and routing her to Cooke Elementary, which otherwise would have had no nursing services.
But her days at Wagner are complicated: Because a student at Cooke is an insulin-dependent diabetic, Packer must leave Wagner midday, drive to Cooke, measure the little girl's lunch to make sure her carbohydrate balance is correct, and administer her insulin.
If the girl's blood sugar is off before Packer arrives or after Packer leaves, there's no medical professional to help.
"I never leave feeling good about it," said Packer. "It's just been such a rocky year."
The scant nursing coverage sends a message, Packer said.
"I just don't believe that the health piece and the liability piece is in the equation that they use when they talk about schools," she said. "It just doesn't seem to factor in."
Stephanie Stover McKenna, Key's principal, said she feels lucky to have Giangiordano's services two days a week - she knows other schools have it worse.
She and most other Key teachers are trained in CPR and first aid, but the day the girl had the cardiac episode, no one recognized it but Giangiordano.
"We're not medically trained," Stover McKenna said. "When a situation arises, we don't read the symptoms as quickly as a nurse would."
Stover McKenna said she "feels this overwhelming pressure, and you make do, but we shouldn't have to make do. These are kids' lives."
Lisa Ciaranca Kaplan, the principal of Jackson, used to have a nurse 11/2 days per week.
When that employee left for a school nurse job in the suburbs at the end of the term, Kaplan feared that she would be on her own, despite the fact that a Jackson first grader died in 2014 after falling ill at school on a day when there was no nurse. (Sebastian Gerena, 7, had a congenital heart defect; it's not clear whether a nurse could have prolonged his life.)
"You'd think we'd have someone, especially in light of what happened last year," Kaplan said. She received an email Thursday, saying a new nurse had been hired, and she may see her in two weeks.
Though Kaplan tries her best - keeping students' medication organized in a large plastic toolbox she keeps in her office, keeping a close eye on kids with known conditions, calling 911 when she knows something is out of her league - she can't do it all, she said.
"I'm barely surviving, and I am resourceful," Kaplan said. "It's very upsetting."
Jackson parents, who have built a thriving community despite enormous challenges, are angry and upset at what they see as a serious safety problem.
Christina Grimes, mother of a Jackson first grader, chalks up the no-nurse predicament to a larger pattern.
"Parents are not happy with the situation, but like so many other issues," Grimes said, "the school is left without basic resources and proper support from the district."
Jerry Jordan, president of the Philadelphia Federation of Teachers, which represents nurses, finds the nurse staffing "absolutely appalling," he said.
"We have so many families living in deep poverty, and for some of these families, the only medical attention they get," Jordan said, "is from the school nurse."