On Mondays, Wednesdays, and Fridays, Rachel Dodek can remain relatively calm about her 6-year-old Alex, newly diagnosed with Type 1 diabetes.
But Tuesdays and Thursdays, when John Hancock Elementary doesn't have a nurse on duty, are excruciating.
An agency nurse is supposed to visit those days to check the first grader's blood sugar and administer his insulin - but someone doesn't always show, and even when someone does, the care is inconsistent, his mother said.
"I'm on edge from the time I wake up on days when I know the regular nurse isn't there," Dodek said.
Years of cuts, combined with a higher-than-usual number of retirements and other staffing challenges, have resulted in an unprecedented problem for the Philadelphia School District: Three city schools have no nursing coverage at all. Sixteen more have no regular coverage.
District officials blame the staffing challenges and say that they are working diligently to fill a handful of vacant positions, that they want to find ways to add health services despite a brutal budget.
But to those on the front line, those words ring false. They see only danger for vulnerable children.
"This has nothing to do with what's best for our kids - it has do with money and what they can cut," said Denise Morris, the nurse at Lamberton Elementary, who feels fortunate to be assigned to just one school all week. "So many of our kids don't have advocates, but this is unsafe."
Diagnosed with diabetes two months ago, Alex is already a pro at performing his own glucose checks, and cooperates matter-of-factly with insulin injections. He likes the days when the regular nurse is at Hancock, on Morrell Avenue in the Northeast.
Less comfortable for both Alex and his parents are the two days each week when an agency nurse is assigned to check his numbers and administer his shots.
"The first week of school, no one showed up, and now, every single week someone doesn't show up," Rachel Dodek said. She works as a florist at a grocery store a few blocks from the school, and on days when no nurse shows, an understanding manager allows her to clock out, run to Hancock, and give Alex his medication.
But that's time she's not paid for, and even when the nurse does show up, there have been problems: an injection administered incorrectly, Dodek said, a glucose gel given to Alex in error.
"The principal always apologizes, but it's not the school's fault," said Dodek. "When my child is in school, it's their responsibility to make sure every one of his needs is met, and the school system is not holding up their end of the bargain. It's unbelievable."
Christina Jackson is no less upset, but more resigned.
Her second grader, Robert, attends Nebinger Elementary in South Philadelphia. He has severe allergies - to peanuts, eggs, wheat, and milk, among other things - and needs monitoring, but Nebinger is one of the schools with no regular nursing coverage.
So Jackson sends Robert to school with a bottle of Benadryl, an EpiPen, and a prayer.
"I just give all the information to his teachers, to the principal, the lunch lady," Jackson said. "But just in case something would happen, you want a nurse there. They would know what to do."
Jackson is used to coping with scant nursing coverage. Her daughter Aaliyah, who died of a genetic condition at age 9 in 2013, needed a tube feed every three hours.
Aaliyah attended the now-closed George Washington Elementary, which had a nurse two days a week. School officials told her she could instruct the girl's teachers how to feed Aaliyah on days when a nurse was not in the building, Jackson said.
But she was never comfortable with that proposal for the medically fragile girl, so Jackson ran to the school every three hours to feed Aaliyah herself. As a result, she couldn't work.
Sabrina Jones' son, Vincent, also needs a feeding tube and daily nursing care. When Vincent left Lingelbach Elementary, which had a full-time nurse, for a class with more supports, she was given a choice of two schools - one close to her home, one a little farther away, one without a five-day nurse, one with one.
She picked Houston, the longer ride for Vincent. She felt she had to.
"Inconsistency is a problem," said Jones. "I picked Houston because they have a full-time nurse."
Superintendent William R. Hite Jr. last week said that he hasn't been comfortable with the nurse staffing levels for "a long time."
The district began exploring outsourcing some health services in the spring. Hite said that the plan was still on the table but that he would do it only if it meant getting more nurses and other medical staff in schools.
A five-day-a-week nurse should be the norm, he said.
"That should be available at all schools on a daily basis," he said. "That's across the city, across sectors."
District nurses also staff private schools, many of which have similar low levels of coverage.
The idea of privatizing nurses has some serious opposition, including from Council President Darrell L. Clarke. The teachers' union, which represents nurses, is also staunchly opposed.
So are the nurses themselves, who say the answer is to expand their numbers. Regardless, parents and nurses are calling out district leaders to address the crisis.
At a School Reform Commission meeting Thursday, Peg Devine, the nurse at Lincoln High, urged a remedy to what she called the "potentially lethal" situations allowed to occur daily.
"This game of Russian roulette," Devine said, "has to stop."