A nurse shares her story of sexual assault [PODCAST]

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“I am a nurse who has worked at a rural hospital. My husband is a board-certified family medicine doctor. In the fall of 2020, I was raped by my massage therapist. I know that everyone has an opinion of what they would do in that situation, and I was probably one of those people. However, to my complete shock (quite literally), I didn’t behave in any manner that I would have thought. Much to my embarrassment, I was a nurse who had no idea what to do when I was raped on top of the previously mentioned humiliation.”

The guest is an anonymous nurse who shares her story and discusses her KevinMD article, “There needs to be a better approach to victims of sexual violence.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have an anonymous nurse. She wrote the KevinMD article “There needs to be a better approach to victims of sexual violence.” Thank you so much for being on the show, and welcome.

Guest: Thank you. Thanks for having me.

Kevin Pho: We’ll get into your article and story a little bit, but first off, can you briefly share your story and journey to where you are today?

Guest: I’m a registered nurse, and I am now in a doctoral nurse practitioner program, and I’m actually married to a board-certified family medicine doctor. So I feel like I have, I guess, a lot of unique insight into this that maybe victims of sexual violence haven’t had before. I don’t know.

The story with this particular article is that I was going to a massage therapist for about a year and a half for chronic pain. I was going to a male who was very strong, particularly for deep tissue massage. And then the last time I went, it was just something completely different, and he sexually assaulted me. It’s still hard to say.

But I guess my response to it, and I don’t know if it was unique from being an ER nurse or what have you, was that I did that depersonalization and derealization, and calmly walked out and thought through, I guess, how to respond to it. I’ve since learned that everyone has very different responses.

My thought process of going to a provider that I knew and trusted after that, for the sexual assault forensics kit, actually really worked against me, because most OB/GYNs and family doctors, I’ve since learned, do not actually do those forensic collection kits. So I was actually told to go to the ER after I went to my OB/GYN.

I think it’s really hard for victims to come out and tell people. It’s still hard for me, obviously, to even talk about it and to use the words associated with it. So you go to one health care professional, and she was very empathetic and very understanding, but then you’re told to go somewhere else, particularly an ER in the middle of a pandemic.

And there have actually been quite a few articles, I think, since I even wrote this, on how it’s discouraging for sexual assault victims to actually get the forensics collection kit. And there’s plenty of research on those kits being pretty vital to prosecution. There definitely needs to be something done, and it’s definitely incredibly complicated and multifaceted.

Kevin Pho: Now, you mentioned that there were multiple obstacles to getting those forensic kits. Can you articulate what some of those obstacles are?

Guest: I know I ended up cutting down my article quite a bit. I think the first time I wrote the article, it was really emotional. But I actually called my family nurse practitioner provider first, who works at a family clinic slash urgent care. Just talking to the person on the phone, their response, the fact that the first question they ask you is, “Is this an emergency?” When you’re experiencing rape trauma syndrome, that’s a really loaded question, because you’re thinking, “Well, I’m not dying. I’m not having a heart attack. I don’t even know if this counts as an emergency.” I didn’t know how to answer that.

And then I thought, “Well, maybe if I hint to this person,” because I don’t want to come right out and say it, because it’s really hard to even come out and say. So I think I said in the article that I was like, “Well, I really need to see a female provider,” and the person on the phone just didn’t have the greatest training and just got loud and angry.

So that’s when I hung up and ended up going to my OB/GYN. Since I had already summoned up the courage to actually tell the front desk person what happened, I actually managed to make it through that appointment. But my OB/GYN, who is pretty fresh out of residency, didn’t even know what to do with it, which was surprising to me. She said, “Well, I have to go ask my partners if we even can do rape kits here.” That’s when it finally clicked for me that I didn’t even know. It seemed to me common sense that OB/GYNs would be the first people you would go to for that, and it turns out it’s actually not.

So she stepped out and asked her colleagues, and came back in and said, “We can do an exam for STIs and stuff, but we cannot do a forensic collection kit. We don’t have that. You’ll have to go to the ER.”

And again, that puts me back at being worried about catching COVID. I don’t want to sit in an ER near any men. I don’t even officially trust any people I don’t know at that point, even doctors. I know, gosh, I just recently read an article about Andrew Yang’s wife being sexually assaulted by her OB/GYN. So you have all this stuff running through your head. You don’t think you can trust anyone. The only person you want to go to is someone you’ve established care with, someone you really feel like you can trust.

After this happened, I ended up learning more about it, and I called a SANE nurse and asked her how it works. And they said, “Well, usually when you go to the ER, the SANE nurses actually go over there.” And I said, “Well, if you were called to a family practice or an OB/GYN office, would you be able to do the exam there?” And she said, “Yes, absolutely.” They could have gone and done the exam if someone had just called and asked them, and they would have performed it all and documented it all.

Kevin Pho: What you’re saying is that both your primary care office and the OB office could have called nurses from the emergency room, and they could have come to you in an outpatient setting to perform the forensics and a rape kit. Is that what you’re saying?

Guest: Well, it’s not actually nurses from the emergency room. The emergency room commonly staffs nurses who are SANE-certified. But this is where it gets really muddy. It is very different by state and by county. If you live in a rural health care area, rural areas actually have a higher incidence of sexual assault, and they have fewer SANE nurses. That’s a sexual assault nurse examiner. But actually, the SANE nurses come from, I think, a local crisis center in this particular area and then go to the ER. I don’t even think they’re technically affiliated with the hospital.

Kevin Pho: So what did you do next after going to the OB office? Did you end up going to the emergency room?

Guest: Actually, I think I put it in my article, but I did not go. It sounds so silly now, but every little step that I took after that happened was the most exhausting, trying thing I have ever done. For me, my whole thing that day was just to get to a doctor. And then I tried two, and it didn’t go super great, and then they told me to go to a third, and I was so tired, and I just wanted a shower.

So no. Actually, that was the whole point of the article: By the end of it, I was so exhausted from telling people, and I didn’t know what happened, and from being embarrassed, that I went home and took a shower and never actually got a kit. [Detail removed by the editor.]

Kevin Pho: What are some of the responses that the health care system could have done to improve the situation when you called them? What are some appropriate things that you would suggest that we say in a similar circumstance?

Guest: Right. With the first one, the family practice clinic that I went to, obviously, training front desk people to recognize victims of sexual assault, and to recognize when someone’s saying, “I only want to see a female,” or, “I want to make sure someone else is in the room.” Additional training is always helpful. I feel like that’s something that’s already being pushed. I’ve seen those signs all over my OB/GYN’s office: “If you have been sexually assaulted, please tell someone.”

So the front desk people being trained, and the CMAs and nurses and doctors, sure, having more training is great. But again, if you get a victim in your office, I think it’s important to recognize how exhausting and how hard it is for them to even get to the point of being there, and that you really should call a SANE nurse and just have the exam done there.

I understand the obstacles with that, as far as patient flow and the room being taken up. I get how that can be stressful on doctors, but I think, for how rare this circumstance kind of is, and the fact that if this rapist gets off, then you now have a rapist running around your local area tormenting women, it would behoove any health care professional to just call the SANE nurse, sacrifice a room, and have that exam done there. I don’t even think the doctor has to document much further than what they normally would, and then that they called the SANE nurse and the nurse performed the exam.

Kevin Pho: Now, as you were going through this traumatic experience, what kind of outside resources did you have available to you to help guide you?

Guest: Yeah, it was actually incredibly complicated and incredibly hard. Again, my husband’s a doctor. I’m in a nurse practitioner program. I actually have two undergraduate degrees, and it was like going through piles of papers and laws to figure out what even would have been the optimal solution for this.

Again, the OB/GYN I went to didn’t even know what to do, and the DA, even with some of the laws, was like, “Oh yeah, I don’t know how the SANE nursing thing goes,” because it’s an evolving field that most people don’t really understand. So with my inquisitive nature, I went through PubMed and did all kinds of reading from journals and stuff, but it was mostly stuff I dug up on my own.

And I called a crisis center, which, again, can be helpful that day. I think it was before I went to the doctors. I called some crisis center number I found on the internet, and I cannot remember which one. I could probably look it up on my phone later. But they put me on hold. And the weird part was that while you’re sitting on hold, you’re thinking that they’re helping someone else who has also gone through the same thing, and I didn’t want to take up the time of other people who may need those resources more than me.

It’s hard to understand the thought process, I think, of women who have been through this traumatic situation. Especially in the first few days or the first week, with rape trauma syndrome, your brain is thinking completely differently than it normally would. And so how I figured all this out, the time it took to find it all, it shouldn’t be this hard, and it shouldn’t be this complicated. I’m not sure.

I think with the crisis centers, an interesting obstacle I found was that I wanted to drive over there and just sit outside and take a few breaths before I went in, and I could not find a physical location for them. It turns out, and I understand why, that they don’t like to give out their physical location because of domestic abuse cases. They don’t want to bring any violence to where their crisis center is. But on that same note, it’s also very hard to find because of that, which is a weird obstacle for this situation.

Kevin Pho: We’re talking to an anonymous nurse, and she wrote the KevinMD article “There needs to be a better approach to victims of sexual violence.” I was wondering if you could share any advice from your experience with other victims of sexual assault, especially those in the health care field.

Guest: Sure. I think the important thing to remember is that there is no normalized response, and it is not your fault. Finding someone and telling them right away, whether it’s a crisis center, a doctor, or a police officer, is really, I think, the best way to go through it. You don’t want to have to mentally sort through it alone. There are people who can help.

I actually think it’s something we should probably be teaching in health education classes to our kids. No one covers, “If this happens to you, what should you do?” We learn all kinds of responses to disasters, but not this one. And until this starts getting reported, and we start actually generating proof against these people who prey on victims, they’re just going to keep doing it. We really need to bring it to light and have some uncomfortable conversations.

And I would say, if you work at a clinic and someone comes in and says this has happened to them, and they don’t want to go to the ER or they don’t want to call the police, instead of just brushing them off and getting mad at them for not having the response you think they should have, you should maybe ask why more, and ask if there’s anything you could do to facilitate a comfortable situation for a forensics collection. Because once that critical time, that 48 to 72 hours for collection, is up, there’s no undoing that. You can’t get that evidence back.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Guest: I know everyone can be overwhelmed with what’s going on in the world, and it’s easy to want to protect ourselves and to assume someone should have had an appropriate or a certain kind of response. Rather, as with everything in life, put yourself in their shoes, don’t judge them, and ask how you can help them. And most importantly, listen.

Kevin Pho: Well, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

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