There are some cases that stay with me– some because I felt a strong connection with the patient, and some because something particularly memorable brought them to the hospital. At least in this case, both are true.
(All identifying details have been omitted or changed.)
She didn’t come in on a gurney, like most of the patients brought into the emergency department. She stumbled in, held upright by a police officer. At first, I figured she must be drunk or high, but when I looked more carefully, I saw the leg irons that made it so difficult for her to walk. Another police officer came in behind her, with a tight look on her face that I didn’t understand yet. I looked at my patient, who was plaintively complaining about the discomfort of the handcuffs around her wrists. She looked about 12 years old. I said hello and introduced myself, and then asked why she was here today. She looked at the floor. The officer holding her arm responded for her: “She was raped.”
I’d like to say that I did what I was supposed to do- go to the attending physician on duty, calmly talk through the case presentation, and request that the handcuffs and leg irons be removed. I didn’t. Instead, I glared at the officer and demanded to know why a child, following a serious trauma, was being treated like a criminal and put in restraints. As you, my wiser Reader, may have already guessed, this caused the officer to bristle onto the defensive and snap at me, “Lady, this is my job.” At this, his partner came over, and after a whispered conference with her, the officer agreed to remove the restraints, as long as a police officer remained with the child at all times. (Knowing that there’s no way I’d tolerate anyone forcing their presence in the exam room during a rape kit, I thought, “Fat chance;” but decided to cross that bridge when we came to it.)
Over the course of the next few hours, I learned a lot more about this patient: She was 14, and had run away from home two weeks previously. She wanted to be with her boyfriend, whom her mother didn’t approve of. I silently agreed with the mother when I learned that the boyfriend was 23 years old, and had broken up with the patient’s adult aunt to start “dating” my patient. She told me, tearfully, that he was really nice to her, and that she loved him.
At first, she did not want to have an exam. The attending physician, along with the female officer, who was really a very kind and gentle presence, and I, all sat with her in the exam room. I had listened to this child’s story in an agony of confusion and sadness– what to say? I believed that she should have the rape kit, because I believed there was enough evidence to suggest that a rape, statutory or otherwise, had occurred. But I also believed that a gynecology exam, done against someone’s will, is tantamount to sexual assault. I would not have any part of talking her into an exam that she didn’t really want.
My shift had ended at 8pm. It was now 10:30pm. I left the room to call my husband and explain that I would be coming home late– I didn’t know when I’d be leaving the hospital tonight. When I went back to the exam room, the attending was coming out– she relayed that the patient had consented to the rape kit and exam, and that she was calling the forensic team now. I don’t know what was said in that room, when I was on the phone, but when I went back inside, my patient was calm and sitting next to the police officer, her head on the officer’s shoulder. (Note: we called the patient’s mother, as we are required to, and the mother refused to come in. This was reported to child protective services, which was, unfortunately, all we could do.)
The forensic team, who have to perform the rape kits, was tied up in another case and took about 90 minutes to arrive. During that time, I sat with my patient. We made a beaded bracelet while she ate a sandwich, and then I prepped her for the upcoming exam, telling her that it would take about an hour, and she wouldn’t have any clothes on, below her waist. I showed her the stirrups that her feet would go in, and assured her that we could give her a sheet, so that she’d be able to cover up, and only the doctor would see her private parts. I explained that there were some parts of the exam that would seem strange: combing her pubic hair, scraping under her nails, and the rectal exam. I showed her a swab, the lubricant, the exam light, and the speculum. I told her that the underwear she was wearing would be kept by the forensic team for evidence. During all of this, as my voice shook and I fought back tears, my patient was quiet. She touched the stirrups and picked up the swab, sweeping it over her cheek. “Will it hurt?” she asked me.
I hesitated. “The exam may feel…uncomfortable,” I stammered.
“Uncomfortable how?” she pushed.
“Well, it may feel strange and…uncomfortable, when the doctor uses her tools to check you out. Down there.” I continued to stutter out these vague phrases, and was ashamed of myself.
“OK. Here’s the deal,” I finally said. “It may hurt. It may not hurt at all. Everyone is different. I can promise you a few things: 1) I will ask the doctor to be as gentle as she can possibly be, and I am sure that she will be; 2) I will work with you to figure out how to make the exam as easy and fast as possible; and 3) you can take as many breaks during the exam as you need to.”
“OK,” she said. “How are you going to make it easier?”
I went through all the options that seemed possible during this particular exam: distraction with an iPad game or movie, deep breathing, guided imagery, and I Spy. She chose to watch a movie, and picked “13 Going On 30.” We started watching it right away, still waiting for the forensic team.
They arrived at last, midway through the movie. I spoke briefly with the doctor and told her of my patient’s nervousness. She immediately responded with kindness, and assured me that she would be very gentle. I went back into the exam room, and told my patient that she could have anyone she wanted in the room with her, and she could also have no one in the room, if she’d rather. She asked me to stay with her, and to hold her hand. In this moment, when I looked at her, she looked younger than 14– younger than the 12 years I thought she was when I met her– she looked about six years old, scared and lonely and lost. I grabbed her hand, and stood next to her head while the doctor and the examiner set up.
I asked my patient if she’d like for me to narrate what the doctor was doing, and she said yes. I told her when the doctor was about to touch her, when the speculum was coming, and when a swab would be going in. She was brave, and she cried– she never asked for a break, and when I suggested one, she refused, saying that she just wanted to finish the exam and get it over with. I held her hand while she cried, and Reader, I cried too.
When it was over, a social worker arrived to take her to a group home for the night. After everything this girl had been through, she was also going to be sent from her family and friends and enter the state foster care system. She would spend her night in an unfamiliar, hard bed, in an unfamiliar, far away place, and my heart hurt, just thinking about it. I said goodbye, and she hugged me tight, both of us crying hard. I left the hospital at 2am, gratefully heading home, but haunted by my patient’s face and that I could not do more.
healplaylove 