Three months ago, I walk into work and the charge nurse immediately pulls me aside.

“Did you finish your SANE training?” she asks.

“No.  I mean, yes.  Well, sort of.”  I was not expecting this question.  I was expecting to head to the waiting room and spend ten hours wrangling the masses in triage.

She lifts an eyebrow.  I feel like an idiot.

“I watched my final observation case last week, but technically I still need to do a case or two under observation.”  After an exhausting, five-day intensive didactic course in Seattle, our forensic program’s clinical training involves a somewhat prolonged version of ‘see one, do one, teach one.’

I’ve made it as far as three ‘sees.’  I have yet to have an independent ‘do.’

Suddenly, I realize why she’s asking me this question, and I’m instantly tense.  “We have a case, don’t we.”

The charge nurse nods.  “She checked in as we were in report.”

“Who’s on call tonight?”

“No one.”

And here’s the crux of the matter.  I am, quite literally, the only person in this entire hospital who has had any training or experience treating rape victims. And I have never done a case alone.

The charge nurse looks at me calmly.  “If you’re not comfortable with it, I will start making phone calls right now.  It’s early enough that I might get a day shift SANE to come in –”

“I’ll do it.”

She raises her eyebrows.  “Are you sure?  You’re the one going to court if it gets there.”

I have been a nurse for eleven years.  I have cared for thousands of people in twelve different hospitals in seven different states and five different countries.

I feel like I’m going to throw up.

But I’m not willing to make this woman wait for hours as we search two counties for another SANE.

“I’m sure.”

The charge nurse nods at me.  “Then it’s your show.”


Four hours later, I send my survivor home with her mother.

The adrenaline letdown is instantaneous.  I am suddenly exhausted, and inexplicably ravenous.  I seriously consider raiding the supply of patient food for some graham crackers and cranberry juice.  I still have at least two hours of charting and processing evidence ahead of me.

The phone clipped to my waistband rings.

I answer.

“Where are you?” It’s one of our PAs.

“Charting in the SANE room.”

He hangs up.  He appears in the open doorway thirty seconds later.  “I need a favor,” he says.


Thirty minutes later, I secure my processed Sexual Assault Evidence Kit in our evidence locker, and walk over to our Emergency Psychiatric Unit.

I chat briefly with the nurse there, sitting behind a triple-locked door of inch-thick wood and a bank of video monitors, one per bed.  I badge myself into the unit, and knock quietly on the second door.

Inside, a young woman lies on her back on a hospital bed, staring at the ceiling.  She was drugged and raped four weeks ago.  She is now suicidal.

She startles at my gentle knock, and sits up.

“My name is Martha.  I’m a nurse trained to help people who have been sexually assaulted.”

She says nothing.

I think to myself, I have no idea what the fuck I’m doing.

I say, “I was wondering if maybe you wanted to talk?”

She hesitates one more moment, and then nods.


Two and a half hours later, she says to me, “I think I can sleep now,” and I smile at her, and leave.

I deliver the evidence from my first case to law enforcement.

I go home, exhausted, instantly asleep as my head hits the pillow.


I have my first nightmare.

/ ~ / ~ /

Six hours into my shift the following night, the triage nurse walks to the back and hands me a handwritten note clipped to a chart.

In triage, my third survivor in two days and I talk for nearly an hour.

I go home, exhausted.


I have my second nightmare.

/ ~ / ~ /

Two weeks later I am working at a small ER in a critical access hospital.  We are enjoying a quiet shift, telling stories, getting to know each other.

The secretary sticks her head around the corner.  “Hey, guys, do we have a SANE nurse at this hospital?”

I look up at her.  “Yes.”

She’s surprised.  “We do?”

“Yeah.  Me.”

She transfers the call back to me.

I answer.


Five hours later, I send my survivor home with her best friend.

I have collected what I expect to be iron-clad DNA evidence from her body.

I submit her kit under an anonymous case number.  She is uncertain if she wants to press charges.

/ ~ / ~ /

Two weeks later, I return home from a stressful car shopping trip in Seattle.  I hate buying cars.  I am tired and crabby and hungry.  I stop to have dinner with my parents.

As I take my first bite, my phone rings.  I’ve set the ER’s phone number to an unusual ring tone, one that sounds like glass shattering.  The number will ring through, even if my phone is set to ‘Do Not Disturb.’

It is the hospital.  I remember, suddenly, that I’ve signed up for SANE call.

“Oh, no.  No no no no.  Not after that car-shopping-shitshow,” I mutter.

And then I answer.

/ ~ / ~ /

Two weeks later, I am at Fred Meyer.  I am standing in the produce section, pondering the relative merits of nectarines versus cherries.

My phone, tucked into my back pocket, rings with the sounds of shattering glass.

I am not on call.  But there is no other reason the hospital would be calling at 9:30pm.

I answer.

/ ~ / ~ /

Ten days ago I arrive at work.  I expect to be working in fast track.  I am not listed on the staffing grid.  Then I see my name at the bottom, next to a small notation:

SANE case en route, ETA 8pm.

It is a complicated case.  It takes nearly seven and a half hours.

/ ~ / ~ /

Four days later, I roll out of bed at noon.  It is my first day off in five days.  As I pick up my phone, a text page from the hospital pops up.

“SANE nurse needed ASAP.   Please call if avail.”

I call the ER.

They answer.


When I arrive at work I lean over the shoulder of one of the nurses in fast track and check the board, a running status of each and every patient in the ER.

She glances up at me.  “Which one are you taking care of?”

I look down at her with shock.  “Which one?”


Nine hours later, after working on both cases, I leave the ER.

I go home, exhausted, instantly asleep as my head hits the pillow.


I no longer have nightmares.

/ ~ / ~ /

I wake up ten hours later.  I am still tired.  I eat breakfast, try to read a book.  I find myself reading the same sentence over and over and over again.  I am thinking about the fact that in six months our forensic team has cared for thirty adult victims of sexual assault, and consulted on more than a dozen suspected pediatric cases.

In a county of just over 200,000 people, we see, on average, two rape cases a week.

And these are just the survivors who come forward.  According to statistics from RAINN, only 3 out of every 10 rape survivors report their assault to the police.

If we’ve only cared for 30 victims, I think, there are probably at least 70 other victims out there.

And unless they walk through the front door of my hospital, they are beyond my reach.


I set the alarm on my phone for a three-hour nap.  I have dinner plans with family.  I put the phone into Do Not Disturb.  I fall asleep instantly.

Suddenly, I am awake, and reaching for my phone.  My alarm is going off.


It’s not.

My ‘wake-up’ alarm is labelled “GET SHIT DONE,” and Stevie Wonder wakes me up every day with an astonishing cover of “We Can Work It Out.”

The sound that startled me awake is the sound of shattering glass.

I stare at my phone.  Glass is broken.  Destruction abounds.

The ER is calling.


In that odd, suspended moment between asleep and awake, I suddenly have an unexpected answer to an unasked question.

Working as a Sexual Assault Nurse Examiner is the best work I will do in my life.
I am good at it.
can do it.
I no longer have nightmares.
It makes me a better ER nurse, for I have again seen suffering, held it gently between my hands, given it a name, and thus all else is relative.

But I am tired
I have logged fifty hours of SANE work in twelve weeks.
I am tired
I have seen three survivors in two days.
I am tired
On the last case, I left the exam room to grab a piece of equipment and found the survivor’s sister sitting in a quiet waiting area, tears streaming down her face, her body shaking with the effort to cry silently.
I am tired
I grabbed her and hugged her and she cried on my shoulder, and then pulled herself together again for her family.

My soul is tired


Glass shattered again and again.

I did not answer.

I fell asleep instantly.

I dreamed of nothing at all.