The following speech was delivered Saturday, May 4th at the 2019 Bellingham Forensic Nursing Conference.

To Dr. Chuck Callahan, who saw a cathedral inside an ETU in Sierra Leone, when I saw nothing but despair:  thank you.

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A few months ago, safe at home in the evening, sitting in my recliner, I found myself perseverating on the pediatric forensic case I’d cared for that afternoon. Unable to come to peace with it, I sent Stephanie a text message.

It said:

I had to use a video interpreter for this case.
When the mom started crying, the interpreter began to cry, too
He was trying so hard to keep it together but he was just so upset

And then I texted:

The worst thing is that I don’t actually know if this child was assaulted
But I saw so many suspicious signs and symptoms
I had to pursue it
But, if I’m wrong, I’ve traumatized that mother, that child, their entire family, and an interpreter.

I feel like a monster.

Steph stopped texting me then, and just straight up called me. I answered and heard her voice and started crying.

We talked for a long time, and I struggled to get to the root of why I was so upset. I circled around it and examined it from all angles, tried so hard to articulate it. Failed.

Then, finally, she said, “It’s such a terrible weight to bear.”

And with those words, I suddenly I felt like I could breathe again. The darkness had a name, the monster was identified and made real. These decisions, these choices, these obligations that come with this profession, with this work we have chosen for ourselves: they are a terrible weight to bear.


That case was perhaps the first time I had ever felt the fullness of that weight. They tell you in your training, of course, that you will be called upon to be the voice of the voiceless, the voice of the victim, the voice of the survivor sitting in front of you.

Who will speak for the woman in triage, silent and bruised, cowed by her abuser, by the man who trafficks her, if not you?

Who will speak for the nursing home patient, silent in her dementia but with blood in her diaper, if not you?

Who will speak for the child who loves the parent abusing them, and will protect them at all costs….if not you?

It has to be you, they say. And you – in that rush of empathy and indignant righteousness that all of us feel at some point along the way – you willingly, passionately agree.

What they fail to tell you – or, maybe, what I failed to remember – is that those are the easy cases. And what a brutal thing to put into words, to say that the cases where the assault and abuse are witnessed, photographable, swab-able, able to be articulated and recorded, that those blatant instances of violence are the easy ones.

The hard ones are the ones that appear in a dusky twilight, in a grey mist, in a fog so dense that you only get hints of injury, a sheen of what might be a bruise, an academic guessing game of where-did-that-urinary-tract-infection-really-come-from.

They don’t tell you that when you pull that trigger, call the police, call protective services, push a child or a vulnerable adult off that cliff of mandatory reporting and investigation – when you do that, the weight of the trauma you MIGHT be causing them and their loved ones falls off that cliff too, and takes you right along with it. That that weight presses on your chest so hard, so persistently, that you feel you may suffocate from it long before you hit the bottom.

I don’t think they told me that.

And if they did, I sure don’t blame myself for instantly forgetting it.


This weight is obviously just one of the many wild extremes of emotion we all get to experience in our work as forensic nurses. At one of the hospitals where I work, we collectively call these diverse feelings “the bandwidth.”

As in, “I don’t know if I’ve got the bandwidth right now to deal with this.”

Or, in the case of a wonderful friend and nurse who resigned from our forensic team last year, “My bandwidth is just completely full.”

Some of us operate on a distinct bandwidth, as in, we can take care of three sexually assaulted adults a night with minimal effect, but we cannot emotionally tolerate taking care of abused children.

Some of us operate on separate bandwidths, as in, ‘I’ll see every single sexual assault case you can throw at me, but if you make me take a post-mortem case, Imma be on the next plane to Outer Mongolia.’

Many of us find our bandwidth is actually refreshed by our work; I can certainly attest to this effect, particularly when my survivor is able to feel safe, feel cared for, and feel free to express whatever it is they’re feeling at any given moment. When I can recognize that through my care, they’ve got some of their autonomy back, in whatever form that takes, my bandwidth is wide open, and ready for more.

Two years ago, at this very conference, our team got word that a case that several of our nurses had worked on had resulted in a conviction and sentence of nearly forty years in prison for a serial rapist. Our bandwidths that afternoon were so bright it was like looking at a room full of rainbows.


Then there are the hard ones.

The ones that we remember, only because we cannot forget.

That one case, that when someone says, “What was the case that got to you the most?”, you lie and tell a story of a lesser case, and keep That Big One locked away in a very quiet and silent part of your memory and soul.

The ones that when you finish, sign the chart, file the papers, and clock out of work, you realize that your bandwidth has just up and evaporated, silent signals into air, transmission ended and lost out amongst the blackness of the night sky.


So what do we do? What do we do when we have lost our bandwidth? What do we do when we have fallen off that cliff, suffocating as we fall? How do we reconcile the sentencing of Brock Turner, the Kavanaugh hearings, the conviction of a rapist and pedophile who will serve no jail time – but yet we are still driven to continue this work, to use our voices and our skills to speak the stories and truths of our victims, and to seek the justice and atonement that they are owed?

What do we do?


I can’t tell you what to do.

But I can tell you what I do.

And to do that, I need to tell you a story.


Just before Thanksgiving Day in 2014, I got on a plane in Seattle and flew to Africa. I stayed there for nearly five months, fighting the Ebola epidemic in Sierra Leone alongside some of the best examples of human beings I have ever met in my life. And it was some of the hardest, heartbreaking work I’ve ever done. Our team felt like a collective Sisyphus, pushing a boulder up a mountainside daily, only to see it tumble back to earth with every community outbreak, every ambulance gurney covered in blood, and every child we buried.

One of my teammates was a truly remarkable pediatrician named Dr. Chuck Callahan. Dr. Callahan served on one of the first teams on the ground in our district, and helped establish some of the protocols to care for our littlest patients, whom were inevitably the sickest. The fatality rate for a child under the age of 5 with Ebola during the West African outbreak was nearly 100%.

As Chuck prepared to finish out his contract and return to the United States and start his quarantine, he sent us all an e-mail. And in typical Chuck Callahan fashion, he managed to inspire us all to continue the fight in just a few paragraphs – but from an unexpected angle.

Chuck wrote:

“The construction of cathedrals has long intrigued me.  It is a word picture that can often speak to our lives.  Many of the massive structures built in Europe a millennia ago were constructed over several centuries so that they were started by one generation of craftsmen and completed by their great, great, great grandchildren.  It is astounding that the vision was communicated to these dedicated men and women not only over days and weeks but over decades and generations.  It was work that ennobled man and glorified God.

At the most mundane level for the laborers it was steady, exhausting work.  It was a paycheck that fed their families.  But that is not enough of an explanation for the intricate details in these buildings, some of which the artisans had to know would be out of sight of man on the ground, and only be seen by God.

I wonder whether these men and women ever felt discouraged; people whose education was rudimentary and probably included no more than their craft and the basic skills needed to survive the medieval world.  From the quarry workers endlessly hammering granite blocks to the masons and artists dangling from fragile, precarious scaffolds some vision must have inspired them to continue, knowing that they would never see their work completed.

We are building a cathedral.  The end of Ebola is the first step for this nation.  Our labors today are an investment in the present and future health care system of this nation; a system that will ultimately impact the nation’s economy and improve the lives of all of the people of Sierra Leone.  Every case of Ebola we care for, regardless of the outcome, moves the system forward.  Every teaching moment, every example of servant leadership, every patient covered with compassion late at night, every administrative accomplishment is a step; another stone, another carving, another tile.

We cannot see the end from here.  The work will be completed by another generation.  But we have seen other cathedrals. We know it can be done.

In moments of weary discouragement, disinfectant that is too strong and children that die too soon, it is a vision of the spire that drives us on.

Know that your tireless work is also timeless. 
In the lives of people and of a nation, we are building a cathedral.”


Now. Back to the present day.

I’m going to read that last part again, and change just one key phrase.


We are building a cathedral.  The end of sexual assault is the first step for this nation.  Our labors today are an investment in the present and future health care system of this nation; a system that will ultimately impact the nation’s economy and improve the lives of all of the people of the United States and Canada.  Every case of sexual assault we care for, regardless of the outcome, moves the system forward.  Every teaching moment, every example of servant leadership, every patient treated with compassion late at night, every administrative accomplishment is a step; another stone, another carving, another tile.


When I come home from a forensic case these days, exhausted, heartsick, struggling to align my belief in the innate goodness of the human spirit with the injuries I see inflicted by humans on each other, I can stop and think of cathedrals.

I see the national discourse on rape and sexual assault accelerating as we gain traction in the greater culture, as people across this country, this continent, and this world begin to stand up and say that which only whispered before: This is not acceptable. This is not ok.

I see women standing up to share their story of survival, to tell the truth of their assault. And when I see them, I am humbled. I am humbled by their bravery. I am humbled by the bravery of all women who report, but particularly by the women who step forward a month, a year, a decade, a generation after they were raped. For they know they will never receive the justice they deserve.

But they also know that they are beacons, they are the lighthouse keepers, they are the flame-bearers of a generation to come, a generation where this terrible violence is no longer a dreadful secret, no longer a source of shame, no longer a crime where the victim is blamed.

I look across this room, at every face here, a room full of forensic nurses and their allies, devoted to the care of these survivors, those who have heard and answered the call to carry these burdens and deliver them to the halls of justice – and I see a magnificent, unbreakable foundation.

This cathedral won’t be finished in my lifetime. It will be completed by the generations that follow me.

But I have seen other cathedrals. And I know it can – and will – be done.

Know that your tireless work as a forensic nurse is also timeless.

In the lives of a people and of a nation, we are building a cathedral.


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To read more posts about the West African Ebola epidemic, click here.

To read more posts about forensic/sexual assault nursing, click here.

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Leon, Grand’Anse, Haiti, 2018