I Can

In the past six weeks, I have taken care of 13 survivors of neglect, abuse, rape, and assault.

Seven of them were children.

I’ve been to six hospitals in four different counties, driven more than seven hundred miles to and from emergency departments, jumped the line for a ferry on a medical priority pass to get to one of them, and called hospital administrators three separate times to get special permission to care for survivors outside my home hospital.

I have packaged up endless bags of evidence, including diapers, bras, underwear, shorts, t-shirts, urine, blood, bedsheets, and submitted 8 full sexual assault kits with hundreds of swabs.  

I have measured necks after strangulation, charted endless lacerations and abrasions, and photographed hundreds of bruises, including those that look like belts and those that look like the bottom of a steel-toed boot.

I’ve talked to a dozen police officers, CPS workers, doctors, nurses, social workers, and domestic violence advocates.  I testified in court, faxed traumagrams to child advocacy centers in three counties, and managed to get time-critical medications from an urban pharmacy into the hands of a public health doctor and onto an airplane to get them to a patient in the remote reaches of our state.  

(The meds took me three days and calling more than ten different people to make it happen.)

I made the phone call that got two children removed from their home. 

I hated the fact that it upset me to do it.

**

I got connected to a rural Sheriff’s Deputy about a month ago.

SD:  “Does Hospital A have a SANE nurse?”

Me:  “No, but I might be able to respond; I’d have to make a call.”

SD:  “How about Hospital B?”

Me:  “They don’t have any forensic nurses at all right now.”

SD:  “Hospital C?  I know it’s a little further….”

Me:  “I’m the only SANE nurse on staff there.”

SD:  “Well, I suppose we could transfer all the way to hospital D….”

Me:  “……….you’ll never guess who the on-call SANE there is right now……”

(spoiler:  it was also me.)

**

In my spare time, I’ve helped train 14 new SANE nurses (though my indomitable co-worker had to shoulder the load solo while I was waiting on court for two days).    We drove to Spokane and back to make connections to the nurses on the east side of the mountains, and see the forensic programs they are fighting, tooth and nail, to implement in their hospitals there.  We scheduled three more hybrid classes in 2023, and have 26 nurses coming to Seattle to learn to be Pediatric SANE nurses in less than two weeks.

**

And in the same time period, we lost five more forensic nurses from three solid teams to stress, burnout, job change, relocation, and exhaustion.

**

En route to Spokane, we stopped at a rural hospital to talk to the ED manager about getting some more of her nurses trained as Forensic Nurses.

“Well,” she said, with a sigh and a shrug, “I mean, I know I have a few that are really interested in learning, but it’s so hard to give them five days off the floor to attend class.  The ED is just so short-staffed right now; I can’t spare them….”

**

The only reason that hospitals MUST provide Plan B to rape survivors is because it is state law.  Otherwise none of the Catholic hospitals in the state would even think about it.

The only reason that hospitals cannot bill rape victims for the cost of their ER visits is because it is illegal to do so.  And yet the bills still somehow show up in their mailbox, a clerical error usually due to the complexity of the paperwork and the rapid turnover in registration departments and medical billing.

The only reason that rape surivors get any specialized care at all is because the nurses of this state and this country volunteer their “off” days to be on-call for forensic programs, 95% of which are hanging on only by a thread, easily dropped by hospital administrators and money-counters who have no idea what we do, or how complex it truly is.

And in some ways, the fundamental human lives and rights protected by this work don’t really matter to the American health care system.

Because at the end of the day, there is no profit to be made from beaten children.

**

We make progress, more so here than in other states, but it is glacially slow, weighed down by the summer break that legislators get, the left/right divide, a backlogged court system catching up on three years of rape trials delayed by COVID, a new state law that makes it harder to keep children safe, not enough police officers or CPS personnel or Forensic Nurses or social workers or advocates, or nurse practitioners who want to work in the field of child abuse and neglect to do the follow-up clinic visits.

Sometimes I send them home, adult or child, and just simply hope for the best.

**

Today I sat the the nurses station, reviewing my injury photodocumentation, on the house phone with my consulting NP, on my cell phone with an ED nurse at another hospital, and yelling my first and last name across the nurses station to the charge nurse who was on the phone with a Sheriff’s Deputy.

When all three phone calls finally disconnected, I took a breath and sat there for a moment.

The ED staff nurse leaned on the desk next to me.

“How the hell are you able to do this job?  I just couldn’t,” she said, shaking her head.

I sat there for a moment, actually thinking about the question, trying to come up with an answer.

**

But I found myself thinking of other things entirely.

I thought about my garden, about harvesting zucchini and lettuce and green beans, and watching the roses bloom and sweetpeas climb the fence.

I thought about tomato-veggie-orzo, with eggplant and basil from the CSA, and the beans from my garden, and cherry tomatoes and fresh torn buffalo mozzarella, balsamic vinegar and tomato paste and fresh ground pepper, and the time it took to just quietly and peacefully prep all the vegetables, and listen to nothing but onions and garlic from my winter garden sizzling in the saucepan.

I thought about sitting in a tent by a lake with my friend’s 6-month-old baby, listening to the wind across the water, watching him play, endlessly fascinated, with a plastic bowl.

He walloped himself in the face with the bowl, and burst into tears, and his mother picked him up and held him and suddenly all was right with his world again.

**

There is growth, and creation, and love out in this world.

And while any of it is left within us, there is hope.

**

But I didn’t know how to say that to the nurse.

So instead I just shrugged, and said:

“I don’t know.  But I can.”

~~