The rape survivor and I talk for ninety minutes.

It’s a long narrative, a complex history of a very vicious and brutal assault.

They talk quickly – they all talk quickly; none of them want to linger long in the memory – and because I can touch type, I keep my eyes on them as my fingers fly quietly across the keyboard, recording as many of their words as I can.

When they finish telling me what happened, we sit in silence for a few moments, staying present in this terrible intersection of a world they used to know, and a future they never imagined would exist.

Then, my patient takes a deep breath.  “OK, this is going to sound fucking crazy, but I swear, it’s true.”

I nod.  “Tell me.”

“You know the sound that a box fan makes?  Like when you put it in a window, in the summer, when it’s super hot outside?  That kind of….that kind of hum?”

“Absolutely.”  I am wrenched back to humid summers in New England, a stuffy farmhouse, the box fan whirring and my mother calling me and my brothers to come have lunch.

My patient wraps their arms around their knees on the emergency department stretcher.  “As soon as I realized what was about to happen…everything inside of me went so quiet. There were no sounds.  It was like I was in an empty room.  And then….then I heard it.”

They pause.

And within that small silence, they begin to hum.

**

I go to McDonald’s after difficult cases.

It’s the only time I ever go there.

I go through the drive-thru, get medium fries and a medium Dr. Pepper, and get back on the I-5.

Just like touch typing, I can eat fries and drink soda without looking at my hands.

And as I come up to freeway speed, my brain slows down in kind, realizing that the day is over.  The evidence is packed and sealed, the photographs and traumagrams reviewed, the written documentation completed and signed.  

There’s nothing else I can do for my patient.

And that’s when I sink into The Swamp.

**

People ask me all the time how I deal with the things I see and hear at work.  All forensic nurses get asked this question; when I used to train nurses to be sexual assault nurse examiners, we had a whole module on ‘self-care.’

(Nothing I ever taught from the module ever worked for me.)

How does one manage this kind of vicarious trauma?  How does one move through a world that shows itself to be violent and ugly and broken?

I have a few standard answers.  

“I put it all in a box, and then close the box, keep it separate from my life.”  

“It’s like a faucet – I turn the water on while I’m caring for a patient, and as soon as I’m done, I shut it off and watch it all go down the drain.”

These are true only in intention.

In reality, the box doesn’t close all the way.  

And the faucet leaks.

**

My patient says, “I knew things were happening to me, but I couldn’t move.  I couldn’t move any part of my body.  It was like I was frozen, frozen in ice, everything cold and silent except for the hum.”

They start crying.

There are never enough boxes of Kleenex in the SANE cart.

“My brain was screaming, fight! FIGHT! Fight and run!  And I didn’t!”

“I believe you,” I say quietly.

“I don’t know why I didn’t fight.”

“I believe you.”

“……I wanted to.  But I couldn’t.”

“I know.”

**

My patients show me which swamp I will inhabit as I head home.

Most of the time the swamp feels like the Swamps of Sadness, and I am desperately pulling  at Artax’s reins.  It is their devastation and their grief.  Everything is cold and muddy, and the rain never stops and it’s just so easy to sink in and feel like you’ll never get out.

Sometimes it feels like the Fire Swamp, and their unmitigated rage explodes out of the ground with only limited warning, igniting everything around it into flame, and together we watch it all burn to the ground.

I am used to these swamps.  They are familiar, a neighborhood dive bar, a worn leather-top barstool in the corner, watered down beer and cigarette smoke and people who will keep you company as they ignore you entirely.  

I know how these swamps feel.

But the most terrifying swamp is nothing more than a brook under a willow tree, crowflowers and nettles and daisies and long purples swirling in the eddies, and as I stand helpless on the bank Ophelia floats past me, silent and at peace with her choice.

When a survivor shows me that they are climbing out on that ‘envious sliver’ above the water, I keep my advocate in the room and leave and find the ED provider and tell them that that patient cannot leave the department, not now, not yet.

There are too many high bridges over the I-5.

**

I hand over another ridiculously small box of useless see-thru hospital tissues and wait until my patient has had a moment to breathe again.

And then I say, “You couldn’t have fought.  Or run.  Even though you wanted to.  It’s not your fault.”

More than 50% of rape survivors experience the ‘freeze’ response when they are assaulted.  They have no control over it – structures deep within their brain, overwhelmed by the collective memories of 400 generations, release hormones that override any fight or flight response that might have existed.

And all movement just….stops.

“That small, cold room?  And the hum of the fan?”

My patient nods, listening.

“Your brain put you there, hid you there, silent and still, because it knew that would be the only way you were going to survive.”

I pause for a moment.  “And you did.”

**

I sit in the swamp, watching Artax give in to despair, eating fries and drinking soda, going 70 miles an hour.  

When traffic slows down in a construction zone, I realize I can hear myself thinking, so I turn Sabaton up to uncomfortable levels, trying to drown it out.

My iPhone tries to scold me, flashing a decibel warning notification.

“You can go fuck yourself,” I say, and turn the volume up yet again.

**

When I finally make it home my ears are ringing.

I collapse on the couch, staring at the ceiling. 

The house is cold, and silent.

I can almost make out the sound of a box fan.

**

This is how I manage my vicarious trauma.

I sit in the swamp, and just…exist.

It takes me about a day, doing almost nothing that requires intense thought or creativity.  Eventually the swamp ebbs and fades, leaving only a thin silvery scar deep inside.

I can’t see it, but I know it’s there.

I know all of them are there.

~ ~ ~

When I was at university my roommate had an awful orange cat.  The cat was prickly, angry, quick to put her ears back and god forbid you had to pick her up.  She didn’t like me, and the feeling was mutual.

I was fighting my way through a four-year degree in nursing, and sometimes, when the stress of school became overwhelming, I would go down with a migraine.  I’d take my meds and pull the curtains closed and turn off the lights and sit in the dark, angry, tired, in pain.

And then the door of my room would creak open a few inches, and this orange feline Herodias would pad quietly into the room, jump silently onto the bed, and sit on my feet.

It was the only time she would ever touch me voluntarily.  I never petted her, and she never purred.

But she would sit, a watchful Sphinx in the sand, until the migraine began to recede.

And then she would stand, stretch, and leave as quietly as she had come.

**

The cat that lives in my house now was one we originally adopted for my mother, searching for a companion for her as Alzheimer’s wore her down to dust and silence.

It was a colossal failure.  The cat was afraid of us and hid for months.  By the time she was willing to be in the same room as a human being, my mother was dead and my father was dying from cancer.

We called her the proximity cat; she would sit near us but she never sat on us.  

After my father died the cat and I negotiated an equitable truce where I fed her and cleaned the litter box and paid her vet bills and, in return, she would throw up on my carpets and shed unbelievable amounts of hair on my furniture.

Thus we have coexisted, planets circling each other in a solar system of fear and acceptance, real and imagined.

She will always be afraid of monsters that don’t exist.

And I will always follow in the wake of the ones that do.

**

As I lay on my couch last night, staring at the ceiling, ensconced in the rain and mud of the swamp, there was suddenly a small thump on the far cushion.

Four small stabby paws walked up my legs and across my stomach.

And then the proximity cat turned twice in a circle and curled up on my chest.

**

And we stayed there for a long, long time.