Wednesday, September 17, 2008

in-SANE


So what about this class I took last week that I keep referring to in kind of roundabout ways? What exactly has all the griping been about?


Well...


I'm now, of all things, a forensic nurse. As in collecting and documenting evidence from victims, and then going to court as a (snort) expert witness. What kind of forensic nurse, you ask? Here's a clue. The acronym is SANE, and it stands for Sexual Abuse Nurse Examiner. The three of us who went through the training are now going to join a small handful (approximately ten) of nurses in our community who will take 24/7 call to do exams on rape victims. We will collect evidence off of (and out of) the victim's bodies, document all injuries (both in writing and with two different kinds of photography), and generally try to put together the most comprehensive written, trace and photographic evidence that we can. In the past week we've learned how to preserve almost any kind of evidence, how to take crime shots like a pro, how to follow a legal chain of custody that won't get your case thrown out of court and what it's like to be on the business end of a speculum for once. (Oddly disquieting, I have to admit. And terrifying. Did I mention that?)


What they can't teach you in class, of course, is how to deal with all of this emotionally. One of the good things about these programs is that as soon as a SANE nurse is activated, so is a social worker/advocate, who is there to deal with the patient's emotional state while we (supposedly) focus unhindered on the physical aspect. I've triaged rape victims before, and always been really relieved to turn them over to someone who knew what they were doing, someone who had a warm touch and the right words, someone with the ability to comfort those who were hysterical or to break through a deep wall of shock and denial. I've handed over paperwork and women in the upright version of the fetal position, and gone back to triage, grateful that my part was over, hoping that some nice, juicy trauma was about to come through the door instead. I'm comfortable with trauma, unfazed by blood and gore. But this, I'd always told myself, was just flat out of my realm, nowhere near my area of expertise.


Not anymore. (Snort again). When they come in now, there's a fairly good chance that they'll be mine, while some adrenaline junkie triage nurse practically dances back to their computer. I will walk them through the process step by step, look at and touch the wounds inflicted on them, and listen as they describe the assault to both the police and me. I will properly package bloody clothing and swab for DNA. I will measure bite marks and strangulation patterns. I will try to stay as focused and objective as I possibly can, try to do the best possible job for her (or him) that I can, try to not let my own emotions overwhem me.


I'd really love to know, though, how you can even begin to keep your emotions out of it. Because I don't see that happening for me. I think I've just shot my own personal comfort zone straight out of the water. What the hell was I thinking?

23 comments:

CrazyCath said...

What you do to cope RC is right a reflective diary. Diligently. Religiously. And insist on a "supervision" session with your supervisor or mentor at least weekly initially, moving to fortnightly then monthly as you become more able to detach. If a particularly traumatic one or violent one comes in, make sure you debrief before leaving.
In my experience, often "supervisors" were plain useless at this or unavailable when needed. I had trusted colleagues who would debrief me and I would do the same for them. A reflective diary helps because you are forcing yourself to write about the experience objectively. It takes some doing, but helps you to remove yourself from the situation and at the same time hug the patient or whatever they need without crumbling. And you hold it it.

Later, when the packaging and stuff is done and the patient is handed to the psychiatrist, insist on at least 10 minutes to yourself. Go to the ladies. And cry if you need to.
It gets better. You cope. You don't get hard (can't do that job if hard) you just adapt.

You'll be fine. And you are EXACTLY the sort of nurse they need. God forbid I would need it but if I do, I hope it is you.

CrazyCath said...

Darn. "right" a reflective diary?
I mean "WRITE" a reflective diary...

darn darn darn

Jo Beaufoix said...

Wow that's a big thing. I think you'll be brilliant at it, but I have they have some way of supporting you through this as well. I cant imagine not being touched by the things you will see, and by the look of the last post it already is doing. Congrats for your 500th by the way sweetie. Brilliant. :D

Anonymous said...

wow! good on you. i spent a year studying the rights of women and alot of it was reading court cases of violence against women. I always found myself just EXHAUSTED reading them. i'm not sure i ever figured out how to cope.

Retiredandcrazy said...

I can't even imagine how you cope. There are real heros out there and you are one of them.

laurie said...

what were you thinking? i'm thinking you thought:

you can handle it

you'd do some good

it'd be something fascinating and interesting and compelling and new

here's what i'm thinking: it'll be hard, but you can do it.

Amy said...

I spoke with a couple of SANE nurses at our local hospital for some stories I was doing. I found them to be quite caring and very informative. They seem to have expertise and BS filters a mile high; I'm sure you'll be good at it. Have you talked with other SANE nurses who've been at it for a while?

Kaycie said...

I'm sure it seems overwhelming right now, RC. I would imagine you'll become accustomed to this new aspect of your work in the same way you became accustomed to the blood and gore of the ER. Let's be honest here, you seem to always be a semi-detached observer with certain cases anyway. I am sure of one thing: you will find your way.

Rudee said...

Good for you. I'm thinking you saw a need and stepped up to fill that need. Since you felt compelled to do this, you'll do well.

It's obvious you have the compassion and I'm thinking that for a trauma junkie, this is trauma enough. Just a bit different and now you'll have the skill needed to become expert in this field.

Janelle said...

You were thinking "Somebody's gotta do it, might as well be me." I think I'd be glad to have a nurse with compassion who isn't about to come unglued in a situation like that (Thank God I've never had to, and hopefully never will) and it sounds like you've got the perfect mix.

As a teacher, I often get the comment "I don't know how you do it" or "I couldn't do your job" but what they don't know is I've got the easy job... it's nurses I hugely, unbelieveably, graciously admire, but sure don't envy.

Maggie May said...

I should imagine that you had to learn how to disentangle your emotions from these cases and leave them before you go home. That surely will only come with practice.
You will be good at this job, I'm sure.

Frances said...

You did it because you care. You care and also, you care.
It will be damned hard. Your job is damned hard already and you do that. Now you are going to do something a stretch further.
All I can say, is if it happened to me, I would hope to end up in your hands or someone like you.
I think the ability to distance yourself enough to do the job will come quickly because you have already learnt that skill.
And I agree with crazycath that you need to use whatever support systems they have, debriefing, counselling - if you don't use what is offered you may come unstuck later on. Get support early on, even before you think you need it, I think these things can be cumulative. Look after yourself so you can do the job and so that you can go home to your boys a whole human being each day.
Keep well and thanks for caring and doing it.

Retiredandcrazy said...

Hi, come on over to my site to pick up an award.

aims said...

Oh RC. Having been on the other side for all of that - rape, strangulation, abuse - I need to tell you (and I really hope they had people there who had been on that side) what it is like.

You have read how my father beat me so badly and the police took me to the hospital. I was only 15 and I was scared and alone. The nurses barely spoke to me and I felt like I was still doing something wrong. I really needed someone to be kind to me. I needed someone to hug me or something.

When I was strangled by my crazy husband I had no-one and was in a country that wasn't my own. I dealt with it myself.

I dealt with the rape myself too since I figured again that no-one was going to give me the emotional comfort I needed. And since it was my husband who raped me - what was anyone going to do?

The victims are - victims. They are in so much need of comfort and so unable to say that.

Please don't ever forget that RC. I know it will be hard for you to do all of this in the first place - but everyone forgets about the need to just comfort the person first. We feel like we've done something terribly wrong and everyone who looks at you must think the same thing.

There are no words to describe what it is like to be on the other side.

The Rotten Correspondent said...

crazycath - those are all wonderful suggestions, and I will definitely keep a diary. For my own sanity, if nothing else. We do debriefings sometimes in the ER when we see particularly awful things, but no one has said anything about doing that now. The nice thing is that we're being given the option to restructure our program to the way we want it. Thanks for giving me so many really useful ideas.

I didn't realize that you had done this kind of nursing? Any more tips?

Jo - I think right now we're just supposed to support each other. I hope that works until we get something else in place.


anonymous - reading (and hearing) the personal accounts is draining beyond belief. I still feel a little battered by it.


retiredandcrazy - I'm on my way to look at the award. Thanks!

laurie - I guess if I didn't think I could do it I would have said no to start with. But it is a little scary.I'm so afraid that some SOB will walk because I do something wrong.


Amy - the class was taught by SANE nurses and they were amazing. You want to talk about unflappable...


kaycie - you're right. I have to stay at least semi-detached or I'd have to change careers. But physical violence has always been really difficult for me. Gunshots and things like that are different to me somehow - more impersonal. But putting your hands on someone to hurt them really gets to me.


rudee - yeah, it is still trauma. Just a different kind. But it's a lot easier to deal with physical wounds than the emotional ones. Don't you find that in hospice?


janelle - so funny that you say that, because I couldn't teach if my life depended on it. A few of my best friends are teachers, and we all look at each other with awe. I don't know how you do it.


maggie may - I try to leave my emotions at work - most of the time anyway. The thing with this is that in addition to everything else, it makes me even crazier than normal in terms of personal safety. I really have to chill out on that. Not be stupid about it, but not insane either.


frances - I do care. But, really, don't we all? Women just have that compassionate bent to them, that urge to take care of things. It would be easier sometimes if we just didn't give a crap, don't you think?


aims - you are - once more - breaking my heart. I don't know how you came through what you did, or how. I just can't imagine.

So much of what we learned in this was about domestic issues. About battered women and assaulted children. About how strangulation is the ultimate in-your-face act of power and control that an abuser can use. About how a lot of people don't see how rape can occur inside of a marriage. About how these women coming in have been victimized and humiliated so completely, and yet still feel that they did something to "deserve" it. It made me sick to hear. And we did hear. Oh, god, did we hear. One survivor after another, one appalling story and battered woman after another.

God, I hope I can do these women justice.

Lil Mouse said...

um. wow. can i say i am so proud of you? all women and those unfortunate dudes, are lucky to have you on their side. because you get it. you have humor and sensitivity and love. you have kids. you've felt pain. you're not a block of ice. just remember that you're responsible for their getting processed safely and comfortably. try and make them comfortable and the rest will come naturally. the emotional thing, you'll have to deal with case by case.

Akelamalu said...

That has to be the most difficult job ever. I'm sure you'll cope admirable, but take care of yourself too OK?

Eileen said...

I have had to attend those exams, as a Social Worker, and I am thanking God right now that someone has compassionate and caring is you is going to be doing this.

You will do fine because it is what you do (and are) an amazing nurse, who wants the best for those she takes care of.

XXXXXXX

Iota said...

What the hell WERE you thinking? But you'll be so good at this job.

Devon said...

Gosh, I have no advice for you as I personally suck at this. I don't detatch well with victims of violent crime.

Shootings and stabbings I could handle for some disturbing reason. But violent rapes bothered me as though confirming my vulnerability as a woman.

It is all horrible and one day I asked myself, "why shouldn't I be horrified when a stranger has gone though this?" I had a choice to become better at detatching or leave hospital work. Can you say hospice anyone?

Just allow yourself to be surrounded by those who love you and will be there for you!

P.S. Happy news... My big dog had his tumor removed from the top of his skull this morning and it is not cancer!!!! It is now time to relax and resume breathing!

Marti said...

Once again RC, your strength amazes me. I think you are just what people need when going through something so horrible.

Good Luck - I know you will be able to handle it and make a difference in people's lives.

Nearlydawn said...

IT IS going to be hard. You are going to find it very difficult to get through. You should totally get extra points in heaven for stepping up to fulfill this vital role. I for one, want to say thank you.

Priscilla said...

Thanks for writing this.