I worked on-call at a local hospital as a Forensic Nurse Examiner for the largest and most advanced forensic program in Kansas City. I performed medical forensic examinations for victims of sexual and physical assault and can vividly recall the evening I made the choice to pursue this challenging career years ago.
I was in the Johnson County Jail – not serving time as an inmate, but rather working as a nurse responsible for providing healthcare to inmates. One of those inmates had just been captured following the kidnapping, rape, and murder of a local teenage girl. What most people didn’t know was that he also happened to suffer from a chronic medical condition that required ongoing analysis and evaluation.
So there I was, face-to-face with him – he was shackled at his ankles and hands, surrounded by four large deputies. As he held out his finger for me to collect his blood, I was startled by his hands. His knuckles were swollen, bruised and covered in scratches from beating her and his stomach was covered in scratches – evidence that his victim literally put up the fight of her life as he sexually assaulted and then killed her. I knew that I was staring at a murderer.
When I finally got home that night I lost it. I didn’t have to act tough any longer. I wept for the girl, thinking about her final moments and how scared she must have been. I wept for her family. I wept because of the evidence left on his body of her brutal attack. And I wept because I had to care for him. That was my job - every day until the day he stood before the judge, crying like a baby as he pled guilty to killing and raping the beautiful teen girl.
I made a promise to myself that night as I cried that I would use that experience to make a difference. To me, I thought that being trained as a forensic nurse would help catch all of the “bad guys” and get them off of the streets. But, I was wrong. Forensic nursing is not the Hollywood version of CSI you see on TV. It is working in the emergency room at all hours of the day or night, providing care and performing medical forensic evaluations for people who are perhaps living the worst day of their life.
One type of assault a forensic nurse is called to consult on is sexual assault, or rape. They come accompanied by police, with a friend, or sometimes on their own. In my experience, I’ve only treated women. Not saying that there aren’t men that have been victims of sexual assault – it’s just not common to see one coming to the hospital for treatment.
The sexual assault victims could be any of us. They are mothers, students, run-aways, young professionals, some struggling to survive, and others that seemed to have it all together. But they all have one thing in common. They all had the courage to come to the hospital and consent to an invasive sexual assault examination.
There were very few that didn’t somehow know their perpetrator. Accused perpetrators have been bosses, husbands, boyfriends, ex-boyfriends, friends of boyfriends, brothers, fathers, acquaintances, and “friends.” The others would come in following a fun night out on the town gone horribly wrong. They couldn’t remember anything from the night before and they were extremely ill, like the worst-hang-over-of-your-life sick. Sometimes a “friend” had slipped something in their drink or other times it was a stranger lurking in the bar, waiting for a moment of opportunity. Almost all of the time, alcohol was a contributing factor in the assault.
What probably none of those women knew was that when they made the choice to come to the hospital for an examination, they would be met at the hospital by a specially trained nurse skilled in collecting, preserving, and documenting evidence. In addition, a trained sexual assault advocate from the Missouri Organization to Counter Sexual Assault, MOCSA for short, would also be present. They would provide them a bag with a new pair of sweats, a bra, underwear and t-shirt to wear home since often their clothing was collected and sent to the crime lab for processing. MOCSA was also there to follow them through the process once they left the hospital with counseling and other support services.
These women also probably didn’t know that in almost all cases, they did not have to report to law enforcement that day, the next day, next month, or ever if they did not wish. They were in control to decide if and when they reported the crime. Nurses are never there to judge but to support the patient’s choice to report or to wait.
If a patient wishes to report the crime and has not already been to the hospital, the Forensic Nurse will contact the appropriate agency and an officer will come to the hospital to take the report. Following the decision to report to police, a copy of the forensic report, evidence, and photographs will be forwarded to support in prosecution for the case.
The only choice that I strongly encouraged was the collection and preservation of evidence. That way, they had control if they were not ready to report the assault. The evidence would be sealed and ready for the day they wanted to move forward to report the crime – if that day ever came. For some, they are never ready and that’s okay. Somehow, knowing that the evidence exists and having the control to report can be as healing as if they actually went forward with the criminal prosecution. Bottom line, a victim’s choice is always respected.
Speaking of evidence… The vagina is an amazing hostess. That’s right! Sperm can last for weeks in the vagina. In fact, it has been found 17 days after an assault. An interesting fact – but most importantly a factor when a victim may think it’s too late to do anything. A skilled Forensic Nurse knows how to properly collect trace biological evidence that can be analyzed by the crime lab.
Sexually Transmitted Disease & Pregnancy
A real and obvious concern following sexual assault is STD’s and pregnancy. Fortunately, medications are offered as prophylaxis to prevent treatable sexually diseases such as chlamydia and gonorrhea. Patients also have the choice to take HIV prophylaxis medications as well. In addition, if appropriate, emergency contraception is offered.
The entire sexual assault examination and medications are paid by the state and is at no cost to the patient. They should never even receive a bill from the hospital.
The reality of forensic nursing was not what I envisioned – it was better. I wasn’t helping to solve murders, but I was helping women with a crucial step to putting their life back together after it had been blatantly disrespected and violated. No one has ever asked to be raped regardless of what our society continues to perpetuate even in this day.
Forensic nursing is helping real women in the community where we live. It is being the rock when someone’s life has been shattered and they are left vulnerable, not knowing what step to take next. It is the experience of taking a patient from tears to laughter by the end of her examination. It is putting her back in control after she had it taken from her.
In the end, we are all real women. The unfortunate reality is sometimes bad things happen to some of us. When they do, just know that there is a safety net for you to fall in to – One where you don’t have to know what the next step is because someone else will be there to hold your hand while you need it.
If you or a loved one have been a victim of assault, please contact us at firstname.lastname@example.org and we will connect you with resources and people who can help.
For more information about forensics services available for victims of assault, please see the attached article from 435 Magazine: Backing Battered Women