TAMPA ó Meet her with her clothes on.
Donít make her greet you in a paper gown, slits down the front and flimsy ties. Shake her hand, if she wants to, and introduce yourself. Pause between sentences. This will make it clear that you are listening; that you will listen, to whatever she has to say. Observe what she is not saying. Ask the question youíve been trained to ask:
"Have you ever had sex against your will?"
Donít ask if she has ever been assaulted. People donít like to think of themselves as victims, and she may not have labeled it as an attack.
"Has anyone you lived with ever slapped, hit or hurt you?" This is about the actions. This is easier to acknowledge than "domestic violence." This is when you pause, when you make eye contact, when you allow space for the thing that makes the room feel so small.
For 15 years, Pamela Kelly has been teaching the next generation of doctors at the University of South Florida how to identify and treat patients who have been sexually assaulted. A certified Sex Assault Nurse Examiner, among other things ó nurse practitioner, midwife, former head of the Hillsborough County center that logs rape kits ó Kelly explains to medical students that they will be privy to the careful space of an exam room, where women have been quietly saying, "Me too," for years.
"It happens to basically 25 percent of women. You see a dayís full of patients, youíre seeing 30 patients," Kelly says. "You have to be out of your mind to not think youíre treating several assault victims every day."
It might not sound like those two words when she is sitting on your exam table. She might nod at your question, might say, "That happened to me." Or sheíll say no, but when it is time for the exam, she canít say anything at all. Her eyes get big. Her knees shudder, then lock together.
Do not say, "Relax." Do not say, "Listen to your body," because she feels as though her body has betrayed her. She is here because she wants to get through this. Wants to have her annual exam ó to be healthy, of course ó but also because she wants to be normal, gripe over drinks with her friends about a hassle they all go through. She does not want this to be the trauma that it is.
Help her. Let her keep her shirt on. She does not have to lie down if she wants to sit up. She does not have to put her feet in the stirrups if it makes her legs shake. She can rest them on the edge of the exam table. She can set the rules.
She might want to play music, or have someone in there to hold her hand. Use the smallest instruments you have. Do only the tests you absolutely have to. Let her put her hand on top of yours, so she does not feel so out of control.
It might not work that day. Thatís okay. Give her time. Let her get dressed, and talk about when she might want to come back. She has all the time in the world. Understand that she might cry in her car after she leaves.
Make sure itís you she sees next time, not another doctor at the practice. Build trust. Make a note in her file. Do not forget that she told you. You might be the only one she ever has.
She might never say anything about it, until one day, she gets pregnant. This will present new issues. She might be scared of giving birth, of losing control of her body. Or the gel you squirt on her stomach for the ultrasound becomes a trigger.
Instead of once a year for that annual exam, she will see you 14 times over her pregnancy. Sometimes, she will be in every week. Sheíll look up one day and say, "I was raped."
Youíll reply, "I believe you." This will be the most important thing you do.
Contact Lisa Gartner at [email protected] Follow her on Twitter @lisagartner.