To protect the privacy and safety of the patients and families mentioned in this story, some details have been changed.
I paused outside Room 65, one of the areas of the emergency room I dread the most; I always wished the "Men in Black
" would appear with their neuralyzer every time
I stepped out of it, erasing my memories of what had just occurred inside. "Two more hours," I mumbled to myself.
My Vocera communication device had been blowing up since I arrived for my shift; it was a busy night; busy evenings in the emergency department, or ED, are not uncommon, but I had just arrived for my fourth shift in a row, and every sound tugged at my brain
My Vocera went off again, just as I was deciding which of my three patients to see first.
said, "We're ready for you in Room 65."
“All right, I'll go over there,” I said.
Then I thought to myself, "Not Room 65 again." I had already been in there twice in the first six hours of my shift.
I walked over to the room confidently, but it wasn't confidence I felt; I enjoy everything about working in the ED, but evaluating children
who are being assessed for possible sexual assault
, which is what Room 65 is reserved for, is one of the most difficult aspects of my job.
Outside the room, I gently pressed the top of the almost-empty hand sanitizer bottle
and slowly opened the door.
“You are doing amazing,” the mother said to the little girl in the room, who was lying on her back, her eyes quickly scanning the room, obviously unsure of what would happen next.
“Hello, again,” I said as I walked in, “how are you?”
I silently chastised myself for asking what was probably not the best question to ask, because she clearly wasn't fine
“Do you remember seeing me in the other room?” I asked, “I did a quick examination and told you I'd see you again, and I'll be assisting this nurse with the rest of the exam, OK?”
While waiting for the sexual assault nurse examiner, or SANE, to finish setting up her kit, I briefly greeted the mother, who approached us and asked, "Can we scoot her a little further down?" We all helped position the patient close to the edge of the bed, and we could all sense her anxiety.
“Can you help her with her legs, Mom?” I asked, “We want them to drop to the sides like a butterfly so we can examine her genitals.”
The SANE exclaimed, "Great, this is perfect!"
Then there was nothing.
We were with this 3-year-old, about the size of my own daughter, in a birthing position, genitals fully exposed to us, her face hidden behind the teddy bear
she clutched in one hand and her mother tightly in the other.
The SANE exposed the child's vulva and vagina with gloved hands and took photographs that could later be entered into evidence, just as we do with other patients in Room 65, and we examined her anal area and took more pictures.
Her mother's eyes pierced us as she waited to hear what we had discovered. A few minutes into our exam, she couldn't hold back any longer and began asking us the questions I'm always afraid to hear: "How does it look?" "Was she touched?" "Did anything happen to her?"
Did anything happen to her? Unfortunately, we often can't tell; we may see some redness, abrasions, or even streaks of discharge, but in most cases, an ED physician cannot definitively say whether or not a child was sexually assaulted.
I turned to the mother and said the same thing I'd said to two other families earlier that day: "It looks a little red, but we can't tell if anything happened; our child abuse
team will look carefully at the pictures and review all the evidence, and help advise."
Tears welled up in her eyes, but she fought hard to keep them from falling onto her cheeks.
“Thank you,” she replied, “we will wait, and I will wait.”
As we helped our patient sit back up, the SANE and I exchanged nods. “Let me know if there is anything else I need to order or when she is ready for discharge,” I told the SANE, before heading over to see another patient.
I paused outside Room 65, but quickly reminded myself that I was a physician and should have a natural neuralyzer built in. We are expected to move on and keep caring, to flip our emotional switches from "sad" to "smiling" in an instant.
As I walked back to the computer I'd left 30 minutes earlier, I took a deep breath and tried to reframe my thinking. I pretended to be calm, but my mind raced through all the little girls I'd seen that day. I hadn't expected to see this many alleged sexual assault cases in one eight-hour shift, but since the COVID pandemic
, evaluating three to four children a day for suspected sexual abus has become standard practice.
I'm haunted by the fact that every nine minutes, child services discovers evidence of a sexual assault on a child, and despite the fact that I work directly with these victims and their families, doing everything I can to help them, I still feel helpless.
Since the COVID pandemic, evaluating three to four children per day for possible sexual abuse
has become increasingly common.
I, like many others, grew up imagining the ED to be like the one on the sitcom "Scrubs," with doctors running codes, staunching bleeding wounds, setting broken bones, and saving lives in the fast lane. I had never heard of Room 65, or learned about the horrifying things that the children I would meet there faced.
I went off to see my next patient, who was suffering from abdominal pain. These cases were easier for me, so I apologized for the delay and let them know I was going to do everything I could for their child.
Two hours later, my stretch of four long days of shifts in a row, seeing three to four sexual assault cases per day, on top of all of my other medical cases, came to an end. As I was signing out, I mentioned the increase in sexual assault cases I'd seen to a colleague who has been an ER doctor for much longer than I have.
“Does evaluating these patients get easier?” I inquired.
“It doesn't,” she replied, “you just live with it and toughen up.”
I've never been a good actress; my facial expressions and gestures almost always give me away. I packed my bags with the same aggressiveness I'd used on the sanitizer bottle earlier. As she was leaving to see her first patient, she turned to me and said, "Always find the good in what you do here. When you evaluate these children, you're helping a lot of kids."
I was lost in my thoughts as I walked through the narrow, circuitous hallway leading to the parking
garage, trying to fish
out the bits of good from my work, as my colleague advised, and I continued to wrestle with these thoughts during my 15-minute drive home, eager to take a shower, my place of solace.
When I finally got into my shower and felt the water
cascading over my head, I let out a cry that I needed to get myself together; it felt so good to give in to this physical
response to my emotions, and it helped to clear my head.
forget that doctors have feelings, too. Most of us do a good job of suppressing our emotions and comforting our patients when they need us. Later, when we're alone in our safer, hidden spaces, we deal
with whatever emotions had rushed up during the day. It's not easy, but it's part of our jobs
, and we're dedicated to doing what's best for our patients.
As I turned off the water, I went from sobbing to laughing. I remembered all of the good I had done that day and held it close to my heart. I knew I was made for this, not only to provide medical care for the children who end up in Room 65, but also to let them and their parents know I was there for them. That I could hold their hands. That I could sit with them.
As I stepped out of the shower, I smiled at my reflection and said, "Enjoy your days off; there will be more kids who will need you."
Then I dashed downstairs to give my daughter our usual bear hug goodnight.
Dr. Nkeiruka Orajiaka is a board-certified pediatrician
who also has a master's degree in public health
from Columbia University
. She is a passionate health educator and a strong advocate for children's health and safety, and she uses personal essays
posts to communicate medical experiences and health education
If you need assistance, call RAINN's National Sexual Assault Online Hotline or go to the website of the National Sexual Violence Resource Center.
Do you have a compelling personal story you'd like to see published on Stardia? Learn more about what we're looking for here and send us a pitch.