By Kathleen Evans

During my second night on trauma call, I had had a very slow day, only receiving my first page at 8 p.m. for a man with abdominal trauma. As we were admitting him, two police officers wheeled in another patient, a middle-aged woman. She had been found unconscious in her neighborhood with her clothing partly removed and disheveled. Every feature of her face was bruised, bloodied, and swollen. She could only groan in pain but could move her arms and legs spontaneously. Police weren’t sure what happened but guessed she was the victim of a sexual assault.

We carefully removed her clothing and accessories and put them in brown bags for the police; we taped bags around her hands to preserve any evidence under her fingernails. CT scans showed bilateral orbital fractures as well as a temporal skull fracture and axonal injury. After the scans, she started vomiting blood, and we intubated to protect her airway. Once she was medically stable, we paged the Ob/Gyn Intermediate Care Clinic to do a forensic medical exam for the suspected sexual assault.

The Ob/Gyn resident who answered the page said she was not comfortable with the patient’s medical stability and wanted to wait until morning. We asked her to please reconsider, as we were confident in the patient’s medical stability and did not want her to have to remain covered in blood and dirt. The resident then said she couldn’t conduct the exam because part of the exam was having the patient say, in her own words, what happened. She was intubated, so she couldn’t speak even if she wanted. My trauma resident begged the Ob/Gyn to break up the components of the exam and collect evidence now. She ended by simply saying, “If it were you on that table, what would you want?” The two policemen weren’t as delicate, saying if it were their wife, they “would be raising ****ing hell.” The Ob/Gyn resident returned an hour later and said she could break the exam into pieces and began the forensic work-up on the patient.

I am glad the system eventually worked for the patient, but I am disappointed it happened the way it did. This trauma occurred at the same time a Columbia University student was carrying a mattress around campus to protest the handling of her sexual assault investigation. It was at the same time the NFL knew Ray Rice punched his now-wife unconscious but only suspended him after a tape of it surfaced. It is clear that our society has a problem in the way it views women and reacts to violence against women. Too many times institutions react in a manner against the woman or do not act at all. I felt like my trauma team was made part of the problem because we had to choose between putting vital medical care first at the sake of jeopardizing action toward catching the assailant It didn’t help that the system seemed designed against helping women in this case – the patient was so brutally beaten by her assailant that she couldn’t speak, which could have helped her assailant by delaying the collection of evidence against him.

As a health care facility, we should never be part of the societal problem of victims feeling helpless. Because hospitals are the only places that can conduct forensic exams, we have to make victims feel comfortable and, if they can speak, heard. Hospitals should have a low threshold of suspicion and should be able to defer to police for a history if the patient cannot speak for him or herself. We are moving in the right direction by allowing victims to receive a sexual assault test regardless of whether they want to pursue legal action, but that’s not enough. If we want society to respect women, if we want society to change the lack of action against sexual assault, it starts with the people best able to determine if a sexual assault occurred. It starts with us.

Kathleen Evans, M.D., Class of 2016, is a third-year medical student. She has always been interested in writing and graduated with a B.A. in journalism from the University of Oklahoma. This is her first publication, and she hopes to continue to write about her experiences in medicine.