On a recent shift in in the emergency department, I evaluated a young woman who had been raped a few summers ago. The shift before that, I’d met with a teenager who had been sexually abused by her father. And just before meeting her I had tended to a middle-schooler who had been sexually assaulted at school.
These three women came to the hospital for variety of reasons — they struggled with issues ranging from truancy to substance abuse to thoughts of suicide. Part of my job as a psychiatry resident is to explore the stressors that influence suffering. More often than not, I find those stressors stem from sexual violence.
I’m learning that for my patients, sexual violence is an abnormal commonality: It happens to almost everyone, even though it should happen to no one.
The #MeToo movement has been a powerful reckoning of the damage of unwanted sexual behavior. It’s given a voice to an incredible amount of pain, and freed some women of the burdens they have borne for years. With the Time Person of the Year Award going to the Silence Breakers, the movement seems to have hit a peak of cultural awareness.
But in the halls of my hospital, and in my day-to-day work as a second-year resident, the task of tending to sexual trauma is ever-present, and sometimes feels suffocating. I am angry on behalf of the women in my care. I am reminded of my own experiences, and I recognize with each shift how pervasive — and persistent — this type of predatory behavior is.
As patients relay the details of these violent encounters, it’s hard not to internalize their horror stories. I feel impotent in my ability to make the world a less hostile place to live, and on some days I just feel incompetent because it’s so hard to keep absorbing these stories.
The intersection of the rise of #MeToo and my growing responsibilities in medicine are forcing me to confront the lingering pain of my own experiences. I also recognize that I may be experiencing secondary trauma, and that it might impact the care I give my patients.
While I was treating the young woman who had been assaulted by her father, I gave her room to share her story. She didn’t reveal much. I was secretly relieved.
Later, while presenting information about this patient to my attending, I couldn’t answer some of her questions about my patient’s abuse. I had convinced myself I was being compassionate by not forcing the patient to relive her trauma, but really, I was hiding behind her silence to not have to absorb another harrowing story.
I reported what I could to the Department of Children and Families, while telling myself that the next time, I would do better. But, the whole experience was disheartening because I didn’t know if I could actually be better about managing my emotions.
I’ve been trying for a long time.
I remember standing over an incubator in the neonatal intensive care unit, afraid to examine the tiny baby girl inside. Born out of incest and rape, she barely weighed 4 pounds. I was a medical student, tending to the outcome of the physical impact of sexual violence, but I didn’t know what to do with all the pain this little baby embodied.
I couldn’t bring myself to touch her. She wasn’t crying, and I used that as an excuse to distance myself from her story of sexual violence. I didn’t know how to help her. I decided in that moment that it would be better if neither of us started crying.
But, is it better to be sensitive or better to be detached? I’ve written before about the numbing effect of medical training. We learn to distance ourselves from our patients’ pain and practice detached concern so that we can do our jobs and focus on the problems at hand without freaking out. As physicians, we must work to hold onto our empathy — the capacity to put ourselves in our patient’s shoes and share in their experiences.
Yet, I doubt I will ever be able to hear a patient’s story of sexual violence and not be angered, not be revolted. Too many of us are intimately familiar with this misogynistic and metastatic cruelty, and I’d never considered what it would be like when we actually do share in those experiences.
When I was a little girl, I took tennis lessons. One summer, before fifth grade, when I was 9, the instructor said sexually explicit things to me. At the time, I didn’t understand why he said these things to me. Yet I knew enough to be ashamed, to feel compromised. I never reported him. I quit tennis instead.
This wasn’t the first — or the last — experience I remember when I think about #MeToo. But it’s the only one I feel safe enough to write about.
To be a woman in this world is to be vulnerable. I know my patients’ struggles, even when I don’t know the damning details. But, if I want to treat them well, as a female physician, subject to the very same societal forces, I need to figure out how to manage those details, and their impact on my well-being. Otherwise, self-preservation will not allow me to serve my patients in the way they deserve.
A recent news poll found that 1 in 2 women surveyed said they had been sexually harassed. The Centers for Disease Control and Prevention says that 1 in 5 women have been raped in their lifetimes.
I need to find, for myself and my patients, that way to bolster strength in lifetimes of vulnerability and that way to find dignity in oceans of shame. Then, I need to help them believe, as I work on this with myself, in their value as women —that they have a right to be heard and a right to be understood, and a right to heal, if that is possible.
But first, I have to deal with my grief that sexual trauma ever happens to us, at all.
This story has been changed to reflect that the statistic from the Centers for Disease Control and Prevention indicates past experience.
This story was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.
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