HJNO May/Jun 2024

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAY / JUN 2024 23 What are some common misconceptions I should be mindful of when working with survivors of sexual violence? There are three common misconcep- tions made by providers, law enforcement, and family and friends of survivors. The first misconception is that after a sexual assault, the memory of the experience is etched into a survivor’s brain making it easy for the survivor to recount what happened in detail. In reality, when in a traumatic sit- uation the brain’s priority is to ensure the survival of the organism (the patient), and that can come at the cost of memory. Thus, a patient being fuzzy on the assault details or having poor recall of the event should not be met with skepticism by their provider as there is a biological reason for this. When the brain is occupied with survival, encod- ing and consolidating memories is simply not a priority. Therefore, we see patients with fragmented memories that are not lin- ear, and that’s OK. We cannot compare our- selves to someone who has recently experi- enced trauma. It seems counterintuitive for the average person because you remem- ber everything that happened to you last night, so surely the patient would remember assault details, right? No, that is not always the case, and that’s OK. The second misconception is that survi- vors will be noticeably distressed, showing signs of anger, fear, and sadness follow- ing a sexual assault. However, there is no normal way to respond to such an abnor- mal event. For many patients, affect may be flat, and speech may be monotone. There is once again a biological reason for this; when the brain senses danger, some of the hormones released are endogenous opi- ates, which dull physical and, yes, emo- tional pain as well. This can produce the flat affect that you may see right after an assault. On the other hand, some patients may present laughing and cracking jokes, as humor can also be a useful tool in dealing with trauma. It is not our place to judge the likelihood of events based on the patient’s method of coping. Once again, we cannot compare ourselves to someone who has recently experienced trauma. Every case presents differently. A third common misconception is that sexual assault always involves physi- cal injury. The presence or lack of injury actually does not support or disprove that an assault occurred. The only difference between consensual sex and sexual assault is consent, which has no physical marker. This is another reason why, as providers, How do I know if a patient is telling me the truth? We are medical providers. Our role is not investigatory in nature; we do not determine the veracity of our patients’ statements. The most important thing we can do as provid- ers is listen and support. A better goal than seeking out the truth is establishing rapport and trust. Consider that the patient may have been discouraged from seeking services. Often, I hear patients say things like, “I don’t want to waste your time,” “I don’t know why I’m here, no one will believe me,” or “I don’t remember, but I know something happened.” It takes cour- age to walk into a hospital or clinic and dis- close that you are a victim. Not all providers know the sexual assault response plan in their area, and that’s OK. You don’t need to know everything, but you can always find out by contacting your local sexual assault nurse examiner (SANE). What does a SANE do? From the forensic nurse perspective, we approach from a place of belief and educate the patient on all options available to them to empower the patient to make an informed decision regarding the care they receive. As we navigate the complex landscape of healthcare, certain issues demand our unwavering attention and advocacy. One such issue is the prevalence of sexual assault among women. According to recent studies, 1 out of every 4 women in the United States has been the victim of an attempted or completed rape in her lifetime. 1 This statistic highlights the pervasive impact of sexual violence faced by women in our community. Yet, amid these distressing numbers, another statistic emerges — one that alludes to countless barriers, which can prevent survivors from accessing essential care in the aftermath of these horrific traumas. Shockingly, only about 21% of womenwho experience sexual assault seekmedical treatment. 2 This discrepancy between incidence and care-seeking poses a critical question: How can healthcare providers better support and respond to survivors in their time of need?