No one person heals the same way after a traumatic event, but each person should be given the same opportunity to heal in a safe environment.
Sam: They took me in, they did a rape kit. They asked me a bunch of questions. They had a police officer come in and get my story and recording it all and everything. And then after that they kind of were like, okay, well we'll be in contact with you. And then sent me home.
Annie: I’m your host, Annie, and this is Indelible: a class, a podcast, and a conversation about sexual violence. Today, we’re going to talk about what happens after a sexual assault. What are some of the different emotional reactions survivors may have? What is it like to go to the hospital immediately afterward? We’ll talk to some experts who can tell us about the hospital process, mental health, and the many ways the healing process can begin. We’re also going to hear the story of Sam, a survivor who’s recovered from her assault with the help of friends and therapy. The voice you heard at the beginning of this episode belongs to her.
As always, please do whatever you need to take care of yourself as you listen. We’ll be discussing some difficult topics, including descriptions of sexual assault.
Let’s listen to Sam’s story.
Sam: So that night it was a night out with friends. We were down on the town like having drinks, like partying as a group…
Annie: The night Sam is talking about happened about two years ago.
Sam: We had gone to this one dance club that was super popular, you know, super known for a lot of really aggressive drinking and dancing, all that kind of stuff. Went there, ended up having way too many drinks and started dancing with a guy.
Annie: She had met this guy earlier in the night and they talked for a while, so she was happy to dance with him at first.
Sam: Had a few more drinks. Got to the point where it was like, I was way too drunk and was like not at all coherent, and he invited me to go get dinner with him 'cause the bar was closing, the dance club was closing, 'cause it was about 2:00 AM. So I went out and got some pizza, and then he asked if I wanted to like go home with him, and I was kind of on the fence because I knew that, in my head I was like, ah, this probably isn't a great idea, but also I was so drunk at the time that I didn't even really know what else to do besides say yes. So, ended up going back to my car, and that's where the sexual assault happened.
Annie: Sam’s friends had been looking for her since she left the bar. They found her in her car, realized what had happened, and immediately took her to the hospital.
Sam: So they were really helpful, really calm, collected, drove me to the hospital, stayed with me there the entire time, through the morning, 'cause like we got to the hospital probably at about 3:30 in the morning and they stayed there until about 8 AM. So they were really, really good. Really a well-needed presence.
Annie: The mystery of that hospital visit can be scary. When someone goes to a hospital after a sexual assault, what happens? To answer our questions, we brought in Nicole Turner and Ti Wohlt, two Sexual Assault Nurse Examiners from two different hospitals who have recieved special training exactly for this.
Nicole: My name's Nicole Turner…. I'm a certified Sexual Assault Nurse Examiner for adolescents and adults. So that means anybody age 14 and up.
Ti: My name is Ti Wohlt.
Annie: Could you walk us through what happens step-by-step when a patient is brought in following a sexual assault?
Nicole: The first step for me is when I get the call from the ER and they have a patient, and they have to be medically cleared first. So that gives me time to get my stuff together and get over to the center.
Ti: They're going through the triage process that we get a quick set of vitals and ask why they're there. And then they become medically cleared, meaning you know, they're assessed by a nurse, nursing staff, a physician, any tests are ordered that are necessary.
Nicole: After they're medically cleared, they're brought to me, and they're always offered if they want to have an advocate with them, or they can have another support person with them.
Annie: A victim advocate provides support to the victim of a crime in any way possible, whether that means speaking and acting on the victim’s behalf, or simply being there to answer questions and help them process their emotions. Hospitals have options when it comes to victim advocates. If a victim is a student at a local university, the nurses might call the school’s Office of Victim Services to come offer support. Other victim advocates are employed by or volunteer with local shelters or law enforcement. It’s important to know that all victim advocates, no matter where they come from, are confidential resources.
Ti: The first thing a victim advocate should, and most of them do, is say, is "I believe you." And that's one of the first things I say to a patient. Because they want to feel heard and they want to feel validated and they want to feel like it's a safe space. Telling them that they're safe, telling them that it's a nonjudgmental zone.
Annie: Aside from a victim advocate, who else is allowed to stay in the room? Any friend they bring with them?
Nicole: I let anyone come in that the patient wants in. I've had to ask people to leave before because I wasn't sure that the patient was safe, if that makes sense. Like a male partner I've had to ask to leave before because it was getting a little intimidating and threatening to have him there. So any time there's a safety issue, I would ask someone to leave. But other than that, I leave it up to the patient.
Annie: What else happens once the patient is medically cleared?
Nicole: Then I have to take them into a room very similar to this where we just do an interview and I just get all the details of what happened, so I know how to direct my exam.
Ti: Once that happens, then we bring them to our space to continue and offer any services that we have for them. So this room is that dedicated room, and it's here that we complete the sexual assault nurse examiner kits, also known as rape kits or sexual assault kits, and take photography and do our medical forensic exam.
Annie: What does the collection process look like?
Nicole: I just start by looking their body over head to toe looking for any injury. We take photographs, we measure the injuries, we document those. We, I swab any area where they may have been touched or where there is an injury. Look at the mouth for any injury swab that if necessary, depending on the type of assault they had…. Then we do the pelvic exam and take pictures and we can collect swabs from inside to hopefully collect DNA there.
Ti: We put the swabs in the dryer and no one can come and go while that's being dry, because the evidence kit is open, at that point and is actually evidence and has to follow a chain of evidence paperwork protocol. So we kind of hang out together and I make sure that they've eaten. I've made sure they can sleep. I turn on some music, we just try to make them comfortable while we wait. We treat for STIs. We also treat for pregnancy, prophylaxis, and pain. And then after all of that is done, then we—we're always discharge planning from the time they get here to make sure that they have a safe place to be discharged and go home to.
Annie: From beginning to end, how long does that process usually take?
Ti: It's a four- to six-hour process.
Nicole: I just gauge what the patient needs and sometimes they need breaks and sometimes there's a lot of injuries and a lot more swabbing and photography that needs to happen that can make it last longer, so everyone's different.
Annie: Do the police have to be involved? What if the patient doesn’t want their parents to know?
Nicole: They have complete, it's at their discretion if they're over 18. If they're younger than 18, I have to notify DCS and law enforcement. I don't have a choice in that…. However, that being said, minors still have a hundred percent control over how the exam goes and what I collect.
Ti: They do not have to report. As well as they do not have to choose an advocate if they don't want to.
Annie: At every point in this process, the survivor makes the choices, including whether or not they want to report to the police.
Ti: I can offer all the services I want. They can choose some, all, or none of my services. And at any time if they say, okay, I've had enough, I can't handle anymore, I stop because they're in control and I want them to feel that way.
Annie: Nicole showed us a rape kit from the hospital. It’s a white cardboard box about the size of a big book, and inside are about ten paper envelopes and a lot of swabs wrapped in plastic.
Nicole: Okay. So inside the kit, the brown bags are for clothing. So these would be kept separately from the kit. Sometimes we can fit the underwear in the kit depending on the size.
Ti: A lot of times people have to give up their clothing. They don't have to, they can give up their clothing as evidence. And so if we're going to collect that and hand it over to law enforcement, then we want them to be able to go home in something comfortable.
Annie: So when someone goes to the hospital for a rape kit, they might want to bring an extra change of clothes with them. The hospital can also provide spare clothes if they don’t bring their own.
Nicole: So that's what these are for. And then we have our swabs. So when we swab, we use two swabs. One of them is wet with some drops of water and then one is dry. So we do the wet and then we do the dry, and then each envelope contains those two swabs together. We have all kinds of envelopes here depending on what we need to collect. There are oral swabs. So if there was any kind of oral assault, it's important to get that.
Annie: Seeing how many envelopes there are makes it easy to understand why the process can take several hours. There are swabs for everything.
Nicole: Fingernail scrapings is part of it. If they fought back, sometimes we can get scrapings from under their fingernails if their nails are long enough. We have one for bite marks, other dried secretions, and then we have the genital swabs. We swab the outside of the genitals and then we also have those cervical swabs that from when we do the speculum exam. So those are all options. And then there are several that are labeled other, if we think of anything else that we need.
Annie: After the collection process is complete, the rape kit is sent off to a crime lab and stored for up to a year. If the patient wants to remain anonymous, none of their information is written on the box—just police precinct documentation and a patient ID number.
Let’s return to Sam’s story. She chose to have a rape kit done in case she wanted to pursue legal action, but in the end, she decided not to file charges.
Sam: Initially I thought that I'd wanted to, which is why the police officer showed up because they asked, you know, you don't have to have a police officer show up if you don't want to. I elected to. However, at that point I was just tired of the whole ordeal. So after that, I didn't really pursue anything further and I just kind of let it drop.
Annie: Filing charges against an assaulter is a complicated process, and there are many reasons survivors decide not to put themselves through a court case. More often than not, the perpetrator and victim know each other and have overlapping social circles.
Sam: I think especially in the media, it's very much depicted as, like, a stranger in a dark alleyway, coming out and snatching you type of deal, or like a stranger breaking into your house. And I mean, I'm one of those weird scenarios where it was a stranger rather than someone I know. But the vast majority of sexual assaults occur with someone that you're familiar with, whether that be a coworker, a friend, a family member, or like a spouse, a partner.
Annie: Statistics vary, but somewhere between seventy and ninety percent of sexual assaults are committed by someone the victim knows. This is known as date rape, or acquaintance rape—a term which didn’t even exist until the late 1970s. And people who are assaulted by someone they know are far less likely to report it to police than those who are assaulted by strangers.
After Sam told us her story, we asked her what part of the whole experience was the most difficult.
Sam: It was for sure, definitely the reactions of people around me, and also the expenses that came with an emergency visit to the hospital, because the hospital that I ended up being taken to didn't accept my insurance. So I ended up having to pay $1,000 out of pocket, which sucked…. So that was, that was shitty. But I think the thing that was the hardest for me was immediately afterwards, my boyfriend at the time who is since my ex, his reaction was just to assume that I had cheated on him purposefully.
Annie: Many survivors of sexual assault face disbelief or even blame from the people around them. That’s why many don’t want to talk about it, or wait a long time until they do. To tell us some more about the psychology of sexual violence, we brought in a mental health professional who has been counseling survivors of sexual violence for years.
Betsy: So my name is Betsy Varner. I am currently a PhD student studying counseling psychology. And as a part of my studies I do research and do clinical work, so seeing people within therapy. In research, I focus on sexual violence prevention as well as understanding sexual violence movements. And then clinically I work a lot with women who have experienced sexual trauma as well as other individuals who have PTSD for a variety of reasons.
Annie: Betsy has also worked as a victim advocate at a domestic and sexual violence crisis center, which was where she first found her passion for advocacy.
Betsy: I think that there is always some nervousness for going to therapy. So I think that's something that a lot of people who I talked to experience beforehand. I think the biggest kind of misconception about therapy is just that it's going to be very prescriptive of, like, if you come in, they're going to do this and going to do this, but the reality is a good therapist is going to adapt to what their patient's need is or what their client's need is. So meaning it's going to look a little bit different for everyone…. So your therapist is always thinking about what's going to be best for you and they are making sure all along the way that you are comfortable with what's happening and that it's meeting your goals and meeting your needs. So you have a whole lot of control in that situation.
Annie: People who experience sexual violence are at a higher risk for depression, post-traumatic stress disorder, and other consequences to their mental health. Therapy can be a useful tool when healing from a traumatic experience.
Betsy: So there are a lot of different approaches to therapy. That therapy can be really long-term or it can be very brief. It just depends on kind of what the person has going on and what they're looking for. But in general therapy just tries to—I think in the broadest sense, you can look at it as it just tries to increase someone's quality of life.
Annie: Some time after the incident, Sam chose to go to therapy.
Sam: Yeah, I went to therapy. It was partially because of the incident and partially due to other stuff going on in my life that I just needed addressing. And I went for probably about six months. And it was good, it was helpful, and it kind of helped me work through like a lot of my own emotions and a lot of stuff regarding how I perceive myself and how, you know, how I react to the incident now as compared to right after it happened. So I think in the end it was helpful, but I don't think, I think I got to a point where I felt like therapy wouldn't do much more for me and the rest of it I had to kind of do on my own, so.
Annie: Another part of the healing process is sharing one’s story with people outside of therapy. It can be incredibly helpful to talk about it with friends. On the other hand, if a survivor tries to bring it up and the person they’re telling is like, “yeah, right,” or “why didn’t you fight back?” they’re much less likely to feel safe sharing their story again. A conversation like that is so important. If someone tells you they’ve been sexually assaulted, what are you supposed to say?
Betsy: I think this is one of the biggest and most important questions to think about, right? Because the vast majority of people who have experienced sexual assault are disclosing to their friends or to their family members, to people who they trust. And so as friends and as people who want to be supportive of individuals who experienced sexual assault, it's so important to know what ways to respond.
Annie: There is no one right thing to say, no script to read from, but there are definitely some guidelines to follow when it comes to talking with survivors.
Betsy: I think the first thing I would say is always start with asserting how much you believe them, right? That's one of the biggest barriers that people come across when they're disclosing being sexually assaulted is that they won't be believed, or they're afraid they won't be believed.... And what happens after that is they may shut down and not tell anyone else again, right? Because they've gotten such a negative reaction.
Annie: Sam faced some negative reactions from the people in her life, especially from her boyfriend at the time.
Sam: There was a huge break of trust between us where I felt betrayed because he thought that I had done it on purpose, and he felt betrayed because he thought I was doing it on purpose, and it was a whole thing. And it honestly, I think it kind of contributed to the ending of our relationship.
Betsy: So first and foremost, start with believing them, right? And, and just conveying that empathy and support, right? In whatever way feels natural to your friendship and your relationship of, you know, telling them that you're there for them and thank them for telling. I think that's a really big thing because it's so difficult for someone to disclose what they've experienced because of the fear of how they might be responded to, or just the difficulty of saying it out loud. So thank them for being honest with you. Thank them for trusting you.
Sam: My other friends were pretty like, they were obviously shocked and upset, but they were much more, you know, calm, collected, just like, let me, you know, tell me if you need support, I'll be there. If you need us to just let you alone, then we'll do that too. Very much willing to accommodate me and my requests and my needs for privacy and stuff, which was really good.
Betsy: From there, it is so much about giving control back to whoever is disclosing this, right? When someone's experienced a sexual assault, they have lost control, right? Control was taken away from them…. So making them in control of what they do next, whether or not they report it, whether or not they go to the hospital, whether or not they go to therapy, whether or not they talked to anyone else. It's their choice, right? And making it their choice is so important.
Sam: My family, on the other hand, was completely the opposite, which was very frustrating, because as soon as it happened, my boyfriend's parents called my parents and they rushed to the town that I was in, they drove all the way there and proceeded to make a big deal out of it and freak out.
Betsy: There's a lot of individual factors of how someone handles things, but also a lot of their social environment, right? So if they experience a lot of blame from others, following that, what our research shows is that their symptoms are probably going to be worse.
Annie: If we have just one thing to say about conversations with survivors, it’s this: Believe them. Belief is the first and most important step. After that, be there for them and ask how they’d like you to help.
Betsy: Provide them the resources, make sure that they know what's available to them. Offer to go and walk to the hospital with them, offer to walk to their first therapy appointment with them, whatever it is, if that's what they want, right? They need to be the ones to choose that, because what we don't want is for more of their control to be taken away from them.
Ti: My biggest piece of advice is if someone were to come up to you and say that this happened to them and ask for advice that you say, I don't know how to help you, but I'm willing to be here to help you through it with whatever you need and then reach out to the, if, with permission, reach out to the appropriate people to find resources for, for your friend.
Nicole: The most important thing I've learned in this line of work is how important it is to just simply believe the person that you are talking to and get your own judgments and stereotypes out of the way.
Annie: Something that all three of these experts emphasized is that survivors react in all sorts of different ways following a sexual assault, and that there’s no “right” or “normal” way to act afterward.
Betsy: No one person reacts in the same way. Whatever picture you have of what a survivor looks like, throw it out the window because it's not. It's, there's no one way to look at it, and that there is no wrong way to heal from it. I think is probably the biggest, that we can't put our own image and values onto how someone heals because they are surviving and the way that they know how to, right? And supporting someone's survival is just extremely important.
Ti: I've had women that have laughed the entire time they were here and they didn't know why. I've had women who have laughed and cried the entire time. People who are numb and people want to talk a lot. So I wouldn't say that there's a common response. Every individual is different.
Nicole: Every reaction possible. Probably from being very traumatized and tearful and needing a lot of breaks to being totally disengaged from the process and like the patient's not really there. To being very, I don't want to say happy, because they're not happy, but that, just like nervous laughter or joking, because everyone's coping mechanisms are different. So you might see any response. But it's important to know that that doesn't mean that it didn't happen.
Annie: Every person is different, and every healing process is different, too. Some survivors might not want to go to the hospital at first. If they decide after a couple days that they want to go after all, that’s okay, too.
Nicole: We can collect evidence up to five days now after the assault occurred. But we still encourage people to come in even if it's after that time frame for the medication and the other resources that we can offer.
Annie: And there are many resources other than hospitals and police. There are sexual assault hotlines you can call, sexual violence crisis centers in nearly every community, and campus resources like the Office of Victim Services, which is a confidential resource, and Title IX, which is not. If you need help, help is always available.
Sam was in therapy for six months, while some survivors don’t want to go to therapy at all, and others view therapy as a lifelong tool. Healing isn’t linear and it doesn’t work the same way for every person.
Betsy: I've seen people in therapy who were well into adulthood into the fifties, sixties who were coming in to talk about trauma that happened when they were a kid. And people who come in immediately after, right? So there's such a variety in when people are ready to address it and, and what people might be experiencing at any given time point.
Annie: But, no matter how long the journey takes, healing really is possible.
Ti: You know, I remember my first case…. And it was right around the time that Brock Turner happened. And I thought, as I watched her, and she seemed pale and tired and she would not make good eye contact, which is very common. I thought to myself, what have I done? I'm going to be so frustrated in this profession….it was an unwitnessed assault with little evidence. What recourse does she have? And I thought to myself, what have I done? I'm going to be frustrated and I don't know that I can do this. But after that four- to six-hour timeframe, she was laughing, telling me about the poetry she writes, we were listening to music, and she walked out of here smiling, and I thought, that's why I do it.
Sam: I think the biggest thing for me is I wish that they would just actually listen to me when I say that I'm fine and I don't need any help or I'm not upset. Cause I think the big part is that they just kind of assume that I'm like some delicate damaged flower that's like going to wilt at like the first, you know, traumatic mention of my traumatic past and it's, I'm just kind of in this place from like, I've worked through it, you know, I've made my peace with it. Like, obviously it's still a traumatic event, but it's not something that I'm going to like freak out and break down anytime you even mention the word rape. And that's kinda how they act…. And I'm like, no, I'm really, like, I—I'm fine. Believe me when I say that I'm fine. Cause to me, it comes off as very, like, patronizing, like you think that you know my feelings better than me. Like you think, I think they have an expectation for how I'm going to react.
Annie: It’s important to acknowledge that not everyone is going to want to share their story. That’s okay. First and foremost, survivors’ stories belong to them, and they get to decide when, where, and how to tell them.
Sam: Don't feel obligated to relive your pain or share your pain for the gratification of others. Cause I feel like a lot of times, especially in media and stuff like that, people like to hype up and, you know, they kind of get off on tragic sob stories and they like to feel bad about things. So they want to hear people's, you know, traumatic histories and not, you're not obligated to have to share that. If you're not comfortable sharing your story, then you don't have to.
Ti: We're not talking about it enough. I mean, half the students that come here, and that's, I'm using half loosely, don't even know that there's an office of victim advocacy or what Title IX is. And so if they had that knowledge and understood the risks more than maybe more people would be more proactive about it. Also, I think that not only are the students responsible for self knowledge and making sure that they have protection and plans in place, but I think organizations like universities also have a responsibility.
Annie: Whether you’re a survivor or if you know anyone who is, there are a lot of ways to get involved with this issue. You can donate to hotlines or local crisis centers, or volunteer if you have the time. Another very important way to help is to educate yourself. Pay attention to the news. Vote for candidates who support survivors, and for laws that help them.
Betsy: You can be aware of the policies that are going on…. be aware of what's going on and do what you can to advocate for change, right? Advocate for more support, for more clear definitions of consent, and I think that's going to be the biggest step in making a culture change and being just aware of what's going on makes a big difference in that and encouraging others to do the same.
Annie: And if someone ever does tell you about a sexual assault, be ready to listen with a completely open mind. You never know how big a difference it can make.
Before we close out today’s episode, we have one last question to ask. Our podcast’s name is Indelible because of a quote from Dr. Christine Blasey-Ford, who was one of the accusers in the Brett Kavanaugh case. While describing her assault, she said that, "Indelible in the hippocampus is the laughter," meaning that the laughter of her assaulters was the one thing she couldn't forget—the indelible, or un-erasable mark that was left on her brain. We asked Sam what was indelible to her about her own assault.
Sam: I think for me, it, weirdly enough, it was the smell of his cologne. ‘Cause it was like, I was in the back seat of my car and it was like a very enclosed space. And like, I was like not really aware of what was going on, like in terms of like sight and touch, but just the scent, the smell of his cologne was very vivid to me for whatever reason. I guess you could call that indelible.
[music fades in]
Annie: Sexual violence can leave a lasting mark on the lives it touches, but never forget: that mark can be healed.
That’s all we have for you today, but make sure to subscribe to Indelible wherever you get your podcasts and stay tuned for future episodes. As always, I’ll hand you over to Jill for the credits, now.
Jill: Thank you, Annie, and thanks to all of you listening. Our episodes are designed to stand alone, but if you missed our first episode on beginnings, I hope you’ll go back to hear our conversation about the redzone--those early weeks of college when students are most vulnerable to sexual violence--and also, of course, our own beginnings here at Indelible. In episode three, we’ll walk into the confusing territory of Title IX legislation and enforcement on campus and try to clear up some of the confusion.
As always, be sure to visit us at indelible podcast dot com to get a behind-the-sounds peek at our podcast and people, as well as resources for getting involved—or getting help. Healing takes time and is different for each of us. If you or someone you know has experienced sexual assault, help is available at rainn.org—that’s R.A.I.N.N.org—or at the National Sexual Violence Resource Center’s website: N.S.V.R.C.org. You can call 1.800.656.4673 for free, confidential support 24/7.
At Indelible, we’re often asked for our advice on how to talk with someone who’s been assaulted. Start with belief and listen without judgement. Ask simply Do you want to tell me what happened?--and avoid asking why questions. Remind survivors that the attack was not their fault. Acknowledge how hard it can be to talk about and let them know you’ll still be around to listen the next time they have something they want to share.
You can find resources on supporting survivors on our website, as well as specific information on state grants funded by the federal Victims of Crime Act that can reimburse expenses related to an assault--including the cost of the rape kit and counseling services.
Thank you to our trio of guest experts on this episode: Betsy Varner, Nicole Turner, and Ti Wohlt. Endless respect and gratitude to Sam for telling us her story.
Special thanks to Kaitlyn and Bekah, our reporters for today’s episode, and to our scriptwriters, Jonah, Kaitlyn, and Bekah. They’ve been busy!
Thanks to Malik and Bekah for the music, and as always, a shout-out to our community partners, The Facing Project and Jana’s Campaign, and our production consultant, Lantigua Williams & Co.
Indelible is made possible by the Virginia B. Ball Center for Creative Inquiry at Ball State University. Once again, be sure to visit us at indelible podcast dot com, follow us on Facebook, Twitter, and Instagram--share and like and all the things: we want to make this conversation big and bold.
Treat yourself with gentleness today.
I’m Jill Christman, and this has been Indelible.