Something Was Wrong - S25 Ep12: Trauma-Informed SANE Exams with Kayla Hartman, MSN, RN, FNP-BC, NYSAFE

Episode Date: March 3, 2026

*Content Warning: medical trauma, sexual violence, rape, domestic violence, intimate partner violence, gender-based violence, sexual assault, human trafficking, and abuse. Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources   Follow Kayla Hartman: Instagram: http://www.instagram.com/thevenakayla Threads: https://www.threads.com/@thevenakayla/ LinkedIn: https://www.linkedin.com/in/kayla-hartman-345a7911a/ SWW Sticker Shop!: https://brokencyclemedia.com/sticker-shop SWW S25 Theme Song & Artwork: The S25 cover art is by the Amazing Sara Stewart instagram.com/okaynotgreat/ The S25 theme song is a cover of Glad Rag’s U Think U from their album Wonder Under, performed by the incredible Abayomi instagram.com/Abayomithesinger. The S25 theme song cover was produced by Janice “JP” Pacheco instagram.com/jtooswavy/ at The Grill Studios in Emeryville, CA instagram.com/thegrillstudios/ Follow Something Was Wrong: Website: somethingwaswrong.com  IG: instagram.com/somethingwaswrongpodcast TikTok: tiktok.com/@somethingwaswrongpodcast  Follow Tiffany Reese: Website: tiffanyreese.me  IG: instagram.com/lookieboo *Sources: -“IAFN - International Association of Forensic Nurses.” International Association of Forensic Nurses - Research.Educate.Lead, 16 Aug. 2023, www.forensicnurses.org/page/IAFN/-“Sexual Offense Evidence Collection Kits, Rape Kits, Consent Form.” NYS Division of Criminal Justice Services, www.criminaljustice.ny.gov/evidencekit.htm

Something Was Wrong is intended for mature audiences and discusses topics that may be upsetting. This season discusses sexual, physical, and psychological violence. Please consume the following episodes with care. For a full content warning, sources, and resources for each individual episode, please visit the episode notes. Opinions shared by the guests of the show are their own and do not necessarily represent the views of Broken Cycle Media. The podcast in any linked materials should not be misconstrued as a substitution for legal or medical advice. Thank you so much for listening. You think you know me, you don't know me well at all. You don't know anybody till you talk to someone.

I'm honored to be speaking today with Kayla Hartman, who is a sane nurse. Sane stands for Sexual Assault Nurse Examiner. I'm so thankful that Kayla reached out as a listener of the show and offered to speak with me and offer her expertise to our community. Kayla, thank you so much for joining me. Absolutely. Longtime fan, first time caller. Thank you for having me.

very excited to be speaking. I think a great place to start would be what exactly is a sexual assault nurse examiner? We've heard sane nurses mentioned a bit this season. What is a sane nurse? A sane nurse, sexual assault nurse examiner, we're nurses first beyond all else. So our background can be in any type of nursing. Those of us who are drawn to this field are generally people who are very

compassionate about survivors, interested in forensic medicine, seeking to provide care for individuals of all walks of life. So sexual assault nurse examiner is someone who has specialized training in forensics as well as trauma-informed care. My training personally, I completed a 40-hour course through the International Association of Forensic Nurses, IAFN, which is comprised of a didactic portion as well as a clinical portion where we had hands-on care. I was fortunate enough to be linked with an active group in my area that practices out of a hospital and we do on-call time. Forensic nurses serve survivors of varying types of violence, not only sexual assault, but we also serve survivors of domestic violence, human trafficking, elder abuse,

workplace abuse, and physical assaults. Such important work. What is the inspired you to get involved in this specific type of nurse examination? I kind of found the training out of the blue. I've had a lot of people in my life that have been through different experiences along the spectrum of gender-based violence, sexual violence, domestic violence, and such. And it's something that I always wished I could do something more. A lot of the time we're looking back when people are sharing their experiences with us and

wishing, wow, I wish there was some kind of intervention that could be performed that could set them on the track that they want to be on rather than feeling alone. Companionship, being able to know that I would be able to provide that. Sometimes I'll use this kind of catchphrase, which sounds silly, but I think it sums up why I like what I do, which is helping victims make the transition mentally into that of a survivor. Initially, I thought I was going to be a dietitian. I started nutrition school and found myself envious of nursing students and all of the really cool opportunities that they had. I'm like, oh, they're catching babies. They're in the OR. They're dealing with blood and guts. They're out in the community, serving people on an individual level. And I found

myself drawn, so I ended up switching over to that. My initial goal was to work in the ICU. At the time, the ICU that I had applied to required a year of a different type of nursing first before you could start in the ICU. So I started in the hospital on a pulmonary intensive care unit, a step-down unit. So it was a lot of folks with ventilators, people with COPD, pneumonia, things like that. And I saw this training pop up on the hospital homepage and I was like, oh, I've never heard of that before. I wonder what that is. We've all probably watched or at least heard of law and order and they talk about the rape kit. I guess probably people wonder who performs that. Who's the person that actually does that job? And that is the role and responsibility of the same nurse. So I signed up for the training, kind of jumped right in.

I have a lot of people that are survivors in my life that are very close to me. And I've been fortunate enough to share in them telling me their experiences and being able to empathize with that. I realized this is very much a calling that I feel is going to align all of the things I'm passionate about, the things that I'm good at all in one. What additional training is required beyond being a registered nurse? Becoming a seen nurse requires doing a didactic, which is the educational portion, and that involves content that covers trauma-informed care, the history of sexual assault and violence historically in our country,

what that means legally, and I'm specifically licensed in New York State, so my lens and my perspective is more specific. in that regard. We also learn about variations in anatomy and physiology, as well as sexually transmitted diseases, violence prevention, legal advocacy, and medications. You mentioned trauma-informed care. I'm curious what sort of nuances you learned about in your training in regards to approaching these types of examinations in a trauma-informed way? Absolutely. Now that I've had trauma-informed care training, I approach all interactions, whether it's

within this setting or not with the trauma-informed approach. And I have the principles of trauma-informed care here in front of me that I'll read off to you. So number one is safety. And that's ensuring your safety and the safety of everyone around you, anyone that's in the room in regards to the direct environment and eventual safety. safety planning when that person leaves the environment that we're currently in together. Number two is trustworthiness and transparency.

Building rapport is a huge element of being a forensic nurse. It's hard to get someone to tell you the worst thing that's ever happened to them if they don't trust you. So being incredibly transparent right off the bat. Three is peer support. I work very closely with a team of crime victims advocates. We work together in providing empowerment, support, and advocacy throughout our encounters with our patients, and they have the opportunity a lot of the time of following them long term, providing ongoing support,

be that navigating the court process, navigating restraining orders, dealing with law enforcement, ongoing self-care, making sure they're making it to their appointments, housing, child care, all of those types of things. so we're really lucky to have that peer support. Number four is collaboration and mutuality. So making sure that our goals are the same. My goals are whatever the patient's goals are, but it's my responsibility to inform them of their choices and empower them to make the choice that feels most aligned with their goals.

Often I'll start with the phrase, hi, my name's Kayla. I'm with the forensic nursing team. I'm here to offer you my services. What are your goals in the hospital today? That can run the gambit of, I just want to get checked out. I want to make a police report. Some people will straight up say, I specifically want evidence collection. Some people don't make that choice. And it's my role in responsibility to make sure that they are informed of all those choices and that we are meeting our goals to align with one another. And that brings us to the fifth principle of trauma informed care, which is empowerment, voice, and choice. So making sure that, I am truly leaning into aligning their goals with what they'd like to have done in the hospital today. Number six is cultural, historical, and gender issues.

So there's a lot of nuance in that regard. The majority of survivors that presents the hospital. Generally, we see the majority of cis women, but certainly we know that other genders and other populations are subject to sexual violence as well. It's hard to speak as far as majority when most people don't present to the hospital following an assault. So those statistics can be hard to follow sometimes. But we do see a lot of vulnerable groups. In my practice, I see a lot of kids from foster homes, group homes, nursing homes, unhoused populations, mental health concerns, a lot of overlap with other vulnerable populations. How common are sane programs across the U.S.?

Are they available in every hospital? They're unfortunately not available at every hospital, though they should be. In New York State, there was a law passed not too long ago that all hospitals are supposed to have seen nurses available 24-7. So the practice, at least in New York State in particular, is growing pretty significantly. But as far as other states, it can be hit or miss, especially when it comes to more rural areas.

And New York State, not perfect by any means, but they are actively working on expanding that care. Though it is unfortunate that depending on the area where someone initially presents for care, they may have to travel to an outside hospital or outside facility, and that promotes delay in care. It promotes the anxiety and frustration. And travel is not something that ever,

everyone can make happen, especially with different capabilities as far as finance, safety, time, things like that. When someone comes to the hospital to report a sexual assault, what typically happens first? So typically this all happens in the emergency department. The first person that someone will see is usually a triage nurse, and that person will get a set of idols, ask a couple of general questions about what brings them to the hospital today. Based on that triage process, depending on the hospital's protocol, they're assigned the priority. They have specific areas of the hospital set aside for victims to immediately go to.

That's a safe space where they don't have to be in the waiting room with the general public, which is considered an aspect of trauma-informed care. first and foremost, medical always comes first, ensuring that someone is medically stable and safe. So if those interventions need to be provided prior to paging the forensic examiner, that takes priority 100% of the time. So if someone's had a head injury or is unstable in any way, then their medical care takes ultimate priority and forensics come second. Once they're considered medically stable or if they're not at risk for being unstable, then they would page the forensic examiner on call. Different programs have different ways that they have folks on call. My program, we generally are on call for six to 12 to 24 hours at a time.

We present generally within one hour, along with our crime victims advocates, to offer our services and see what those goals are. that the patient has and what we can do for them. Generally, they'll be placed in a room. They generally won't give you anything to eat or drink, and that's for preservation of evidence. The triage nurse, it's not their role to investigate what happened or ask many detailed questions. They kind of leave that up to us as that's our role in responsibility,

and they won't have you get changed into a hospital gown unless it's medically indicated for your care. You can have whoever you want in the room with you, be that, a family member, a friend. Sometimes if people are coming from a college or university, they'll have a representative from the college or university there with them. There's really no limit per se on who you can have in the room with you during your hospital visit. Are survivors required to report to police in order to receive medical care? Absolutely not. We offer care regardless of whether or not someone wants to make a report.

there are situations where we as forensic examiners are mandated reporters, and it is required for us to reach out to child protective services or other agencies in regards to our mandated reporter status to ensure the safety for that survivor going forward. Can someone receive treatment for their injuries without doing a rape kit? Yes, absolutely. The rape kit is entirely optional. No one. can ever be forced into doing one. I've had situations where someone will come to seek care and someone who's there with them is attempting to pressure them into doing a rape kit. Rape kits are completely optional. They require the consent and the assent of the individual. And I'd like to speak on the difference between consent and assent. Ascent is considered a voluntary agreement from someone unable to give legal permission. So that could be a minor or someone that's under the influence of

alcohol or drugs. It could be someone who's incapacitated in some regard as far as their mental status, someone with intellectual disabilities that doesn't sign their own legal paperwork, but they have to be able to give us, which is their understood permission for us to provide those services. consent would be a legally binding authorization given by the patient themselves or a guardian. So assent is basically the willingness to participate. And a rape kit requires both consent and assent for us to be able to perform that. But assent trumps consent as far as if someone wants to participate or not, it is ultimately up to them. So we can't force anyone to participate against their will.

Could you explain what is commonly referred to as a rape kit? Sure. It sounds much scarier than it is. Ultimately, a rape kit is a set of materials that is set aside that assists us in doing a head-toe assessment of a survivor's body and making sure that we are collecting evidence along the way. generally the New York State rape kit has about 15 steps to it. All steps are optional. There's a standard sexual assault evidence collection kit here in New York State and varying states have their own versions of this where basically it's a number of envelopes. Each are labeled.

They come with Q-tips and it allows us to write down on that envelope where that key-tip was collected on the body and what the source of material might be. That could be a swab around the lips if there was the capability of there being saliva in that area. It could involve swabbing the breast, the inner thighs. There are more intimate steps as well, which I think is probably what folks think about when they think about sexual assault exam. But truly, it is a head-to-toe assessment. Sometimes we'll collect hair samples. We can collect trace evidence, which would be something along the lines of,

if I found some kind of a fiber when I'm doing my initial eyeball of the patient, like, oh, there's a fiber from a carpet, and that can give us evidence in regards to where the assault occurred. So that would technically be considered. Trace evidence in debris. Debris something like if there were leaves in the hair or like gravel in the knees. So we're collecting evidence that supports the victim in establishing time, place, and so on. The most common types of evidence that are collected, there can be saliva, there can be touch evidence, there can be semen, hair, fibers. Trace evidence can really run the gambit. I've had folks bring in physical evidence in regards to the assault where they brought a beer bottle that the assailant

had been sipping out of because that gives us the capability of collecting DNA off of it. I've had patients bring in tissues. We do collect pads, tampons, diapers. Whatever truly the person feels is relevant and would be helpful. We collect clothing. Underwear is certainly something that we often collect for people that have vaginas. We know that secretions can pool in underwear, and so that's a great spot for us to be able to collect evidence from. I wanted to speak to the time frame of evidence collection as well, because this is certainly something that comes up quite a bit. Per the International Association of Forensic Examiners, evidence should be collected within about 96 hours in order to have the highest rate of success in collecting that evidence, so where it will

show up when they process the kid. But certainly, we can collect evidence outside of that window, and I will never ever dissuade anyone from getting an exam done if it's just because it's outside of that 96-hour window. The examination is a head-to-toe examination. Often there are no visible injuries following a sexual assault. That's not abnormal, especially when it comes to the oral and vaginal mucosa themselves. They're very, very fast-healing areas. They're flexible areas. So it's not uncommon.

it doesn't mean that something didn't happen just because there's no injury, that's something that in our training we talk about quite a bit because it can be presumptive on the part of if we are called into a courtroom to testify that the prosecution will question us on like, oh, but you didn't see an injury on this patient. Yes, that is still consistent with a sexual assault. And there is still value to getting a forensic examination, even if you're not participating in taking evidence or pictures, there is still something that we can offer you. If someone has showered or changed their clothes or waited a day or two, should they still come in? Absolutely. We ask all of those questions when we go through our initial assessment in order to

help us in figuring out what our best chances of collecting evidence are and where on the body that would be from. That being said, just because someone has showered or changed their clothes doesn't mean we can't collect evidence from them. I'm always open to trying no matter what to collect that evidence. Generally, after a period of about a week, my understanding is that things degrade, but I have heard of evidence being collected at times past that time frame. What happens to the evidence after it's collected? So it's the responsibility of the forensic examiner to maintain a chain of custody. Chain of custody basically means that it's within our possession until it is officially dried, sealed, and locked in a secure place or provided to law

enforcement should someone choose to make that report. Unfortunately, the kit cannot be run without a law enforcement report attached to it. Because that's likely who funds the kit being run? In New York State, we have a crime lab, and that's how the kit gets run. But unfortunately, my understanding is that they need something to be able to connect it back to. Gotcha. Is the examination itself painful? I would say that it can be uncomfortable.

Certainly, it depends on what injuries the person sustained. We try to make the exam as comfortable as possible. I like to explain every step as I go and ask permission. frequently along the way. A lot of the exam ends up being different cutips that are either moistened or not that are slid along the area where we're collecting the evidence. A pelvic exam is not necessarily required. It's again up to the survivor if that's something that they want to participate in or not. It does provide us the capability of swabbing the cervix, but we can do an examination without doing a pelvic exam. And certainly on our pediatric patient,

we're not performing a pelvic exam or entering the vaginal canal if they have not had their first mince use. If there's a part of the examination that someone doesn't want to participate in, then I am all for that. Certainly it's my role to explain the importance of each step of the examination and the consequences of declining that, not necessarily in a negative way, but just so they are fully informed. What medical treatments, if any, are often accompanied need with the same exam, like, for example, is STI testing typically done as well? Yes. So generally, STI testing is performed, and we generally will offer prophylactic treatment for STIs as well. That can include antibiotics that are given there at the hospital,

as well as HIV post-exposure prophylaxis, and that involves a medication that is taken over a one month period. We do perform testing in the hospital to make sure that someone would be a candidate for varying types of treatment options. We also offer pregnancy prophylaxis, and we can offer prophylaxis against things like hepatitis as well. What trauma responses do you typically observe of survivors when doing these types of examinations? It really runs the gambit. Every single case is so very different and it requires a collaborative approach very much reading the room. I've seen survivors that cries, survivors that laugh, survivors that have a very flat affect. And I can see all of that within one examination on the same person.

There's no right or wrong way to react to the examination itself. There's no right or wrong way to react to trauma. It's a very individual experience. We think of the classic fight, flight, freeze, and now there's considered a fourth response, which is fawn, which is similar where you kind of appease the perpetrator just to be able to get through. I have survivors ask me all the time, is this normal? Am I reacting correctly?

And there really is no right or wrong. Everyone's completely different and will react in a number of different ways. Some people are angry. Some are tearful. Some are anxious. Some are laughing. And none of those are the wrong response. What emotional barriers prevent people from seeking care from your perspective?

I think denial is probably one of the biggest ones. They don't want to acknowledge that something happens because it's scary and it makes it real. Other barriers can be different emotions, fear of coming to the hospital. can be huge. I take care of people all the time that say I hate hospitals. I think denial is probably the biggest barrier, but fear of the unknown of coming to the hospital and what to expect during an examination itself can be huge. People do have a lot of medical trauma, which I do think can be a barrier as well, especially folks from marginalized groups, simply seeking care for any illness or injury, be it in response to a violent crime or not, can be very daunting because you don't know what you're

walking into and how you're going to be treated by the individuals working that day. That's especially true when it comes to the LGBT community, people of varying intellectual of physical disabilities, people of color that historically have not been treated equitably within the healthcare system and continue to face discrimination in that regard. In what way, if any, do sane nurses work with police or law enforcement? We generally take a pretty collaborative approach. We are able to be in the room if someone chooses to make a police report. We offer our presence.

We act as advocates when law enforcement is present. If someone chooses to have their police interview done and I'm in the room and the police ask something inappropriate or something that sounds very victim-blaming, then I will interrupt and request them to reframe that question or advocate on the survivor's behalf. I know that they are working from a different perspective than I am, but it ultimately is my job as an advocate to be protective in that way. So they will do their investigation.

We'll collaborate as far as sharing evidence, pictures, information. When it comes to the rape kit itself, we're able to, once that's completed, to hand that over to them if the police report's done. But when it comes to other types of documentation, be that our charting, photographs and such, then that requires a separate subpoena for them to be able to take those pieces of information. You mentioned previously that the survivor can have someone in the room with them while getting an exam if they would like. if someone were to, God forbid, find themselves in that position where they're supporting a loved one going through a rape kit, what from your perspective could they do to show up for the survivor in that moment that might be helpful? I think remaining open to what their survivor wants, not attempting to dictate or convince them to pursue any one path or another based on their own feelings, based on their own

motivations. Sometimes I'll have parents that are present following the unfortunate event that their child, be it a pediatric or an adult patient, it's still your baby, and parents are inherently protective of their babies as they should be. However, a lot of the time I find myself acting as kind of an in-between for what the patient wants versus what the parent wants. So showing up and actively listening and advocating for what that person is seeking their goal in the hospital that day, not forcing them to do anything that they don't want to do, and then just being present, supporting them through that. I think it's important that they ask questions as well and be participative to some regard.

A lot of the time when a survivor is in this situation, which is highly stressful, we're not always absorbing all of the information that we're given. So being there is an extra set of ears and eyes to absorb that information can be really helpful as well. What kind of skills are helpful for a sane nurse to have for someone who might be considering this job? Remaining non-judgmental is huge. We see people from all walks of life. And I think as nurses a lot of the time, we find ourselves with these skills already in place. So I do just want to preface that.

but in particular standing up for someone when things are difficult and things can get heated. Things can get difficult. Maintaining a safe environment, intervening when things are not aligning with the plan that you and the patient have agreed upon, being willing to intervene, being willing to advocate. It's really important to be able to separate your personal bias from your work and you have to commit to doing that. I always like to say, this is the first time I'm meeting you. You're the expert of you and you're helping me navigate. This is a work that we're doing together. Ultimately, it is collaborative. So being willing to listen and have the person be the expert of themselves and admit that I'm not

the expert of you and letting them take the lead in that regard. Active listening is certainly huge. Remaining empathetic. There are things. that people will say that are very shocking and very horrifying. But when it comes to someone disclosing something like that to you, to let that shock and feeling horrified kind of go and just taking it in and sitting with them and being present, because you being reactive isn't necessarily always productive. But you can acknowledge it without emotionally reacting to it.

And I think that's something that takes a lot of practice. And sometimes I'll be in situations and I won't know what to say. And that's understandable. We're all human. People will say some really shocking, horrifying things. And I don't always know what to say. And it's okay to admit that. It's good to be human and to be humble and to just put all your cards out and let the person know to be completely transparent and walking it with them. Yeah, I think it's always a comfort when you're around authentic people. So showing up authentically is a way of building trust. Definitely.

When I'm in a situation such as this, yes, I know all of the things that need to be done to complete a rape kid, but I'm not the boss of the situation by any means. I take it moment by moment. It's a constant checking in with the person that you're providing care to to make sure that they are as comfortable as possible and that they are basically running the show. I always encourage lots of taking breaks. We have to know our role, but we don't have to be an expert in others' experiences. We never can be.

It takes listening and constantly learning and adapting in order to do our best work. Every single case I go into is so totally different that I never truly can adequately prep myself for what I'm about to do. It is a lot like improv where you're rolling with the punches and some days are really, really hard and other days are really energizing and just remaining open to people's experiences in a non-judgmental way and really realizing what a privilege it ultimately is to walk with people through this, even though it might not seem like that at times, but ultimately, people are putting their trust in you, and it is a privilege to share in their experiences and make a difference for how they see themselves in the situation going

forward. I really like to think that the work that forensic nurses do ultimately impacts people from a long time to come and how they continue to process their experiences. I've been at times personally and professionally the first person that someone has ever told this to. And I do want to share with the audience that if someone discloses to you, it's really, really important how you react, offering your sympathy, your compassion, your openness, not rushing to judgment, not offering your emotions into it is highly important and thanking the person for sharing with you and trusting you and figuring out how you can support them going forward. What should juries or the public better understand about these exams?

I think many people assume that it's a very cold and clinical examination. We try to make it as warm and comfortable as possible. We try our best to collaborate with the patient to meet their goals and to make it the least foreign as it can be under the circumstances. I think for a lot of us, going to the OBGYN, feels difficult due to our own trauma. And so something that is so personal in such a vulnerable moment is really scary and can be really fear-inducing. But that's one of the reasons I'm so thankful that we are able to have you on because

I think when we're informed, that helps break down a lot of barriers for us. Yes. When we know what to expect a little bit more, what our rights are, how we can advocate for ourselves. It certainly helps us feel more. more confident going into a situation. Absolutely. And the nurse is there as your guide, not to dictate any one thing or another, but to just offer

choices, empower you in those choices and do their best to make that happen for you and the way that you want it to happen. There are certainly elements of the legal process and such that are out of my control. But if I can provide things in a manner in order that make the patient. feel the most comfortable and the most empowered. Really, the whole goal is to give choice back to someone whose choice was taken away from them. And even in the littlest moments, that is always the ongoing goal. I've definitely described it to parents before who might be pushing for one piece of the examination or the other. Listen, your child, your loved one has had choice taken from them.

My goal is to offer them as many choices going forward as I can that will bring them back to a point of empowerment and feeling like they're back in control of some things. Absolutely. Is it ever part of your job to testify in court? I've been lucky enough in my 150 sexual assault cases that I have performed. I have not been called to court. I think there's a couple of reasons for that. My understanding is that there's a small proportion of survivors that choose to continue through the legal process, which I know that you know, can be very, very time-consuming, traumatizing, daunting.

They're often dismissed. There's a lot of elements why we might not make it to that courtroom. Ultimately, yes, it would be my responsibility to testify in a court. courtroom if the prosecutor or the defense had questions about the process of the forensic exam. I would be the person that answers those questions. We may be asked questions about what evidence we collected and why, why we didn't choose to collect a specific piece of evidence, interpreting lab results and injuries. We do the possibility of cross-examination as well. So if we're matching

the history with the injury, we can say, yes, this injury appears consistent with based on the shape, based on the size, based on the location of the body. And so we are putting that puzzle together sometimes for the courtroom in regards to the evidence that we've collected. Does someone have to pay for their rape kit? What if someone doesn't have insurance and they're worried about costs? I can only speak to New York State specifically. In New York State, the Office of Victim Services provides what's called a forensic reimbursement for all rape kits. So if the person signs consent to have New York State pay for their rape kit, they will do that. And they will also pay for relevant hospital expenses related to that visit.

It can become a little complicated when it comes to follow-up visits and medications that are prescribed outpatient possibly. but in New York State, it is free to the survivor if they consent for us to build the state. You mentioned a backlog of rape kits in the system. Why do those backlogs happen? Is it strictly financial? Is it a lack of resources? I think there's a multitude of reasons. I do think there's a lack of resources.

I do think there's some financial barriers. I think there's some prioritization barriers as well. certainly not an expert in that regard. What if any follow-up care is recommended after the rape kid examination? We recommend if you have a primary care provider to follow up with them. I generally will counsel my patients as to repeat STI testing within a three-month, a six-month, and a nine-month period. When it comes to counseling and things like that, I certainly can only make recommendations that I would highly encourage someone to connect with a trauma-informed counselor,

which our program is great because we have it kind of built into our system where we can immediately place a referral for that. So some people will choose to follow up with personal counselors and such. What would you say to someone who's unsure about reporting? I would say that considering reporting now is something I would advocate for just because the information is going to be the freshest in your mind. That being said, I have also advocated for people to get a kit done and then stew on whether or not they'd like to make a report. The beauty of that being we are collecting any relevant physical evidence at that time before it degrades or washes away.

Choosing to report or not is an extremely individual process. It can be certainly traumatizing in some ways, empowering in others. it really depends on what the ultimate goal of the survivor is. Some people, their goal is to never think about it again. And I think there's validity to that, no doubt. Other folks want to see justice served to its full extent and some people fall in between. I think it's important to know that you don't have to be alone. When it comes to reporting, there are people here to back you up and to advocate for you and to help you navigate the process.

I wonder if we could talk about the patient's rights and maybe remind them of the rights that they have because sometimes I think we forget in medical settings that we still have our autonomy and our rights, especially when I'm thinking about survivors from marginalized communities, like perhaps they were experiencing some racism from their examiner. Could they ask for a new examiner? Absolutely. It's always within their right to ask for a new examiner. I will say that in my experience, it rarely occurs. I feel like younger generations are more

collaborative in their care, and we do see with older generations, they still somewhat adopt that the provider as the expert and doing exactly as they say, whereas I think a lot of, and this is just generalizing, younger folks are more collaborative in that regard. I think the advocates certainly play a role. It involves empowering yourself to pick up on subtle changes in, for lack of a better word, the vibe in the room, being open to feedback, being aware of your privilege and such on the examiner end, acknowledging your privilege and really doing your best to stay humble and promote a collaborative environment tends to prevent against those types of barriers. And understanding and making it well known that you don't

understand the full experience of any one individual or another. And we never fully will. Truly. I'm wondering, is there any specific nuance when it comes to a rape kit when it's being conducted on a male survivor in terms of types of evidence that's collected or the way that the exam is handled? I would say it remains to be on a very individual basis, regardless of anatomy, we really don't have any restrictions as to what kind of evidence we can collect based on someone's anatomy, their gender presentation, et cetera. I think when it comes to survivors, a varying anatomy, that there might be less understanding on their part, perhaps, of what we can offer them. And that is absolutely our role to explain

and empower and ask those questions to be incredibly collaborative. and make sure that we're doing right by them and collecting the evidence. I'm curious how long the process typically takes and why sometimes survivors mention that it takes a long time. With hospitals in general, things move a lot more slowly than we wish they would behind the scenes. For a number of different factors, with the exam itself, it is time consuming. It requires us taking a history, organizing that history. organizing that history into figuring out what kind of evidence we'd like to collect, taking breaks, or sometimes interrupted by other parts of the medical team.

If someone has had a history of a head injury or a strangulation, as I mentioned before, medical always comes first that trumps forensics every time. So there might be other portions of their medical care happening interwoven throughout the process. We might have different family members come. coming by. We might have law enforcement dropping in. It really can be a time-consuming process. The evidence collection itself generally doesn't take that long. We can kind of pop right through it. However, I like to take time for the survivors to be able to ask questions as we go, take breaks. If we finish one portion of the exam and we need to take a break to have a snack, then that's

certainly an option as well. There's just a lot of different pieces of the puzzle that were constantly putting together, it can be being in contact with colleges, schools, family members, making sure that we have a safe discharge plan because that can be one complicated element of things as well, making sure someone's children are safe, making sure their pets are safe and cared for, finding solutions as far as a safe environment for them to return to following the examination, waiting for blood work to come back, waiting for imaging to come back. Those are all reasons why it might be an extended period of time. How do you as a provider take care of yourself after doing this important work? It seems like it

would be emotionally very heavy on top of the physical demands of the job. It can definitely be exhausting. Ultimately, I find the work energizing because once I'm building connections with people and I'm making sure that I'm aligning with what their goals are for themselves and their experiences. There's this moment at certain points in the exam where we, myself and the survivor will sometimes have like a sigh of relief. So I do find it both energizing and exhausting all at once. It's great to have a group of peers to be able to lean on to process things. When I first started, our team was pretty small and there was a lot of burnout that happened. And there is in this field either someone finds that they're working a lot and doing a lot of exams and getting burnout in that regard.

And the opposite can be true where someone's not doing a lot of examinations and they feel like their skills aren't up to par. And it depends on the number of people that are available to be on call, who you have to lean on. I personally am a big fan of trash TV and hot yoga in my coping skills. also leaning on my colleagues. Absolutely. Where can listeners follow and support you or reach out to you if they'd like to make connection with you? Definitely. I'm happy to provide my LinkedIn. And that would probably be the best way to get a hold of me to discuss anything professionally. I can also provide you with my Instagram. Awesome. And we'll make sure to link those in the episode notes. We cannot thank you enough for coming on and sharing your expertise and helping

make this process a little bit easier for someone who really needs this information. So thank you so much not only for listening, but for reaching out and for being willing to educate all of us. I am very happy to do so. And if anyone has any other questions going forward that I could possibly provide some clarity on, I'm more than happy to do that. Thank you so much for reaching back out to me. And I'm very happy to provide some clarity regarding something that can be so done.

I love the work that I do and I don't think I could do anything else. It's truly an honor and a privilege. Thank you so much. Next time on something was wrong. College is a time where people are experimenting and people are learning about themselves. I had gone to a lot of parties with student athletes, both of UVU and BYU, where they were drinking and they were doing things that the LDS faith doesn't really condone. We had heard that these guys were going over to SL's house.

We were mostly just trying to meet new people, kind of hang out and see where the night took us. There's so much going through my head. I am not even considering still that something so horrible was going to occur. Thank you so much to each and every survivor and guest for sharing their experiences with us. And thank you for listening. Something was wrong. is a broken cycle media production

created and executively produced by Tiffany Reese. Thank you endlessly to our team. Associate producer, Amy B. Chessler, social media marketing manager, Lauren Barkman, graphic artist Sarah Stewart, and audio engineers Becca High and Stephen Wack. Marissa and Travis at WME, audio boom, and our legal and security partners.

Thank you so much to the incredibly talented Abiyomi Lewis for this season's gorgeous cover of Gladrag's original song, You Think You, from their album, Wonder Under. Thank you to music producer Janice J.P. Pacheco for their work on this cover recorded at the Grill Studios in Emoryville, California. Find all artist's socials linked in the episode notes to support and hear more. If you'd like to share your story with us, please head to Something Was Wrong.com. If you would like to help support the show, you can subscribe and listen ad free on Apple Podcasts, purchase a sticker from our sticker shop at brokencyclemedia.com, share the podcast with a loved one, or leave us a review.

Want to stay up to date with us? Follow us on Instagram and TikTok at Something Was Wrong podcast. As always, thank you so much for listening. Until next time, stay safe, friends.