A Report

“Mommy, what happened to this girl?”

I turn around to see my 7-year-old daughter sitting on the floor with the latest issue of Rolling Stone. In less than 30 seconds, she’s managed to flip from an innocuous cover featuring Dave Grohl’s uncontroversial face to the image of a girl, looking at the ground, her body covered in red handprints.

“Why is she sad?”

Do you remember where you were the first time you read the story about a University of Virginia student named Jackie? I do. I was sitting on the train, heading home from a long but mundane day at work. When the issue first showed up in the mail, I remember seeing something about “sexual assault” and “college” on the cover and thought, well, obviously, I’ll need to read that. I mean, it’s sort of one of my things.

But when I finally opened to the story later that day, I wasn’t expecting what happened next. I mean, besides nearly missing my stop.

Now, I work in a college health clinic. I’m one of the people that sexual assault survivors on a college campus might find themselves talking to, after. The fact that sexual assault is happening on our college campuses is not news to me.

But I don’t work in an emergency room. I don’t even work in the campus urgent care clinic. I’m the clinician you might see in a routine visit days, or weeks, or even months after it happened. When you finally muster up the courage to see a medical provider in the hopes that they can run a few tests and tell you that physically, at least, you’re okay.

What this means is that most of the time, before they even end up in my exam room, my patients have usually decided that they don’t want to file a formal report against their assailant.

When I first started working in college health, honoring this decision was hard for me to accept. Really hard. But prevailing wisdom won me over. We want survivors to feel comfortable coming forward to access all of our carefully planned support services, right? Wouldn’t mandated reporting and the specter of unsolicited disciplinary action serve to silence, to an unknown degree, those survivors who need help, but haven’t yet found the courage – and believe me, it takes serious courage – to enter into the unknown and very scary legal side of their already traumatic experience?

So instead, I would be a sympathetic ear. I would help them give a name to their experience, using the words “sexual assault” or “rape” if they hadn’t yet used it themselves. I would slowly and thoroughly walk them through all their options, from the medical side to the administrative side to the legal side. I would give them lists of phone numbers, or call them myself if they’d let me. I would tell them that, legally, I had to file a report (check out the Clery Act if you’re not already familiar with it), but that if they so chose, the report could remain anonymous.

The day after I read the UVA article for the first time, I found myself waking up in the middle of the night, unable to get back to sleep, unable get the story out of my head.

At first, I wasn’t entirely sure why. I mean, Jackie’s story is, without question, horrifying, and really hard to read. If you don’t find it affecting you in some way, well, no offense, but you’re probably kind of a bad person. Just saying.

But there was something else nagging at me about the story. And then I realized what it was.

That administrator that the author calls out, in no uncertain terms, for her – and by extension, her institution’s – inaction after Jackie came to her for help? The one that you, as a reader, find yourself condemning for being part of the system that fails to protect and seek justice for Jackie and other UVa survivors? The one that, for some reason, is seen by survivors as such an ally on campus?

I saw myself in that administrator.

Well, I mean, to a point. There are pretty strict confidentiality rules that limit what information medical providers are legally able to share with others. Even when it comes to discussing patient information with other university officials outside the clinic’s walls, signed consent on the part of the student is needed. But still. I bought into the spirit of the law here, not just the letter.

And then, a few months ago, I moved to another state. One of the only states in the country that mandates that health care providers make a formal report to local law enforcement (I’m talking the real deal, not the campus PD) every time they’re made aware of a “suspected violent injury”.

At first, I complained. All the native Californians I now work with, who never knew any differently, were a little baffled. Um, hello, it’s a crime, right? Shouldn’t we let the cops know? But this idea, that the best way to honor the survivor was to honor their wishes when it comes to reporting, was lodged in my brain.

And beyond the theoretical, I was afraid of what this would look like in real life. What about the patient who decided that morning that the most she was up for was a quick visit to the campus clinic to get STD testing? What would she say when her profoundly difficult – but clinically relevant and necessary – disclosure was met with the news that a full, non-anonymous report would be filed with the local police, with or without her consent? Would this idea of a mandated report deter survivors from accessing the care and services we might be able to provide?

And then, I started seeing patients. And guess what? So far? Not even remotely an issue, as it turns out. Every patient I’ve had to have this discussion with has completely, 100% understood. Even, almost, as if there’s a sense of relief in the decision being out of their hands. As if it clarifies the fact that it was, in fact, an actual crime that took place.

So that’s the me that read this article. The me that had already started to come full circle on the idea that initial university respondents to reports of sexual assault should be required to, at a minimum, formally report every act of suspected sexual assault to come to our attention to local law enforcement.

And that’s the me that found herself trying to figure out how to answer a first-grader’s simple question about a magazine article.

After giving some half-assed answer, shoving the Dave Grohl issue to the back of a tall dresser, and wrapping up bedtime posthaste (parenting fail, probably), I found myself thinking about the big girl my little girl will someday be, and the world she’ll be living in. Would I want the school staff tasked with keeping her safe and healthy to turn around and dump the decision of whether or not to report a potential crime back in her lap? Hell no. That’s their job.

If we, as university administrative and clinical staff, aren’t doing everything possible to protect the survivors, and ultimately, other students, under our care, then we’re not doing our job.

Advertisements

Dear too-many colleges: here’s why you’re next in line for a Title IX suit

ivy

Another week, another famous institution of higher learning in the news for mismanaging cases of sexual assault on campus.

This time, it was Harvard. The most common response, from what I can tell, seems to be summarized thusly: “Oh myyyyy – even at Hahvahd?” (eyebrows raised in surprise, mouth forming a delicate “o” of prim concern).

The morning the story broke in the local news, I happened to be having lunch with these two guys who work in administration at a nearby college. Guy #1 says to me, “So, have you heard about Harvard? And the sexual assault case?” Why yes, yes I have. Guy #1 continues, in a voice of genuine concern: “So, what can we do to keep people from drinking so much?”

Guy #2 murmurs in agreement, eyebrows knitted with empathy.

LADIES AND GENTLEMEN. EXHIBIT A. This, right here, is the crux of why colleges keep finding themselves in trouble when it comes to dealing with sexual assault.

I know, I KNOW. It’s not like Guys #1 and #2 are alone in their thinking here. Just read the comments section of any article on the college-sexual-assault topic for a primer on the latest and greatest in victim-blaming. The idea that intoxication negates one’s ability to provide consent seems to be a logical stretch for quite of few of the world’s armchair analysts.

But here’s the thing. I don’t really care if some random dude with a laptop disagrees with whether rape is rape when alcohol is involved. I mean, I don’t like it, but one guy with an opinion just doesn’t matter all that much. The extent of his power ends once his opinion’s been expressed.

However. If you’ve made a career for yourself in college administration or college health, and you continue to think that the epidemic of sexual assault on college campuses is really about excessive drinking and morning-after regret, don’t act shocked when your school is next to hit the news with a Title IX suit and a bunch of unflattering media attention of your own.

Yes, you could be the next Harvard. Or Dartmouth. Or Mizzou. Because sexual assault is happening on college campuses EVERYWHERE. It has, without question, happened on your campus. And if this common-yet-ultimately-wrong-minded perspective frames how you choose to respond to a sexual assault survivor’s case once it’s been brought to your attention, there’s a good chance that survivor will feel justifiably wronged. And, if they’re feeling brave enough, they just might decide to take this dissatisfaction with you and your colleagues public. Very, very public.

Don’t misunderstand me. I’m not denying that there’s a problem with binge drinking on college campuses that we need to address. But it needs to be addressed as an issue that’s separate and distinct from that of sexual assault. After all, just because it might be easier to mug someone who’s walking home late at night after they’ve had few drinks with friends, it’s not like the mugging itself isn’t still a crime.

I mean, someone who’s been attacked and robbed isn’t told by the authorities that their mugger didn’t REALLY commit a crime, because, y’know, you WERE pretty wasted, after all, and maybe sorta kinda asking for it by walking down the street in the middle of the night. I mean, who’s to say you didn’t HAND that aggressive stranger your money when he asked nicely? Who knows? He said, she said. You know what? Let’s just chalk this one up to youthful indiscretion and a lesson learned.

Hell no. Safety bulletins are sent out, city and campus police start patrolling overtime, and no one rests until the assailant’s been caught.

Intoxication may make a predator’s job easier. But it doesn’t make them NOT a predator.

In a perfect world, everyone would GET THIS, and this tortured public debate over what-is-or-isn’t-rape would cease to exist. I’m not naive enough to think that sexual assault wouldn’t still happen – because some people are terrible human beings – but society would deal with it the way it does any other violent crime. Meaning a) those who choose to commit a crime are consistently removed from the community for the safety of others, and b) the threat of criminal charges and incarceration might make some of the would-be assailants of the world think twice before committing assault. Both of which would result in less sexual assault. And I’m pretty sure we can all agree that less sexual assault = GOOD.

Those of us who work on college campuses need to be held to a different standard than Random Laptop Guy. You can’t hold regressive and harmful views on a topic as important – and yes, public – as sexual assault, with those views shaping your institutional response to individual reports of rape, and NOT expect that it might come back to bite you someday.

Unless, of course, you’d been hoping to end up on the front page of the Globe someday. In which case, vaya con Dios, my friends.

More than an absence of No

20140213-170629.jpg

The chief complaint varies: “STI testing”, “pregnancy test”, “GYN problem”. It’s not until I enter the exam room and see my patient, eyes downcast and voice in a near-whisper, that the real reason for the visit becomes clear.

Apparently, it continues to be open season on questioning the legitimacy of the sexual assault epidemic. This time, it was the Wall Street Journal that decided the world needed yet another article blaming women for their own rape. So brave, WSJ! It’s about time someone stood up for those poor accused assailants.

I mean, it’s not like assault survivors have had their trauma minimized and dismissed for years – er, decades – wait, no, EONS now or anything. “She was drunk, so she was asking for it” is today’s “she was wearing a short skirt, so she was asking for it”, which is really just another version of “she’s female, so she’s always, somehow, asking for it”.

In case you missed it, the numbers around rape in college are pretty insane: approximately 1 out of every 4 to 5 college women will experience sexual assault at some point while they’re in school. Numbers like this are hard to ignore; a incidence rate of 20-25% must meet epidemic criteria by pretty much anyone’s standards. But rather than saying “holy crap, we need to do something about this”, some people prefer to respond to these numbers by questioning their legitimacy, citing evidence that assaults involving college students often involve alcohol — ergo and therefore = not-rape.

If you’re one of these people, a question: have you, or anyone you know, ever actually been to college? You know, that place where day-that-ends-in-Y is cause for celebratory drinking? Where the next generation’s ingenuity is expressed through the laborious construction of elaborate snow-carved beer pong tables? Where it’s often harder to find an event WITHOUT alcohol involved than with?

In other words, yeah, binge drinking in college is a legit problem. I’ve seen more injured wrists and broken collarbones than I’d care to admit due to the ubiquitousness of college alcohol use. But part of being a young adult living on your own for the first time sometimes means figuring things out the hard way – like how to consume alcohol responsibly, without the puking and blackouts. Today’s monster hangover paves the way for tomorrow’s dignified glass of Malbec (or three) with dinner. We’ve all been there. I know I have.

Which is why I see myself in the eyes of my patients. The ones who come to the clinic after a night where yeah, maybe they had too much to drink, but that didn’t mean they planned, or deserved, to wake up too-early the next morning, dawn not quite ready to breach the horizon, in an unfamiliar room, clothes and hours unaccounted for. In pain.

There is no amount of alcohol, no level of intoxication, that justifies assault.

If you think that the real epidemic is one of morning-after-regret-turned-false-accusations, spend some time with me at work. Look in my patients’ eyes as they struggle to tell their stories. And know that you, and others like you, are part of the reason that most of them will never file a formal report, no matter how many ways I talk to them about their rights, and resources, and recourse. All they can handle, in that moment, is a modicum of damage control: please, just tell me what I can do, what I need to do, to be okay.

Today, all I can offer is damage control – antibiotics, EC, labs, lots of counseling. But tomorrow, I’m hoping for more. I’m hoping I’ll stop waking up to rape apologia in the mainstream news. I’m hoping that the socially accepted definition of consent will shift from an absence of “no” to an enthusiastic “YES!”

Because eventually, I’m hoping that the gradual elimination of rape culture (eternal optimist that I am) will mean that I get to spend more time focusing on the more mundane aspects of a career in college health: strep tests, ankle sprains and contraception.