Fault lines

A survivor of a multiple sexual assault talks "around" her experience and how it has affected her life

I had an argument with my best friend (one of the few people who knows) when I told her I was writing this article. "For God sake, make sure you are anonymous," she said.

I was probably going to make that a prerequisite of writing this anyway but her attitude upset me. Why? Because she implied that I had done something wrong; something to be ashamed of; something that will ruin my reputation and hamper my career if anyone ever found out about it. But I don't blame her. That is what I think. So what am I talking about? It is difficult for me to say--but here goes.

Conspiring circumstances

Circumstances conspired so that I was out on my own in a foreign capital city late at night. Of course I should have known better, of course I should have thought twice about it. But I was a junior doctor and champion athlete in my early 20s enjoying a walk in an exciting city--I was invincible.

Three men and a knife in a back alley suddenly changed that forever. I am not saying any more about it. I can't. Since it happened, my mind refuses to go there--self survival I guess. So I am sorry to disappoint you if you want any graphic details, but I am sure you get the picture.

Afterwards I remember lying there thinking I was dead. When I realised that what had happened wasn't just a nightmare so I wouldn't wake up and life would go back to normal--I wished I was dead.

Hundreds of things flashed through my mind, the main one being HIV, closely followed by my promising career lying in tatters. Like me.

I don't know how long I was lying there but it took a possibly rabid dog sniffing round me in the alleyway to force me to move. That should be "to try to move." My God it hurt. There was blood and other bodily fluids everywhere. What a mess. Like me.

But then a strange thing happened. Unconsciously, my mind took over. Automatic pilot. I mentally ran a checklist of what I needed to do. One: get up. Two: cover myself up. Three: stuff myself with hankies to stop the bleeding. Four: go back and pack. Five: go to the airport. Six: go straight to a genitourinary clinic when I arrived back in the United Kingdom. Seven: never ever tell a living soul what just happened.

Yet there was method in my madness. I was too emotionally numb to feel anything at the time but savvy enough to know that if my family found out, they would never get over it. If my boyfriend found out he would never forgive me. If my colleagues found out they would pity me and whisper about me behind my back forever. "Why," they would say, "was she there in the first place?" "Why didn't she run away, struggle harder, scream louder?" They would continue, "Why didn't she report it?" All the questions I was asking myself.

I couldn't report it. I was in a country where I could hardly speak or understand a word, the police were notoriously indifferent, sexual assault was common, and forensic examination possibly non-existent. Good excuses but not the real reasons. I knew that there was no way I was ever going to let my life fall wide open for others to prod at in court, my private life and sexual history laid bare for all to see. All in another country. Humiliation twice over--no thanks.

Operating on autopilot guided me to action point six. But it took being straddled on a gurney in a genito urinary clinic back in United Kingdom to thaw my emotional numbness. I was almost flattened by a wave of shame and guilt. As the tears rolled silently down my cheeks as the speculum went in, all I could think of was, "It's my fault. It's all my fault."

I thought at the time that the senior house officer was a cold blooded monster but, in retrospect, she probably helped me enormously. The way she tutted, tapped her fingers and rolled her eyes when I let myself cry uncontrollably gave me a warning sign of things to come if I ever told anybody else. So I didn't.

I continued with my life as if everything was OK. With some stitches, the physical scars healed. The screen, including hepatitis B, hepatitis C, and HIV miraculously came back negative (although it was an agonising six month wait).

A girl on the edge

But if anyone looked closely they would have spotted that I was a girl on the edge, ready to self destruct at any minute. I ran so much that I got multiple stress fractures. My boyfriend left me because I wouldn't let him anywhere near me. I wouldn't visit my parents for fear that I would break down under their concerned questioning about my odd behaviour. My colleagues were astonished yet grateful when I offered to do their shifts as well as my own. I couldn't be still or unoccupied for a single moment in case my mind would wander back to areas that I couldn't emotionally control. I was a mess again.

As my coping mechanisms were gradually worn down, I realised that I had to either go and seek help or have a nervous breakdown. It might sound like an easy choice but it wasn't. Asking for help was one of the hardest things I have ever had to do in my life.

Rather than sympathy and a box of hankies, my counsellor gave me a really hard time. She challenged what she called my false belief system that it was my fault. In fact, she snorted in disgust at the very idea. "Of course it's not your fault," she would declare. Rather she would insist that it is the nature of society (and the misguided women who make false claims of rape) that make me think that it is my fault.

To be honest, I am still not convinced. I have some very deep mental and emotional scars but I am not a man hater, I am not afraid to go out on my own at night, and I have a life and career.

But I am not strong enough to put my name to this article. My best friend is right. Ask yourself honestly, would you treat me differently if you knew who I was?

   

           

Responses published this month Articles Responses LIFE Fault lines       Anonymous (May 2004) Stuart Sutton (May 13, 2004) Read this response LIFE Fault lines       Anonymous (May 2004) Stuart Sutton (May 13, 2004)       fourth year medical student, University of Newcastle stuart.sutton@ncl.ac.uk On receiving last month’s studentBMJ I was extremely sceptical about how interesting and relevant an entire issue on sexual assault would be to an undergraduate. The short article by the anonymous survivor of sexual assault made me realise how wrong I was1. What she experienced is something too horrific to imagine and I found her courage in writing about it awe inspiring. Although the assault itself was terrible I was more disgusted to read how she was treated by the female gynaecology SHO in the UK. What on earth could possess anyone, let alone a doctor, to be so dismissive when a patient breaks down and cries in front of them? Where was the caring attitude that it is so crucial in any healthcare profession? As doctors we must remember that every patient is a human being and treat them as we would want our sisters, mothers or grandmothers to be treated. The importance of being empathetic has been well documented by the studentBMJ but I have never read a piece that demonstrates how appalling a consultation can be when no effort is made to empathise with the patient. Although no doctor wishes to encounter sexual assault it is something we must be prepared to discuss and treat the aftermath of in an open, honest and above all caring manner. I wonder what difference it would have made to the young woman involved if that SHO had let her express her emotions without prejudice, offered support and the opportunity to talk to someone in a safe, friendly environment? Anonymous. Fault Lines. studentBMJ 2004; 12:199 (May)