I'm An ER Pediatrician. The Hardest Part Of My Job Is What Happens In 'Room 65.'

"She began asking us the questions I’m always afraid of hearing: 'How does it look?' 'Was she touched?' 'Did anything happen to her?'”
The author photographed after a difficult day of seeing multiple child sexual assault cases.
The author photographed after a difficult day of seeing multiple child sexual assault cases.
Courtesy of Nkeiruka Orajiaka

Note: Details in this story, including room numbers, have been changed in order to protect the privacy and safety of the patients and families involved.

I paused outside Room 65, one of the areas I dread the most in the emergency room. I always wished the “Men in Black” would appear with their neuralyzer every time I stepped out of it, and erase my memories of what just took place in there. “Two more hours ― you can do this,” I mumbled to myself.

My Vocera communication device had been blowing up since I arrived for my shift. It was a busy night. It’s not unusual to have busy evenings in the emergency department, or ED, but I had just shown up for my fourth shift in a row and every sound I heard tugged at my brain.

While I was deciding which of my three patients I needed to see first, my Vocera went off again.

“We are ready for you in Room 65,” the nurse said.

“OK, I’ll head over,” I replied.

Then, to myself, I said: “Not Room 65 again.” In the first six hours of my shift, I had already been in there twice.

I walked over to the room confidently, but it wasn’t confidence I felt. I enjoy everything about the ED, but evaluating children who are being assessed for possible sexual assault ― which is what Room 65 is reserved for ― is one of the hardest parts of my job.

Outside the room, I pressed the top of the almost-empty hand sanitizer bottle, maybe a little too aggressively, and slowly opened the door.

“You are doing amazing,” I heard the mother say to the little girl in the room, while stroking her hair. The girl, 3 years old, was lying on her back, her eyes quickly scanning the room, obviously unsure of what was going to happen next.

“Hi, again,” I said as I walked in. “Are you doing OK?”

I silently scolded myself for asking what probably wasn’t the best question to ask. She obviously wasn’t OK.

“Do you remember seeing me in the other room?” I continued. “I did a quick examination and told you I’ll see you again. I’ll be assisting this nurse with the rest of the exam, OK?”

I briefly greeted the mom while waiting for the sexual assault nurse examiner, or SANE, to finish setting up her kit. She got closer to us and said, “Can we scoot her a little further down?” We all helped position the patient close to the edge of the bed. We could feel her anxiety.

“Mom, can you help her with her legs?” I said. “We want them to drop to the sides like a butterfly so we can take a look at her genitals.”

“Great, this is perfect!” the SANE said.

Then there was complete silence.

There we were with this 3-year-old, about the size of my own daughter, placed in a birthing position, genitals fully exposed to us. Her face was covered with the teddy bear she held in one hand. With the other hand, she gripped her mother tightly.

With gloved hands, the SANE exposed the child’s vulva and vagina and took photographs that could later be entered into evidence, just like we do with other patients in Room 65. We looked at her anal area and took more pictures.

I could feel her mother’s eyes piercing us as she waited to hear what we had discovered. A few minutes into our exam, she couldn’t hold back any longer. She began asking us the questions I’m always afraid of hearing: “How does it look?” “Was she touched?” “Did anything happen to her?”

Did anything happen to her? Unfortunately, we often can’t tell. We may see some redness, abrasions or even streaks of discharge, but in most cases, an ED physician cannot conclusively say if a child was sexually assaulted or not.

I turned to the mother and spoke the same words I’d already told two other families that day: “It looks a little red, but we can’t tell if anything happened. Our child abuse team will look carefully at the pictures and review all the evidence, and help advise.”

Tears welled up in her eyes, but she fought to stay calm, so none of them dropped onto her cheeks.

“Thank you,” she said. “We will wait. I’ll wait.”

The SANE and I exchanged nods as we helped our patient sit back up. “Let me know if I need to order anything else or when she is ready for discharge,” I told the SANE. “I’ll head over to go see another patient.”

Outside Room 65, I paused but quickly reminded myself I was a physician and should have a natural neuralyzer built in. We are expected to move on and keep caring. We are expected to turn our emotional switches from “sad” to “smiling” in an instant.

I took a breath and worked to try and reframe my thinking as I walked back to the computer I’d left 30 minutes earlier. I acted calm, but my brain was not. It raced through all the little girls I’d seen that day. I didn’t expect to see this many alleged sexual assault cases in one eight-hour shift. However, since the COVID pandemic, evaluating three to four children a day for suspected sexual abuse has been more and more common. I detest that this is beginning to feel like the norm for children ― or for anyone.

I’m haunted by the fact that every nine minutes, child services finds evidence that a child has been sexually assaulted. Even though I’m working directly with these victims and their families and doing whatever I can to help them, I still feel helpless.

“Since the COVID pandemic, evaluating three to four children a day for suspected sexual abuse has been more and more common.”

Like many people, I grew up imagining the ED as being like the one you see on the sitcom “Scrubs.” I pictured doctors running codes, staunching bleeding wounds, setting broken bones and saving lives in the fast lane. I never heard about Room 65, or learned about the dreadful things faced by the children I would meet in there.

Erasing these memories ― or rather, locking them in the depths of my brain for the time being ― I went off to see my next patient, who was suffering from abdominal pain. These cases were easier for me. I knew this patient’s family might be upset about having to wait a while, so I apologized for the delay and let them know I was going to do everything I could for their child. Still, I couldn’t help but think: If only you knew what room I just came out of and what I saw in there.

Two hours later, my stretch of four long days of shifts in a row ― and seeing three to four sexual assault cases each day, in addition to all of my other medical cases ― finally came to an end. While I was signing out, I mentioned the increase in sexual assault cases I’d seen to a colleague who has been an ER doctor for much longer than I have.

“Does this get easier?” I asked her. “Evaluating these patients, I mean?”

“It doesn’t,” she replied. “You just live with it and get tougher.”

She could tell her response made me uneasy. I’ve never been a good actress; my facial expressions and gestures almost always give me away. I packed my bags with the same aggressiveness that I’d used on the sanitizer bottle earlier. As she was heading off to see her first patient, she turned to me and said, “Always find the good in what you do here. When you evaluate these children, you’re helping to make sure whoever did this to them can hopefully be prosecuted.” Then she turned and left.

As I walked through the narrow, circuitous hallway that led to the parking garage, I was lost in my thoughts, trying to fish out the bits of good from my work, as my colleague advised. I continued to wrestle with these thoughts during my 15-minute drive home. I couldn’t wait to take a shower ― my place of solace.

When I finally got into my shower and felt the water cascading over my head, I let out the cry that I needed to get myself back together. It felt so good to give in to this physical response to my emotions, and it helped to clear my head.

Sometimes people forget doctors have feelings too. Most of us do a good job at holding it together. We’re able to set aside what we’re experiencing, and comfort our patients when they need us. Later, when we’re alone in our safer, hidden spaces, we deal with whatever emotions had rushed up throughout the day. It’s not easy, but it’s part of our jobs, and we’re dedicated to doing what’s best for our patients, even if it might be hard or painful.

As I turned off the water, I went from sobbing to letting out a chuckle. I visualized all of the good I did that day, and held on to it. And I knew I wouldn’t have it any other way. I knew I was made for this ― not only to provide medical care for the kids who end up in Room 65, but also to let them and their parents know I was there for them. That I could hold their hands. That I could sit with them a little longer if they ever needed me to.

Gently stepping out of the shower, I turned to my bathroom mirror, smiled, and told my reflection, “Enjoy your days off ― there are going to be more kids who will need you.”

Then I ran downstairs and gave my daughter our usual bear-like goodnight hug.

Dr. Nkeiruka Orajiaka is a board-certified pediatrician with a master’s in public health from Columbia University. She practices as an emergency medicine pediatrician in Ohio. She is a passionate health educator and a strong advocate for children’s health and safety. She uses personal essays and blog posts to communicate medical experiences and health education. Her writing has been featured at Stat, PopSugar, Today.com and other parenting channels. She is a wife and mother of three children. You can contact her on Twitter and Instagram at @dr_norajiaka or on her blog, drnkeiru.com.

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