Case Report

Maya J. Sorini

The morning after I am raped, I forget how to be a medical student. I need someone to tell me what to do. I sob in a bus terminal, shipwrecked, until my sister’s distant voice, rendered immediate through our iPhones, tells me to go get a rape kit. I consider how to do that, now that I no longer exist. I call my best friend in medical school and beg him to take me to a hospital. I don’t know why I feel like I am begging.

It is the weekend between my fifth and sixth weeks of surgical rotation. Everyone in the terminal and on the bus ignores that I am openly weeping except for one man, who hands me a tissue and puts a hand on my shoulder. 

My friend collects me and drives to one of the more pathetic hospitals in the area, because I am not sure I will survive having a classmate or professor administer my rape kit at the good hospital. The waiting room is empty. I have to say “I need a rape kit” to the woman at the front desk, whose face changes. I am suddenly very aware that we are in a Catholic hospital.

When I am sent to triage, the ER nurse looks at me like I am a waste of time. Maybe I look too healthy to be in an emergency room. Maybe she is thinking, why do these patients keep coming here for problems their primary care provider should handle? Why are they wasting our time and resources? I tell her I was raped. My tears come back, hard and fast like a thunderstorm. Her face softens.

My friend and his girlfriend bring me blankets, a meal, a phone charger. They sit close to me and alternate holding my hand. They look me in the eye. They do not cry. Soon, both of them will be doctors. 

The nurse talks around my “condition” like I am pressurized, with the potential to explode at any time. The doctor interviews me from the open doorway so he can escape and avoid my shrapnel. Neither of them touches me.

The sexual assault nurse practitioners take two hours to arrive. They make me sign papers that I cannot read because my eyes are burst riverbanks. Nobody will let me pee. I really need to pee. 

The nurses make jokes about how hard it is to work with technology, that this would be so easy if they could do it on paper. They read empathetic statements off their computer. They make me tell the whole story, especially the violent parts, and take notes riddled with typos. They point at diagrams and ask me to specify how each injury occurred. They remind me of cops.

There is speculation about how to describe my pelvic exam while I am undergoing my pelvic exam. I have my eyes shut again because I am allowed to shut my eyes. My legs shake in the stirrups. I am not allowed to shut them yet. The speculum stays inside me a long time as photos are taken and remarks are exchanged. The rape nurses leave with their evidence and my underwear in a paper bag. 

My hospital nurse cannot say “HIV” at regular volume. She whispers that part. She does not touch me. She asks if I want my friends to leave while she administers the medicines I need to prevent infections. She hushes over the word “infections.” At no point does she say the words “rape” or “assault.” 

The doctor answers my questions from the doorway. He does not ever touch me. The first nurse, from triage, comes to give me the antibiotic shot. She looks me in the eye and apologizes for what I have been through. I tell her I am sorry too. She is careful with me and warm with my friends. She brings me dinner. She tells me I will get better.

When I leave the hospital, I have no idea what to do. The world is not the same world I walked before. My house looks different. I am suddenly glad the nurses took my underwear, so that I do not have to have them. I tell my grandmother I spent the day with my friends, and no I do not need dinner.

The next day, I pick up my pills, which render me so inhospitable to microorganisms that nothing in me can survive. The pharmacist looks up when I hand him the stack of prescriptions. He asks quietly, “Are you okay?”

I tell him no. I am crying again. His eyes leave the screen to meet me— he tells me he will expedite the prescriptions. His silence spans decades, oceans, tells me that something bad has happened to him, or someone he loves, or his people, or his nation, or his land, or his skin. Neither of us has to ask for any details. Grief knits the air between us, thickens the room, makes this pharmacy feel just for a second like a cocoon, which is quickly torn in two when the pharmacy tech tells me that all I have to do is pray, and God will take the pain away. I drink an entire quart of Gatorade in the parking lot, washed with tears, and down a handful of pills. Metronidazole makes my mouth taste funny. I learn to take it just before a bite of food.

My primary care doctor, upon learning the news, tells me over the phone that I must have an unrelenting relationship with the truth, and that I will be back to normal quickly as long as I do not lie to myself. He tells me to stop struggling with the idea that it was not my fault. He says I am wrong for taking three weeks off from school, because that will allow me to malinger.

My psychiatrist’s voice is measured over Zoom. I can feel his anger. He wants the man who caused my tears to die. He wants to hurt him; I can see it in his usually gentle eyes. This doctor who has treated me since I was a teenager, who has seen me through every evil my mind has conjured, knows he cannot medicate me out of this one. He knows enough not to try. He uses words instead. He tells me many times it was not my fault. He tells me he is sorry. I am sorry too. He schedules me for an appointment the next week, maybe just to hear my voice again.

My gynecologist makes his office staff move patients around to see me, stat. His voice is melted caramel, his eyes soft, his words a salve. When I start the appointment, I am trying to be flippant and humorous. I am not crying and speak matter-of-factly. He knows what I am doing and does not stop me, but instead keeps asking what he can do. When I answer, he asks “what else” until I break down. We talk for a long time. I know he knows more wombs than mine, more ravages and more tragedies. When I go to pieces in his exam room, he does not panic, or lean back, or seem to think I am dangerous. He holds my eye contact. He tells me the way recovery likes to meander and what landmarks I may see on this route. He is glad I am taking time off and going home. He tells me I am going to make a wonderful doctor. We stand, and he opens his arms. He asks, “May I?” 

I nod and he holds me for a long time while I weep into his white coat, with his hands on my back and the crown of my head, reminding me how it feels to stand on solid ground. I leave tears on him.

When I return to school, I don’t tell my classmates why I left. I am as vague as possible so they can form their own theories. Only one girl, a classmate on surgery with me, seems genuinely worried. I am not brave enough to tell her what happened or that her concern is important to me. I am glad she is going to be a doctor soon.

I apply for disability to get time off for my once-a-month psychiatry appointments. The student accessibility director insists on getting detailed reports from the hospital and all my doctors. The process is like the speculum exam, rendering raw what was already damaged. My psychiatrist gets angry again, at the school this time. He is angry out in front of me, like a mother elephant charging hyenas. I know from the way he acts that I am not the first weak thing he has defended. It is good. I am not brave. I get to go to my appointments. I will have to repeat surgical clerkship from the beginning.

On my family medicine rotation, a woman tells me how hard her life has been. I listen for a long time. I believe her. I can tell she has been raped. I want to tell her I have too, but I say nothing. It is not a patient's job to take care of her doctor.

The pharmaceutical salesman for Truvada comes to the office to peddle his HIV pills. Without thinking, I comment that I hate his drug’s cruel side effects of fatigue with insomnia. I panic. I make up a story about a needle stick. Everyone believes me. They remark that having doctors who have taken medicines like this is useful for patients. I nod.

I have a clinical exam where I must counsel an actor playing a patient about contraception. I can feel something in the room with us. What I am feeling is that this character has been raped. I look the actor in the eyes and my voice does not shake as I tell her in caramel tones that I am sorry. I go through an impossibly detailed list of ways to make her feel safe during the pelvic exam she has been putting off. The actor is visibly impressed. The actor tells me at the end of the simulation she feels ready to have a pelvic exam.

I fend off a panic attack in the cafeteria while discussing the simulated case with the same friend who took me to the hospital. His actor did not reveal she was raped. I start to cry and have to go to a small room. My friend lets me cry into his shirt until I have stained it with snot. He never makes me apologize. He never asks if I am okay because he knows that the answer will be a lie no matter what I respond. We talk about the things I have been doing since the assault. I realize that I have been putting off my follow-up pelvic exam.

I go for coffee with a poet in New York City. At the cafe, a drunk man is looking at me. He has a Four Loko can in his hand at 9:00 a.m. and the owners tell him many times to take a walk. He goes into detail about how he would rape me, describing what he would do to various parts of my body. I call the police. The man disappears before they arrive. The police are handsome and prompt. For the first time in my life, I am glad to see their guns.

I get a $1,046 medical bill from the hospital where I had my rape kit. The hospital I went to was out of network; the in-network one is my school. I call the billing company, again and again, hoping someone will take pity on me. I don’t have $1,046. I am six figures in debt, studying to become a doctor, learning by example, especially when I am the example. 

After four months, I speak to an insurance representative with a slight southern accent. I tell her why I was in the hospital. She is incredulous that I have been billed at all, as the hospital should know not to bill for services surrounding a rape kit. She tells me the bill will go away. I ask her name. I say thank you, Nicole, for your compassion and generosity. The tears in my eyes don’t sting.

I meet more patients. They each have their own slice of grief. I learn the right ways to ask hard questions. I start to take shape again around a new form, the form of physician-in-training. I almost never cry. I decide I want to become an emergency medicine physician. People ask me why I would choose such a difficult career. Why would anyone want to see that much suffering?

On shift in the emergency department, I see “domestic violence” as a patient’s chief complaint. I do not ask the attending if I can see her; I tell him I am going to see her. She has been crying. Her feet are bleeding from where the wine bottle he threw at her slashed them. Her hands shake. She doesn’t know what to do.

I hand her tissues. I squat down so that we are eye to eye. I ask her to tell me what hurts, then what happened. Her story makes me angry like my doctors were. I put the anger far away from me and decide instead on truth. I look her in the eyes and tell her something bad happened to me too, and she breaks down into tears. She asks what I did in her shoes. I tell her the truth again— I did what she did, I came to the hospital, and I let people help me. I never saw him again. I cried many, many times. Eventually, I healed.

I leave the room and report to my attending, “I will not send her home until I know she’s safe there.” His eyes widen, but he nods. He signs the orders for the treatment plan I propose. I carry them out, finding the social workers, finding her nurse for pain medicine, gathering wound care supplies. I wheel my patient to the bathroom. I wheel her to get X-rays. I wash her feet with a whole liter of sterile saline and wipe it with fine gauze, my first anointing. I suture her wounds. I make sure they are perfect; they are one part of me holding her together.

I ask her, “What else can I do?”

She says, “I’m okay.”

I say, “No, really, what else can I do, for you, to make you safer?”

She tells me a few things.

“Okay,” I say, “What else?”

She tears up again, and I hold out my hand. She takes it.

“What else,

What else,

What else?”

Maya J. Sorini is a narrative medicine scholar, medical student, essayist, and award-winning poet. Her first collection, The Boneheap in the Lion's Den, won the 2023 Press 53 Award for Poetry and was a semifinalist for the 2024 Poetry Society of Virginia North American Book Award. Maya has a master's degree and has taught in Columbia University's Narrative Medicine program, and she continues to work as a freelance Narrative Medicine workshop facilitator and lecturer. Her work has appeared in arts and medical journals including The Journal of Medical Humanities, Intima Magazine, The Brown Journal of Medical Humanities, and the Journal of the American Medical Association. Maya is a fourth-year student at Hackensack Meridian School of Medicine applying for emergency medicine residency.