Forensic Nurse, Heather

[00:00] Michelle: **The following episode contains graphic sensitive content relating to adult and pediatric sexual assault and abuse. Please proceed with caution. **This week I talk with Heather, a sexual assault nurse examiner, or a SANE nurse who provided comprehensive information about the field of forensic nursing. She also gave us insight into the life of the victim and what they endure during the thorough examination process. With law enforcement and victim advocates as allies, the evidence she collects helps bring abusers to justice. Mental health is crucial for these nurses and allied professionals as they witness humanity at its worst. Heather prioritizes her own mental health by taking part in case debriefs and distressing at the beach with her family. In the five-minute snippet, Heather tells us about her experience with the paranormal. Here is Heather. You're listening to the Conversing Nurse podcast. I'm Michelle, your host. And this is where together we explore the nursing profession one conversation at a time. Well, hello Heather, welcome to the program.
[01:29] Heather: Thank you for having me.
[01:32] Michelle: Well, it's my absolute pleasure. Ever since I started the podcast, it's been a dream of mine to have a forensic nurse on because from a very early age, I think at age twelve, I started watching Quincy, Medical Examiner and I wanted to be him because I thought he was magic in how he could examine a deceased person and get all kinds of evidence and find out when that person died and how that person died. And so found out about forensic nursing late in my career. But if I had to do it again, I think I would do that. So I'm really glad that you're here. So let's just jump right in and tell me, what is a forensic nurse?
[02:31] Heather: I think like you said, you're watching shows and the term forensic, it's an investigative term and it really does fascinate everybody. When they hear that term forensic, they're thinking, I talked to other nurses and they're like, oh my gosh, I watched CSI and I watch all these shows that have that aspect of it, and I kind of chuckle because it's a little bit different than what everybody their picture in their mind about what it actually is. So a forensic nurse, like I said, it's an investigative term, forensics. And what we do there's a couple of different avenues you can take in forensics. There is the death investigative aspect of it, where some nurses actually work in the coroner's office and they help the coroner determine cause of death, they help investigate those causes. And while we do go in into coroner's offices in one of our facilities, forensic nurse, to us, what that means to us is we do sexual assault exams, we work with law enforcement. When they get reports of sexual assault, they get reports of domestic violence, child abuse and neglect, those type of reports. That is mainly what we do. We intake those victims of violent crimes and they need an exam done so we help look them over head to toe. We do an assessment of them, what nurses do, we look them over head to toe, make sure there's not any injuries that need immediate attention. We document those injuries that we find using the tools of the trade. We photograph the injuries head to toe, what we're looking at externally. After that, we collect DNA swabs for law enforcement and for investigative purposes. We use those little QTIP swabs that we're all very familiar with and just run it over different parts of the skin. We have a set protocol on where we kind of swab on their body based on their history and then what the state or crime labs say that we need on everybody. So we do a set protocol and then we add additional swabs based on that patient's history. After that, in females, we do pelvic exams. So we're looking at the genital region, the anal region. We use a speculum to look internally. We use anoscopes to look internally, sorry, rectally. And we swab internally. Some of these terms, sorry if I'm not saying them right, sometimes my word is not quite right.
[05:45] Michelle: Oh, yeah, great.
[05:48] Heather: We do internal DNA swabs as well as looking at the tissue and then anal exams as well. On male victims, it's a little bit different. Their genital regions are all external and then we can do rectal exams on them as well. After that, we have a set protocol of discharge instructions and medication that we give based on state mandates and then our own personal protocols. So, yeah, it looks in pediatric patients, because I like to say we do see everybody from birth to death, that's our range. We never know what we're going to get. We never know the age group we're going to get. We never know what type of exam we're going to get until we get that call from law enforcement. But it's just a tool. As forensic nurses, our main priority is to make sure that that patient is first of all, physically okay, that they don't need to have immediate medical attention, that they are stable and able to be released to go home. We need to look at their mental health, make sure that they're safe going home, they're not going to harm themself or others as we discharge them. Just those main things that nurses do is our main priority. Secondary to that is the investigative tool. So we do work with law enforcement. That evidence and the reports that we collect do go for investigative purposes. But when defense attorneys are kind of coming at us sometimes and saying, you work with law enforcement, you're trying to collect this evidence to put this person in jail. And that's not our main goal. Our main goal is to make sure our patients are safe, that they're taken care of, that they have all the follow-up care that they need, and just making sure that they're okay is our main priority. And then but we do collect that evidence so that we can have prosecution in those cases that absolutely need it. So yes, that's basically in a nutshell what a forensic nurse does for our purposes. But like I said, there's kind of different avenues you can take as a forensic examiner, but that's mainly what our job is.
[08:15] Michelle: Okay. Wow, that's so interesting and it's so comprehensive. You just gave such a good description of what you do. So would you be classified as, like, a SANE nurse or Sexual Assault Nurse Examiner?
[08:30] Heather: Yes.
[08:31] Michelle: Okay. In our institution, these nurses were called SART nurses or Sexual Assault Response Team. And so they were part of a team that had special training in examinations and collection of evidence. So do your patients come in through the emergency room or where do you have like, first contact with your patients?
[08:56] Heather: So where we're located and where we perform exams is a pretty wide range. We see almost complete, I can say in the Central Valley. We see all up and down the Central Valley. And so those smaller hospitals that cannot support a SART team or SART nurses and that's funny, you mentioned that nurses love acronyms, right? Yeah, we have an acronym for everything. And so SANE nurses, Sexual Assault Nurse Examiners,  there are SAFE nurses. Those are kinds of physicians, nurse practitioners, the higher educated, higher level of education, those types of nurses,
the advanced practice nurses, and then physicians. So we as just nurse examiners. That's where SANE nurses and the SART team include all those auxiliary entities that we use. DA's office, law Enforcement Advocate Group. So yeah, we can be called a bunch of things, but in these localized rural communities, they cannot support a ton of nurses that are specialized in this because there's so much overturn of nurses, they can't pull nurses off of the floor just to spend a couple of hours with one patient. They have to actually bring them in and have them on call specifically for that purpose. So it's like you have to have double the staff. So where we come in is we're a small nursing corporation that provides that care. So we are outside of the hospital. We're not connected to any hospitals per se, but we do work within hospitals. So if a patient can't be discharged from a local emergency room, we have the ability and we have MOUs with our different hospitals that allow us to go in and practice inside and work with law enforcement. So we will come in and do exams in hospitals, but mostly we have satellite offices where we will get notified by law enforcement that they have a report. So they have a victim who needs an exam. If they have already reported to law enforcement, they've either walked into law enforcement's office, they've called 911, or send an officer out to their home regardless of what they did. If they don't need to be in a hospital. If they're stable, they will come directly to one of our satellite offices and we have a setup where we can do those exams.
[11:45] Michelle: Wow. Okay. Yeah. That was a big question in my head. I know because I worked in a hospital that these victims would frequently come in through the emergency room and just how you said we had several SART nurses that were actually NICU nurses and labor and delivery nurses. And we'll get to your background in a second because I know you have a labor and delivery background. But in the beginning, when this started and they were providing this service, they would call them and they would be working on the floor in the unit and say, we have a victim come in and that nurse would leave and be gone for like five to six hours. So it's not sustainable, yeah, and then they started putting them on call for certain days so that they were off and they weren't getting pulled from their assignment. And that worked out a lot better. But you do have a background in L&D, is that right?
[12:59] Heather: I do. That's where I started.
[13:03] Michelle: Okay. And I would think that with your background in L&D and obviously your patients are coming in and they're pregnant and they're delivering a baby. And so in the course of that, you are doing vaginal exams. And so is it just a natural progression that this type of sexual assault examination would just be kind of natural with your background?
[13:40] Heather: We have quite a bit of labor and delivery nurses that fall into this work line of work. And even when we have to go and testify, it actually does help if you have a labor and delivery background because you are very familiar with female anatomy. Even with my background, there's some anatomical terms that I didn't understand. There was some anatomy I didn't understand. And so I'm very familiar now because we have to be to identify injuries. But it does help. It helps to know what normal anatomy looks like. Not that very pregnant women have super normal anatomy, but it helps to know those markers, what you're actually looking at, even internal I didn't look through a speculum. I didn't ever do triage nursing, so I did never use a speculum in labor and delivery. But you're still to look at the cervix I know how it feels. I know how the cervix feels, but I didn't ever know what it really looked like. And so it is it's like a natural progression where you are familiar with the anatomy, you're familiar with the female body. If we do have pregnant women that come in for exams, we have the knowledge and kind of ability to really make sure that they're stable, make sure we're not doing anything or introducing anything into their vagina that can stimulate labor. And it really does help us to make sure that they're okay because there is that kind of specialized knowledge you have. But it is funny, we have OBGYNs that specialize in sexual assault as well. So it is kind of a natural progression. But not every nurse that we get our labor and delivery, but I've had quite a few that have come through, so it's helpful. It really is.
[15:51] Michelle: Yeah, I would imagine so. Along those lines, when you were a labor and delivery nurse, did you ever have a suspicion that your patient, that you were laboring was like a victim, a sexual assault victim, or did they divulge any information that I'm being assaulted or maybe on a vague exam, did you see anything that would lead you in that direction?
[16:23] Heather: I don't specifically, what I think was more prevalent with domestic violence victims that would come in and then our young, young teenagers that would come in where you do have a suspicion, maybe they didn't want to disclose who the father was. Maybe there was family, there was a family relation that was involved. So those types of suspicions, yes, domestic violence, I did see injuries and partners that were very suspicious about what's going on in the home. But as far as injuries, it's really hard. And what I kind of learned in this process is our anatomy. The female genitalia is so vascularized that it heals itself within 24 to 48 hours. Even violent injuries where we have lots of tearing, those injuries can heal very quickly. So, yeah, it's not so much the injuries that I saw to the vaginal area and I really didn't know what I was looking for. With sexual assault injuries, you really have to know what you're looking for. So I would just probably assume it was something natural from the pregnancy or just delivery itself. But yeah, those young, very young teenagers, we obviously always suspect that something else is going on or domestic violence was the biggest problem, I think that we would see.
[18:08] Michelle: Well, okay. Wow, that's really interesting. So along those same lines, you saying that the genitalia is very vascular and it heals very quickly. What happens in the case of a victim coming to law enforcement and saying, I was assaulted last week or two weeks ago and how does that go with the examination? What happens with that process?
[18:50] Heather: We have a couple of different types of exams that we can do. So if we're talking about age, we need to know when we get a victim, what the age is of that victim. So in pediatrics, it's actually eleven years and younger. And for them, when we get a victim in, they are notoriously late disclosures, meaning unless it was witnessed or there is an injury to that child where they would go to a parent and say something hurts down there. Typically, they won't disclose what happened to them because it's 90% of the time, a trusted family member. They've been threatened or told that something's going to happen if they told us. Just like with us, predators don't want to harm their victims. They want long-term relationships with these people. So they make it pleasurable. And you're not going to say anything? They know it's wrong, but they're kind of like, this is weird, but it feels good. Not putting that on the victim. It just is our basic anatomy, when you're touched a certain way it feels good. So I mean I can go on and on and on and on about why pediatric patients disclose late. So for them, unless, like I said, it was witnessed or there was an injury, typically, we see them later. We see them months, years after they finally come forward and said something. And what we're looking for in them, especially when their hymens haven't estrogenized yet. And this is again a whole other teaching lesson after their hymens haven't estrogenized. I'm sorry, before their hymens have estrogenized. And that isn't as stretchy or elastic. We can see those injuries if there was complete penetration. What we're looking for are the lacerated hymens. We're looking for the deep lacerations that heal those stages of healing. We can look for those. But if we're talking about twelve years and older, which is considered an adult for us, they have the right to their own privacy. They're under their own HIPAA. They have a right to refuse exams anyways. We have up to five days to collect DNA on everybody. We have up to five days to collect DNA. That's just how long that they've been able to find DNA on patients after the fact. So in adults and teenagers a lot of factors come into it so we look at their hymen, the elasticity, elasticity of it, we look at if they're sexually active prior, if they've had any injuries, say a straddle injury can mask as a sexual assault injury, it can look the same. So when that hymen tears or there's deep lacerations in the vaginal area that leave a scar, we're looking for that as well. But in adults, if they've had babies, if they have been sexually active for years, it's really hard, almost impossible to tell what is an old injury and what's from the assault. So in our adults, we don't typically.  So in our pediatrics, we can do what's called an acute exam or a nonacute, so those acute or anything up to five days those nonacute are anything after that five-day period where we're not necessarily collecting DNA but we're just looking for evidence of injuries. In adults, we can only do acute so in our teenagers, we have to take it case by case and really know the history, know prior sexual history, and things like that. We can actually extend that up to like 17,18 as long as we know that what we're looking at would be from an assault and not from anything else. But other than that for females, we only have that five days to look and then at that point, we're collecting DNA and we're looking for bruising and things like that that may potentially be there. But yeah, anything that has healed, we can't tell if it's from a prior incident of sexual contact versus an assault-related contact. So it really does depend on what we're looking at. We have to take them case by case and really know what we're going in to find.
[23:36] Michelle: Yeah, it sounds like they're so individualized that you couldn't possibly I mean like you said, you have protocols for all these different ages, but you just have to take each case as an individual. And obviously, if you can't collect DNA, that's going to have some kind of effect on the outcome of the case.
[24:02] Heather: Yeah, it depends. I like to say, and what I tell my nurses is we are a very small part of the whole picture. They do bring us in and everybody wants evidence of something happening to them because it's a validation. It's a validation that something happened. When our families bring their kids in and it is a trusted family member, they have to know that they're breaking up their family for a reason, that this child isn't lying, even though they want so badly to trust their children. And heaven forbid, we do have parents that come in and just accuse their children the whole time, but they want validation and they want to know they're doing the right thing because it does break apart families, accusations, and trusted family members going to jail and things like that. They want validation. Even females, when we have alcohol or drug involvement and they really don't remember what happened to them, it's kind of like, okay, something did happen to me. I'm not just coming here for no reason or I don't remember it. So did it happen? Didn't happen. It can be like psychological warfare on them because they just don't know what happened. And you have to have that validation. But unfortunately, 90% of the patients that we see come with no findings. That doesn't mean nothing happened. And we have to explain that to both parents and then the victims themselves. It doesn't mean nothing happened just because we didn't see anything. It just means that we didn't see anything. That's all that means. And there are like I said, I do a two-hour training for law enforcement and advocates explaining this concept, why we have no findings and we have to go on the stand and testify to why it's normal to be normal. And so it's a hard concept for a lot of people to get that because they don't have that validation from the report. And we're such a small part of it. The investigation goes on regardless of our part in it. But it is more concrete when we do find DNA. It's more concrete when we do find injuries because you can get on the stand and say, hey, this suspect's DNA is in this victim and it shouldn't be there any other way but with sexual contact. That's concrete, more so than he said, she said type of testimony. So we always want it, but it can go on regardless. There's lots of different aspects that come into the investigation and not just us. So it's scary on our end to think, oh my gosh, if I didn't get that DNA in that spot or if I didn't see any injuries, like, are they going to come back on us as examiners? Can they say they didn't do it because we didn't find anything? I tell my nurses and I have to tell myself as well, that's not on me. We did the best we could, we got everything, we tried to get everything we could in that exam, but if there was nothing, there's lots of different reasons why and I can explain that to victims' families, juries anybody who wants me to explain that to, I can explain that. So it really does help regardless, I guess.
[27:37] Michelle: Well, you have like a superpower. You're amazing to talk to, obviously, when you talk about my nurses. You have nurses that work for you or for your company?
[27:53] Heather: Yes.
[27:53] Michelle: Are these nurses that you train?
[27:57] Heather: Both. So I started working in a company doing this business and the owner has since retired and graciously allowed me to step in and take it over. Now I do own and run the company myself and have nurses that we employ to do this work as well. So it's not just me trying to cover a large area. I have quite a few nurses that help me do this work. So it really does help.
[28:35] Michelle: You're training nurses. How did you get trained? What do you have to do to be a forensic nurse? What does that entail?
[28:45] Heather: I think the biggest issue is just finding a position. That was my biggest challenge when I initially tried to figure out who does this and what it is. I worked at a local children's hospital before I became a nurse in their emergency room. And I would see these nurses and physicians that sometimes go in with these brown bags and their camera and their set up and go in there and they'd be in there for an hour and then come out and they'd have all this evidence in their hands. And I was like, that is so cool. Who does that and who works with these people, this subset? And so after I became a nurse, worked in labor delivery, worked in Med-Surg for quite a few years, and really didn't find much satisfaction in that work. It was really hard for me to really love nursing and feel like I was doing much good because it's just kind of work to keep people alive. And so I remembered like, oh, who was that that did that? Didn't understand the term forensic, didn't know exactly what they were called. And kind of Googled, as we all do, who does sexual assault exams? And then forensic nurse came up and then I miraculously found a job opening locally that they just happened to be hiring. Got an interview with this company and learned from there. So when I started, we started as contract nurses. We actually paid for our own training. We worked for a company but as a contracted nurse. So you weren't an employee at that time. And I had to pay a good chunk of change to have the nurses that were other contracted nurses pay them to do to follow them. Basically, you shadow them and they train you. They teach you what you need to know. On my own time, I did it without being paid. So we do up to ten cases, which is about 40 hours of hands-on training with another nurse. And like I said, I kind of shadowed another nurse at that time and was a contracted nurse after I was on my own. We also are required to participate in 40 hours of intensive training. And I did it through a group called California Clinical Forensic Medical Training Center. It's a big long word, CCFMCC is what it is. I went to Sacramento, did this 40 hours of training. It was a week-long, really intensive. They taught you really all that you needed to know. So we have to do both adult and pediatric trainings. That's intensive. So it's 80 hours total. Again, on your own time. But really the hands-on was with those contracted nurses and just finding them and getting my time in, because that's what you're really looking for, hands-on time. So, yeah, it was really intense. It was all on my own time. I paid for my own training. That was about eight years ago. Almost eight years ago. That's how it worked. Now, because of the new laws, contracted nurses are kind of no more. And since I took over, now they're employees, so it's set up a little bit different, but the same. You are training under another nurse and then are required to take those intensive training courses.
[32:52] Michelle: Well, that's a lot of dedication and that's a lot of commitment to do that training and to do it on your own time. I don't think a lot of people would have done that. So that just really shows your level of commitment and motivation. So I was thinking when you were talking about the actual exam, does the victim get to have anybody in the room with them? Does a pediatric victim get to have anybody in the room? Or is it the same with an adult?
[33:34] Heather: Yeah, absolutely. So we have victim advocates that we work very closely with, and their sole role is for emotional support and then giving them resources for afterward, because they follow these victims through the court process, really set them up with all the aftercare that they need. We see our victims and then we kind of don't know the outcome for them unless we go to court with them. But these advocates will spend hours following up with them, going to court, giving them what they need emotionally, all that support. So they're there during the exam, we call them in with every case. They get to know the patient, they get all their information they are allowed if the patient would want to come into the room, that's mostly for our teenagers and adults, pediatrics, it's case by case again, if they're more cooperative with us and an advocate in there, then we may bring them in to do that. But mostly we allow a parent to come in as long as it's not an offending parent, and there's no risk of that. They'll come in with us and really help to calm the child down and things like that. But teenagers are a little bit different. They either want it just one-on-one and we can keep that confidentiality between us. Sometimes they want a parent, sometimes they want an advocate. So it really does depend, but everybody has the right to have emotionally somebody there for their emotional support regardless of age.
[35:24] Michelle: Well, I totally agree with that. I had no idea that there were these victim advocates that were available to do that. Are these volunteers or do they get paid? Do you know?
[35:36] Heather: No, it depends on the agency. So every county has their own set of advocates. It's not just like one broadcast like us. Every county has their own advocates and it really does depend. But for the most part, they're volunteers. This is on their own time, they're coming in at all hours just like we are. And it is voluntary. So obviously they get a good turnaround, it's difficult work and just like my nurses, their turnaround is up there. But they are amazing. I have nothing but good things to say. There is one or two bad apples every once in a while. But these advocates really do take on the victim's support, they take on their cases, they follow up with them, they hear their stories, but it's all voluntary. So I love our advocates. During COVID they weren't allowed to come into the offices with us during exams. And I really learned to appreciate the help that they are for us because we're having to introduce and do things. To victims and revictimize them in some cases because we're obviously doing internal exams on an injured patient sometimes. And so it's very painful for them sometimes, and so having to start and stop and really talk to them and really it takes more time up and it really does slow the whole process down when we're the ones having to play both roles. We do, and we can and we will in every situation. But having that extra person there that talks to them, that they sit at the head of the bed. So they're not able to see anything that we're doing down at the bottom of the bed. But they sit up there, they talk to them. Our little kids, they'll play videos on their phones, they'll play with them with stuffed animals, kind of distract them as to what we're doing. And I can't even tell you how appreciative I am of their services because it is very difficult to get through an exam without that assistance.
[37:58] Michelle: Well, they sound fantastic. And man, again, the dedication and commitment to helping victims, it just has to be forefront for them. So, being a nurse, do you get to provide any education or resources for these victims, like in the moment? Or is that allocated to somebody else? Like maybe the victim advocate? How does that work?
[38:30] Heather: Again, we all have our roles and our purposes and what we're trying to do. We have lots of opportunity for education with our victims of domestic violence and victims with strangulation, there is a whole set of instructions on what to watch out for. This is my soapbox with strangulation. I'm trying to get education out there about the importance of exams or knowledge and the damage that it can do even when there's no external injuries. That's my soapbox moment. But there's lots of education. For domestic violence victims, we try to educate them on the seriousness of certain injuries, on the seriousness of staying in the situation, not trying to bully them or make them feel bad about it in any way. But there is some education there. Obviously, with STIs, there's some education we need to go over with the victims, what to look out for, what to be tested for. We give medication with discharge, so there's education in that. One of those medications is Plan B. So we need to go over informed consent to be able to give that medication and just really inform them of what the purpose of that medication is and what it's designed to do. There's lots of misinformation out there on it, especially very conservative families and views. There's lots of misinformation on it. So we do educate them on that. We educate them on when we have patients that were worried about their mental health, maybe we have those teenagers. We can see those self-harm marks. They're cutting. They have some history and background of self-harming. We really do need to do an in-depth, not an in-depth, because I don't want to say, I'm not a psychologist, but we need to go over those steps. Like, do you have a plan? Have you ever tried to harm yourself or commit suicide? Do you have a plan to do that? Really making sure that we're sending them home safe and giving them some education, that this may trigger an event, this may trigger a response from you. And I need to know that you're safe going home. And my teenagers, sadly, the majority of the ones we're seeing are between the ages of eleven and probably 20. That's the majority of our clientele right now. And so the destructive behaviors and keeping yourself safe goes into that. Again, not super in-depth, but just starting the conversation with them, making sure that they understand their behaviors may bring them back to us and that can put them in harm's way. This is all being done as we are doing the exam. We are constantly talking to them. If it's a good forensic nurse, you're constantly talking to them, telling them what we see, educating them on injuries and follow-up care. Why I don't see injuries, we're constantly educating them on that it's okay that I'm not seeing anything that doesn't mean nothing happened, and giving them that background. So there is a lot of information that comes at them during that exam and then at discharge. What advocates do and so ours mainly focuses on safety and medical education and information. What our advocates do is educate them on follow-up therapy. Maybe they need to use victims' crime compensation for financial support and any costs that are associated with a sexual assault. Giving the families the information because it's not only the victims, sometimes it's a whole family that needs support and so they need information on that. Our advocates do provide, I am not remembering, blocks a person from having access to a restraining order, sorry. They help them with that process. So they have their kind of own set of all the information. But it is a lot that kind of comes at them. But the advocates are always there for follow-up questions. They can get a hold of us if they have follow-up questions. If it's just not something that at the time they were able to intake and retain because of them being in fight or flight mode still. And so the advocates always are able to get a hold of us and we can always talk to the patients afterward as well.
[43:31] Michelle: Well, it sounds like the victims are very well supported. First of all with all the education that you provide them, like in the moment during the examination and then with the follow-up with the therapy that they need, the financial compensation, it sounds like there's a lot of systems in place to really help support these victims. So I'm really glad to hear that you touched on the mental health of the victims and that is so important. I want you to talk for a moment about the mental health of the nurse examiner. What is in place to support that person? Do you have a therapist? Are there resources for you that are provided by institutions or are there other resources for your mental health? And what do you do for your own mental health? Are you a runner? Do you have a punching bag in your garage? How do you take care of yourself? Because what you see, what you hear it just has to be so overwhelming at times. Tell me about that.
[45:03] Heather: Yeah, we've all heard the term tertiary or secondary trauma and PTSD and all those terms we hear. And there is a reason why the suicide rate of policemen is so high after I started doing this. Nothing but respect for those officers and workers that see the worst of the worst of humanity at every turn and still are able to function normally in society and not hate everybody. I tell my nurses when they come in, you have to respect law enforcement. And there are bad apples. And I'm never saying that all law enforcement police officers are good people because they're not. But I have sympathy for those that have hardened hearts and have kind of a grim outlook on life and those that suffer with mental health because you have no idea what they see on a day-to-day basis. We think that we see bad things, but what I hear from them, what I see from them, what I hear and see myself, it does cause some damage. Long term. I would hear about secondary trauma and about self-care and making sure that you're okay, making sure that you have that outlet for it. I kind of put it in the back of my mind, didn't really understand what it was doing until I started to work, actually have hands on. And I would notice that I was having a really hard time sleeping. I would notice that I started to get anxiety when my children were out of my eyesight. I would start to get anxiety when my kids wanted to go play at other friends' houses. And I didn't understand why. And I didn't understand until I took an Advanced Strangulation course. After that course, it was about a week. It was four weeks of two days a week training. It was all online. And my family, they were like, you are really mean right now. Why are you snapping at us? Why are you so mean right now? Why are you yelling at everything we're doing? And it took me back. I was like, what? And I didn't mean to be, but I stopped and paused and thought, and I was like, oh, my gosh. Now I understand. Now I understand what this is doing to me on a daily basis. And it's not until your family kind of points it out that you've changed. Your personality has changed. So when I talk about workers in this field and them being very gruff people, or we laugh at nurses, just have a sick sense of humor anyways, right? You can be in the break room laughing about something and eating your lunch. You kind of have to put that front up. And I like to say I have a bubble, and really you can't. I compartmentalize, I think things, but at some point, it does get to you. And so when they talk about self-care, it's because they see how much the suicide rate and law enforcement and nurses that do in ICU, nurses during COVID that suicide rate went way up. So when you see this constantly and you're under constant stress, it does take a toll, and your mental health really does suffer. So I tell advocates, I tell law enforcement, you just remind them all the time. I tell my nurses. We have the ability within a SART team because we have contracts with each other and within our own group to really dive into each case. We debrief in really hard cases, we talk about it, we do case reviews, and it allows the nurse to really talk about the case, because mostly what harms us is keeping it in. And while we need to keep confidentiality, being able to talk amongst ourselves is helpful. Really checking up with the nurses, making sure that they're okay, especially in really hard ones. And we just had one recently, really talking to that nurse, talk it through. What? Is anything bothering you right now? Is it really hard? In our really bad pediatric cases, we're constantly like, are you okay? What do I need? Let's talk about this case a little bit, and then it just relieves a little bit of that stress. And then having something that you can fall back on, having something that you can do that takes your mind off of it. And while I used to exercise, now I'm a nurse, I have a bad back. So that's really hard. Sometimes my safe place is the beach. Going to the coast and really hearing the ocean, spending time alone at the ocean, just listening to the ocean with my husband is really helpful to me, and that is what I know relaxes me and where I can go and just kind of let everything go and take a minute. But everybody has to, or you really do suffer, and we never want that to happen. But it's 100% a real thing, and I didn't know that until I started doing this.
[51:09] Michelle: Thank you for sharing all of that. I have a saying that I've had for a long time, and it's nurses are people too. We can seem kind of superhuman in a way, but we are not immune to feeling all the ways that you just described. And self-care is more than just taking a warm bath and burning candles, that's good for you, for somebody else that might be going on a run, other people that might be journaling. So we just have to find what is good for us. And I just imagine what you go through on a daily basis is very traumatic. And I'm so happy to know that there are so many resources in place to support the nurse and law enforcement and all of your team in supporting the victim. So that makes me very happy. And wow, thank you so much for what you do. Thank you for teaching others thank you for all of your supportive victims everywhere. I'm going to get some of those resources from you because I want to link them in the show notes, but definitely some domestic violence, some suicide prevention. I'm going to link all those in the show notes.
[52:47] Heather: Okay.
[52:48] Michelle: I'll get those from you later. But thank you so much, Heather. If you could see me right now, my mouth has just been, like, open the whole time because I think I'm like so many people that had a certain picture in their mind of what forensic nurses do, and you just added so much to it. So thank you so much.
[53:18] Heather: No problem.
[53:20] Michelle: Yeah. Gosh, what a pleasure. So we are going to kind of switch gears here for a second, and I do this thing at the end called the five-minute snippet. We talked about it, and this is just a kind of a way to have our audience just learn a little bit about you, kind of your off-duty side. So are you ready for the five-minute snippet?
[53:47] Heather: I am. I told you, I'm not really interesting outside of work. It's consumed, like, my whole life, and so I was like, oh, my gosh. And it's what I emailed you. I don't know what I like. I have no big knowledge. I have knowledge about a lot of little things, but I am not an interesting person, so good luck. This might be really bad.
[54:12] Michelle: Okay, let's see. Are psychopaths born, created, or both?
[54:19] Heather: I think both. I think the true psychopath is in the medical term, born, but I think environment and there can be enough abuse and neglect in somebody to cause somebody to act like that as well.
[54:33] Michelle: Plays a big role. Yeah, I agree. What's your favorite ride at Disneyland?
[54:40] Heather: Pirates of the Caribbean.
[54:42] Michelle: Okay. That scared the crap out of me when I was a kid. Let's see. Do you think psychics can help solve cold cases?
[54:54] Heather: I think we need to be really careful with them, but I think there can be cases and there have been that have been solved by people that see more than we do.
[55:07] Michelle: Yeah. And psychics, you don't know if they're on the up and up. Like you, I think there are some that are totally legit, and I think there's some that it might be an act, but yeah. Which Disney villain would you be?
[55:28] Heather: Oh, that's a good question. That's a good question.
[55:37] Michelle: Well, the other side of that is which Disney princess would you be?
[55:42] Heather: Oh, funny. I like Rapunzel.
[55:48] Michelle: Okay.
[55:49] Heather: I just think that or maybe that movie was just more close anyway.
[55:53] Michelle: Yeah. Let's see. Have you experienced the paranormal?
[56:01] Heather: Yes. My daughter, ever since my daughter was born, has had the ability to see things ever since she was a little kid. And since she's been born, we, in turn, have had some instances in our home where we've seen shadows and heard specifically a little kid's voice multiple times in multiple homes that we've owned. So I am a true believer.
[56:30] Michelle: I'm with you. I do believe. Which Disneyland character do you most identify with?
[56:45] Heather: That's another good one. These are good ones.
[56:47] Michelle: They're very thought-provoking.
[56:49] Heather: Whichever one isn't perfect. I think the more recent ones, we think about Disney characters. Oh, I'm thinking princess.
[56:60] Michelle: Yeah, just a character.
[57:02] Heather: I don't know. Oh, my gosh. Whichever one is not perfect.
[57:08] Michelle: That's probably all of them, right?
[57:12] Heather: The most flawed one, yeah. Oh, my gosh. I don't know. I can't even think of one.
[57:18] Michelle: They're very thought-provoking. Why do you think some people in relationships murder their partner instead of just leaving the relationship or asking for a divorce?
[57:31] Heather: Yeah, we deal a lot in this. I think, again, environment plays a lot into how somebody reacts to situations if they are not shown good behavior as a child or it's modeled a certain way, and that's how they know how to react to stressful situations. It can, in turn, not allow them to have the ability to walk away from a situation or to destress, or what is that called, deescalate a situation. So I think that plays a lot into the role, and just some people are just horrible people in general.
[58:17] Michelle: I think that is just a very true statement. Some people are just horrible people. If you could know the honest truth about one unsolved murder case, which would it be?
[58:32] Heather: Again? It's a Delhi murders. It was solved recently, but that has always,  I've listened to podcasts, I've read about the case. Just the fact that they had him on video, they had his voice, and still could not solve it for years later was astonishing. When police officers can find a suspect in a random town in Mexico. Yeah, I think that was that one. And I'm glad that they've identified the suspect in that case.
[59:07] Michelle: It's so interesting to me that several podcasts have been able to solve missing persons cases,  murder cases. I'm like, wow, that's cool. Well, that is all of our time today, and I have really enjoyed myself. Like I said earlier, my jaw has been dropped the whole time. You just have so much knowledge and so much experience and so much resolve and so much advocacy for the victim. I imagine that's why you do it. You're such a great advocate and such a great example of a nurse. So I thank you so much for bringing everything forensic nursing to us today. Thank you.
[59:58] Heather: No problem.
[59:59] Michelle: I appreciate it. And you have a great day.
[01:00:02] Heather: Thank you. You too.
[01:00:03] Michelle: Okay, take care. Bye.