Getting raped can be just the beginning of a nightmare.
But a new program in Oklahoma is fast becoming a model for dealing with a crime that nobody wants to confront
by Ann Patchett
Making progress: when Debbie Rollo, below left, was raped in Tulsa in 1987 she was treated like just another emergency‑room patient. Today she would be taken to the waiting room at the Sane program, below, where she would receive counseling and a rape exam conducted by a specially trained nurse.
Friday the thirteenth came on an unseasonably warm day in February in Tulsa. When Debbie Rollo went back into her apartment after taking out the trash, she left her front door open. In the 30 seconds it took her to put the trash can back in the kitchen a man with a gun walked in, shut the door, and raped her. This is not the end of the story.
The first thing the nurse at the emergency room did when Rollo arrived was take her clothes. She was left alone in an examining room for more than an hour, wearing only a hospital gown. "It was cold," she says. Rollo is a tall, attractive woman with red hair, but what is striking about her is not her beauty. She has the serenity of someone who has turned her life over to God. She retells her story calmly. The woman doctor who performed the exam was kind, but early on in the process three young male interns came in, saying that they had never seen a rape exam before and wanted to watch. "At this point, the exam was so overwhelming that I didn't know if I had a choice or not," Rollo explains. Hospital records show that Rollo had ejaculate running all the way down the inside of one leg and halfway down the inside of the other. As part of the exam a sample was taken. "They had a microscope in the room and took a slide while I was standing there. One of the lab techs who was looking in the microscope started going, 'Ohhh, ohhh,' and I didn't know what she was seeing. She invited another lab tech to look at it. I'm asking 'What is it? This is something relating to me.' Then they finally told me there were mobile sperm, and they had never seen it before and they invited me to look if I wanted to."
She didn't want to. She wanted to get home and take a shower. She left the hospital wearing a set of borrowed green surgical scrubs. The man who raped her was never caught.
Debbie Rollo was raped in 1987, four years before Tulsa implemented an innovative system to address what happens to women after they are raped. Since 1991, the city has trained a group of nurses to perform forensic rape exams, counsel victims and testify in court as expert witnesses. Advocates for rape victims now champion Tulsa's approach, known as the Sexual Assault Nurse Examiners (SANE) program, as the best way to confront a crime that no one wants to deal with, not personally, not publicly. This year several cities, including Oklahoma City and Kingston, New York, have started programs modeled on Tulsa's. Massachusetts is adopting the system statewide; New Jersey is likely to do the same early next year. And 27 cities, including Portland, Oregon, Tucson, Arizona, and Anchorage, Alaska, are in the process of developing programs in consultation with the founders of Tulsa's.
To appreciate the system that now works in Tulsa, you have to understand the one that once failed there and continues to fail in so many other cities. Each year about 100,000 rapes are reported to the police, though the actual number of rapes is thought to be higher. According to the National Women's Study, a survey cited by the Justice Department, one in eight females reports that she has been raped at some point during her lifetime. In most of the country, if a woman is raped, chances are she will be taken to the emergency room of her local hospital, as Debbie Rollo was. She will not be allowed to change her clothes, shower, smoke, urinate, defecate, eat, or even have a drink of water, as any of these actions may destroy evidence. She may wait in the emergency room with a police officer at her side for up to ten hours because anyone who has been shot or is having a heart attack ‑in short, anyone who may be at risk of dying‑ will be given priority. Some women, at this point, will decide that it is not worth the wait. They will leave the hospital, forgo the exam, and significantly reduce the chances that an attacker will be arrested, much less prosecuted. Those who do stay will receive a bill. A rape exam costs the victim between $300 and $600.
Jessie Dragoo, the clinical director of a Tulsa hospital, has been one of the city's sixteen SANE nurses since the program began four years ago. Over lunch, she explains that like the other forensic nurses, she works part‑time for SANE and is on call once a week. Even before Dragoo got involved with the program, she knew that women often were not treated with care after they had been raped. As an emergency‑room nurse, she had assisted overextended doctors who often had limited experience with the seventeen‑step rape exam and little desire to take time from their hectic schedules to testify in court. Now, as a SANE nurse, Dragoo has conducted more than 60 exams and is comfortable testifying as an expert witness.
While talking to Dragoo I get word that a rape has been reported. I head over to Hillcrest Medical Center, a sprawling private hospital where SANE is located. A sloping cement walkway leads to a basement‑level side entrance that allows for some privacy. Despite the fact that this is a hospital, there is no funny hospital smell. Inside the empty waiting room, current magazines wait beside comfortable chairs. The framed pictures are of that anonymous hotel‑room variety that is meant to soothe rather than inspire. In fact, the whole place is soothing, down to the tiny blue and brown leaves that float on the wallpaper. A small waiting room, a miniature version of the main one, has a large closet stuffed with donated clothing, mostly shapeless house-dresses, sweatpants, and loose tops, divided into small, medium, and large sizes. Clear‑plastic organizer boxes full of bras and underpants are stacked neatly on the top shelf. After her rape exam, a woman is sent home from SANE wearing clothes, not a hospital gown or surgical scrubs. In the bathroom, where the rape victim can shower immediately following her exam, a cabinet is stocked with Ziploc baggies, each containing a small bottle of shampoo, a comb, mouthwash, a brightly colored, animal-covered toothbrush called New Zoo, toothpaste, and soap. There must be 100 such baggies packed up and ready to go. I can't help thinking, What a lot of rape.
No matter how you try to dress it up, an exam room is an exam room. The high windowsill of this particular exam room has been lined with stuffed animals, pink elephants, teddy bears. Fancy sheepskin slipcovers hide the metal stirrups, and yet there is no disguising the table the patient must get up on, the low, rolling stool where the nurse will sit. There is a box of disposable latex gloves and the overbright lights that are universal to pelvic exams.
When a police officer picks up a rape victim in Tulsa, he or she contacts Call Rape, the local rape‑advocacy hot line. The hot line dispatches a trained volunteer and pages the SANE nurse on call, who this Wednesday afternoon is a woman named Kathy Bell. I wait for her in the examination room because the rape victim, a teenage girl, has arrived, and I am not allowed to meet her. She is accompanied by her parents, a police officer, and a Call Rape advocate.
When Bell comes in a few minutes later, she and the police officer talk easily as they go over a few details about the girl and the examination procedure. Bell, the director of SANE, came to the program after a long career as a critical‑care nurse. She is the kind of nurse you would want to find in an emergency room, in a rape clinic. She has the calm good sense you know would hold up in dire circumstances. "We don't get many exams in the afternoon," she tells me once the officer has left, "but the rape happened on Monday. The girl told her friend today at school, and the friend told the principal; the principal called the parents. I'll talk to her for a while first. If you can get them to open up to you, start talking, they'll tell you things they didn't even know they remembered. That gives me a lot of information about where to start the exam. But it's hard." Her tone is matter‑of‑fact. "She will have taken a shower, changed clothes."
The rape‑exam kit, which Bell lays out, comes in a white cardboard box about the size of a package of copier paper. Inside there are seventeen envelopes, all with instructions printed on the front. Bell opens each one in advance so that the exam, which can last up to two hours, will go as quickly as possible. When everything is ready, I walk through the bathroom and into the smaller waiting room. Then Bell calls the girl inside.
I am both sorry and hugely relieved that I cannot stay in the room. I have been through this kit with Ann Morris, the Tulsa police department's forensic chemist. I know the drill. I know that fifteen is the average age of a rape victim in Tulsa (the national average is older, with most rapes occurring between the ages of 20 and 24) and that this fifteen‑year‑old has never even had a pelvic exam before. Bell will make her comfortable, get her talking. She is a good listener; she knows how to hold still and look you in the eye.
If the girl had gone straight to the police after the rape, Bell would have collected any clothing that might have come in contact with the rapist. The girl would have removed her clothes while standing over butcher paper, and the paper would have been saved, too. But the clothes she has on now are different from the ones she was raped in. There's no point in taking them. She will have to give up her underwear, though, even two days later, because of the possibility of drainage. Next, Bell would have gone over the girl's body with an ultraviolet Wood's lamp in search of traces of semen; because of its bacterial content, semen glows under the purple light. Now there is no need.
By the fourth step, it becomes increasingly apparent why it is so important to come in for the exam right away. Kathy swabs the girl's mouth with something that looks like a large Q‑Tip and then makes a slide. Two days of eating and brushing her teeth would have destroyed any hope of evidence there. Normally, a nurse would concentrate on the area between the front lower lip and lower gums, where semen is most likely to collect. After this, an oral washing is taken, which should be the first time a victim would have rinsed her mouth since the rape. I asked Ann Morris whether a nurse would skip this step if the victim said she'd had no oral contact with the rapist. She explained that people forget; they're in shock, in denial, ashamed. It's better just to do the same procedure to everybody, straight across the board. Still, a woman can refuse any part of the exam at any point.
Now Bell combs the girl's hair over a piece of paper to collect any foreign hairs. After that, 40 hairs are pulled from different locations on the girl's head to distinguish her own hair at the time of the rape from any foreign hairs that might be found. Next, pubic hair is combed, pulled. Bell offers to let the girl remove the 25 needed pubic hairs, which she does, several at a time.
Then there are a series of steps much like the ones performed on the mouth: a vaginal swab and smear on a slide, an anal swab and slide smear, and a swab and slide smear of the cervical mucosae. Photographs are taken. During this procedure the speculum usually stays in for about five minutes‑up to ten, if there are more serious injuries. That's considerably longer than an exam on your average trip to the gynecologist. It's an unimaginably long time, considering what has happened.
Things are beginning to wind down. The girl runs a piece of filter paper over her tongue to distinguish her saliva from her attacker's. Her nails are scraped, one envelope for each hand, to check for bits of flesh in case she scratched the rapist. If a nail was broken during the attack, a clipping is taken so that a match can be made to any fingernail found at the site. Two vials of blood are collected. At the end of the exam Bell counsels the teenager about HIV, offers her a high‑dose antibiotic to knock out other sexually transmitted diseases. Morning‑after pills are also available.
And then it's over. "It sure looked like she was raped," Bell says once the girl is gone. She begins to sign and seal all the envelopes and return them to their box. She's doubtful that anything ‑an arrest, a trial, punishment‑ will come of this, though. The boy was a minor, too. They'd had consensual sex before. The girl had gone over to his house freely to try to break things off. The fact of a rape is not enough.
Most rapes that occur in the United States go unpunished. According to the Department of Justice, nearly half of all rapes are not reported. Of the 104,000 rapes that were brought to the attention of the police in 1993, only about one‑third led to arrests. Of those 38,000, fewer than half ended in convictions. After I leave the hospital, I go to have dinner with Erica Felix. After Felix was raped two years ago, every agency in Tulsa responded admirably: the police, Call Rape, the SANE program, the district attorney's office. Yet that does not begin to make this a good story.
In July 1993, Felix left the pool at her apartment complex to go inside and have lunch. She is 25 now, a small‑built aerobics devotee who manages to project an air that is both energetic and serious.
"I was all loaded down with stuff from the pool," she says. Her voice is neither calm nor upset. She has agreed to meet me because she believes that going public with her story might be of help to other women who have been raped, might help promote the SANE program, might even be helpful to her in some cathartic sense, though at the moment of telling, this is difficult to imagine. "I turned around, and there was this mask. He jerked my head back, and I saw this knife in front of my face, and he said, 'I'm going to cut you.'"
He twisted her beach towel around her head so she couldn't see and told her to lie down on her stomach in front of the couch. "Basically, he wasted no time," she says. "When it was finished, it was really weird ‑this is kind of one of the things that still give me chills‑ I was lying on my stomach and he wanted me to put my bathing‑suit top back on, but it was hard to reach around, and I was shaking, and when I got the strap done, it was twisted, and he said, 'It's twisted,' and he undid it and redid it right."
Before he left he put her in the bathroom and told her he planned to give up drugs. He also told her not to tell anyone. She called 911. The officer took her to the SANE office. It would not be the time for Felix to notice the soothing wallpaper at Hillcrest or the stuffed animals lining the windowsill. What did help was the advocate from Call Rape, who was herself a rape survivor, and her SANE nurse, Katherine Gibson, who told a story about a close call she had had with rape years before. "Being in the room with two women who'd had the experience was comforting," Felix says. "I thought, Here are two people who are going on with their lives and seem normal." Before each step Gibson told Felix what to expect next. The advocate held her hand, "especially during the pelvic exam," Felix says. "After it was finished I took a shower there, which was wonderful, but it was also hard, since it was the first time I'd been by myself."
Case in point: after her rape in 1993, Erica Felix was examined by a SANE nurse. Because of the accuracy of the evidence collected during the exam, her attacker was recently sentenced to 70 years in prison.
Six months after the rape, the attacker was caught. A year later, the case went to trial and Gibson testified for the prosecution. When the SANE program was first established, the D.A.'s office played a critical part by agreeing to an unusual arrangement: Nurses, instead of just doctors, would be permitted to testify as expert witnesses in rape cases. In preparation for this new role, Gibson and all the SANE nurses attended a D.A.‑sponsored witness‑training session, a mock trial during which nurses took turns being grilled by prosecutors. Now, though most cases that the D.A. pursues end in a plea bargain, the state has won every trial in which a SANE nurse has testified.
Since Felix never saw the rapist's face, the most crucial evidence was the forensic material that Gibson had removed from Felix's body during the exam. The DNA from the semen samples was later found to match that of the suspect, and the jury found him guilty. This past winter he was sentenced to 70 years in prison.
On my last day in Tulsa I meet with a group of SANE nurses for a training session on loading film in a special camera attached to an instrument called a colposcope. The colposcope is an important innovation in rape exams since it can magnify the inside of the vagina up to fifteen times, revealing microscopic cuts and abrasions. It is particularly helpful in prosecuting date rape. By comparing photographs of the cervix after consensual sex with those after rape, a jury can see when force was used.
SANE nurses don't get together much. By virtue of being on rotating call, they come to these rooms at Hillcrest alone. In their other lives, they work at different jobs, at different hospitals. So they are glad to be together, feet up on chairs, drinking coffee, eating raspberry pudding cake. They display the same bad sense of humor as off‑duty homicide cops at the end of a twelve‑hour shift.
When they do gather they are free to complain, and they do, in between slices of dark pink cake. Who else understands the frustrations of all the cases that never make it to court? The sadness for all the women in marginal circumstances, the homeless or mentally ill who get raped again and again? The irritation at the endless barrage of stupid questions born of prurient interest: Was he black or white? What was she wearing? "People want real detail to make it OK in their minds," says Allison Beach, a SANE nurse who is currently staying home with her two young sons. "Then they can say, 'Oh, well, she should have known better. What was she doing there anyway?'"
Jackie Romanello, a Call Rape advocate, shows up in a Christmas sweatshirt and Santa bear earrings. She has volunteered to be a live model for anyone who needs to practice using the colposcope camera. Romanello is the kind of woman who gets a party going, and things brighten up considerably after her arrival. "Remember that girl who wouldn't let you examine her until I started praying with her?" she says to Beach, and they all start laughing. "We were here all night, praying our hearts out."
When everyone has had her turn loading the camera, Romanello gets up on the table. "I don't mind," she says brightly. "I've had so many of these damn pelvics." But when Theresa Valento, another SANE nurse, puts the speculum in and pops it open, you can tell that she minds it just a little. A light sweat breaks out on her forehead as she stares hard at the ceiling. She stops cracking jokes. Kathy Bell stands beside her and holds her hand, as Romanello has held many hands before.
"Doing good there," Valento says in that soothing voice that the person on the other side of the sheet tends to have.
And I go and look through the colposcope at this part of myself I have never seen before. I am careful to take just a minute, but it is a remarkable thing to see. From this particular vantage point, rape seems like an unfathomable violation. The exam, no matter how kindly and correctly performed, is painful. Nothing here at the SANE clinic is going to end rape. It's only going to offer us help at the moment we most need it.
Valento pats Romanello on the knee. "OK, baby," she says, flicking off the hot light and sliding the speculum out. "That's it. It's over. You did great."