CW/TW: Sexual Assault in hospital

In this thread I’m going to try & explore an often forgotten cause of PTSD/ ICU trauma

You won’t find it unless you carefully, gently explore it with your patients in follow up clinic

1/n

Imagine...

You’re critically unwell, brain confused already with sepsis

We bring you to intensive care, intubate and ventilate you.

Blessed release from the pain for a little while

2/n

The next morning, you sort of wake up

A weird fugue state between alive& dead; between awake and asleep

You can’t talk, there’s a burning hot poker shoved down your trachea, and another in your food pipe

You see a bunch of people with masks. They’re saying something to you
3/n

You remember needles being stuck into you last night.

The lights never went off. The monitor on a makeshift table next to your bed was blinking. Sometimes flashing a red light.

Your back hurts, as does your head. And you can’t think straight.

It feels like torture
4/n

But they misplaced your hearing aids, so you can’t really understand.
Faces covered by masks- no lip reading

Suddenly you realise curtains have been drawn, and a group of 3 strangers is now uncovering you.

Poke, prod, listen to your chest- uncovered

5/n

You’re turned to a side, a DRE is performed. ‘We need an enema’

Then your catheter is changed

You don’t know who’s doing this or why.

But you’re screaming inside- where we can’t hear you.

6/n

This feels like sexual assault.

Even if it’s being done with the best of intentions, and legally, since you can’t consent, this is being done in your ‘best interest’ and with the knowledge of your family

But you’re here... you didn’t consent to any of this

7/n

We don’t know if you actually have a history of being assaulted before, and whether we are actually triggering you

We don’t even think about this

And I’m not sure what we can do to make it better... apart from talking to you more, and trying to explain

8/n

But what I’d hope is that we are sensitive to this when, like a quarter of our patients, you come back to follow up a few months later, completely traumatised, beset by nightmares; and ask you, gently, having built up rapport, how YOU actually felt

9/n

We like to think we’ve got better at delirium management, but most ICUs don’t run a follow up clinic

Even ones that do, do not have THIS as part of their standard questionnaire

There’s societal notions of shame, & denial around this

You won’t find it if you don’t look
10/n

@WesElyMD @DrDaleNeedham @DrJulie_H @TantamKate @MarkThomHudson @iceman_ex @WelshGasDoc @drp297 @maheshramanan @RanaAwdish