On a Sunday afternoon, I arrived on the hospital for my psychiatry ER shift. As medical college students, we control the monitor board for brand new sufferers to see. Two names turned vivid pink, and I selected to comply with Jackie Swanson. Her preliminary ER analysis learn “Affected person is a 30-year-old feminine right here for SI, HI, and AVH in context of latest sexual assault and cocaine use.” She was introduced emergently by ambulance after being discovered unconscious at a fuel station a number of miles away.
After I walked by the bay space, I noticed a affected person in each mattress. I quickly discovered Jackie on the finish of the row. Her palms, arms, neck, and eyes have been coated with myriad odd however cool tattoos. She was visibly emaciated and was tearful as she mentioned hello to me. Earlier than we began the interview, she slowly motioned together with her hand for me to tug each curtains round us.
“Take heed to me. If I get discharged, I’ll do medicine and shoot myself within the head.”
Jackie has a historical past of schizophrenia, PTSD, and drug abuse. As a toddler, her mom was a drug addict. She would give her to males each week who brutally raped and assaulted her numerous occasions. As early as she might keep in mind, Jackie suffers from flashbacks and hallucinations. It started as listening to the voices of her deceased aunt and brother. Over the subsequent a number of years, the satan seems to her day by day and says disparaging statements:
Nobody loves you.
Everybody that you just knew are gone.
They raped you since you are nugatory.
Refill the tub to the highest and drown your self.
To struggle off her hallucinations, Jackie began utilizing medicine. It began with meth and marijuana and graduated to cocaine and heroin. After shedding custody of her sons, she spiraled into melancholy and had ideas on and off about suicide. In February 2015, she overdosed on cocaine and awoke within the hospital on life help.
“I used to be turning into my very own mom, doing coke and no matter I might get my palms on. I bought my physique for extra medicine … I turned a violent particular person and several other occasions needed to finish my life.”
In direction of the top of the interview, I requested Jackie if she works and she or he instructed me in a extra silenced voice, “I do journey … I’ve been transferring all through the state for the previous yr or so.” Her tone was very alarming, and I then requested her the next questions:
Have you ever ever been compelled to do work you didn’t need to do? – “Sure.”
Have you ever ever been compelled to have intercourse to repay a debt? – “Sure.”
Does anybody maintain your driver’s license? – “Sure.”
Have bodily abuse or threats made you fearful to depart your job? – “Sure.”
Has anybody lied to you about the kind of work you’ll be doing? – “Sure.”
In late 2016, Jackie was approached by a meth seller she’s recognized from many occasions previous. If she would promote his product, she would have entry to “all of the meth on this planet.” She would even be protected and have a spot to remain. She accepted the provide and began working for him.
Subsequently, Jackie has been exploited and intercourse trafficked for the previous 18 months and has been to the ER a number of occasions for nonspecific cough and complications. Nobody has ever screened her for human trafficking.
“I went to the ER so many occasions as a result of I needed assist. I’m sick and uninterested in being ignored; I’d slightly be lifeless proper now than to be raped once more … Everybody that has overwhelmed and raped me are those I need to kill. Not you or any physician right here.”
After getting right into a struggle with one of many males holding her captive, she escaped and ran. She ran till the soles of her toes bled and blacked out at a fuel station. Now, Jackie is right here in entrance of me. Alive.
After I approached my attending to current, she mentioned, “Come again a bit of later.” The resident I introduced to didn’t specific my issues, although he promised that he would see her quickly. He by no means did. After I spoke with the social employee, she dismissed my claims that she was a sufferer of human trafficking.
“She’s psychotic and never coherent. A lot of what she is saying is probably going not true.”
I used to be disheartened and confused as to why a affected person was being allowed to fall by the cracks. Jackie was in limbo and nonetheless an important hazard to herself. After rounding on my sufferers the subsequent day, I walked downstairs to the ER to speak to the on-call attending. The primary particular person I met was that attending who by religion held Ms. Swanson’s voluntary admission kind in her palms.
After arriving to the inpatient unit, I continued to work with Jackie for the subsequent two weeks and witnessed marked enchancment of each her temper and general outlook on life. No extra ideas of suicide or murder. No extra visions or voices of the satan.
On my final day on service, I mentioned the discharge plan with Jackie and talked about her hopes for the longer term.
“I’ll take cost of my well being and keep sober. Nothing in my life means extra to me than my two boys. I hope to in the future see their faces once more and see them graduate from highschool and no matter they go on to do from there.”
Within the ER, you’ll encounter complicated psychiatric sufferers who’ve a number of points together with suicidal and homicidal ideations, substance use, temper issues, and typically human trafficking. As a medical pupil, you ought to be a steadfast advocate on your sufferers particularly when you really feel they aren’t getting the eye and medical care they deserve. In the end, it’s quintessential that an correct historical past is taken, security issues are addressed and the perfect remedy choices are carried out for a sufferer of human trafficking.
Ton La, Jr. is a medical pupil and pupil editor, the New Doctor.
Picture credit score: Shutterstock.com