Part 3
After you notify your supervisor and the Social Worker on call, you continue to check in with Sue periodically until the SANE Nurse arrives. (SANE stands for Sexual Assault Nurse Examiner. SANE nurses are certified and have special training in forensics to assess and follow through on cases such as the one involving Maria and her family.) The SANE nurse talks to Sue and Maria and explains the next steps to be taken. She then asks you to help her in examining Maria since you already have a relationship. Her exam focuses on looking for general physical signs of abuse as well as on the vaginal and rectal areas. She gathers history continually as she talks with her clients, often having you distract Maria when she asks particularly sensitive questions. Here is some of the data you have from the exam.
The family consists of the parents Sue (35y/o) and Juan Serra (36 y/o) and 2 children, Maria and her younger sister Tamara, who is 4 ½ y/o. Mom notes that neither of the children have any ongoing health care problems. She says this is good since both parents work in entry level jobs that have no insurance coverage. Their income is below the poverty level and it is hard to make ends meet on a routine basis. The family is under some stress given the tight economic times but Sue maintains that Juan is a good provider. As Sue talks fairly easily about Juan, you note that she does not seem unduly frightened or worried.
Sue had no problems when either child was born. Both children have developed normally, Maria has often been ahead of typical developmental timelines. Maria loves school and enjoys her teacher. She has never been a nervous child, but is very active. When she was about 4 years old, she was very interested in her body and her mother often had to tell her to “not to touch herself”. Sue wonders aloud if Maria could have hurt herself on her own.
After the SANE nurse engages Maria in some playful talk, Maria allows her to help her undress to her panties. You notice that Maria has a number of bruises on her legs, there is what looks like a new one on her right knee. Maria says she was playing at school and Jamie pushed her down. She pouts a bit as she says this saying that she won’t talk to him anymore. No other bruising, swelling or redness is noted on Maria’s trunk, arms or legs.
Gradually the Nurse moves toward an examination of the genitalia. As she does so, Maria becomes overtly more anxious and asks her mom to come closer. With gentle question, the SANE nurse elicits the same information you got from Maria earlier. As she looks at the “hurt”, you note that there is redness and swelling around the vulva and what looks like an abraded area. The rectal area looks normal to you. Concluding her exam, the Nurse obtains several specimens for further testing. Both of you help Maria get dressed and you leave.
Now let’s think a bit about this case and complete these activities…