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Unusual Nurses 3_No Ginn 2 box 4/2/10 6:02 PM Page 23 the trauma. And then she had the duty of informing the woman that, as much as she just wanted to go home, her home was now a crime scene and she and her husband would have to stay in a hotel. Seeing people on their worst day is just about Emerson's specialty. She's been the clinical director of the Keller Center since it was founded in 2001. While the center is located within San Mateo Medical Center, it's a distinct entity, funded mostly privately and working with police, local doctors and social service agencies to provide the right information for law enforcement to convict abusive partners, rapists, and other perpetrators of violent crime. In addition to doing exams and working with police, Emerson also meets with Child Protective Services staff members, victims' advocates, social workers, district attorneys and other officials as necessary to prosecute crimes. And when the cases go to court, she's often the first one called to describe the evidence and explain what it means. "It's an incredible job because sometimes a woman will come in who's been married to the same man who's been abusing her for years, who's tried to kill her, and I'm the first person she's sitting down and talking to," she said. "Sometimes you can see the weight lifted off their shoulders, that their lives might be different from here on out." Emerson sometimes follows cases for years, providing expert testimony in court. She also gives lectures to medical students and community groups about the signs of child abuse and how to recognize it. Because she's worked so closely with local doctors, they know to refer any patient who's been abused to her center for treatment. The majority of the cases she sees are child sex abuse, and those are the ones that keep her up at night. Because such molestation is often ongoing, the exam she does for those cases is very different from the exam she did on the home invasion survivor: Instead of looking for acute trauma, she's looking for evidence of chronic abuse. She describes one case where a mother brought her 16-year-old daughter into the center after finding her common-law husband sexually assaulting the girl. When Emerson interviewed the teen, she revealed that the abuse started when she was 11. It began with tickling, she said, until at 13 it became full-on vaginal penetration. It stopped at 14 and resumed at 16. Emerson remembers being confused by the two-year gap. She asked the girl what happened. "She tells me, 'Oh, that's when I got cancer,'" Emerson recalled. "She had to have a kidney removed and she was too sick for him to molest her. After she got better it started again." While Emerson has a team of at least a dozen other nurses and nurse practitioners working with her, she says cases like that still take an emotional toll. MARCH 2010 "The cases that are really hard are the families where childhood sexual abuse has occurred," she said. "It's finally disclosed, the father has been arrested, the mother is devastated. All their income comes from the father and now the family is destitute and near homeless. How can you tell a child that when you tell the truth it's going to be OK, when in reality life may become chaotic and unpredictable?" On the other hand, Emerson said, the home invasion survivor she treated "was really strong and articulate. I know she's traumatized now, but I know she'll end up being OK." The Visitor Angie Eccles, RN F or Angie Eccles, RN, one of the biggest challenges of her work as a visiting nurse isn't finding the time to get to a patient or the work itself. It's Fido and Fluffy. Like the time when Eccles was perched in the kitchen of an older man with a leg wound, changing his dressing, and looked towards the doorway to see a huge, black pit bull staring her down. "Will he be OK with me putting this dressing on your leg, or will he think I'm attacking you?" Eccles remembers asking the dog's owner. He assured her that the dog would be fine, and he was. Eccles? Not so much. "I did the dressing to the best of my ability but that dog just sat there the entire time. He didn't bark or snarl. He just watched me with those beady black eyes," she said. "It raised the hair on the back of my neck." As a visiting nurse, Eccles has spent 34 years driving from home to home, doing house calls on patients too remote or frail to make the trip to the clinic or the doctor's office. By now, Eccles knows her corner of South Portland, Maine—where she's spent half her career—like the back of her hand. The therapy itself is straightforward, Eccles says. It's the environment in which she works that's complicated. After all, she treats the same medical conditions as any nurse in a hospital: changing dressings, checking IVs, treating and preventing pressure sores, and educating patients about how to care for their health when the nurse is no longer there. But because homebound patients aren't under the watchful eye of a nurse 24/7, and because the home environment can sometimes encourage old, bad habits, the care requires more education and the support of family members. "Seeing people in their homes and on their own turf you get a better perspective of who they really are and what their learning abilities are around their disease," said Eccles. "Patients are also more comfortable in a home situation—there are no bells or buzzers and few interruptions." But seeing people in their homes is a double-edged sword. Take the pet issue, for one thing. Once a cat has jumped in Eccles's lap during a visit, she carries that pet hair and dander to the next home, possibly causing a reaction in her next patient. Sometimes she has to begin setting up a sterile work environment all over again. Several of Eccles's patients over the years have developed pressure sores from laying in the same position for too long, a problem that in a hospital would be carefully monitored and treated—or pre- W W W. N A T I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 23