I did my emergency medicine residency at the county hospital in Oakland, California. One of my last years there, the homicide rate really jumped up in the summer, with drug-related killings and random violence. “Code 3 gunshot coming in” got to be an almost regular occurrence on my shifts, day or night. For the failed codes, the homicide investigators came in street clothes, and some wore belt buckles with “187” on them, the number for homicide in the California Penal Code. We sometimes had to create a “chain of evidence” by dropping a recovered bullet into a labeled envelope. It all went by very fast, and then we moved on to the next case. My scrubs would get blood soaked, through to even my underwear, from leaning against the gurneys. There were also a lot of automobile accidents and sometimes shattered glass seemed to be everywhere. And, we took care of the prisoners from nearby Santa Rita, the Alameda County Jail. They would clank through the ER with their chained ankles. There were a lot of heroin addicts coming in with abscesses and other medical problems. Some would help us draw their blood samples when it was necessary, as they had destroyed most of their veins. I could go on and on as I have a lot of images left in my mind from those days.

But there was also a backdrop of crimes perpetrated on older people, women, and children. Purses were grabbed, and elderly women knocked down, sometimes breaking a wrist or a hip, the start of a downhill slide into a nursing home. Elderly people who were trusting opened their front doors to robbers, who pushed them down and ransacked their homes for what could be sold quickly on the street. Or, sometimes it was their own children who had done them physical harm because the children were addicted to drugs and needed money for the next buy.

That screaming baby with the broken arm, or the toddler with burns from mid-calf down, they had both been the victims of their parents. A mother broke her baby’s arm because the baby wouldn’t stop crying. A father put the toddler into hot water in the bathtub. The whys are very complicated, but the actuality was still there in front of you.

I did a lot of rape exams, especially in the summer when doors and windows might be left open for relief on a hot night. I would take a history of what had happened to the women and write it on the chart. I would ask, “What did the rapist do to you? Did he have a weapon? Oral sex? Sodomy? Used any foreign objects? Intercourse?” Sometimes I needed simpler language or needed to repeat as the women were upset and crying. There were often other injuries to be documented like facial cuts or missing teeth from being punched, bruises in various places, broken arms. And medical follow-up needed to be arranged for these women. Volunteers would come in from the rape crisis center at any time of the night to support the women.

One night I did a rape exam on an 81 year old retired schoolteacher who presently lived alone in her Victorian home near the hospital. She had lived there for many years. I knew the street where she lived, older wooden houses neatly maintained. A young rapist had climbed in through her open window and she had awakened to find him standing over her in her bedroom. She said, “Who are you?”, but he did not answer. He was immediately on top of her, his young body on her thin old one and had intercourse with her. She said that she did not resist a lot, but just did what he told her to do. It was over quickly and he left.

My physical exam revealed minimal bruises. I was able to collect semen left by the rapist. But, most rapists were not caught. It seemed pointless to ask her when her last previous sexual intercourse was, a question that I would usually ask. She did tell me that she had never been married. And then she volunteered, “I am a virgin.” I don’t remember what I said to her about that. The woman in front of me on the gurney, a prototype for the kind schoolteacher that some of us were lucky enough to have had in school, kept saying, “I am sorry to bother you. Thank you so much for helping me.”

  • Pam Hemphill MD/ JMP 1977