Phoenix Cast

Forensic Exams as a Site of Healing

• Phoenix Center at Auraria • Season 5 • Episode 6

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Join Caitlin Cornell (she/her) as she talks with Denver Health SANE nurse, Michelle Metz (she/her) as they provide a review of what SANE exams entail, how SANE exams can facilitate the healing process for survivors, and ways professionals in this field can mitigate burnout.

Community Resources

  • Denver Health  303-436-4949

Denver Health SANE Program

  • National Suicide and Crisis Hotline 988
  • National Sexual Assault Hotline 1-800-656-4673

Run by RAINN (Rape, abuse, incest national network) this hotline is free and available 24/7 

  • National Domestic Violence Hotline  1-800-799-7233

Auraria Campus Counseling Resources 

MSU Denver: 303-615-9988

Located at Tivoli Student Union Suite 651

CU Denver: 303-315-7270

Located at Tivoli Student Union Suite 454

CCD: 303-352-6436

Located at Tivoli Student Union Suite 245

  • Colorado Crisis Line  text TALK to 38255

operated 24/7, free and confidential

  • Auararia Crisis Helpline  303-615-9911
  • Victim Connect Resource Center Stalking Helpline  contact the VictimConnect Resource Center by phone or text at 1-855-4-VICTIM

If you are in crisis and need immediate support, please call our 24/7 interpersonal violence helpline at 303-556-2255.

Request an Appointment with an Advocate at
https://www.thepca.org/online-appointment-request

Request a Violence Prevention Presentation at
https://www.thepca.org/prevention-education

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Caitlin Cornell:

Good morning and welcome back to the Phoenix Phoenix cast. My name is Caitlin Cornell. And today we have a very special guest. We have Michelle Metz from Denver Health. Michelle has been partners with Phoenix center for a while she does trainings for us, which we love so much. But she also does a lot of cool work in the community and has been running Denver's SANE exam program for years. So I'll have you maybe talk a little bit more about that and about what you do

Michelle Metz:

for years. That's exactly it. So I have been, I've been at Denver Health for 23 years, which is longer than a lot of your people have probably been alive, which is weird. That's really weird. I started out as a paramedic in the emergency department at Denver Health, became a nurse two years later, in that same emergency department. And then I was one of the original SANE nurses back in 2006. And took over the program, the end of 2011. So I've been doing some form of forensic nursing anyway, for the last 17 years.

Caitlin Cornell:

Wow. Yeah, that's a long career, it's impressive to to go from one very different type of emergency care to another, you know, because I can't imagine it gets less stressful with these different settings.

Michelle Metz:

It's just different. It was stressful, but it's definitely different.

Caitlin Cornell:

So can you describe your role, you know, as somebody who's not only, you know, a forensic nurse, but kind of handles that entire program.

Michelle Metz:

So that's exactly it. I run the program. I'm responsible for educating, managing the nurses, and we have a team of 17 nurses. And I think it's important to realize too, with, I'm the only one that this is my only job for everybody else. They work someplace else, and then they do this on top of it. So I have nurses with a wide range of backgrounds, labor and delivery nurses, emergency department nurses, I have a good number of psychiatric nurses to which Wow, which is interesting, or no, it's all very look very different. I think sometimes there's things that I wouldn't think about. But so yeah, I manage the nurses, I handle the schedule, I still take care of patients, I still do quite a bit of patient care. And then little outreach, things like helping to make sure that I'm educating the community, but also our providers in the hospital. I do a lot of education of the docs and the advanced practice providers in the hospital, too.

Caitlin Cornell:

Oh,wow. So just wearing a lot of hats.

Michelle Metz:

Yeah.

Caitlin Cornell:

That's great that you guys also do education within the hospital that I didn't realize that was something you did.

Michelle Metz:

we do. So when you look at your average nursing school or medical school, they don't really, you know, you might get an hour's worth of lecture when it comes to to violence whatsoever. It's not. And it's kind of passed over pretty quickly. And so which if nursing school is a really good example, right? You you learn all of this broad kind of nebulous stuff, and then when you go someplace, is when you sort of specialize. So it's making sure that all of the providers who interact with patients who are either currently victims or have been victims are educated so they know how to actually take care of them appropriately, or at least communicate.

Caitlin Cornell:

That is an important piece for sure. So you talked about, you know, your that you were one of the original SANE nurses, which is so crazy. It's crazy to think that that's been something that's so recent, you know, you would think it's been a longer shot, what program are like people to recognize that need sooner? Can you talk about like what kind of inspired that shift from emergency medicine to forensic nursing?

Michelle Metz:

So when I was still a paramedic, actually, I had gone to a conference, and there was a forensic nurse who was talking about SANE Nursing. So in the past, it was SANE nurses, sexual assault nurse examiners, as things have changed, and we've we've evolved to take care of more people who have been victimized, so domestic violence, strangulation, different types of abuse. That's where we've sort of adjusted to being Forensic Nurses. It's a little bit more of an umbrella. But we're still called SANE nurses. And it's an oxymoron. It feels like sometimes, but it's sort of that kind of like a Kleenex for tissue. Yeah, that you will still hear us constantly refer to as the nurses. That so I'd gone to a woman who was speaking about it, and part of it was, it was like, I can make a difference. Right. Which made me that whole idea of made me excited. And having been a female tech in the emergency department. What used to happen is the providers, the residents, or the doctors would end up doing These exams, you know, they've called them rape kits back then they would do, but they would do these exams on our patients. And I ended up being the chaperone in there a lot. And so I started to look at also what we needed and what was missing. So when I got an opportunity between hearing her talk about it and feeling that, oh, I can make a difference. But also seeing up close, I could make a difference.

Caitlin Cornell:

Oh, I can imagine

Michelle Metz:

. It's, I mean, it's, yeah, it sounds kind of sad, but I just wanted to make a difference. So that's what I did

Caitlin Cornell:

That's really great, like filling those gaps, because, you know, I feel like it's really easy for those be overlooked when they're systemic. So it's nice to know that like, individually, that that can still be something that's kind of plugged by this education and outreach and all of that.

Michelle Metz:

Absolutely.

Caitlin Cornell:

So I really do appreciate you kind of like tackling that delineation between SANE and forensic nursing head alongside a lot of people hear SANE, and they think it's only sexual assault, which is so important to know that it also applies to other forms of IPv, which is, you know, interpersonal violence for anybody who does not tune in regularly. It was pretty good. I'd say IPV and people arew like, What are you talking about? That?

Michelle Metz:

Well,that's exactly it. Yeah. Yeah. Yeah. So

Caitlin Cornell:

we're still trying to colloquialize that one. But we're getting there. So

Michelle Metz:

well, and I think it's also though, I don't know if people, I don't think they realize how common it is, and how necessary it is to have have something in place to take care of people. But it's the non judgmental care.

Caitlin Cornell:

Absolutely.

Michelle Metz:

So important. You know, relationships are difficult in the sense that they're relationships. So bad things can happen. And sometimes it's difficult for somebody to really recognize that that bad thing is, is really bad. Does that make sense?

Caitlin Cornell:

Yeah, absolutely. That's I mean, you know, even working the hotline, that's a lot of what we do is just that emotional reassurance is, you know, people calling in and they need somebody to tell them that like, it is okay to be upset about this.

Michelle Metz:

And what happened wasn't okay, exactly. Well, and it's like that too, with with sexual assault. There are a lot of things that happen consensually, that are okay. It's when it's shifts over from being consensual. That's the problem. But I think sometimes that becomes a barrier for somebody even reaching out when, when there were things that happened consensually leading up to it, because it makes it confusing. A little bit. Yeah. You know, and we recently had a patient where that was, that was the issue. She's like, but I did all of this stuff beforehand. It's like, and you could do all of that stuff. Plus two other things. But when you said no to this, and they still chose to do that against your will. It's it shifted, and anything that you did beforehand did not make that. Okay. Is that

Caitlin Cornell:

oh, yeah, no, and that's something that we kind of have worked to talk about more on our campus as well is because a lot of students in relationships, they're still learning those social scripts, those norms, and the ones that they've inherited from maybe like, relationships in the home, or, you know, like media that they consume are not always the best reflections of that. And so you see a lot of that obligation, which I think is really hard to break down. It's like the no, You never have to do anything.

Michelle Metz:

You get to say no, to that part,

Caitlin Cornell:

exactly. Like,you know, doing one thing is not an automatic answer to something else. So that is something that is very important to us here as well, and that we've been trying, you know, as like a prevention education, you know, team to really push a lot harder, just because a lot of students they don't realize, you know, like they're not familiar with, like coercive rape, or maybe, you know, like that that's not just a violent, you know, thing that happens that there are different different whatnot, that that that that it is violent, but not in the way that you see depicted that like it is not always somebody like holding you down.

Michelle Metz:

I have had patients say to me, I mean, it wasn't rape, rape.

Caitlin Cornell:

Yes, like myth of the legitimate, rape right? Like that, like, probably the most annoying myth of rape culture, but like, we hear it all the time, and it drives me nuts.

Michelle Metz:

It's like you don't have to have, I can tell you in the probably 1000, that's not actually an exaggeration, which is upsetting. The 1000s of exams that I have done over the years, there are very few that are really, really violent or strangers. Nobody is pulling somebody off the streets. You know, it really is, it's somebody who you've at least made an acquaintance with. And even when there are there violent aspects to it more often than not, it's, it's being coerced into something, it's it's those things, that's what's normal, that really is what's normal, not what we see in the media.

Caitlin Cornell:

Oh, yeah. And, you know, just in case y'all wanted some statistical reinforcement for that, that is something that I try to drop in all the time. You know, 80% of rapes on average are committed by somebody like people know, so it's very rarely those strangers, you know, and even when it is suddenly, you know, violent in the way that we think of violence 12% of the time, so, so from RAINN, so if y'all want to do your own research, please go out ahead, but love them whilst they have amazing resources. Um, but yeah, I think that's great that that's something that you guys have built into your practice. You know, this already kind of that trauma informed lens which is really hard to get Sometimes from the services that we're trying to refer clients to,

Michelle Metz:

Oh, 100%. Yeah, I tell new nurses, when I'm

Caitlin Cornell:

Oh, yeah, I think that was actually one of orienting them and talking about stuff is that I think a big part of, of really what we do one of our one of our biggest worths is that we can normalize stuff for people and really help them to understand. It's not, it's not shocking that somebody waits a day or two or more to come in to see us, right? It's not surprising that somebody went after an event, a non consensual event went to a partner or somebody who they feel really secure with, and maybe had sex with them right, as, as kind of a safe space to do this. You know, and explaining that to patients. It's all of those things. my favorite, my favorite parts of the article you wrote. And if you guys don't know, you know, Michelle has put out some really great resources, including an article about what to expect during a sexual assault Assault Nurse exam that you can find about kind of what that looks like, at Denver Health. But I liked that you talked about how it serves as a foundation for healing and about how that time with you guys can really help contextualize that experience in a way that not just normalizes it, but kind of helps to reconcile what happened for the people that come through your guys's office.

Michelle Metz:

It is amazing the difference frequently in the patient who walks into so at Denver Health, we have a special room to do our exams in that we typically do it's we call it the SANE suite. Even that name sort of makes me chuckle. But anyhow, it's a little bit, it's quieter. It's in a back hall. And, you know, I think a lot of times I can tell somebody, people can tell them that nurses not going to make you do anything you don't want to do. They're they're nice there. But until you actually get into that situation, you have no idea. And so the patient typically that walks into that room with us is very different than the one who walks out. And you can just see it, you can see they've relaxed some you can see a lot of times there's there's laughing and giggling that goes on during an exam. It's It's invasive, I'm not gonna lie, right, I'm depending on what happened. I'm going to look at people's parts, if they'll let me Yeah. But it is on their terms. And it's it i i Really, I can't control the criminal justice system. I can't control a whole lot of things. But what I can control is when that patient is in front of me. And it's I feel like they're on they're on a path to healing afterwards. Yeah,

Caitlin Cornell:

and I love that so much. Because in a lot of I've kind of scoured like previous is like I kind of have to know my forensic exam basic knowledge. And so many other people need to talk about the forensic applications, the physical evidence, and you very rarely see people talk about that emotional aspect of it, and about how that can kind of totally change the way that somebody thinks about or the experience or the way that they experience support or don't. So, I love that that's something that you guys, just like, of course, we center that already

Michelle Metz:

that is my primary goal. And that's when I tell nurses first and foremost, we'll forget stuff, right? We we're human, we're not infallible, we whatever. But if you can 100% say that you took the best care of that patient and met them where they were at. That's all that matters. We can explain. If I forget to swab something, I can explain that. But if I went against what somebody wanted, or I wasn't as caring, or I didn't take care of them the way they needed, then that would be a failure.

Caitlin Cornell:

Yeah, absolutely. Best case scenario,

Michelle Metz:

that's but that's exactly what it is. I so my daughter just went away to college this year, exciting. I mean, it's very exciting. But she had brought up. And this was just like two weeks ago. And you know, they were doing some of their trainings and what she was critiquing, by the way and whether or not they actually did. I know, I was like, Don't be stepping up, because I already told some people. But what she had brought up when we were talking about the media, she said, she goes, if you look at the way a forensic exam is portrayed in the media, be it a book or TV show or Miniseries or whatever. She's like, they seem very cold, and clinical. And there's no space in there for the person who's receiving the exam. And I guess they had gotten into a conversation and she said to me, she said, I know that that's not what people get when they come to see you. And you need to let the world know that they can come in and they'll be taken care of which sort of it really did. I was like, oh, oh, okay. I didn't even think about any of that. But it's letting people know that they're going to be that their wishes are going to be honored and they're going to be taken care of.

Caitlin Cornell:

and break it down into like, Hey, this is what they get right And this is what they really don't. But even so, you know, when you just need to have the voices that you know are immersed in this You know, speaking out about this or that not the ones who are maybe like privileged, and that the most discussions, that's what is really difficult. And you see a lot of that stigmatization happen with these I'm sure, I'm sure you know, you've seen that, like, the effects of that all the time.

Michelle Metz:

Well, because they're terrified about what I'm going to do to them. I mean, really, I've had people be very, you can see it in their face, and it's like, No, I swear, I swear, I'm gonna just take care of you. However, you're okay with being taken care of. Oh,

Caitlin Cornell:

yeah, I know. Because we, whenever we have a couple of people, we send it over. It's always like this very, very difficult decision. And it's like, no, I promise, this is gonna be a safer space. Yeah, for you. But it's just as hard to kind of get people there. Sometimes.

Michelle Metz:

It's just so overwhelming, which I get, but I promise you'll be better off when you walk out. They're nice. I swear, let me make a phone call.

Caitlin Cornell:

like Michelle does our training. She's a sweetheart. Oh, man. All right. Well, it's a kind of shifting gears a little bit, I wanted to talk about kind of just like what like a basic forensic exam looks like for people who aren't familiar with that, just to kind of maybe, like, walk them through, like not nothing too crazy, but just kind of get to get an idea. Cuz I think a lot of people are used to again, like, these, like medical drama portrayals that like, seem very traumatic in themselves, or

Michelle Metz:

they seem horrible, like, absolutely horrible. So important to know, there are a couple of things. First off, so here in Colorado, we have a couple of different reporting options. Now an exam is going to look the same regardless of your option that you choose if you choose an option, but knowing that there are some differences. People can report to law enforcement by reporting to law enforcement, you talk to law enforcement, and a investigation gets started. They can medically report so basically, medically reporting means that law enforcement has their identifying information. But no investigation gets started. However, the evidence that's collected can be sent to the crime lab for testing. What I see is patients in particular who don't know what happened, they don't have a clear memory. Sometimes they'll lean into doing that one, because they're just not sure. Okay. If somebody's between the ages of 18 and 69, they can be anonymous. So an anonymous report is, it literally is exactly that. Law enforcement gets no identifying information, they give us the case number, that evidence that's collected, sits on a shelf, nothing happens unless the patient changes their mind. Which is really important to know, like, really, truly, nobody's doing anything, you're not getting any evidence, or you're not getting any kind of any answers. But it's a really good placeholder if you're just not quite sure. And then of course, patients can choose not to have any exam at all. The exam itself is, you know, one of the first things that I say to people, and I know I've said this, on and off, kind of as we've been talking, but I always tell them, when I introduce myself, this is their exam, not mine. If there's anything they're not okay, what they get to say no, sexual assault is about power and control. It is not about sex, the one thing I can assure you that I will give back is power and control, you can say no. We go back to my area that that same suite that I talked about. And so if a patient is wearing the same clothing, law enforcement likes to have that clothing as evidence, potentially, the caveat is you don't get that clothing back. So if it's your friend's sweater that you borrowed, and they didn't know, you borrowed it, don't give it to me, you get to say, you get to say no. Now, if, if somebody's object related on some clothing, I, you don't want to give it up. I'll swab that. Like there are things that I can do. So you don't have to give that to me. And the truth of it is, I would say, most patients, I see about 36 to 48 hours after the assault. So more often than not, they have showered, they have changed their clothes. So that's okay, too. I start out with gathering a history. You know, the whole idea is, is we've got to build some rapport pretty quickly.

Caitlin Cornell:

Oh, yeah. And imagine that's very difficult place to do that. Right. So

Michelle Metz:

I mean, it the only thing is, is it just starts out broad. You know, are you allergic to any medicine? Do you take any medicines, this exam? It's a medical forensic exam. And it really is it's medical, first and foremost, everything that we do, it's so I know where to potentially look for injury, what medications to talk about what medications to give somebody, if they're willing to take them, they want to take them. It's all of those things. So so the medical part is really important. If it's somebody who has menstrual periods, we'll ask about menstrual periods. We do ask about last time if they had any kind of consensual sex, which that matters in case when we're collecting evidence that we find multiple. Yeah.

Caitlin Cornell:

Oh my goodness. Yeah. Multiple cross contamination.

Michelle Metz:

Here's something else though that's really important is, you know, when somebody comes to us and they've never had a sexual experience beforehand, sometimes this is the point to where we have that conversation of, if there's any form of force penetration that has nothing to do with whether or not somebody's ever had sex before. Does that make sense? Oh, absolutely.

Caitlin Cornell:

Yeah. Like, kind of making that distinction between rape and sex, because that's, I hate seeing those lumped in together.

Michelle Metz:

It's not in it that's important to have the distinction between what makes something actual sex or not, and it doesn't change one's virginity status, if somebody chooses to penetrate them. So like we have those conversations or talking about birth control, you know, do you are you on birth control? Do you want to get pregnant? Do you use condoms and making sure that they have access to those things, because again, this is this is medical care. It is not just I want to hear about this really bad thing that happened to you. I want to take care of you as a person all the way. After those questions, we get specific about the assault. I always, you know, will ask where it was who was with their safety planning that goes into things? Oh, yeah. Because as you know, 80% of the time you know who the person is. We, I always tell patients with my next three questions, I will say, Look, I don't expect a yes answer. Again, it's where to look for evidence and guide my exam. But I will ask if there was any kind of force any kind of threats and any kind of weapons involved? More often than not, the answer's no, you know, we will also talk about, you know, we always hear about, you know, flight or fright, fight or flight gets me all the time. But more often than not, I hear that patients froze, and which becomes really, it can become confusing, because, well, my brain stopped and I just laid there. That doesn't mean what happened was okay, we do specifically ask about if there was any kind of strangulation because pressure on the neck can be hugely problematic, and people can look fine.

Caitlin Cornell:

Yes. And that was something that I had no idea about until I started working here. And I had so crazy that those injuries are so extensive, even if there is no bruising, even if you feel fine.

Michelle Metz:

I have had patients personally have had patients that next looked like mine does right now. enough that I wouldn't have even taken a photo of them. And they had bilateral tears in their vessels in their tiny tears, right? Could be fine. Or it could as it scabs up can cause them to have a stroke. So they're looking at particularly women who have experienced strangulation in the form of dv, who are young and healthy, having strokes a few months after a strangulation event. So often, you might see a month, so our next need to be off limits,

Caitlin Cornell:

wow.off Limits. Okay.

Michelle Metz:

So that's why we asked that. After that, I asked to get the verbatim history to the best of my ability to have somebody tell me about what happened. And I do my best to record that. So by recording that, sometimes people will give me a little bit more information that won't come out otherwise. So again, I can make sure that I'm treating them appropriately. And then from there, that's most of the charting is there. And then we do a head to toe exam. And that's really looking at everything head to toe, I take photos of any injuries that I might find three photos of each one of them. When we talk about swabbing for evidence, it's literally moistened Q tips that I touch on areas. So depending on the history, I will you know, for example, if there was any kind of kissing, forced oral or anything along those lines, I'm gonna do swabs around the lips. So kind of Peri oral area, chin, nose, skin cells, potentially you can get from there and also saliva. Wow, I No idea. For strangulation. We always swab the neck because there's enough pressure to cause skin cell transference. Oh, it's kind of I mean, it's really it is kind of cool.

Caitlin Cornell:

Yeah, I mean, that's just I just had no idea you guys could get so much because I feel like when most people hear forensic exam, you just think like bodily fluids. Yeah, you have no idea about like skin cell transfer, or that you know, like, there are little all these little things you guys can look for,

Michelle Metz:

that we can potentially get. So I think that's the other thing is, yeah, managing expectations. So yeah, because, you know, the only thing I know, for 100% that I won't get as what I don't attempt to get, you know, so if I don't swab it, I'm definitely not gonna get anything there. But sometimes there are reasons why something isn't detected. So it doesn't mean that something didn't happen. Yeah, that's I think that that is the other part that is sort of problematic is I can't look at anybody's genitalia and say if something happened or not. I you know, we can swab things and it can go to the crime lab, but sometimes it does. wouldn't show anything and it's, there aren't a lot of solid answers that you get from this. Even if I were to see injury, I can say I see this injury. However, I can't tell you what caused it, because I wasn't there and you don't remember, sort of thing. So the the beauty though is, you know, like I said, we've gotten a patient's history, we've, it's guided whether or not we're going to give them medications, what medications to give them. I've documented any injuries that I have found so that the exam isn't just about getting a couple of swabs to look for DNA. This will sound kind of hokey, but it's holistic. It's looking at that person in front of me, and it's treating and taking care of the entire person. Oh, absolutely.

Caitlin Cornell:

Yeah. And I feel like, you know, I get the same way. And I'm like, I'm gonna sound really corny. But you know, it's the same thing about just any kind of discussion around this, right? Is that, like, you're building foundations that are going to be just integral to real healing?

Michelle Metz:

That's exactly it. Well, it's like, especially if, you know, not everybody wants to deal with the criminal justice system. Oh, yeah. Which is okay, right. It's okay. It's okay, one way or the other. But I'm also asking people to make these really big decisions, and a time when their brain is not ready to make really big decisions. So that's the beautiful thing about doing like an anonymous exam, that stuff sits on the shelf. And if you never go back and revisit it, that's fine. But if as things change, and you decide you want to go forward, and maybe talk to law enforcement, you actually have that evidence there. And I think that's, that in itself is powerful. Because again, it's just in case. So because you don't know where you're at. And a week, a month, a year, I just had a patient reach out to me, it was a year and a half ago that we did an exam on her and she has done some therapy. And she's like, I really feel like it's important to contact law enforcement, I want to go forward. But if she hadn't done the exam, she wouldn't have had that ability to maybe that's what she wanted to do.

Caitlin Cornell:

And I love that that's, you know, that's a big part of what you guys do is just giving people the choice. Because it's all about, you know, kind of giving the agency back. I think just having all those options, helps to accomplish that in a way that is probably the least intimidating possible.

Michelle Metz:

Oh, yeah, absolutely. Well, and our brains aren't set up to make major decisions during traumatic events. That's the hard thing. And I've had patients also who have come back, like, why didn't you do this? A couple months later, it's like, because you said no, you declined? Well, but you should have. I wanted to, however, I also need to give you that ownership, I'm not going to take, take that away from you. So I Yeah, I'm a fan of the, let's do an anonymous one and just set it on the shelf. And then you can decide later on if you don't want to. I think another really important thing, too is, is even if somebody came in today and said I want to report to law enforcement, and then in a week, they changed their mind. They're not stuck doing anything that way, either. Oh, that's using stop. Now, when I had said like between 18 and 69. So if somebody is under 18, or over 69, so 17 and under 70. And over, they just fall into mandatory reporting ages. Just because I have to call and tell law enforcement doesn't mean that they have to talk to them. And I think people should know that. And absolutely, if some if I have a 17 year old who's like I absolutely don't want to talk to the police we'll stand there and be like, they don't want to talk to you and be that person. But we but they do fall. That's why they can't be anonymous, because we have to tell law enforcement. Yeah,

Caitlin Cornell:

those mandatory reporting requirements do get you every once in a while. So

Michelle Metz:

but at Denver Health, if you were 17 and under and you don't want your parents to know, we do not call parents.

Caitlin Cornell:

Oh, okay. That's good to know.

Michelle Metz:

So I know that particularly, I'm sure with your population, that the last thing they want is their parents to get any kind of notification about what has happened. Now, they might just need a little bit of time to go forward with all that. But again, we can give you time. We're not calling parents up. We're also i This is a Denver Health sort of specific thing too, though, you know, you talk about this, like, what about the bill, we don't charge people to just walk into the hospital. Now if you see need to see a doctor for something, if you need X rays, that's different and a bill can come. But we there's absolutely zero bill that happens if somebody's only complaint, is sex assault and they don't do anything else. There's zero bill, no explanation of benefits or going to your house or your parents home or anything else. There should be nothing there. And that includes the medicines too. So we don't test for sexually transmitted infections. There's no reason to, from the standpoint of if somebody was sexually assaulted in the last seven days. They're not going to if they do test positive, it's because they already had it. Okay. It takes about two weeks for somebody to show positive So we just treat prophylactically Oh, okay. Which is nice, right? So you just, you know, you take six pills here, eight pills there. We also have prophylaxis to prevent HIV, which we do for free. And we give somebody the whole month's worth of prophylaxis, which, elsewhere, it's about $3,000, for a month of the HIV prophylaxis, those

Caitlin Cornell:

are so expensive. It is absolutely insane. And that that's why, you know, we , this is where we send anyone do we need to just because we know you guys kind of have that umbrella

Michelle Metz:

Well, it's the financial part, we realize how problematic it can be for somebody, and I'm sorry, but being the victim of a crime does not mean that you deserve to now spend months dealing with financial hurt. And you know what I mean, long, I would much rather do everything that we can on the front end to negate some of it.

Caitlin Cornell:

For sure, for sure. And that that's been a pretty extensive look, especially for your guys' resources. So thank you for that. You know, I know there's a lot of little caveats to walk through, but no, very helpful. You know, like, I've already obviously heard this and I get to but refreshers, never hurt and then especially for our audience today, like new information

Michelle Metz:

will take care of you regardless, you know, I mean, that's, I think that's it. And yeah, we understand. I also understand why, again, somebody would not want to have their insurance involved. They don't want to so if we can avoid you getting a bill. That was that was one of the first things I did when I took over this program was I worked really hard at trying to make that happen. Yeah,

Caitlin Cornell:

that's really cool. That's something you championed I respect there Wow, that that that is really amazing. Yeah. Oh, my goodness. Well, props to you guys for having that figured out. I think it's awesome. Yeah. Yeah. Like, and especially with healthcare stuff that can't be easy to convince them.

Michelle Metz:

I keep waiting for somebody to say something otherwise, but still, thus far, it's all been status quo. They don't mess with us. So good.

Caitlin Cornell:

Oh, wow. Yeah, that's great to hear. Um, I also did have a few frequently asked questions. Yes. That, you know, I kind of got rounded up from the interwebs. And just some curious students on campus. So just gonna shoot those out if that's all right. Yeah. So one of the common ones was, how long does it take to complete a SANE exam?

Michelle Metz:

So it can vary a little bit. I've been doing this for a really long time. And I'm, I am probably an hour, hour and a half absolutely tops, you have a newer nurse, it's going to take a little bit longer, I would say you should anticipate three hours kind of door to door. Okay, that's. So there are some things that go into it a little bit, if somebody's history is really long, or there are a lot of injuries, because we're photographing all of those that can add some time to an exam. If somebody is concerned about HIV, and they want to do the prophylaxis that has to be started within 72 hours of the assault, I guess that's important to know. Yes. But we also need to do a blood test just to make sure that they're HIV negative before we can do that. So that adds about 20-30 minutes on to things. So a little bit, but probably three hours door to door. Wow.

Caitlin Cornell:

Yeah. Okay, good. Good to know. Um, do you as SANE nurses testify in court?

Michelle Metz:

we do. I, you know, it's it's hit or miss. I do some blind expert testimony to on strangulation and domestic violence. So I testify more than probably, I do testify more than the rest of the nurses do. It's only a few times a year. Um, there's a multitude of different reasons why when you look at the criminal justice system, you know, people play out. Sometimes it doesn't reach the criminal justice system. So there are reasons why something might not actually make it to court. But we have testified.

Caitlin Cornell:

I know it's, that's one of our biggest struggles here is just the road to court long. And kind of breaking that down can be a little crazy, but the bare minimum a year. Yeah, yeah. And just you know, for the who actually makes it that far, right. Like who actually gets into the courtroom

Michelle Metz:

and getting into the courtroom? I mean, getting into the courtroom, right. It's not a slam dunk. No. And it's you. So that's, I think that's the understanding, too, is is realizing, no matter what happens in the courtroom, the people around you believe you. Yeah,

Caitlin Cornell:

there's no guarantee but we have people like you in your office. We have people like this office who are always going to, you know, support that no matter what, even if you know, systemically we don't see that reflected all the time.

Michelle Metz:

Yes, it's nice way to put it.

Caitlin Cornell:

Yeah. Thank you. All right. Um, are you guys confidential for that? 18 To 69 population? We are okay. Yeah. You know, I, we know we have to ask.

Michelle Metz:

Yeah, so unless somebody says it's okay to speak and tell the police what's going on. Okay, so if you're reporting to law enforcement odds are, but if I'm going to say something, though, or I'm going to call so I've, I've had patients who are reporting to law enforcement, and they tell me something where I'm like, oh, you know, we should probably try to get evidence from that area. I'm going to call them and let them know. Okay, um, that type of thing, but otherwise, I'm not reaching out and telling people anything unless the patient's okay with it. Well, yeah, man. Okay with that, right,

Caitlin Cornell:

the patient centered care. Yeah. Um, we already kind of talked about, like, how a SANE exam is performed, how long does it take to process a kit usually.

Michelle Metz:

So when it comes to processing a kit there, if somebody is reporting to law enforcement, and mind you, it goes to the crime lab. So once I get done with my stuff, it is set off to the crime lab, I don't hear anything. It's about three months to get those results back. If somebody is medically reporting, so they want to have their evidence tested, but they don't know what they're doing, no crime, or no investigation is getting started. It gets sent to the crime lab, but they're going to triage those, and it's going to go to the bottom of the pile. Okay. Does that make sense? Yeah. Because there's, they're not doing anything with it. So it'll just work through and that'll take a little bit longer. I typically tell people to anticipate three to six months. But obviously, you know, who knows, it could be quicker than that. I would rather tell them, it's going to be longer than it's going to be two weeks, because

Caitlin Cornell:

that's probably I would rather have the window, you know, for sure. And then just how I know that we've actually talked about this a lot, and how about how important it is to break this particular misconception down. For how long after an assault, somebody can come in and see you.

Michelle Metz:

So this is Denver Health specific, but we will see patients up to seven days after an assault. Other places usually stop at about five days, but we go up to seven days out, okay? It's okay, if you've showered, it's okay. If you've bathed, it is okay, if you have done all of the things. It's that this again, remember, this exam is about more than just taking a swab and touching a body. Yeah, with it. It's about a whole lot of things. And we can still take good care of them up to that seven days out. I, I've done one or two at about eight days or so, you know, a patient is just like, I just, I want this exam, but I just couldn't make myself come in beforehand. Yeah. And we'll do that. I mean, but right around there is where the stop-off is.

Caitlin Cornell:

Yeah. Good to know, I feel like a lot of people I've spoken to with, they always think that after 48 hours, there's no way. So it's great to hear that, you know, you guys not only extended that five to that seven days,

Michelle Metz:

well, and there was a study done. So I think that's the other part too, which is kind of exciting. It was they had taken consensual couples, they had them abstain for 10 days, did a swab, went home, made a deposit, and then did swabs I think it was three, six and nine days I might be off on those days. But 65% of the people after 10 days of abstinence still had recoverable vaginal DNA. Oh, so right. This is I'm talking about vaginal DNA. I'm talking about the same lab. I'm talking about the same collection and all that. So granted, there's there those potential issues with the study, but it still showed that we it can still live up there a longer time.

Caitlin Cornell:

Yeah, that's very, still very promising. And you know, where people often just one sale, one note, you know, write it off

Michelle Metz:

and I'm incredibly lucky because working in Denver, the Denver crime lab and Denver Police and the DHS office and us we all work really closely together. So when this came out, I was able to call one of my contacts at the crime lab and said, Hey, look, here's a study. Let me send this to you. What do you think they had a meeting? And she's like, oh, yeah, I solidly feel like seven days.

Caitlin Cornell:

Well, it's awesome. You guys are so interconnected, as different agencies where

Michelle Metz:

we have very, very, very good relationships. We're very lucky. Oh,

Caitlin Cornell:

that's awesome. No, it's like you don't hear that very often.

Michelle Metz:

You don'tand I listen, other people talk and I just sit there and go hmm

Caitlin Cornell:

Well, it's unfortunate, not how it is here. Oh, man,

Michelle Metz:

I think a lot of us also put any egos aside and realize that even though we have different, we all have different goals in some way. Yeah. Overarching, we all want to do the best job we can. And I think that there's mutual respect, and I think that makes a big difference.

Caitlin Cornell:

Yeah, I think a lot of just being able to de-center yourself in that work is super important. It's just one of them to any kind of care but like it's great to that that is the culture when it comes to that

Michelle Metz:

because none of it's about us personally. Right? I know it should be about me, but none of it's about me.

Caitlin Cornell:

Oh, man. Yeah, I think that's about it for our frequently asked because you covered everything else when we spoke for the FAQs. Was there anything else you wanted listeners to know about and if there was particular any like misconceptions, you're like, Man, I just want to like hit back against that. Yeah, and my last thing is, this is just from

Michelle Metz:

I think the biggest thing I want people to know is it's a safe space to come. Um, we are not going to force anybody to do something that they're not okay with. And it really is they're in charge. I don't want. It's not yes. I mean, from the standpoint of you are in a hospital, again, depending on what's going on, depending on what's going on where you, you know, or whatever the history is, I am going to be looking at people's parts, you know, what have you. But it's, it's not. It's not traumatic. I try, I strive really hard for it my experience with you know, like directing people, you know, to not be traumatic, it shouldn't be a traumatic experience, it should be a positive experience. I've had patients look at me afterwards and say, that was actually almost fun. I'm so glad I did that, which sounds really weird, right. But, you know, it's all because it is about them. And it's about, it's patient centered. And it's about taking care of the person who's in front of us, and I don't have an agenda. So I think that that's it, don't hesitate to come in, it is a great, it's a great way to get the care that you deserve. At no cost to over to your guys' resources. If somebody does want to get, you know, a forensic exam, they just pop it in the emergency room and request thatat the desk, right? That's exactly it. You just come in and say that's what you need. Remember, it's healthcare, it's okay to say, you can say I need to see a SANE nurse, I need a forensic exam. Any of those things, no matter what they'll take, they take them back to a private room right away. They do vital signs, and then they get social work involved to to go over all of their options and such. Oh, great. Yeah, we have a good setup.

Caitlin Cornell:

I was gonna say, go fast track and everything.

Michelle Metz:

Yeah, no, it's because you know, emergency departments are busy, but it does take priority. And so even if there's somebody who's stuck sitting in the waiting room, it's like five minutes, and then they bring you right back on in.

Caitlin Cornell:

Oh, lovely. Okay.

Michelle Metz:

So but yeah, like, it's,it really is this is patient centered. And don't be afraid to come in. I think that's the big part of it. I'm not going to tell anybody, we're not going to, we're not going to you know, let anybody know, that shouldn't know if you don't want them to know. And, like, you deserve the care. Oh, we and we do see everybody. So probably 20% of our patients are male. We see a good number we see transgender patients, we see you know, Denver Health, we have an LGBTQ Center of Excellence. And then we also do gender affirmation surgery there. Okay, so we see absolutely everybody.

Caitlin Cornell:

Yeah, lovely. I mean, with interacting with your guys's department, I would I would not expect otherwise. But I'd love it love to have that disclaimer for everybody so that they know, I'm shifting gears a little bit. I know, we've kind of talked about a lot about like, you know, SANE and forensic exams and kind of going out really kind of trenched deep into the technicalities there, I do want to talk a little bit about like your experience as somebody who's in a care like a caring profession and about how, like, it's a long career, you know, having spent like two decades, like as some form of nurse, you know, it is extremely impressive, but it's also something that we see a lot, even in our work is that we see we do see burnout and that and we do see people you know, having a hard time, you know, with how do you do this for that long, you know, how do you continue to interact with these kinds of very traumatic experiences?

Michelle Metz:

I think first and foremost, is, it's not about you. And I think that perspective is really important. It can be upsetting if it feels like it's about you, right? When Yeah, I get called in at three o'clock in the morning. If somebody isn't pleasant to me, that's not about me, right? They're having a bad day. So I think keeping that perspective, right? Being aware of what you can do and what you can't do, I know that I treat people really well and I can control what's in front of me in the sense of how I treat somebody how, you know, offering them playdough to play with with their hands during an exam or listening to music while we do it. I can control that. Yeah. The things that we can't control realizing that you just can't control it. taking time off. I like to travel a lot and so I might answer my phone when I'm traveling, but I'm still not working when I'm traveling. Okay You know, I love to say that I do yoga like four times a week that would be a lie. I do work out but it's it's all under duress. Doesn't make me feel better having done it I cuddle with my dogs every morning before I get up I spend five minutes of very focused, deliberate cuddling with my dogs.

Caitlin Cornell:

I love any kind of intentionality but I think having that applied to dog cuddling you might be the favorite way I've seen that. It's

Michelle Metz:

so nice because there's so once they feel me kind of wake up. They love me and it's a bucket filler. So it's and it's taking the time I don't read Anything that's very deep, I read very embarrassing books that I would die if anybody actually saw because it's all fantasy, you know, keeping it light.

Caitlin Cornell:

having like, I also love to read and like I've gone across the whole spectrum of like shoved out of my deep dark corners of my closet to like, Hey, I'm gonna make everybody and my mother read this.

Michelle Metz:

I only understand two important books that I do want. That's a lie. I do one important book a year. And that's about it. Like I should read this, but most of it is, it's just fluff. And I love it. i

Caitlin Cornell:

It's been my favorite form of escapism since I was smaller than I can remember. So I support that 100%.

Michelle Metz:

That's a bucket filling. Yes, yes. And

Caitlin Cornell:

we have our own little library here that we have people check out too so I love that I'm working on like doing a little book club.

Michelle Metz:

Yeah, I just don't think anybody would ever want to read the books that I'm necessarily reading. Vampire fiction. No, no, that's not what we do in our book club

Caitlin Cornell:

you joke about it. But the amount of people now like the amount of popularity that that specifically like female author, like romance has gained in the last 10 years. Like, like, oh my god, it's so different. So I love seeing that, I think it's really interesting to sere how people are exploring relationships and intimacy in my way, and in a much different way. Yes, yes. Because like, that might be like the, like, boring clinical application. The other part is like, it's just fun to read stuff. So

Michelle Metz:

give me fluff, just give mw fluff

Caitlin Cornell:

I just want to feel happy. So like, we're gonna run on over here. But I also think it's fascinating to see people growing up and deciding to apply like new norms to the way that that's authored. Very cool. Yeah. Well, thank you so much for taking the time to chat today. You know, I'm always grateful. I know y'all are all super busy over there. But you are a supeer important resource for us, we love to do what we can to highlight that for everyone in our community. Cool.

Michelle Metz:

Thank you. Because I do think it's important if anybody ever has any questions or anything like I'm here, I'm not going anywhere, as far as I know. So always reach out anytime.

Caitlin Cornell:

Yeah, well, thank you so much. Alright, and that is it for the Phoenix cast today. Remember, we are knee deep in season five. So you know just if you haven't seen the other ones go on, catch up. It's already linked on our page. If not, you know, just explore, have fun, and we'll see y'all next time.