SURREY â€” Sometimes Lynn Gifford dreams about her patients.
"I used to get angry a lot," says Gifford, clinical co-ordinator of forensic nursing at Surrey Memorial Hospital. "At the world, and men, and just people in general – why do they have to treat each other this way?" But she realized being angry would not serve her patients well so she focused on just caring for them during their time together.
"It is really important to focus on the moment that you are in. Sometimes it’s just a little bit of care, a little bit of compassion, a little bit of advocacy that will potentially enable that person to change their lives. We can’t change their lives. But we can help, we can support people."
Gifford leads a team of 20 forensic nurses at SMH’s emergency department. She’s been a nurse for 39 years and a forensic nurse since 2002. She grew up in Ontario, where her mom was a nurse. The nurses’ role is to help victims of violence of all ages. The patients come from across the Lower Mainland.
A patient comes to emergency seeking treatment for a physical injury. If the wound appears suspicious, particularly in the case of a youngster, or if the patient reveals they’ve been abused, a forensic nurse will be called in.
A woman arrives at the ER, saying she fell down some stairs. Her face, arms and stomach are bruised. Suspecting otherwise, the ER nurse discretely offers her the care of a forensic nurse, who discusses her options in privacy in a suite designed to make patients feel safe. The patient declines police involvement, explaining she’s economically dependent on her abusive partner. The nurse tells the woman she can return any time.
"Sometimes people say no (to telling police)," Gifford notes. "It is frustrating. That’s where it stays. The only person who really can report that to police is the victim."
It takes some women many visits to the emergency room before they have the courage or the support to be able to change their lives.
"It’s always a little bit disheartening when it happens because we know people are still stuck in their cycle, their pattern. But we also know from a lot of scientific research that it takes women up to 10 times of seeking care from the police or the hospital to actually get ready and be able to leave a violent situation."
Men too. About five per cent of the forensic nurses’ patients are men but that number is slowly increasing. They now see as many as 10 annually, Gifford says. When the program started, they’d see maybe one or two each year.
Currently, there are no male forensic nurses.
Gifford says SMH doesn’t foist treatment on anyone who is uncomfortable.
"Whatever the patient says that they need, or want, we have to try our very best to do that."
Trust, she notes, is a very fragile thing.
"As we build the trust little by little, then when we get to the part of the examination that’s difficult and intrusive and invasive personally, there’s enough trust there that patients will be willing to go as far as they need to go to collect the forensic evidence," Gifford says.
"It’s a very fragile thing because people come in with their trust gone. Their whole world has just been shattered; they don’t know any longer whom they can trust. I think of it sort of as a kind of spiritual wound. To me, it’s the most important thing to rebuild quickly because people have to go back out in the world and trust people. You can’t walk around not trusting anybody."
VITAL ROLE IN COURT
Besides caring directly for patients, and gathering specimens when required, forensic nurses are called to testify in court. Gifford has done so many times.
"Ultimately, we are collecting forensic evidence for lawyers and police."
Surrey Crown prosecutor Winston Sayson recalls a highprofile case where the accused pleaded guilty at the last minute. Sayson suspects the work of a forensic nurse, who meticulously documented 29 injuries, played a critical role in that.
"I believe it was a key factor in the accused pleading guilty at the last minute," Sayson says. "Powerful objective medical evidence."
Surrey practicum teacher Michael Edward Herrera was sentenced in 2013 to 26 months in prison for luring a Surrey high school student into a perverse "master-slave" sexual relationship.
A forensic nurse found 29 bruises and abrasions on the girl’s body.
Sayson says the nurses are professional, neutral and "very thorough."
"Unfortunately other communities don’t have this," he adds. Northern B.C., for example.
Gifford said forensic nurses see a couple patients per day in Surrey and Abbotsford. There is a nurse on call at all times.
Patients younger than two are referred to pediatric specialists. For older children deemed vulnerable, a social worker is brought in. If the alleged abuser is an authority figure, police are alerted.
There are exceptions. For example, a 12-year-old might say she was at a party and something bad happened but she doesn’t want anyone to know, not even her parents.
"If we feel that the child is safe in their home and they’re protected in their home, and their parents are providing the support and safety that’s important, there’s an Infant Act that protects a child’s access to health care. So if the child comes at 12 and says, ‘Yeah, that happened and no, my parents don’t know but I’m safe at home,’ we have to not tell. And that can be really challenging."
The best part of Gifford’s job is seeing victims begin to heal.
"If we do our jobs well, they walk out having made the first one or two steps they need to make to begin to heal."
The worst part is dealing with a patient who rejects help.
"You just get this sinking feeling knowing that they are going to get hurt again, and they’re going to be back. It’s kind of a sad part of life for everybody, but we are the only ones that can fix our lives. We are all the masters of our own lives."
‘AN INQUISITIVE MIND’
Forensic nursing is not yet recognized as a specialization in Canada. One can earn a PhD in the field in the U.S., but not yet here.
Newton resident Sheila Early, a pioneer of forensic nursing in B.C., co-founded the Forensic Nurses Society of Canada in 2007.
Early began her nursing career in Saskatoon in 1968. She noticed over the decades that nursing, when it came to victims of sexual violence, hadn’t progressed.
"I wanted to make a difference."
So she set about developing Surrey’s program in the early 1990s.
"I did the leg work, if you want." Early made 28 court appearances as a forensic nurse. She left SMH in 2007 and today teaches forensic nursing through the British Columbia Institute of Technology, where she’s received a teaching excellence award.
Are the best forensic nurses trained, or born?
"A little bit of both," Early says. "You need an inquisitive mind. Every forensic nurse is a very good fact witness."
For victims of sexual assault, she has this to say.
"Life will not be the same, but it doesn’t mean it can’t be good again."