Linda Walther has been a registered nurse for four decades, but it's in the past eight years that she's found her calling: working with survivors of sexual assault.
"If I had found that job 20 years ago, I think I would have been able to do so much more in my career as a sexual assault nurse examiner," Walther said, standing in an exam room at Hennepin County Medical Center. "It's really my passion and what I love doing."
The patients she treats at emergency rooms around the Twin Cities require not just medical care but exams to collect evidence.
Compassion defines Walther's approach to every exam. She tells her patients that for the time they are together they have her undivided attention.
"I think that's probably the main reason I love this job so much, is being able to build that relationship with a patient, and seeing them from their lowest point," she said. "And by the time they leave, you've given them a lot of resources, helped them make some tough choices and you've taken care of their health."
Walther is the incoming president of the Minnesota chapter of the International Association of Forensic Nurses. Forensic nursing is a relatively small specialty that is growing fast as medical personnel play an investigative role in potential domestic violence, unexplained death and sexual assault cases. The specialty includes sexual assault nurse examiners, known by the acronym SANE.
She does much of her work at the Hennepin County Medical Center's urgent care and emergency room in downtown Minneapolis. Victims may have to wait up to 45 minutes for Walther or another SANE nurse, so they're taken to a quiet, secure place.
"Instead of having them wait out in a regular waiting room, they would bring them back to the special room that we have for sexual assault patients," Walther explained.
Sexual assault exams can last up to four hours. The collection of evidence follows a strict protocol. The procedure, she said, includes "a head-to-toe exam of their body, looking for any injuries, documenting that. And then doing the genital exam, and then giving them medication to prevent any sexually transmitted infections."
Walther arrives at exams with fresh socks and underwear for each patient, because their clothing often becomes part of the evidence. The items are donated by sexual assault support groups.
Sometimes a friend or family member accompanies the victim. But Walther said that when she conducts the detailed interview about the assault, everyone else must leave. She doesn't want others to influence how the victims choose their words. Sometimes, either before or after the exam, her patients give a statement to police.
U.S. Justice Department statistics show that a majority of rape victims do not report the crime. Walther understands why.
"People are afraid they're not going to be believed," she said. "They're afraid of repercussions, and they're just not sure how to proceed, as well. So I think it takes a lot courage to come forward and say that something like that happened to you."
Other factors may keep the reporting rate low. Many of Minnesota's more than 140 hospitals don't have SANE nurses. Walther said some medical personnel are reluctant to perform sexual assault exams; some ER personnel worry about satisfying all the legal requirements about collecting evidence. In addition, Walther said, the medical exams can take two to four hours and pull overtaxed nurses away from other duties.
Underreporting makes it difficult to determine the incidence of sexual assault. Figures from the Centers for Disease Control and Prevention suggest the national rate of sexual assault in the past few decades has declined by nearly half. In Minnesota, Bureau of Criminal Apprehension data show 1,971 reported rapes in 2013, down slightly from 2060 in 2012 and 2080 in 2011.
The BCA's numbers for 2013 work out to an average of five reported rapes a day in Minnesota. Fewer than half of those reported in 2013, 41 percent, led to an arrest.
Walther is frustrated by the low number of perpetrators brought to justice. In eight years, she's seen nearly 500 patients but testified in only 15 cases. Numbers supplied by advocacy groups suggest that only a handful of perpetrators are convicted.
"Ninety-eight percent of rapists walk free," Walther said.
Walther, 60, was born in Rochester, Minn., and completed registered nurse's training in 1975 at the old Midway Hospital in St. Paul, now HealthEast Midway. Her nursing resume includes a Peace Corps stint in Brazil, work at a refugee camp in Thailand and in a drought-stricken region of Africa. When she returned to Minnesota, Walther worked in Twin Cities intensive care units.
A search for a new challenge persuaded her to become a sexual assault nurse examiner.
SANE certification is overseen by the International Association of Forensic Nurses. Certification requires 40 hours of training along with a mentorship, and there are additional requirements to be met before working with young patients. Certification must be renewed every three years.
Walther is certified to conduct sexual assault exams on adults, adolescents and children. About one in 10 of her patients is male. She works primarily at HCMC in Minneapolis and at Region's Hospital in St. Paul, but she responds to calls from 16 other area hospitals.
The feedback Walter hears from people who work with rape victims is that those who report the crime seem better equipped to face life. The nurses dispense medical treatment, they tell the victims they're are not to blame for the incident, and they put patients in touch with people who can offer more help.
Walther is passionate about her work. There are moments, after she's finished an exam, when she knows she's done something important for a person. That's when her patient thanks her or even, in some cases, asks for a hug. "The greatest honor that I have in my life is to be able to be there with a victim of sexual assault and go through that whole experience with them ... of starting their healing journey," she said.