1:00 P.M. with Amielynn Abellera, Kristin Villanueva and Dr. Kathleen Sekula

Always good, always good.

Always very happy. Cut, say, "Freshest" for Aldi. To Aldi price.

“This week, Tafeltrauben, 650 grams for 0.2 € 9.90.”

Or cultural heritage, 1.25 grams for 0.1 € 9.30. In your Aldi Nord, for years. And wait for it to be lost and finished. Aldi. Good to see you, Aldi.

Swat? Really? I suck it off. You spent time in the Middle East? More than I would have liked. I worked in Kabul with Metzans one frontier

and in 2020 at the maternity hospital. I met the most incredible bravest doctors there. Bastie Barchie. Tragedy. You should grab a beer sometime.

Share your worst stories. I'd like that. She's in school. Yep. Maybe.

I'd like to be around low enough to find out. Welcome to the Pet Podcast. The official companion to the Pet on HBO Max. I'm Dr. Luke Batell, physician journalist and I would talk about the show every day if I could.

And I am Hunter Harris, a screenwriter and cultural critic. Today, it's one o'clock on the Pet. It's episode seven. And we get to hear from the people who keep the pit running the nurses.

We'll hear from Ameland Avalara, who plays nurse Perla. And Chris and Villanueva, who plays nurse princess. I can just look at Ameland slash nurse Perla. And I know that something's up. We work alongside together.

It also helps that we're friends, both on camera and off camera. So I can feel her energy and no words are needed. We want to talk about the real challenges nurses face in today's world. And we're going to talk to the people who make sure

that those stories are told accurately in the pit. Today's shift starts now. Let's start with character and then we can move to Madison. How does that sound? I mean, you know how I roll.

That sounds perfect. OK. The most maybe heartbreaking sequence this episode was the sexual assault victim that nurse data is giving this examination to.

And I really appreciate it that this examination kind of takes the whole episode. Like, we keep kind of going back and watching Dana with this patient. And you get a sense of like how invasive this

has and how vulnerable it is for this woman.

“I think that's exactly why it was included.”

This situation happens. Sexual assault is a known issue. And there's so much that happens in the duality of medical care, but also in kind of giving, giving a victim that privacy rebuilt, reestablishing trust,

kind of that duality of humanity in Madison, which charges her state in nails. You're in control now, Alana. Where had it helped in support you? Once I opened this kit, I cannot leave the room.

But if you need a break or some edge, just let us know, OK? There's also so many logistical things to collecting all this evidence. I did not realize that like Dana can't leave the room that she has to kind of be like glued to her chair.

And she can't like be in the ED, like running stuff as she normally would be. So everyone else is like kind of caught a little bit off guard. I would say without her leaving the ship. And she really owns her role.

She kind of steps like as you mentioned, they keep going back to the episode. And she's in that room. And obviously, it's a private room. There's privacy.

And there's nothing in the background. And Ms. Dana is focused on that situation. Yeah. You know, Dr. Al-Hashamy comes in. Runs the medical screen, which is appropriate to make sure

is there any cute injuries that need to be addressed. And then Chargerstein is assuming the role of a sane or a safe nurse, a sexual assault nurse examiner or a sexual assault forensic examiner. And you're right, she follows a protocol. But also, the language she uses, the trauma-informed wording,

which she says things like urine control now, really powerful scene.

“Yeah, I was also, there was one moment where I think she was like”

about to hug the patient. And then kind of takes a little bit of a step back. And I think you're right. It's very trauma-informed. Like, maybe they don't.

Maybe she doesn't want to be touched right now. Just after what she just experienced. I thought that was really really moving. I was honestly wondering when this was going to show up in the pit. And, you know, it's a horrific scenario.

It does happen. But to kind of show the protocol and how trust is reassert, I think it's important. And, you know, the hope is that if somebody, unfortunately, is going through some type of scenario of sexual assault,

they kind of have a little bit more of an understanding of what happens in ER, the safety, the trust, the precautions. And maybe this convinced is one person to go and, you know, regain her agency, get in there. Yeah.

I just, just even seeing like that woman kind of alone in the frame alone in the shots, like you can feel the loneliness there. And I just can't imagine.

I mean, I would always want to see it in my corner.

I thought that was really special.

She's like, she's explaining each step and kind of showing her this is why we're doing what we're doing to kind of reassure Alana that she is in control. And she has the ability to say no. But, you know, Tarsha Stena said the minute I open this friends, they kid, I have to stay in the room.

Just kind of that clear communication. It's important. Yeah. But I also like that she said, you know, you can take breaks. We can pause if you need if like this feels too overwhelming.

Um, part of me is like, what are these people going to do without her in like the ED like running like Tarsha Stena? But it's important that she is like fully present. I think for Alana. That's really special.

Yeah. Do you think I'll Dr. Al Hashmi was a little too quick in the same. Like she did her part. Like you got to make sure you're checking for acute injuries. She was in and out.

No. I sort of like how quick and concise Dr. Al Hashmi is in that way. Because Narsina is one who's really building a relationship with Alana in that moment. And, you know, you don't want, you don't want to kind of overwhelm her like too me people, too much information at the same time.

Because I'm just going to slow clap to all the nurses who are fans of the show are watching, who are saying or saved trained. You have an incredibly important job. Oh, and this can't be good. Who's that?

That is Hospital CEO Trent Norris. He's the big boss. Hmm, nice outfit. Hey, Rockstar, gather your staff, please.

Sure, anything you want to tell me first?

No.

“Hey, everybody, can you gather around this enough for a moment, please?”

And have your attention, everyone. And in turn of the zaster, a Westbridge has been identified as a cyber attack. So Westbridge is down. There's been a cyber attack. And then another hospital old dominion is going down to.

And preemptively, the, like, you know, big head, exact of the hospital comes down and says, we're going to like cut off all the computers ourselves. We're going back on paper. That I, I literally gasped so loud. I was watching my dog and she's like, jump up and look to me.

Because I was like, what do you mean every computer is done? And then brushing to take a photo of the board? Oh, my gosh. Any physicians, nurses, anyone who has worked in health care for, let's say, more than 10 years.

Uh-huh. Or even in some sites and underserved areas or in international communities has been in the clinical setting where we did not have electronic charts. Like, not having computers at all. That's like, even older than that. But when I started residency, you know, I was at a few hospitals where you were paper charting everything.

Oh, no. And we still have these situations where we call them downtime. Sometimes it usually happens in like the middle of the night when they run maintenance. And they shut down the electronic medical records. Sometimes the computers.

When that happens, you're sitting there and you're like, oh, my gosh, you really realize how much the medical system relies on electricity in general, obviously. Yeah. But electronic medical records, like sending prescriptions to pharmacies, sending orders to a radiology, center, sending lab orders, everything happens electronically, including patient records, including triaging patients and the board. Like, it's, as well.

I'm actually like, I'm sitting around like, we should have thought of cyber attack.

“Like, there's, why would I think of cyber attack?”

It's kind of like happening right now in other news headlines and like, we kind of got this hint about like the uprising of AI in this season. I'm like, I don't know. I feel like I thought I should have thought of that. That's something. I mean, what is Dr. Oh, Hashmi going to do with her app now that, like, there's no paper pencil.

Yeah. Well, how's AI going to help us now? Now, I'm like, why can't cyber attacks happen to like things that we really need to be attacked? Like, student loans? Like, why is it a hospital?

Like, what's the benefit there? I mean, we're going to cut tape when I say, why can't they be attacking that?

But the reality is, and this does happen, I've been involved in one of them.

Like, well, I shouldn't say, I didn't do the attack. But I've been at an institution where hackers held the medical records hostage. But they will essentially prove to a hospital that we can hack into your EMR. And give us X amount of money. Let's try to medical records.

Give us X amount of money, or we're going to release this patient information. And so hospitals over the last few years have really built up Stronger security standards, not only in their own IT departments, but also sending us physicians, nurses, anyone working in the hospital, more of these trainings, like more ways to look out for fishing schemes on emails and things like that.

Once again, why can't they hack an insurance? Like, why the hospital?

“But I think this is a really good moment of tension between Dr. Robyn Dr.”

Alhashmi again, where Dr. Alhashmi is the one who hears about the, who learns that they're shutting everything down first. Why could Dr. Alhashmi have given Dr. Robyn like a heads up? And why would they tell her and not him? That is interesting. Yeah.

It's almost like the C-suite, the leadership is, is pitting people in the pit against each other. But it's like, you know, they kind of told her. And I mean, I feel like she should have immediately told Dr. Robyn like, oh my gosh, I can't even, like, that's not the way for him to find out. Right, especially when kind of this whole day, she's been telling him, like,

And then this big piece of information is dropped, and she kind of,

you see her, she's like, feels awkward, I guess? Yeah. But I kind of wish that they could rely on each other. Maybe like they're both a little bit, like, not trusting one another completely. Alright, sabbatical could not come soon enough.

I wonder to how you explain to patients, like, don't freak out, but we don't have computers right now. Like, how is that going to work? Patients are like, damn it, what now? Like seriously, this is like the same day we're all this happening,

now we're going to shut down. Now like the width can be even longer, and now like they're going to be more diversions. And guess what, guess what? They're still probably going to blame the doctors for this, because that's just what happens.

Everything's our fault. No, not to me. No, I appreciate you. Let's just make a PSA of Hunter Harris being like, not everything is the doctor's fault.

All day, we've seen Langdon try to talk to Dr. Robbie and Dr. Robbie. Honestly, very like cold, very cruel, really like playing him off, pushing him away, actively avoiding him. And finally, they are stuck in an elevator together.

They have this moment when they're on the roof, waiting for another patient. And it is, I mean, you can cut the tension with the knife. Like, I felt so bad for Langdon in that moment. Okay, I'm just going to say it. I'm sorry.

I've been trained, I've been trained out of patient's presence. I'm really fucking sorry. I don't know if I have to get it this way. I'm really glad that you got the help that you need. But I don't know if I want you working in my ER.

It was funny, because it always felt like a weird rom-com.

motif when like two people are trying to talk and they get stuck in a room or an elevator. And they're forced to confront their feelings. And I know this isn't a rom-com. But like, they're in an elevator together.

And you're right, they kind of look, then they don't look at each other. And I'm like, I'm sitting on like, Dr. Robbie, come on. Like you know he's trying, you know what he went through. You're leaving me for three months. I know you're hurt, but say something.

Say anything. I read on the line.

“I think he says, you know, Langdon is like trying to apologize.”

And then Dr. Robbie says, I'm really happy that you got the help that you need. But I don't know that I won't be working in my ER. That was devastating. It was.

And then I think Langdon is like so shaken by that.

Not only like does he lose this, you know, very clear sense of like, Brotherhood, friendship, whatever. But also that now Robbie like doesn't trust him as a doctor. Like professionally, I think he sees Robbie as such a mentor. Like that's really disappointing.

And like you see him almost like deflate in the moment. And then he freezes up later, right? With the patient for him, Dr. Garcia. And I don't think it was very fair for Dr. Robbie to say it. Number one in that moment.

But also without like a longer conversation. Like he followed from what we know according to the rules at PTMC. You know, Dr. Langdon followed the protocol. He like took time out, he went to rehab. And I don't know what happened to his privileges in the hospital, for example.

But he's back in and he's legit and he's ready to practice.

“So the hospital is like, yes, you have done what you need to do.”

And you're ready to go and finish your residency. Dr. Robbie's like, I don't want you in this ER. So it's it's it's a personal issue that he has. It's nothing related or nothing that he can enforce professionally. So I feel like he needs to sit down with Langdon.

But I have a problem. But you're allowed to practice here according to your privileges. But there's a lot more to unpack than that one line. Yeah. I mean, I'm thinking it's like very like dark doctor Robby this season. Like the way that he talks to Alhashri, the way that he's dealing with Langdon.

And even Langdon with the patient who had the leg issue, the weight stress. Yeah, yeah, yeah. I mean, I like that Narcina was like, okay, either like bring him in or like leave him out because you like Robby taking him setting off to triage. I'm like, what is like, you can front him somehow. Is it dragging on? Is it dragging on?

No, I got to be at the point where like I just want to see resolution. No, I kind of like this. I have Dr. I like it. It's very dramatically rich to see him in the wrong in this scenario. Because I feel like he is. That's fair. I'm almost ready for there to be like pick a direction. Like either we're going to work together

or there's going to be like a catastrophic split between the two of them. And so we can just move on to different traumatic arcs. But then all of a sudden, maybe there's a little bit of a foreshadowing when they're treating that patient who got hit with the boat propeller. Because it's like Dr. Robby's like Langdon is your show, like he's communicating with his eyes.

And like Langdon is like, you just told me you don't want me in your ED. But now I'm going to be directing care and like I can almost see it in the acting. And like Patrick's acting when he's like playing this resin who's like what you don't trust me but you do trust me. But now I'm being a put on this like there's a lot happening.

It really felt like bullying to me.

“Honestly to watch Robby, like kind of sending him out without like, okay, let's see what you can do.”

And I'm like, oh my gosh, like this is not the Robbie that we know from these ones. Dang, Robbie the bully. Yeah. We've gone there. No, but I think it's good. I think I didn't know why he plays it really well.

Like that's a real sharp coldness. I'm like, I would not want to be in your bad side.

What happened to you? Oh. Well, it grays my vest. You were shot? Shot at.

“Geniuses thought today was a day to Rob a good square house.”

Didn't think about how long would take the little de-appliances.

They panic. Oh, hell broke loose. Jesus. Kind of sexy. He's, she walks in on him shirtless.

And he's like, there's nothing sexy than like, tending to your own wounds. I was over there. I think so. So she even took a wound that you took like protecting someone from bullets.

Hursing someone shot. No, I was shot at. Like, he's such a cowboy. I love him. I don't know.

She like, there's like this tension of her. Like, let me treat your wound. And also, I need to ask Sean how to see about his like chess routine. Because he's kind of jack. I like how this builds upon like the like the subtle tension between them from last season,

where he is very like Dr. Abbott is very impressed by Dr. Mohan. And I like that now. They get this little moment of like, yeah, real flirtation. And I also like the he immediately sort of helps her with Orlando Diaz. And kind of like breaks the rules a little bit.

There's also this really quick moment when she's tending to his wound on his back. And Dr. Robby walks by quickly and like looks in the room and just keeps walking.

“It's one of I think like iconic double takes that I've ever seen.”

Like, he's so like, what's going on? And also, I'm not going to get involved. Like, whatever they're doing, that can be theirs. Like and leave it privately. I feel like when you when I watch this show,

we have like really fun notes because they're just different. And sometimes he's topics of like, oh, they're not big enough to be like a full discussion. But like, maybe a quick like bullet point is something that caught your eye. Because you're going to ask you like, tell me a few moments of this episode. A few details where you were like, oh, like, that's fun.

I think three very quick things. The difference between Javadi's mom and her dad. Like, they, you know, her mom is very strict. But like, also wants her to go into surgery and her dad is like a little bit more chill. Like do what you want.

And I wonder if there's like something different about like their specialties. It may be speak to like those character differences. Um, that was interesting to me. Also, uh, Dr. Abbott kind of like, and Dr. Alhashme and Dr. Robbie being like, good.

I don't know. Maybe like he's still very resistant, very dismissive. Um, and the big CEOs grilling for the July outfit. That was funny to me. I like those. I like those.

So are you guys ready? So I got my three quick things that are obviously going to be a nod to some small medical detail. Some workflow detail. Well, this episode also has like this subtle nod to kind of burnout and physicians working in crazy scenarios. Because you got this one little moment where you have a doctor sleeping on a patient bed.

Oh, yeah. Just because it took a quick nap and like that actually does happen. Sometimes we're sleeping on floors and so forth. Like whatever in empty conference room just could have quick nap in. Whitaker also throws a protein bar for the residents.

And he's like, you got to eat on the gugs. We don't have time to eat. So that was one little kind of theme in this episode. Yeah. Also, like, hey, you know, at the ongoing conversation about gun violence in America.

Dr. Abbott makes this comment about how even with a bulletproof vest in AR15 can still cause damage.

Like just to think how powerful those guns are.

And last but not least, I am glad that there's a little PSA about the risks of heat related illness. And anyone who's outside when it's hot, but especially our young athletes. Oh, yeah. And this football player was like, I'm fine. I'm fine. And it's like, well, two days, like, I got to get back out there. I'm like, oh, my gosh.

You're in high school. You're in high school. You don't need to be pushing yourself. Heat related illness happens in high humidity. Even if people don't realize it because they're losing so much fluid. They're not sweating and cooling us efficiently.

I also want to go back to the high school and question the coach.

“I mean, like, what are you doing in terms of breaks right now?”

Yeah. Like that entire scenario is we see it play out every single summer across the country. Look, so much is going on in the pit with this code black. And I think we need to go straight to the source. And here from two people who are right in the thick of it.

Let's hear from my favorite nurse duo in the pit. Kristen Villanueva, who plays nurse princess. And amulet Abalera, who plays nurse perilla. Son, you're part of the new Javadi. What are you doing here?

What? What are you doing here? Kristen Amulet is an honor to have you both here. Like a little personal note, I work in a hospital.

I work with a lot of incredible Filipino nurses.

They are all my guerillas, my at days, my thief does. So I'm very stoked to talk to both of you because I think nurse perilla nurse princess just hits a relatable note for a lot of people. I want to start with a moment that was that was pretty important to me.

Nurse perilla is like right there.

It's like a six cents when nurses know what is happening. What physician needs our what patient needs are.

“And I think that's true of a lot of nurses.”

I think you both throughout this series have moments like that. I was curious if you could comment on how you kind of identified into that role and you transformed into these ER nurses. Well, speaking of Louie, I think that is perilla's favorite patient. But I think that is such a beautiful thing about being a nurse is that they are sort of three or four or five steps ahead all the time. And have a way of anticipating what's about to happen mostly because they're so experienced.

And you know, I think nurse perilla has been working at PTMC for over five to six years now all through COVID working, you know, side by side with Dr. Robby.

“And so I think she has learned through, you know, osmotic experience on how to be five steps ahead of of the doctors, but also still patient and waiting.”

And also ready to support whatever order they're about to make or whatever their what road they're going to take.

I think in addition to that too, they're not just amazing at what they do in their profession.

But they're amazing humans in a sense that they're very empathetic, so they're very sensitive to energy and so I can just look at. Amelind slash nurse perilla and I know that something's up, you know, we work alongside together. It also helps that we're friends both on camera and off camera, so I can feel her energy and no words are needed. So that true. I want to talk about the code block because in this episode, we learned that it's a cyber attack. How does this change the day for perilla and princess.

I know for me. I asked our med texts are real your nurses on set. Like, is this happens to you right now? What is your reaction? And I don't know if I could use curse words, but they used curse words like right away. Oh, they're like fuck me. No. No. And yeah, one of them even told me like, I think they have rules and regulations around that and what they would do, but they haven't drilled it yet.

So they're afraid of whatever that first drill will come or if God forbid the actual thing happening, but yeah, it's it's no bueno.

“Yeah. On a scale of one to ten with ten being a pain in the ass, the nurse texts were saying, this is the worst. This is the worst thing that could happen in terms of how do we keep all these balls up in the air.”

And you know, stay accurate know how to how to chart our patients know who's in which room, how to keep track of everything. And it's just it would just be the worst thing that could happen in terms of trying to stay on top of what we're trying to do in each hour. You know, when we're looking at situations like the code black or patients really ill princess and perla all the nurses are almost like the Greek chorus just like looking at their expressions. And their tone sets the stage for how people should be feeling like is it things can be tens, is it not a big deal like that happens in the real world.

And you to have this amazing dynamic, we also kind of banter and talk smack and Tagalog, which is this great kind of escape. We get to see what perla inferences are really thinking about it. So I was curious about how you thought of weaving in that cultural context and how it found its way into the story. It's all the writers. Yeah, they, they, they would write it in English and then they would say this will be spoken in Tagalog. Yeah, so kudos to them. They know exactly what happens in real hospitals.

Yeah, I was about to say it's so accurate. Yeah, it must be. I think so. And it's, you know, call it gossip, call it talking smack, but you know, I think that princess and perla are just partaking and you know, Shakespearean, aside with each other. You know, and just sharing information with themselves and with the audience, you know, in a metastyle, like away from the people that they're observing. And I think you go into any hospital and any workplace and I think that is almost the joy and in observing humanity in all its foibles and commenting on it.

And I think that perla and princess have been in this hospital for a long time together and they've seen people come in and out.

“They know who's senior, they know who's not and it's, I think it's fun for them. And it allows them to, you know, take a little bit of a break connecting.”

And, you know, for that to cross with a cultural dimension of Tagalog is, I think, just this wonderful thing to portray in what the reality of a hospital is. How hard is it to keep track of everything when you have so many scenes, so many patients and so many people on set. I have a, I have a princess tracker on my Google Doc. Oh, I love it. Yeah, yeah, like, and I didn't, I don't know why I didn't do it last season, but I did it this season of just, you know, tracking where I was last at who was the last patient I saw.

Where are they now? Where are the other patients? Are they getting their CT scan? Did we discharge this patient? Yeah, no, it's, it's very hard. So every time a new episode drops, I'm, I'm the same as everyone else. I don't know. Oh, that's true. True. It does, of course, help that we are shooting it in real time. Princess and Pearlah are in different traumas at different times, and we leave to go check on our other patient.

And Amy Lynn as the actor always has to ask, scripty, how much time has passed.

When, where was I before this because two minutes can pass, but that was maybe, you know, I filmed that on Monday and now we're filming that on the next two minutes on Thursday. So it is sort of an actor problem, or that I love figuring out, and also, you know, a parallel problem of, you know, who which patients need to check up on, and who was either last, but that's that, you know, we've been having fun with that.

“Speaking of Amy Lynn, the actor and Pearlah, Amy Lynn, you come from a family of healthcare professionals, right?”

Like, dad's a doctor and your mother's was a nurse. How much did your personal experience kind of play into you developing the character Pearlah? So much. Yes, my dad is a retired family practitioner. He had his own little private practice in Stockton, California, and my mom started out as an RN in the CCU, at the critical care unit, and then upgraded in her 40s to a nurse practitioner. And so she, I was very familiar with hospital settings going following my dad at rounds and things like that, and also with my mom in the clinic as well.

“And I think it allowed a familiarity of all of the, just being comfortable in these spaces, being comfortable in a hospital, being comfortable with the language, even though it's still, you know, I still have to reverse it quite a bit.”

But there was a definitely a sense of a little bit more comfort in knowing what these tools are inside in a hospital, and what a blood pressure is, and what an IV is, and, and also just being, and to seeing a doctor's dynamic with the patient, when observing my father, and then also how it's a little bit different with a nurse's dynamic with my mother. And they work together in the same clinic too, so I really am grateful for being in that space with them, and they've been enjoying watching me sort of bring it to life.

We know that princess speaks like maybe four or five languages. How does that add to like the dimensions of her character and is that fun for you? They said six actually excuse me six. I don't know what the six are.

Oh, it's very fun. I've always been enamored by people who are is a polling lot. Is that the topic for folks who can speak more than three languages have always been enamored by them and in awe.

And I've always loved putting on accents, although I'm not one of those who can just like, I need to study it in a week. But yes, no, it's been fun. It's been great. Do you speak multiple languages, too? If I'm lost in the jungles of Costa Rica, I could find where the gasoline station is. So it's Spanish. So I could.

I have emergency Spanish in my backpack at Tagalog. I'm that's my first language.

It's probably the same in Spanish.

Okay, yeah, fun fun series question. Is there anything that either one of you learned from the nursing consultants, the medical writers that that really surprised you about being a nurse in the ER, was there like an aha moment? I'm I'm still trying to get over the fact that these are real cases that we're presenting as the reality of an ER department. And the nurses say, yes, this does happen all the time. This is actually what our day is like we and also the trauma of nurses being assaulted. That fear every day is real is very real. And that to me is so discouraging and so confusing to how these people who are dedicated to helping and caring and to save their lives are being, you know, acted out against.

So that's hard for for me. And the nurse takes really that's just not water off their back, but they're just like shrug. Yeah, that's the truth. And that's hard for me to follow.

“I think Perla has that line after Charger stand against punched. And she says we've all been assaulted.”

That's just daily life damn well, I'm glad that the pit at least shed awareness and put a light on it because it's almost like workplace violence against nurses against doctors.

As almost normalized, if that happened in any other business, it would not be tolerated for more than a day. Yeah, correct, correct. This is awesome. I think so. Salamah, thank you for all of you. Thanks Salamah, thank you so much.

I got some tricks, I got some tricks. Appreciate you, Bob. Thank you. Thank you. Awesome.

I was so excited to talk to them, like they're such a relatable part of the show because there's so many incredible Filipino nurses.

I was actually sold on the accuracy of the pit because in season one, when you first hear nurse princess, I was like, oh, yeah, they did their homework. I think that they have such good, they have such good chemistry together, such a good relationship. I like want to be gossiping with them. I want to be whispering with them. I want to know what they have to say. And I do like how they are kind of an audience proxy for

“like based on what, I don't know, what expression they have on their face and like, okay, so that's how it should be reacting.”

Like that's, this is good news or bad news. I can tell immediately from them. It's totally true and it's a testament to the preparation they both did and their acting skills. Because if you think about an actual ER, this nurses have seen everything, depending on how long they worked, they've kind of been conditioned to it. So if they're freaking out, I'm freaking out. If they're calm, that gives me a little bit of, you know, like a little bit of calmness too. And patients and families look to nurses also, like they really do set the tone of a busy hospital.

I have to not my hat to Catherine Linasa, charge nurse Dana and how she handles the entire situation with the survivor of sexual assault. And we know that this interaction is inspired by the actual work that sexual assault nurse examiners do every single day. These saints, as we call them, and we are fortunate enough to talk to an actual saint from Pittsburgh, Dr. Kathleen Sakula. I'm so honored that she's going to take the time to speak to us about our work because it is extremely important and necessary.

And definitely variance by ring. You're a master of the story, also the school of the school, just to get some rest and then get a heart attack. And then you're a master of the school, and you're a master of the school, and you're a master of the school.

“Dr. Sikola, can you tell us what saint is and how it fits into the healthcare system?”

Okay, saints are sexual assault nurse examiners, and they're especially trained to assess and treat patients who have been victims of really any type of treatment. Really any types of assault, but sexual assault in particular. And they just sexual assault nurse examiners just really came into being in the 80s, late 80s, early 90s, and forensic nursing then started to be recognized.

Yeah, I think there were a few things. One of the biggest misconceptions in caring for a patient who's been assaulted is that they all present in the same way.

They should present as being very sad and being upset. When in fact, they can present to the unit in many different ways. Some of them can be totally silent. Some may be very anxious, you know, that's expected. And we've had, you know, some of them might be giggling, and that's their reaction to anxiety. And so for a long time, nurses and physicians, you know, saw these patients when they came into the unit as being maybe faking or, you know, being not credible in some way. Now we know that they've presented many different ways when they commit. So it's very important. And in most hospitals, most emergency departments now are working very hard to get saints on board, so that there are 24 hours or at least that you have a saying that you can call in.

“Who's on call if a case comes in because they take a long time and that was the other thing that I think people aren't aware of a case usually takes somewhere between three and four hours to complete.”

What does it actually take in terms of of training to become certified and to become a sane.

To take some learning how to collect evidence, so that's, you know, that's a big part of it. But the other thing is is to learn how to assess the patient because they're different, they're different type of patients, even though most patients coming into the ED or anxious, but the assault patient is different and their sexual assault victim, especially. And it's a different way. We teach nurses who are training to become saints that you really respect their personal space very, very clearly. You ask them you let them know if you're going to touch them because they have just been violated. So we talk about it as trauma informed care. So we give back to a patient, control over what's going on.

Kathleen, what is the path to becoming sane certified in terms of a protocol look like is it something that, you know, you go to a specific program to do, can you do it within your own hospital under an mentor and do you see a trend.

More nurses wanting to become saints certified or is there a gap.

We have many more nurses becoming saints certified. So first they take a die-dactic course and that's like 40 to 60 hours of being online with expert nurses who are teaching them all about the process. And it's like to interface with the emergency department and throughout the hospital. And then after they've completed the die-dactic course, we provide them with hands on a three, three day, eight, five every day hands on course where they learn and they actually do the exams. And after that they go back to their home clinical setting and if they're very, very lucky there's another same who's been practicing who can then take over preceptorship with them and help them until they feel that the nurse is ready to do it on their own.

“And once certified they have to renew that certification every three years I believe it is.”

Is this about reporting? Because you can do this collection without a police report for now and not of it goes in your permanent medical record. I don't want to do this anymore. So in the same examination, you're collecting evidence, but what does support look like from law enforcement or how does that relationship work as you're as you're doing this work? One of the things that we have been able to make a tremendous change in is our relationship with our legal and with, you know, the especially police departments hearing the Pittsburgh area.

“We met with the chiefs of police and we talked to them about why it's important for the police to understand where they would take a victim to that particular setting.”

We want them to know where there are scenes practicing. Now we have a lot more sayings here in the Pittsburgh and surrounding area, but at a time there are only a couple hospitals that had sayings that they could either call in or that were on on board all the time.

So we have good relationships with law enforcement throughout. How else do you think that the culture around saying and this kind of trauma informed care has evolved over time?

I think through education and then feedback from some of my research is my background is in psych mental health before I became a forensic nurse and I still am an advanced practice psychiatric nurse. However, I see the patients, the victims, we use both the word survivors and victims. It's just interesting that over the years people have come to realize that we were not doing things right.

“With victims of sexual assault. First and foremost, and when I first started practicing those patients with sitting in the waiting room for hours, for hours, and many of them would just get up and leave.”

Now hospitals know that that's not good care. When a patient comes in and they say they have been sexually assaulted. If the saying is is working that day or we call them in with the advocate and we get them in as soon as we possibly can. So we've learned a lot and you know, I think we've educated our fellow nurses and physicians. This trauma informed care and understanding even police officers. This is a wonderful thing that's happened over the past. I would say five years is even policemen now believe that they should wait to really intensely interview the patient or the victim.

Sometimes they'll wait a day or two. They'll come in and they'll get just an initial story and then they'll set up the time with the patient to meet with them in a day or two. It used to be everybody was having them tell their story.

“You know, the nurse was telling them to advocate the police officer for sure. And so then when they go to court, the police officer would testify sometimes well, that's what she told the nurse when she went in, but that's not what she told me.”

So now we've gotten that down so that we only have the patient tell their story once if we possibly can and then we give the patient time to settle, you know, to for their anxiety level to decrease.

We know from research that many memories and of what happened come back to them within the first 24 to 48 hours. And so they're just a better narrator of what happened if you give them time to decrease their anxiety. Wow, I cannot imagine the pressure of having to, you know, recount everything again and again and again, especially in a moment of trauma. If someone has been sexually assaulted or if they love someone who's been sexually assaulted, what would you say is to be like their first course of action immediately following attack.

“First thing that we would want them to do, we want them to report it to either call a police the police department or just present at the hospital and say I've been sexually assaulted and we can get them to do that.”

It's much better than if they wait for 48 hours or 72 hours and then report not that we can't get evidence even that we can, but it's not as easy. And on college campuses and we had some grant funding, some large funding for the Department of Justice, where we did training with our health departments in the universities and colleges. And so we even have new guidelines for colleges and universities to train their student body to talk about, if this happens to a friend of yours, this is something you can do. You can't force them, you should never force them.

But you can try to talk with them and say I'll go with you to the hospital or I'll call the police for you, but it's ideal when they come, you know, right after it's happened.

This has been such an inspiring conversation. Thank you so much. No, Kathleen, thank you for sharing your insight and thank you for doing what you do.

I was so moved by Dr. Secula and like the important work that she's doing, and I guess I never really thought about how specific and how highly skilled you have to be to be a sane and to collect evidence, but also to be like an empathetic listening ear to someone, maybe I'm like one of the worst days of their entire life.

“It's like they have three jobs at once, and they're taking their time, and I appreciate that in the show.”

When Charles and her staying at took on this role, it basically span the entire episode. She was focused on that patient.

They didn't shortcut anything, and they actually gave it the attention it deserved, and a lot of that is thanks to the medical consultants. In this case, Dr. Secula, who made sure that the process was accurate, it was thorough just like it is in real life. Yeah, and also I think it's a good reflection opportunity. You'd like check her biases that we don't know how someone is going to react, and that someone might not always like come and crying or come and super emotional. And with Alana, she definitely seemed very vulnerable, and I liked that Dana did not really like try to smother her, like try to be too affectionate or too understanding, because I don't know that would have worked.

“You have to build trust, which Charles and her staying at does, but would also really infuriate me in many situations, and I've been in the situation in talking to patients.”

Survivors sometimes feel like what's the point, like they feel powerless, or feel like the institutions or powerful individuals or people with money are going to get away with it, so they don't want to relive the trauma. That means also have this job of providing that reassurance and a protected space, as well as ensuring someone we're going to do everything we can to make sure that law enforcement catches who did this and saves other people.

It's an incredibly daunting process to think about, and I'm just so glad that there are people who are trained and who do this efficiently.

And I think speaking to Dr. School's area of expertise, the idea that the way that we treat victims and survivors and the level of empathy and understanding the fact that now, like you're not immediately interrogated about what happened, that they take statements like days later, really speaks to how like the culture around sexual violence, I think, is turning in our favor that there is a lot more understanding and empathy. Well said.

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