Violence Against Women
Speakers: Astrid H. Heger, M.D., FAAP (click here for biography)
Soap Summit 3

Transcript of Proceedings
October 18, 1997

SONNY FOX: Now at USC, at the hospital down there, is the Violence Intervention Unit. It is run by a remarkable woman named Dr. Astrid H. Heger. Into this unit come women, teenagers, who have been battered and violated in some way or another. I was invited to go down there one day and Astrid was kind enough to let me sit in one morning and I must tell you it was an eye opener. At the end of it, I went to Astrid and I said I don't know how you can even have a sense of humor working with these cases. But she's dedicated. She works with these people on an immediate basis and has some insights into that aspect of being the first to deal directly with the victims of abuse. I think that should be the next level which we would like to carry this conversation. Dr. Astrid H. Heger.

AUDIENCE: [CLAPPING]

DR. ASTRID H. HEGER: I assume the reason I was invited to come is that I am a doctor representing General Hospital. I think that it's an interesting experience to be a pediatrician, which is my training, and then leap into the area of domestic violence. I, as Rob Reiner said last night, was that person down stream who was taking the bodies out, literally. I got tired, actually, of catching the bodies as they came down stream. It was very depressing and I actually came to the point where I decided ! had to go upstream. It's remarkable what you find when you go up there and begin to look upstream at those families and find that they all live in what I call the chaos of violence. And that eighty percent of the mothers came in with these kids, were victims of domestic violence.

I was talking to Bonnie Campbell last night and saying, in desperation, we had to build a program that focused on domestic violence and sexual assault. It was self preservation that brought us there because these women could not protect their children and they couldn't heal the children if they didn't have a mother. The women that I've seen are incapable of bonding because they are trying to survive the day. It is an amazing place to walk in and begin to peel away those layers of what these women are living with.

I thought today that probably the most important thing I could do is not to talk to you about domestic violence, but to talk to you a little bit about the women and the children that are in my practice. I find that they are incapable, and are not strong enough to come and tell you often what is happening to them. You are in a unique position as educators on television. In actuality, you can actually be their voice. And so I'm going to be their voice for a little bit and then I'm going to pass the baton on to you.

My life this last week, just from a domestic violence point of view, was a thirty-three year old woman who came into the hospital admitted with a fractured pelvis, both legs broken, when her husband backed his white Mercedes over her and then drove off, and passed over her body again. She came in in critical condition, and as she came around she said it wasn't my husband, that a jogger had the license plate number and he was arrested. Or it was the nineteen year old who was out on a date with her boyfriend she's had since high school, and when she refused to have sex with him, he knifed her multiple times and, when she was bleeding, raped her. She came in by ambulance. Or maybe, hitting very close to home, it was the thirty-seven year old wife of a studio executive who couldn't understand the other morning when she woke up and she had hurt too badly to go to the bathroom and she noticed she had all these injuries that she hadn't noticed the day before, and she couldn't remember what had happened to her the night before that she came to the hospital because her vaginal area was so badly torn and she needed some help. And when they raided the house, they found rohipnol in the husband's drawer and he had been drugging her and raping her and she had no memory, and she had two young children in the bedroom down the hall.

Or it was that day in my clime when I looked at the door and it was a really hot day and there was this young mother coming up the ramp. I have two trailers on the streets of east L.A. right by the bus stop. So it's a very real place to be. I buy my lunch from the fruit vendor for two dollars for a bag of fruit at lunch time. So it's actually a very economical place to be. And it's a very real place. And this young woman, Maria, came pushing this little stroller up with these two little boys in this stroller. And she said "They told me if I came in here you'd find me a safe place to go today." And what she said is exactly what Bonnie talked about. She talked about how the father of these children, her spousal significant other, who she has been living with for the last three years, who she dated in high school, who told her she was a fat ass, her told her she was stupid, and told her nobody would take her to the prom, and nobody would date her and that she was dumb, and she knew it was true.

Because her parents actually had told her the same thing. So it was strictly validating what she already knew and she knew that she was, she didn't have any values. So when he started beating her that was what was normal, was acceptable, and then when she became pregnant at six months he kicked her in her pregnant belly and these two baby boys were born. And they stayed in the hospital for three months. She came home after three days and he raped her when she came home after delivering two babies three days before. And he continued to beat up on her but now she's brought these two babies home and the babies are blind. He hates these babies because they are blind, and they are not going to be okay. And she comes in and she says if you don't get me out of here, he's going to kill them this week. And I need to be empowered to take these children out.

And very close to home to me was that morning when I came in around seven-thirty, a couple of months ago and there, waiting for me, was the police department from East L.A. with Olga Trujillo, age fifty, who was sitting there with tears streaming down her face saying to me I don't want this prosecuted. I don't want anything to happen to my ex-husband because my children tell me it will shame them. And this woman the night before was sleeping in her room and this ex-husband who had put her in the intensive care unit ten years before with a fractured skull and she left him ten years before and he came back and he said if you make one sound Olga, I will kill the children. That's all she lived for were those three children, the oldest one is in college, the youngest one is in high school, a senior in high school. And all the others are in school and she works twelve hours a day and she's trying to find a way out of this. And she's sitting there at the end, and this is what annoys me sometimes when I talk about what I do. Because it is very real and when I examine women for being assaulted and for being raped, I am at the end of that examining table and their injuries are very, very real to me. And her breast was purple from a huge bite mark on it. It was almost obliterating the side of it. Her back was completely bruised. She had a huge black eye, swollen shut, and he had fisted her vaginally and rectally and his severe savage rage against her, and she's sitting there telling me I cannot go to court, it will shame my children and it's my fault. I can't do this to my family and tears streaming down her face. And our job is to make sure that she in fact could go forward because I guarantee you, if that man gets out of jail he will kill her next time. There is no doubt in my mind that she will be dead.

Part of our role is to try to advocate for her and make her strong enough so that she could go forward. I think the cycle goes on and I think when Sonny was there, what he heard where it was a whole family of children that came in, and when you talk to the ten year old boy who is now setting fires, killing animals and raping other children, what was the environment that he described. With his mother getting beaten every day. How it then cascaded off to him, while his sisters were being assaulted and he learned to assault the little girls from the father who was assaulting the mother. It was a family game that they played. And they knew how to play it out on those that were weaker, although these boys were only eight, ten and twelve. And it's that cycle that we're talking about. I think Bonnie touched on it.

I have to say I love my job, I hate what I do. I have a wonderful job. It's amazing. These people are amazing. I think we educate. Let me tell you the hardest thing that I do that you could help me do is to be the voice, two things that you educate, when you put this on television. How many hundreds of children and women have come into my clinic over the last fourteen years and said I told because I was empowered by something I saw on television. Hundreds of them. That was a voice that encouraged them to come forward. Educate the victims that they aren't alone so that they can come forward and get some help. You know it's like the D.A. that came into my clinic and said I hate to prosecute these sexual assault cases where a woman or a child was sexually assaulted unless I have a dead body. Because when I have a dead body, we all know something bad happened. It's an absolute statistic. But if it's only a bruise, if it's only a black eye, if it's only a sexual assault and they survived, then maybe nothing bad happened. Maybe it's not a crime, but we know murders are a crime. We could at least identify that.

I think that as we educate society we come to the place where we are no longer tolerant on waiting until we have dead bodies. Society begins to say to each other, women that meet together, that are there at school, begin to look at each other and say oh, Mrs. So & So, what happened to you that you have that bruise. You begin to penetrate the density that is the medical profession, that I am part of. Well we don't want to go there. We don't want to even entertain the diagnosis that this is not accidental trauma. Because it is too tough to go there. We don't want to visit that space. But when it's something that is part of our life, we begin to say everybody accepts it, we're talking about it, we're talking about it whether it's in groups in the community, that's where you can make a huge difference.

It is an incredible opportunity for me to talk to you because I'm reaching a point where the stories are too hard to hear anymore. I mean it is so hard to hear the stories. I thought Lance Morrow's essay in Time Magazine, was a wonderful essay talking about the death of that little boy in Cambridge. And the quote that he talks about is "nothing human is foreign to me." In my job, unfortunately, nothing human is foreign to me. Nothing shocks me anymore. I expect very little from society. And so I would ask you to help me be empowered, all of us who get to sit there at the end of that examining table and look at these incredible injuries. Imagine taking a five year old to surgery to repair a totally destroyed vagina from being raped. That's my job. Or to have a woman come in that's been fisted and has to go to surgery or she'll never have urinary competence again. Those are the kinds of things that I'm seeing and I want to make it not okay. But I can't do that because I am just a blond pediatrician in East L.A. eating fruit from a fruit vendor and I need a more powerful voice, and I see you as that voice. Thank you.

AUDIENCE: [CLAPPING]

SONNY FOX: Okay, open for discussion from the floor. Anybody want to talk about that. Does anybody want to go down and spend time on this?

DR. ASTRID H. HEGER: You're welcome to come down if you'd like to. We obviously don't expose you to our exams, because we wouldn't expose any of the women or the children that we take care of to that, but the idea of looking at the texture and the real fiber of what's going on and what these people are like. They look an awful lot like we do. And I think that anybody who has come there goes away a little bit changed about the fact that it is a very real, real place to walk. I would invite you to come. I will put a couple of things out about our program, but I just happen to throw in there if you're interested and since we are in L.A., and we have a domestic violence, sexual assault, child abuse and elder abuse program that has all these pieces that you mentioned together. We're happy to be a resource for you if you need it.

QUESTION: Do the men ever show up at the clinic and threaten you?

DR. ASTRID H. HEGER: Oh, no. We're pretty invisible to the batterers. I think an interesting thing we were talking about at the table ------ we had a request from the community that I work in, which is very close to Ramona Gardens, which is a very, very depressed part of L.A. in East L.A., was to try to create a walk-in clinic for women and incorporated their health needs as well as their mental health advocacy needs. It's identified as the Round Center, it's called VIP, because we're all very important people. We certainly thought our patients were very important people. And the other thing that is interesting as being a medical professional is keen in this because it's very easy for the women to say I'm going to the doctors. We are not always invisible. There was a moment, we do run a rape program and occasionally people will point out, and there was a moment that the Bloods invaded our clinic looking for the three Crips girls that were victims of rape, that were going to testify. That was an exciting morning. But that is very rare. We're not invisible to the victims, but we maintain an incredibly low profile.

One of the stories I didn't tell, was one of my closest friends kept talking to me about her nineteen year old daughter who happened to be one of the most beautiful young women I've ever seen. She is drop dead gorgeous and she kept getting into abusive friendships. All her boyfriends were abusive. They all beat her up. And she brought her to see me. And I just said to her, we are totally blown away and confused by your choices. Tell me when this started. And it all went back to the fact that her father's partner in his law firm raped her when she was thirteen. At that point she lost all her self esteem. That's what I see all the time. These women have no self esteem. They have the inability to see themselves as valuable, and to get out of it. And then there are women who do in fact, if we can empower them and build that self esteem.

So part of our program is aimed at the mothers and the children in joint bilingual mental health services and the huge focus is on trying to get that mother empowered and recreate her self esteem. That's a big part of what we do. I very rarely see women with extremely high self esteem come to see me who are in ongoing battering situations. And it goes back to their own victimization, seeing their mothers victimized. Some of the things that Bonnie talked about, you look at a study of women who are in battering situations. There were about forty-two. If you look at all the statistics from a scientific standpoint, the one consistent risk factor in all those studies is that the mothers were battered. They lived in violent homes where there was battering going on. It was a model for that. Some of them think they are going to die. That does have an impact, but that's not the primary focus.

In my practice a lot of it has to do with the cascade affect onto their children. These women, unfortunately, are off of the system which comes in and takes the kids away from them because their kids are living in violent homes. The mother loses the children and that's a real problem. It's when they see it becoming a risk to the children. They often times come in and try to seek some kind of help for it. They also come in if somebody steps up to them or a friend, a parent, a family member and empowers them, or shares with them the fact that they are not alone. It's that one connection, that one person who comes into their life and tends to pull them out, that seems to bring them in on the self reporting, or getting them into our program of self reporting.

QUESTION: I'm absolutely fascinated by the whole process. I don't understand, do we have an increasing amount of violence in our society? Is it more that we're able to deal with it now?

DR. ASTRID H. HEGER: I think we've always had this degree of violence. I think that we're becoming more aware of it. We're beginning to identify it and acknowledge it. It's like, we can use a medical model. It is like identifying a new disease. The disease may have been there for a long time, but we're not beginning to focus attention on it as a disease entity, and we're becoming more and more aware of it. And candidly five years ago when I tried to get this domestic violence program started and acknowledged and funded in Los Angeles County, I couldn't get anywhere because it was not a problem. It wasn't a big enough problem to get the bureaucrats involved in supporting it. However, over the last three years there has been a slight increase in the awareness of domestic violence and so there was an interest in supporting it. When you start talking to people who have been involved in this over the last years, that there is an increasing level of savagery against these women. I will tell you that if you go back and I have an on site advocate who has been doing this in the Hispanic community for fifteen years. What they saw fifteen years ago, and what they're seeing now, they can't stand it.

SONNY FOX: Hold it for just a second. I want to know if Bonnie, do you want to add anything to that?

BONNIE CAMPBELL: We had this discussion last night. I think we're just learning more about what we're seeing. Doctors are again finding domestic violence, sexual violence. I don't know whether it's the existence of increased savagery or whether it is a new level of outfight contempt and hatred and rage towards women. But everywhere I go I hear exactly what Astrid just said. The violence is getting more savage to the eye of those who deal with it.

DR. ASTRID H. HEGER: We're seeing that individuals who use speed tend to have those moments of increased rage and a lot of the child workers and a lot of domestic violence assaults we're seeing from that degree of savagery are related to the use of speed. Thank you very much.

AUDIENCE: [APPLAUSE]