At 5 a.m. in the ER, Dr. Anne treats patients in crisis. She collects forensic evidence from sexual assault survivors. She sets the shattered bones of domestic abuse victims. But beneath the white coat, she wrestles with a crisis of her own.
Anne's father is a convicted serial rapist. Her mother is lost to severe schizophrenia, hoarding, and the streets. Raised amid religious fundamentalism, foster care, and poverty, Anne ran in the opposite direction—becoming a Harvard-trained doctor. To survive, she severed ties with her father, shed her faith, and built a controlled life.
But the ER is a mirror. When Anne treats women injured by their partners, or patients wrestling with PTSD and addiction, the boundary between doctor and patient collapses. Caring for them forces her to ask an impossible question: How will she explain her parents to her young daughters—and should they ever meet their grandfather?
Rise After Silence is a visceral, unsparing memoir about the collision of professional duty and buried personal trauma. It explores how private violence never stays private. It compounds. It migrates. It demands to be brought into the light. An unflinching look at what we inherit—and the work of deciding what we pass on.
At 5 a.m. in the ER, Dr. Anne treats patients in crisis. She collects forensic evidence from sexual assault survivors. She sets the shattered bones of domestic abuse victims. But beneath the white coat, she wrestles with a crisis of her own.
Anne's father is a convicted serial rapist. Her mother is lost to severe schizophrenia, hoarding, and the streets. Raised amid religious fundamentalism, foster care, and poverty, Anne ran in the opposite direction—becoming a Harvard-trained doctor. To survive, she severed ties with her father, shed her faith, and built a controlled life.
But the ER is a mirror. When Anne treats women injured by their partners, or patients wrestling with PTSD and addiction, the boundary between doctor and patient collapses. Caring for them forces her to ask an impossible question: How will she explain her parents to her young daughters—and should they ever meet their grandfather?
Rise After Silence is a visceral, unsparing memoir about the collision of professional duty and buried personal trauma. It explores how private violence never stays private. It compounds. It migrates. It demands to be brought into the light. An unflinching look at what we inherit—and the work of deciding what we pass on.
“I woke up with my pants down,” Sandy says, her head resting against the wall in the ER, where I’m the only female doctor on shift. Moments earlier, the nurses called me, worried she might bolt, so I rushed to see her ahead of other patients who’ve been waiting all night.
It’s 5 a.m., the most peaceful hour in the ER—if such a thing exists. Most of the intoxicated and high people have settled into sleep. Despite blinding fluorescent lights and constant foot traffic, the hallway patients are managing some shut eye. Those in the waiting room have lost hope and passed out in chairs. The steady hum and beep of cardiac monitors feels oddly soothing.
In one of our few private rooms, twenty-one-year-old Sandy is trying to decide whether she was raped. The aftermath of a roofied Tinder date is not an uncommon part of my Sunday morning line-up. I dodged this bullet in my online dating—not because I was careful, just lucky. The inner Fundamentalist Pentecostal girl in me shudders thinking about how many open-lid alcoholic beverages I once accepted without question.
Compared to the first time I completed a sexual assault kit, I am different now. Hardened. Bitter. A traumatized female doctor who will plead with Sandy to undergo a forensic kit—even while knowing it may retraumatize her and does not guarantee the closure she deserves. She will refuse. And I will think, harshly, how it won’t matter anyway, because the legal process will only alienate her and rob her of immeasurable time and dignity. I am part of the broken system that pays lip service to helping women but offers little other than sutures, medications, and a vault where DNA evidence is stored and forgotten. Looking for emotional healing and justice? Look elsewhere.
“I went on a first date last night,” Sandy says. “I only had one drink. I don’t understand why I can’t remember what happened.” She taps her foot, avoiding eye contact. “I still had my shirt on. And when I pulled up my underwear, there was blood, but I’m not on my period.”
“It sounds like you may have been sexually assaulted.” I offer as gently and directly as possible.
She hardens her jaw. “We were at the restaurant. I was tired from a long work week. So maybe it was that? He was funny and charming. But then… he wasn’t there when I woke up.” Tears well up but she blinks them back. “I’m just here for a prescription for the morning-after pill.”
“I’ll write that for you.” I say. “But I’d also recommend collecting evidence, and doing STI testing and treatment, just in case.”
“I don't think I need that.”
The words come quickly, like saying it can make it true.
I begin my familiar, weary monologue about how, if she wants the answers she is seeking, it’s best to do the exam sooner rather than later. I want to tell her that waking up with her pants down and not knowing how she got that way is a horrifying experience that may never cease to haunt her. My recollection of that possibly happening to me is a dull, distant memory that I’m unclear about, but the terror of not knowing still grabs me.
I’ve been down this road of trying to convince a patient to undergo a kit so many times. Maybe we need a sexual assault follow-up service that goes directly to people’s homes because they feel so uncomfortable in hospitals.
Staffing emergency departments, especially on the weekends, is hard. This day, at this hour, there isn’t a social worker. So, I hastily print off information about sexual assault centers, anonymous STI screening clinics, the script she’s asked for, and others she didn't—to treat for gonorrhea, chlamydia, and to prevent HIV transmission. Medico-legally, to treat without testing puts me at risk, but I don’t care. Someone who roofies and rapes on a Tinder date might not be responsible with their sexual health, though it’s impossible to know.
“Go home and rest,” I say. “If you decide later that you want evidence collected, you can still come back within a week. Just… don’t wash your clothes or shower yet if you can manage.”
“Thank you,” she says, “but all I need is the morning-after pill.” She leaves all the other papers behind and hurries for the exit.
I know I am good at my job.
But every time a Sandy walks out the door, I feel otherwise.
Writing this story is an attempt to transform the hurt inside me—to live with the sorrow I’ve witnessed as a female ER doctor and reckon with my own painful history. I hadn’t realized that caring for others in crisis would unearth things I’d tried to outrun: my mom, my dad, myself—and force me to figure out a way to explain it all.
Especially to my daughters.
Whom I pray never become a Sandy.
PART ONE:
Chapter 1: ER Doctor (November, 2009)
Becoming an ER doctor was a journey to heal from things I didn’t know I was carrying. My patients taught me that silence preserves wounds—and speaking truth is where healing begins. But I’d conditioned myself to suppress everything.
My unexpected unraveling started just as I was finishing medical school.
I am in Toronto, visiting as a senior medical student from Edmonton. The goal of the elective is to showcase my skills, impress the staff, and land a coveted residency spot. The odds are not in my favor—I have no connections in any Toronto hospitals.
Before the shift, I study my latest Bible: Tintinalli’s Emergency Medicine Manual, the key to impressing preceptors with my in-depth knowledge of every possible type of case. I shower and put on my scrubs. I’d made sure to find ones that fit properly, rather than the usual hospital ones designed for men—too big in the groin and too short in the legs for my tall, thin frame. I tidy my thick curls into a neat bun, pin back the straggler strands, and apply light mascara to my green eyes and a lip tint. I’ve never worn make-up to a shift before but want to appear a little more sophisticated. It’s the big city, after all.
It's a wintery, slippery-sidewalk morning, as I hustle toward the sliding doors of St. Michael's Hospital. The city center is gray in every way: the concrete, the icy pavement, and the buildings that crowd out an equally murky sky.
The automatic doors roll back, and I navigate through the crowd of people queuing, pacing, coughing, cursing. The air reeks of blood, body odor, foul wounds. I find Dr. Mike, my elective supervisor, standing stiffly at a computer station. He’s substantially shorter than me, with a grim demeanor.
“Where are you visiting from?” he asks, the boring question dished out to eager-eyed applicants.
“I’m from Edmonton, University of Alberta,” I say proudly, despite assuming Toronto people would find this the opposite of impressive. To my surprise, he lights up.
“Me too,” he says, giving me a solid nod.
I tell Dr. Mike I want to move to Toronto to work with their Addis Ababa Academic Collaboration, whose mission is to establish Ethiopia’s first emergency specialty program. I hope to contribute long-term to a sustainable project, to build the capacity of local experts instead of continuing with the short-term disaster relief projects I had experience with, which felt more like band-aid solutions. Dr. Mike is of a similar mindset and does humanitarian work with the Red Cross. He tells me about a blog he’s written, and I resolve to check it out.
We start the shift with a team huddle and handover. Eight patients are being transferred to us from overnight, and a junior doctor gives us the rundown.
“Bed 1: awaiting repeat troponin enzyme to rule-out heart attack. Auto-discharge. Bed 2: might get called about this one sooner. Police drop-off. Stella. Frequent flyer. High on meth. Punched through the glass door of a convenience store. She has a complex hand injury with embedded glass that still needs repair. Bed 3: awaiting CT for possible appendicitis—”
He's interrupted by Stella, shrieking from Bed 2. Wanting to prove my usefulness, I rush to her bedside.
“Fuck you fucking cunt lady doctor,” shouts Stella. “Get me out of here! I don’t give a shit about my hand!” She glares at me, clenches both fists, then spits purposefully around the room like an automatic sprinkler.
Dr. Mike appears behind me, unfazed. “Five-point restraints, and 5 and 2,” he orders. Four security officers mobilize and tie her limbs to the bed so the nurse can inject 5 milligrams of Haldol and 2 milligrams of Ativan into her upper arm. The efficiency of this meth-patient management amazes me.
“I’ll check to see if there’s any family to call,” I offer.
Scanning Stella’s chart for an emergency contact, I find a son named Owen listed.
“Hi, Owen? This is Anne. I’m a student doctor working at St. Michael's Hospital. Did you know your mom is here?”
There is a long pause followed by a calm, friendly voice. “No, I didn’t, but I’m not surprised. What did she do this time?”
“She punched through glass and has deep cuts on both sides of her hand. She wouldn't allow us to repair it, so we had to give her a sedative.”
“I’ll be right there.”
He sounds responsible and conscientious, and I’m curious to meet him.
Stella succumbs to a chemically induced slumber, and I get to work: prepping the skin with betadine, rinsing her wounds with sterile saline. Then I begin the slow process of extracting each shard of glass with medical tweezers.
Owen arrives mid-procedure when I’m digging around Stella’s tendons to extricate a piece lodged between them. He’s around my age, maybe 26, with a Dior leather briefcase, tight-knotted tie, and glistening Rolex.
“I’m sorry for my mom’s behavior,” he says immediately. “She never really recovered from the years my dad hit her. And she had a rough childhood too. She’s a nice person when not under the influence.”
His need to apologize feels painfully familiar, and his excuses too. I have a running list of people for whom I owe an apology on Mom’s behalf. Most recently, when she used her charm to buy a new bed on lay-away, dodged the bill, then gave them the number of her daughter, “the doctor.”
“It’s no problem,” I say to Owen.
Her skin is tough, like leather, and difficult to puncture with the 5.0 nylon suture.
“I work on Bay Street. I’m a hedge-fund manager,” Owen says, watching me tie off each knot. “We’re donating a substantial sum to Seaton House where my mom frequents. It’s the only way I feel I can help her at this point.”
Whatever her life’s challenges, Stella has done something right by raising this good human. I understand what he means about feeling helpless. In medical school, they taught us to focus squarely on our patients, and not share our personal stories; it would be akin to using them as our own therapy. So, I made a pact with myself to never tell patients when their situations mirrored mine. I tried to find closure in my life through humanitarian work abroad. But maybe I need to be more like Owen and support a charity here in Canada.
“That’s impressive work, Owen,” I say, finishing the final suture. “She’ll be ready to go as soon as she wakes up.”
I review my suturing handiwork with Dr. Mike, hoping he’ll note it in my evaluation card.
“Great work, Dr. Aspler,” he says, and gives me one more nod.
Walking home after the shift in the dark, the winter air freezing my fingertips, Stella’s bloodied hands stay on my mind. Her injury reminds me of the first time I saw Mom’s hand cut by glass—when I was four years old.
My dad, who was a taxi driver in Toronto, got advice from a passenger about cheap houses in the booming oil-laden province of Alberta. With his final funds, he put a $5000 down payment on a house in Edmonton.
“We are leaving today!” Mom announced to my six-year-old sister Marcia and me while Dad was at work. To her, it was time to move there from Ontario at once.
And so, unbeknownst to Dad, we boarded the train at Toronto’s Union Station toting a solitary suitcase, two child-sized backpacks, and thin jackets, headed toward a snowy Northern spring. For three days, Marcia and I ran up and down the aisles of the railcars, watching as the scenery changed from the high-rises of Toronto to the expansive flat lands and unending blue sky of the prairies.
We arrived at our prospective house in a recently built suburb of southeast Edmonton: a sign—Welcome to Mill Woods—invited us to a new life. Compared to the shack we'd been living in, the house looked like a castle: crisp white siding, tidy black shingles, and a spacious lawn begging for a game of tag. The current occupant was surprised to see a woman and two small children on his doorstep when he’d sold the house to a man.
“We’re here to live in our new house!” Mom said.
The man frowned and explained about something called “possession date” and that we’d need to find somewhere else to stay.
“We’ll stay in the yard if we have to,” Mom said, undeterred. Then she turned to us with a giant smile. “Girls, we’re going on another adventure!”
We visited the Pawnshop strip, where Mom sold her wedding ring to the highest bidder. It was fun bartering with all the dealers. Flush with cash, we bought a tent and a king-sized sleeping bag at the Canadian Tire store.
Marcia and I adored camping, and this was no different. The chill of Alberta’s April didn’t bother me as we snuggled in a shared sleeping bag. But after a few nights in the tent, someone called child protective services, and social workers flagged us as a family at risk. They contacted Dad in Toronto, who had no idea where we were, and summoned him to Edmonton.
Dad took us to a seedy motel to wait out the last weeks before we could move in. I was excited about another new place for a sleepover. Only the “M” of “Motel” lit up in the sign, and Marcia said the neon flashing capital letter of her name made her feel special. She pleaded to get candies from the next-door convenience store, but Dad gave the familiar refrain: “We don’t have the money.”
I didn’t get how he could say that because Mom had brought along a collection of pennies in mason jars.
The aroma of Labatt filled the air that afternoon, and the drunk version of Dad appeared in full force. Marcia and I were sitting on a satin bedspread when he held up one of them in the air, like he’d throw it at Mom.
“OUT OF CONTROL!” he yelled. I wondered if he was talking about himself or Mom.
“I couldn’t live with dirty rats running across our kitchen table,” she shot back. “You’re a dirty rat too!”
He threw the jar at her face. Mom ducked, and it hit the wall with a blast. Shards of glass and pennies exploded in all directions.
“Quick!” Marcia said, guiding me. “Stuff as many as you can in your pockets. Each penny equals one candy.” Marcia showed me how to avoid cutting my fingertips on the glass as we pocketed the change.
“June, YOU NEVER LISTEN!” Dad wheeled around and punched a hole in the wall. “I told you a thousand times we didn’t own the house yet.”
Marcia and I escaped with the pennies, into the convenience store next door. Marcia was unusually tall for her age and seemed old enough to be my babysitter. With our tightly braided locks, we didn’t look like the riff-raff we were.
Though we’d scavenged little money, we had a plan. “Annie, drop the wrapped ones into my rain boots when no one’s looking.” She stood close to me so the store attendant couldn’t see what we were doing. Like a game of toss, I plopped pink lollipops—the expensive ones—down the long shaft of her red rubber boots. We then proceeded to the checkout to pay for the cheaper penny candies.
We emerged happily with both our paid and unpaid candies and settled onto the nearest concrete curb to devour them.
“That’s my girls!” Mom said when she joined us on the curb from the motel with a smear of crimson below her eye, as she plucked a long shard of bloodied glass out of her a palm.
After the slow walk home, lost in thoughts about my parents, I take a hot shower to wash the hospital smell from my skin and slip into fleece pajamas. Retreating to the couch with a steaming cup of blueberry tea, I open my laptop and search for Dr. Mike’s blog online. I’ve never read a blog before. His most recent story is about his six-month mission in Sri Lanka. Tens of thousands of civilians had been trapped with limited medical care as government forces have been battling Tamil Tiger rebels for four years. I respect Dr. Mike’s courage to work in a remote area and be the only doctor on call 24/7 with limited resources. Reading how he was a champion for women and children targeted in combat, how he stayed up for two days straight to save a baby girl injured in a bomb blast, I am overcome with tears.
His writing voice is much more outgoing than his in-person demeanor. His stories contain a hopeful brokenness I’ve never previously encountered, a quiet desperation to grasp what is human among the horror. Sipping my tea, I click on the next post, and the next, and the next. Over several hours, I read his entire blog and when I reach the end, my heart aches to know more about him. Never have I spent so much time with someone else’s words, other than reading a book.
A warmth is developing in my being like I’ve never experienced. Dr. Mike feels like my soul in the mirror. Something signals a lingering pain, a search to find himself, a fierce commitment to make meaning in a troubled reality.
As I lie in bed, trying to rest so I can shine on my next shift, an uncomfortable truth dawns.
Shit, I’ve just stalked my professor. And now, like a digital loser, I’m crushing on him based on what he posted on the internet.
***
After the month-long elective is over, I fly back to Edmonton. Dr. Mike adds me on Facebook and messages saying he’ll be in Alberta over the Christmas holidays. When he suggests we meet up at the Black Dog Pub on Whyte Avenue, at first, I think it might be just an ER doctor (Dr. Mike) and a medical student (me) grabbing a beer, like a mentorship meet-up.
I’ve been in the OR all day, holding retractors, feeling my legs go numb from hours of standing in the same spot, and the last case goes late. I barely have the chance to smooth down my long hair, which has collected in a nest in my surgical cap, let alone put any make-up on.
I burst into the pub ten minutes late, and he is sitting in a small booth by the window. He looks more attractive than he did on shift—a tight, black muscle shirt showcases his well-sculpted upper arms, and he has the right amount of gel in his dirty blond hair. He invites me to sit next to him rather than across from him, making me glad I’d topped up my deodorant at the last second. Maybe I’m not here to get advice about my emergency medicine career.
Our knees are close enough to touch. He orders a pint of Sea Change Blonde, and I ask for my regular gin-and-tonic.
I feel compelled to explain the hard liquor. “I drank these all the time when I lived in the UK.” I also need a salve to get through this date—I mean, if this is a date?
There is no way I’ll tell him how I creeped all over him on the internet. Instead, I blather on about my master’s research on tuberculosis in Zambia. I can’t decide if I should sell myself as a candidate for the University of Toronto 2010 Emergency Residency cohort, or as his girlfriend.
But then he starts telling me about his ex-girlfriends. And that’s when the energy shifts: it has to be a date.
It’s also when Dr. Mike abruptly—and drastically—changes the subject and tells me about the many ways he was hurt growing up. “I was abused as a child,” he says.
I absorb the information, not needing specifics, though he’s honest about them. His early suffering mirrors that of my father. He is braver than me because I disclose nothing about my past. I express deep sympathy, but, internally, I shudder. I don’t know how I’ve ended up attracted to someone with a childhood like Dad’s. Maybe it’s because Dr. Mike has found a different way out of it: long-distance running and reflection, rather than denial, suppression, and rage.
There is no way I will be equally honest.
I conveniently leave out, My mom has serious schizophrenia, sometimes is completely unstable. And, My dad is an ex-con.
But I don’t need to say any of those things. It’s obvious I’m a bit messed up. After all, who dates their professor, and doesn’t even realize they are doing that? Which is how I’ve found myself in this situation of simultaneous infatuation with Dr. Mike and intense self-loathing.
I want to grasp what’s beautiful about my horrific identity and origin story, and to accept myself again. I just don’t know how.
And while love will end up being the catalyst for me, it’s not love from Dr. Mike that will take me there. Mine will be a long journey — through buried memories, through witnessing the suffering and bravery of my patients —to where I can finally arrive at the simple lesson both Jesus and my mother had always tried to teach.
To tell the truth.
Rise After Silence is the debut memoir from Emergency Room (ER) professional, Anne Aspler. Coming in at just shy of 300 pages cover to cover, Rise After Silence is an eye-opening account of Aspler's life in ER, the patients and colleagues that shape her working day, juxtaposed with the author's life outside of the nine-to-five. Sometimes, it is hard to make out which makes the more challenging read. In her author's note, Aspler informs readers that certain identifying details (such as names and timelines) have been changed, and the cover is designed by award-winning illustrator, Natàlia Pàmies.
Rise After Silence is a gripping read, carefully laid out into four distinct sections and covers in great depth childhood and adult assault (both experienced by the author and by her ER patients). A pivotal moment in the memoir is the author coming to terms with the abusive crimes of her father around the time of the #MeToo movement. At the same time as thousands (if not, millions) of woman around the world start speaking up, Aspler, too, has her eyes opened to suppressed memories from her childhood. Bearing in mind Asper's own mother was, by this point, a diagnosed schizophrenic, then as a reader it feels like a wonder this high-flying, Harvard qualified, professional was able to pull through life at all during this point.
In slightly lighter moments in the book, we see the author navigating the complicated world of online dating and becoming a parent for the first time, but in truth these moments of light are limited and can be found left sparing amongst Aspler's broader life story. Even her experiences during a residency in Rwanda and the moment when the author and her sister finally get hold of their foster records, they feel bittersweet in nature.
Rise After Silence certainly brings something to the table in the topics it tackles head-on. It is full of colourful characters and demonstrates a strong growth arc of the author, starting in a turbulent place, to ultimately land in a mental state which is moving in a positive direction. This also includes a decisive decision on her relationship with her convicted father. The darkness of this memoir might not be for everyone, and while this reviewer never expected Rise After Silence to be "happy-clappy", sometimes the moments of good felt all to brief. If nothing else, this memoir serves to remind us how far we have yet to come with protecting women and children from harm.
A very well put together book, just be prepared for the tears and anger along the way.
AEB Reviews