This morning we got report about a woman who was in the trauma bay waiting to be sutured by the doctor of the day. She had come in during the night, a head injury with two facial lacerations. There was alcohol on board so she had no recollection of how she had received said injuries. She denied that it was her husband that had inflicted them. He was at the bedside, in faded blue jeans and a thick black sweatshirt. When I walked by I saw that he was holding her hand through the siderails of the stretcher.
I had a brief glimpse at half of her face as I proceeded into the ICU to say good morning to my cardiac patient. What I saw momentarily jarred me. Her head looked deformed from the swelling. I didn't want to stare but it seemed her skull was double the size it ought to be. Jagged streaks of dried blood still criss-crossed her face. I heard howling coming from the room later as she was being frozen for her sutures. I tried to block the sound out.
I busied myself with my ICU patient and then went back out to the floor to bring in emergency patients.
I went into her room to start a saline lock in order to give her some I.V antibiotics. The sutures were perfectly aligned and identical. A vertical line of knots traversed her face in two places, each about 8-10cm long. Her eyes were nearly swollen shut. Her mouth looked almost like a snarl due to the swollen, abnormal position of her lips. Her nose was broken, but not displaced. Sadly, I doubt it was the first time.
I asked her how she had received the wounds to her face. She said she'd been at a party and had gotten into a fight with some people. I asked if it was fists that had cut open her face. She said, "no, their boots".
I remember the first domestic abuse patient I had as a shiny new grad working in the emergency department. She came in because she was having a hard time breathing. Her story was that she had fallen down a flight of stairs. There was a perfect imprint of a boot tread on her neck, starting to turn bluish-purple.
A boot tread.
That image haunted me for years, though time caused it to fade into the background. I had forgotten that woman until today.
I worry a little about the shell I have developed in the past 7 years. Back then, the image would have been right behind my eyelids every time I closed them for a couple of weeks. This time, I felt a pang of sadness and despair for the patient, but was able to carry on my day without much more thought.
When I scrubbed away in the shower tonight I wondered how I had gotten so callous. The irony is I devote myself to this work because I believe that health care is a way to make a positive impact on humanity. Yet somehow it seems that through the years I've lost some of mine along the way.