So Obvious

We are called to a young woman in her thirties. Our computer screen sends it to us as a possible broken arm.

As we arrive at the house we are met by the rather excitable husband. He is all sweetness and light, thanking us for turning up so quickly, saying how worried he is and smiling at us a lot.

His wife is in bed, hidden under the duvet, she's fully clothed so we remove the cover to speak to her. She's not very communicative and every time she says something she looks at her husband for approval.

My crewmate is attending, so she's the one carrying out the assessment, but from across the room even I can tell that the bruises around her wrist are from a hand grabbing the arm. Bruising from fingertips is really rather obvious.

We ask what has happened and she tells us that she slipped over in the bathroom and banged her wrist on the radiator, something that doesn't explain this pattern of bruising, she also tells us (after conferring with the husband in their native language) that it happened earlier today. She's obviously not happy, no-one is ever happy about hurting themselves, but this is something unusual.

We move them down to the ambulance after raising an eyebrow at each other to make sure that we both know the suspicious situation.

In the ambulance my crewmate asks about any analgesia, if she's taken a painkiller for the pain. The patient says yes, she took some last night.

Oh, asks my crewmate innocently, I thought you hurt yourself this morning.

More muttered dialogue in a language we cant understand before we are told that the painkiller is for a problem the wife gets on only two nights of the year.

If this were a 'Casualty' or 'E.R.' script I'd be laughing at the screen for the scriptwriter having such an obvious cliché while making it all too obvious.

As it is there is little that we can do – we handed the patient over to the triage nurse and made our concerns known to her, then delegated any decision upwards by noting our concerns on one of our 'vulnerable adult' forms. I'm not sure these forms are designed for this purpose, but we do what we do and if someone in the upper rungs of management wants to throw it in the bin it's up to them.

He is the thing, we have no idea what happened – no-one was volunteering information and we are only with the patient for a few minutes so it's not really appropriate to start investigating. Did the husband do this to his wife? Was it an assault in the street that they are ashamed about? Was she trying to hit the husband and she got the bruising while he was restraining her?

Who knows, I can't judge. I'm not the police so the best we can do is draw it to someone else's attention within the confines of patient confidentiality. All I am, as one politician said, is a taxi driver with bandages.

9 thoughts on “So Obvious”

  1. It's all too easy to jump to conclusions, especially when the limited time you spent with the patient has been portrayed in words to us losing even more information such as body language on the way.It certainly portrays a grim picture of domestic abuse but as you have said “we really have no idea”. The problem with a lot of service work is that we don't see an 'end-to-end' picture of an incident or problem. Each person in the chain is encapsulated in their role and don't see the full picture.

    You just have to do your part and pass it on, hoping someone actually resolves the matter at some point in the chain. Which is why your post a few days ago of treating the attacker and the attacked at different points in the night was so surprising – you got an insight you don't normally see.

    Anyone intimately involved in a situation should be able to access information through the life of the issue. Be they the victim, wanting to find out details of the attacker's arrest/court appearance/sentence etc; a paramedic/nurse etc who has dealt with someone along the chain and even (as long as proper controls were in place) a good Samaritan who stopped to help.

    Privacy in some ways has gone so far that any benefits to care which occur through transparency are being lost.

  2. To be fair Ken and many of his colleagues did change their tune a bit after they were dragged out of the Grand Hotel in Brighton. Speaks volumes about politicians.

  3. I've been trying to think of a calm, reasoned, response to this post for a while now.I can't.

    This makes me so angry. So very, very angry. Domestic abuse always does. What angers me most is her apparent enabling of him to coverup and continue his behavior at a later date. Good on you for at least making a vulnerable adult report.

  4. This is such a complex subject, the constant terror lived by genuinely battered wives or husbands, disables them from rational and organised thinking, survival is seen in terms of avoiding the next bout of violence in the short term, very often the victims are led to believe that they have deserved the brutality, and the brutal partner is in fact a victim of some imagined wrong, i.e. the dinner not being ready on time. !

  5. Anyone intimately involved in a situation should be able to access information through the life of the issue…. even (as long as proper controls were in place) a good Samaritan who stopped to help.”I respectfully disagree with that specific point for a great many reasons.

    The main one being that there are already organisations who will help domestic abuse victims, but the last thing people who have survived that situation need is to have a permanent record that can be accessed by any “good Samaritan” which discloses this information – information which many women find deeply shaming.

    Given that some women who are badly abused change their identities, anything permanent that can be accessed by anyone puts their lives, and often the lives of any children they have, in immediate and real danger.

    Not to mention that allowing wider audiences to know which women have a long history of abuse amounts to a kind of Argos Catalogue for abusers themselves.

    I don't have the details to hand but I read a few years back about a man who deliberately initated an (abusive) relationship a woman he'd met after seeing police called to her house – it flagged her up as “victim material” and as I recall nearly cost her her life.

  6. Jumping to conclusions is dangerous.After a drunken night out, my boyfriend and I started playfighting in the street, showing off to a mate of ours. We were both into martial arts at the time. The result was a fat lip for me – looked bad but wasn't – and a bruised knuckle for him, amongst other bits and pieces of bruising. The whole thing was a laugh, and not abuse of any sort.

    Unfortunately, the next day my boyfriend's bruised knuckle turned out to be a broken one, so we went to A&E. He was too embarrassed to say how he'd got the injury, so made up a story about doing it moshing. It was very, very clear, from the glances at my cut lip and uneasy demeanour of the medical staff that they assumed this was an abuse case, and the care he got was poor.

    So, I applaud Tom for NOT leaping on the obvious assumptions, and considering possible alternatives.

  7. You're not just a taxi-driver with bandages, you save lives. I wonder if the politician who said that would appreciate the irony if a 'taxi-driver with bandages' gave them life-saving medication after a heart-attack, or a car crash.

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