Andrew Florence, a friend of mine doing an ER residency, emailed a journal entry to some of his friends. He has given me permission to post it here:
This morning I cried for the second time during residency. Neither time has been in the ER. The first time was last spring as I saw a family in tears, surrounding their 17-year-old daughter’s bed in the surgical intensive care unit, having just heard the official declaration that she was brain dead, and now faced with the previously abstract concept of organ donation.
She died in a head-on collision caused by my other patient down the hall who lost sight of the road as she reached down to pick up the cheeseburger that had fallen off her seat. Not yet knowing the irreversible tragedy caused by this momentary act we’ve all committed, her primary concern, aside from her broken ankle, was whether I could salvage the eyebrow ring I’d just removed from her swollen brow, “since [she'd] only had it in for a week and didn’t want it to grow in.”
Last week I walked into a room knowing only that the patient’s chief complaint was assault by boyfriend. There I met a very pleasant, yet physically and emotionally traumatized young woman accompanied by her mother. She had a swollen black eye, multiple facial contusions, and hand-shaped bruises around her neck consistent with attempted strangulation. Despite her painful looking appearance, she was stable and seemed to have sustained no permanent damage. She explained the circumstances. Her boyfriend, who lives with her and her mother and her step-grandfather, had come home from work only a few hours after she had dropped him off, and found her doing her nails getting ready for the day. He screamed at her, accused her of cheating on him and began to assault her. He beat her in the face and held her down. As she finally broke free he pulled at her but she was able to run out of the house and down the street only partially clothed.
Not knowing much more than this I felt like I could almost profile him. Was she cheating? No. Was he? Most likely, and was now projecting his guilt on her. I asked if he had a criminal history. Yes, something drug related. Does he still do drugs? He quit. My guess is he’s back into them pretty heavily and is again projecting his guilt and desperation on her. Has he ever hit her before? No, but he is verbally abusive and very controlling. Mom standing nearby had not witnessed this behavior, she said he had always seemed to come off clean. He did have a job and was paying a portion of the rent. These facts surprised me as working in the ER has introduced me to a generation of free-riding parasitic males who do nothing but create work for society as a whole, usually living off welfare girlfriends doing drugs, playing videogames, spreading STDs and assaulting people.
I spent quite a while talking to her and her concerned mother about what today’s events meant. I told her I thought she needed to cut all ties with this man. Fortunately they didn’t have any children together, so she could completely rid herself of him. She was very receptive and agreed it was the thing to do. She had filed a police report. It shocks me how many of these women refuse to condemn these criminals for whatever incomprehensible reason. I guaranteed her that he would never change. I’m okay with being wrong in that guarantee, I’d rather err on the safe side. I’m generally an optimist and believe strongly in our power to change for the better. Domestic violence, however, is one area where I just don’t believe in second chances. I just don’t think they are capable of changing. Do I believe in forgiveness? Yes, but never again in person.
I really felt like we had a good interaction. I sensed that she felt listened to and I could tell she trusted me. She left the emergency department smiling. She seemed strong and optimistic. I committed her one last time to follow up with the police and see that she take precautions that this not happen again. I hadn’t really thought too much about her and her mom since and I wouldn’t have been able to come up with her name.
As I opened the Sunday paper today, a headline caught my eye, so I turned to the front page of the metro section. “Suspect held in triple slaying.” For some reason my first thought was, “I wonder if that suspect has ever been my patient.” So many of our patients are in and out of jail, I wondered if I would recognize the name. The picture above showed two medical examiners wheeling a bright blue body bag across the street. As I read below, I recognized a name, but not of the suspect. It took a few seconds to piece things together. “For nine anxious days, 26-year-old Trudy Murrow had feared that her ex-boyfriend would finish off his earlier attempts to kill her. He went beyond that, police said Saturday, to fatally stab her, her mother and her step-grandfather at their north Minneapolis home late Friday.”
The paper reported that he had lived with the family until he beat her up on September 1. That was the day I met her. Since then, he had apparently raped and kidnapped her at knifepoint and had eluded police several times. I turned the page and recognized photos of Trudy and her mother. “On Friday night, just before the slayings, a friend visited Trudy and her family. Trudy felt just a little better because Jones hadn’t called her all day. They were repainting her room, trying to make her comfortable. She was going to throw her old bed away and try to forget what had happened.”
The police chief said, “Sometimes at the end of the day, you still can’t prevent something from happening, that’s why our thoughts and prayers go out to the family.”
I’d never met a murder victim before. I’d never sat with two murder victims and gotten to know them a little bit and sent them on their way. How do you sit with a mother and daughter and give them advice on avoiding a dangerous situation, only to find out that they had followed it perfectly and it did nothing for them? Just nine days before they were stabbed to death in their home we talked of a brighter future. I had looked over every inch of Trudy’s body to see if she had any lasting injuries. She didn’t.
As I sat there with the newspaper in my hands, Abigail looked up at me with her big three-year-old eyes and said, “Why are you sad Daddy?” I didn’t really know what to say. I told her, “Because one of my patients from the hospital died. I tried to help her but she died anyway.” She tried to comfort me and asked me if I wanted to see her picture of a “sad building.” She has been very curious about a picture we showed her yesterday, on the anniversary of September 11th, of her as an infant in Elizabeth’s arms as we stood in front of the gaping black hole in the crippled Pentagon, a mile from our old home.
I have been thinking about Trudy and her mother all day. I don’t really know how to describe my thoughts. Although I know I will never forget this, I can’t really tell what impact it will have on me. After all, already this week I had to tell a mother, surrounded by emotional and quite dramatic family members, that her 27-year-old son was indeed brain dead, as could be expected after he shot himself in the head during a standoff with police.
But like I said, I have only cried twice so far in my residency.