Stripped down the first thing you see on the patient is the purple and back bruise on the left bicep. It is raised and angry, and you can tell with out asking that it hurts. But that it hurt much worse the moment it was created. It has a matching circular hematoma on the right, but it was the left side that took the most force. Every physician and police officer can recognize these bruises. They are thumbprints from being grabbed, and shaken. Behind the deltoid you can see the matching fingerprints that go with each thumb. Fingerprints always leave that distinct pattern of one large bruise and 3-4 smaller ones close by. Travel down the arm and you find the bruises around the left wrist, same pattern, same story, different day. No defensive bruises along the forearms, she either didn't fight back or couldn't. Sometimes defending themselves these patients will be covered with bruises from elbow to wrist. Hit hard enough they'll get a nightstick fracture, an isolated broken ulna usually seen when you get beaten by the cops. The back is free from any physical evidence, maybe an abrasion on the scapula from being thrown against the wall. Even though you can't see anything she complains that her back is twisted up inside, the muscles ache when she stands. Moving to the abdominal exam, there are three raised fresh scars from a recent surgery. The superficial stitches are intact though from the way she gets up, holding her stomach tightly, its fair to assume the internal ones may have stretched or snapped. Scattered bruises down the shins round out the significant findings. She assures you that her face is fine, it happened Christmas night, and he knew people would be taking family photos. It is important to him that she still looks beautiful to everyone else, regardless of how broken and battered she feels inside.
Everyone hates these patients. We pretend that we don't, we say the right things to their face, how its not their fault. Even though in the back of our minds we wonder what she must have done to deserve it. Why she can't just leave. She says she's afraid, afraid it will push him over the edge and he will come back and kill her. And I reassure her that he won't, though in the back of my mind I can picture all the dead women I have seen after they made a run for it. The ones who were beaten to death, or shot in front of their families. The ones who make it to the hospital still alive with their throats slashed, the ones covered in multiple stab wounds. I try to pretend she is wrong when my work shoes are stained with evidence to the contrary. I try to tell her that the police can protect her. That she will be safe. I try, but we both know the truth.
It's two days after Christmas. I just got out of the shower and I'm drying off with a towel. And that patient, and those injuries, are just my reflection in the mirror.