The shift last night in the ER started with a bang. But the first thing I did was check on my patient whose head met the concrete the night before. He survived the surgery and was now in Neuro-ICU. Whew! But still the worst may be yet to come. Sometimes patients with traumatic brain injury, it’s better for them to have died at the scene.  When they came out of the fog of the deliberately induced coma, they are never the same. If they are quads forget it. If the brain has regressed so far back, to infancy, forget it. Adult diapers, drool, bland diet, bed sores. Harsh, I know, but for me, it’s about quality of life.  

The case that freaked me out the most was the woman who was a victim of domestic violence. I’ve seen lots of women over the years who have been battered. The cycle theory of violence is one of the most important contributions to how we understand domestic violence and I used it to help assess where the woman was in the cycle. The phone rang in the social work office – I could see by the caller  ID that it was from inside the hospital.  The voice at the other end was speaking in a low, panicked voice. I could hear a child whining in the background. The patient said she got her husband to bring her to the ER by feigning an asmtha attack. She planned not to go back home with him now that she had gotten out. The woman stated, “He’s getting violent on me and I’m not going back.” She put the phone down and shouted something at her kid. I asked her where she was in the hospital and she replied in the lobby by the giftshop. The husband was in the trauma waiting area. I told her I would come over immediately. I grabbed my stuff and fairly sprinted down the long hallway. I saw the woman by the house phone, she was struggling to get her child fastened into the stroller. He was screaming and she was screaming back. As I approached she pulled his pants down, he was wearing a diaper, and spanked him hard on the butt and legs, then pulled his pants back up. I was appalled at the the brutality and said, “You can’t hit your child.” She replied, “Don’t tell me I can’t hit my child.” I said it again and at this point the security officer came over and told her to chill out. Then she said, “He’s not going to hit me.” So the reason she was hitting her 3-year-old son was because he hit her. And her husband was hitting her. Hitting is for everyone. Finally she got him locked down in the stroller and raced to the exit. I knew she felt humiliated. I just stood there saying to myself, what the hell just happened? I was supposed to talk to her about getting out of her violent home and help her get into a shelter. The opportunity was completely lost because now I was the judgemental social worker from hell. 

The Cycle Theory of Violence teaches that when battered women ask for help to leave their partners that is the golden moment. It’s a window of opportunity to get free of the violence. It means they have thought through the pros and cons and are ready to take action.  But the system for helping battered women is not ready with the resources at this critical moment. I went back to my office and hoped she would call me again. I called the Domestic Violence Hotline to see if there was an opening for her. The woman said no, there was no shelter available and to call back in a couple of hours. This is almost always the case – women cannot get into a shelter immediately. So they go back home and the cycle begins again. And then society blames women for not leaving the men who abuse them.

In the United States there are more animal shelters than shelters for battered women.

The drivers for the Department of Human Services arrived to take the homeless to shelters. I chatted with the woman, she was from Russia. She asked me where I was from and I said here, the United States. She said, oh, you look so European. The other DHS worker told me he feels like they are just a taxi service, taking the same people to shelters night after night. Nothings changes he said. What has to change I asked him? We need more subsidized housing he replied. I asked do you think if Obama is president things will get better? No, he said, all politicians are crooks.   

Towards the end of the evening I was sitting at the desk in the ER with the worker who takes vital signs. She said I had missed the action earlier. She was taking a patient’s blood pressure and suddenly the patient whispered, “I’m going,” and then fell out and went into cardiac arrest. She started CPR and the trauma team in the back ran up to the front and took over. They continued giving the patient CPR until they got up to the Cardiac-ICU. It was a total ER moment. I was bummed that I missed it.

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