"He left me in a pool of blood"

As I entered the exam room, I couldn't help but notice the scar on the patient's neck. I decided not to ask her how she got it right away.

"Hi, I'm Dr. Davis," I said. "What brings you in today?" Lisa Robbins (not her real name) proceeded to tell me that she'd been having numbness along the scar, which she'd acquired less than a year ago. Her soon-to-be ex-husband had assaulted her when their relationship was falling apart, she said.

"In any event," Lisa continued matter-of-factly, "he left me in a pool of blood." (He'd obviously lacerated her carotid artery, I thought to myself.) Luckily, a neighbor heard her pleas for help and called 911. Lisa received several units of blood at the hospital, where a vascular surgeon repaired the artery. She followed up with him once, was told the scar was healing well, and was discharged from his care.

While trying to get my bearings, I asked Lisa which hospital she'd been in and which vascular surgeon she'd seen. I attempted to cover up my inability to relate by adding, "I just need the surgeon's name so I can refer you back to him for another look at the scar." She couldn't remember, so I assured her I'd do the research, obtain the hospital records, and facilitate the referral.

"I'd like to see you in a month," I said. Lisa promised me she'd be back.

She was my last patient of the day, and as I drove to pick up my 10-month-old son from daycare, I couldn't shake the memory of that encounter. I shivered with every thought of that horrible attack. In retrospect, I wondered how she was coping, especially with two young kids, but realized I never asked her. Also, Lisa told me her husband was in jail, but was a divorce pending? Why hadn't I asked these questions?

As physicians, we're taught not to get too involved, to keep our distance and just treat the condition or disease. But sometimes, the only way to help the patient is to get to the root of things.

Recalling a very painful memory

When Lisa came back a month later, she seemed sullen. She'd received a letter about the referral and had an appointment scheduled with the vascular surgeon for the following week, she reported. I asked how she was doing; the response was, "Good." And the kids? "Good."

I examined her and asked about counseling for the family. The kids were going, but she'd stopped because it wasn't working for her, she replied. She made a couple of other excuses for not continuing, including her work hours.

I sat back down and looked at Lisa. I sensed there was more she wanted to tell me, but didn't know how. So I started with one question.

"Can you take me through the entire day of the incident?"

"The incident?" she repeated, sounding surprised.

"Yes, start from when you woke up. What was the weather like? Did you drink coffee or tea? What did you wear?"