Domestic Violence: The Bright White Blade
It was late in my shift–night shift at a busy ER. I was so tired, and ready to go home and crash in the bed. The night had been fairly routine, and we had a few empty beds in our critical care area, one of which had just been filled by a young woman complaining of the worst headache she had ever had. She admitted that she had just had a fight with her ex-boyfriend at 4 that morning, but he had left and she had fallen back to sleep until about 5:30am…then drove herself to our ER at 6am with the headache. She was alert, oriented, and walking.
She also had some facial bruising and a few lacerations, but had no other complaints. Routine imaging tests were completed, and I and my coworkers began to give report to the oncoming day shift.
Report was brought to an abrupt halt when the day shift doctor swore loudly at the X-ray display around the corner from the nurses’ station. We all peeked around the corner to see what was wrong, and were confronted by a film showing a perfect white image of a 5 inch knife blade INSIDE the white outline of a skull.
The cause of the headache! Apparently, the fight had included a knife, which snapped off at the hilt after it was stabbed into her head. Her hair had hidden any indication of the knife blade or bleeding from the scalp.
Welcome to domestic violence, the subset of abuse that results in physical injuries, some of which may not be apparent at first glance!
I don’t know the end of the story for that woman. I hope she found a safe place after her surgery and hospital stay. Unfortunately, many victims of domestic violence will face more and more abuse before seeking help, if they even get the chance to seek help.
As nurses, we should include a question about abuse or domestic violence in all of our verbal assessments or questionnaires. Abusers or victims are not obvious in most cases, and all patients, if alert and oriented, should be given an opportunity to answer assessment questions with a nurse or other medical professional in private.
In addition, safety services should be free and available to victims of abuse, whether that abuse is physical, mental, emotional, financial, or otherwise. While “social workers” may have lists of these resources, nurses should also have access to copies of these services to reference or give out (depending on facility policy).
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