Emergency Care of the Abused

There are obstinate and unknown braves who defend themselves inch by inch in the shadows .... There are noble and mysterious triumphs which no eye sees. No renown rewards, and no flourish of trumpets salutes. Life, misfortune, isolation, abandonment, and poverty and battlefields which have their heroes.

Victor Hugo (1802-1885)

It requires more courage to suffer than to die.

Napoleon Bonaparte (1769-1821)

This important book is very unique in providing a clear, eye-opening and sobering look at the nature and frequency of abuse and a practical guide for caring for such patients. Topics range from child abuse, sexual assault and elder abuse through to forms of abuse much less frequently discussed, such as intimate partner violence, and victims of torture and human trafficking. And the numbers are staggering and heartbreaking.

Many of us have only to close our eyes to see our last patient, the victim of elder abuse, of intimate partner violence, of rape - skeletal from neglect and food deprivation, covered in infected bedsores, bruised, battered and disoriented - as clearly as if we were standing before them now. The feelings of compassion and sorrow, of incomprehension that such pain and suffering was inflicted by another, of wanting to do more, yet being uncertain what we can do to be more effective - the memories are un-erasable.

Since many more abused suffer silently, each well-organized chapter provides practical guidance in broaching the subject, in how to address immediate medical needs and needs for ongoing care. One of the major strengths of this book is that it challenges all clinicians to consider abuse as being part of a patient's experience and to start asking questions in order to allow them to obtain the emotional, psychological and physical help they may desperately need.

This book is a valuable and quick resource for emergency room teams, those in general practice as well as for critical care teams who, though they may be involved in resuscitating those most violently abused, may not be as attuned to the special forensic evidence and legal considerations that arise. While the book is clearly mainly anchored around situations in the United States, it does provide lists of web-based resources that could be used by practitioners around the world - either as sources of information or even as models of systems of care that could be developed and adapted to suit specific needs.

An additional chapter that may be useful in future editions would be one that addresses how healthcare workers can continue to cope when working with such patients, with hearing stories and seeing signs of the worst inhumanity and cruelty imaginable. For those that see such patients only occasionally and for those who, unfortunately, see such abuse more regularly due to the nature of their practice, such experiences cannot but take their toll.