Charts Unwritten

When the Room Stops Spinning: Intimate Partner Violence and the Emergency Room

Written by:

Advocate in Scrubs

Content Warning: This post discusses intimate partner violence (IPV), trauma, and emergency care. Please take care while reading.

The emergency room isn’t built for quiet. Even at 2 a.m., you can hear the hum of fluorescent lights, the clipped radio calls from EMS, and the unmistakable rhythm of overworked sneakers against sterile linoleum. But in Room 7, everything was still.

A woman in her early thirties lay curled on the stretcher, her wrists trembling just slightly beneath the hospital blanket. Her chart listed “dizziness, nausea, possible head trauma,” but it was the last line in triage that made the attending raise an eyebrow: “Patient reluctant to speak in front of partner.”

This was not a novel presentation. October marks Domestic Violence Awareness Month, but for those of us in medicine, advocacy, or public health, every month is shadowed by the same quiet emergencies: bruises masked as falls, fractures labeled “clumsy accidents,” or trauma tucked into silence.

The Invisible Epidemic

According to the CDC, more than 1 in 3 women and 1 in 4 men in the U.S. have experienced some form of intimate partner violence (IPV) in their lifetime. For Black women, the numbers are even higher. And yet, IPV remains dangerously underdiagnosed in clinical settings. Why? Because our systems weren’t built to catch it.

Emergency departments are often the first — and sometimes only — point of care for survivors. But physicians and nurses face immense pressure: treat the acute, stabilize the vitals, discharge when ready. The trauma behind the symptoms? It can be missed.

I’ve seen this happen again and again as a Crisis Volunteer Advocate, called into emergency rooms to support survivors during forensic exams. We arrive not to fix or to probe, but to sit with someone as they try to reassemble the pieces of safety and control. Sometimes we hand over warm blankets or provide comfort in the form of food. Other times we hold silence. Every moment matters.

Advocacy as Clinical Presence

There’s an argument to be made that advocacy is clinical. When a survivor is met with consent-first care, when they are not forced to relive trauma for the sake of paperwork, when someone tells them they can pause or stop at any time: those are acts of medicine, too. They reduce cortisol spikes. They ground the nervous system. They foster trust.

That night in Room 7, I watched the SAFE (Sexual Assault Forensic Examiner) explain the exam gently, outlining each step like a guided meditation. When the patient hesitated, she was told, “We’ll move at your pace.” That phrase should be engraved in every med school hallway.

This is the type of presence-centered care I hope to practice one day as a physician. Not because it sounds good on paper, but because I’ve witnessed how deeply it changes the trajectory of someone’s healing.

Why October Matters

Domestic Violence Awareness Month isn’t about one purple ribbon or one hospital shift. It’s a reminder that the trauma patients carry into our exam rooms doesn’t begin or end with vitals. It’s cumulative, intersectional, and often invisible.

Advocates know this. Physicians know this. Social workers live this. And yet, the burden to act too often falls on the survivor alone—to speak up, to self-identify, to ask for help. That’s backwards. We need systems that recognize and respond without waiting for disclosure.

One promising evidence based model comes from Futures Without Violence, which offers protocols like CUES (Confidentiality, Universal Education, and Support) that reframe IPV screening into universal education. Instead of “Are you safe at home?”—a question that can feel confrontational or dangerous—the clinician might say, “We’ve started giving all patients information about healthy relationships. Here’s a card in case it’s helpful to you or someone you know.” Subtle. Powerful. Trauma-informed.

The Role of Medicine

Medical schools are slowly catching up. Some now offer elective courses in trauma-informed care. Others partner with community organizations for IPV prevention training. But we still have a long way to go.

In my ideal future, every hospital has a dedicated space for forensic exams, every EM attending knows how to safety-plan, and every medical student learns to recognize that trauma is a medical history—not a side note.

We also need to talk about staff trauma. First responders and providers who work closely with IPV cases carry a heavy emotional load. Vicarious trauma, burnout, and moral distress are real. If we want to retain people in this work, we must create systems of care for the caregivers, too.

Policy, Not Just Presence

IPV doesn’t happen in a vacuum. It is shaped by housing policy, access to transportation, healthcare coverage, language justice, and immigration law. Survivors in rural areas may live hours from a hospital with a SAFE. Those without insurance may avoid the ER entirely. Survivors with disabilities face barriers that are rarely discussed. Trans survivors are often misgendered or denied care.

This is why my public health background matters. I’ve published on Medicaid expansion, worked in city health agencies, and advocated for survivor-centered policies in both clinical and legislative spaces. Because changing the outcome for one patient in Room 7 is not only meaningful, but builds a system where every patient feels safe, heard, and supported.

A Future I Want to Build

I want to become a SAFE-trained emergency physician who listens with precision and intervenes without assumption. I want to be part of a team that understands the full context of a patient’s visit. I want to work in a hospital that offers wraparound care: advocacy, social work, mental health support, and legal aid referrals—all in-house.

That vision starts with awareness, continues with action, and is sustained by institutional courage.

So this October, while the world turns pink for breast cancer and orange for Halloween, I’m lighting a candle for the survivors who go unseen, unheard, or disbelieved. And I’m recommitting to building a healthcare system that sees them, hears them, and believes them—loudly and clearly.

— Advocate in Scrubs

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