Charts Unwritten

The holidays are painted as a time of warmth, togetherness, and joy. Strings of lights glimmer in windows, carols spill from store speakers, and images of happy families flood social media. But in the emergency room, winter tells a different story. As a Crisis Volunteer Advocate, I’ve come to recognize a seasonal pattern that doesn’t show up in holiday cards: a sharp uptick in domestic violence, family conflict, and silent suffering behind closed doors.

December isn’t just about festivities. It’s about proximity.

When “Home” Isn’t Safe

Many people associate December with homecomings. College students return from school. Families reunite under one roof. But what happens when home is a site of harm? For survivors of intimate partner violence (IPV), returning home for the holidays can feel less like a celebration and more like a sentence. The close quarters, financial stress, and cultural expectations of unity can create a volatile environment.

I’ve been called into ERs in the middle of gift-wrapped nights—Christmas Eve, New Year’s Eve, the in-between days when clinics are closed but the hurt doesn’t stop. One survivor, a woman in her mid-30s, whispered to me, “I told myself I’d make it through the holidays first.” The tension had been building for weeks. Her partner had become increasingly controlling, and with the kids home from school, she felt trapped. It wasn’t until the garland came down that she came in, bruised and shaking, ready to talk.

The narrative of “We’re doing this for the kids” often keeps survivors in unsafe situations through December. And when the ball drops on New Year’s Eve, many make the quiet resolution to choose safety in the new year.

Why ER Visits Spike in Winter

Emergency rooms don’t slow down during the holidays. If anything, they become emotional pressure cookers.

Family violence isn’t the only issue. Mental health crises increase in the winter months, especially in regions where Seasonal Affective Disorder (SAD) is more prevalent. Feelings of isolation, grief, or financial hardship can become magnified under the weight of holiday expectations. For those with trauma histories, holiday triggers such as certain foods, songs, traditions—can lead to emotional and physical dysregulation.

Add alcohol to the mix, and we see a rise in injuries, sexual assaults, and reckless behavior. It’s a pattern I’ve seen repeat every December. And while the ER is equipped to handle physical emergencies, many of the emotional wounds go unspoken.

“New Year, New Me” — and New Crises

There’s a powerful psychological shift that happens in late December: people begin to hope again.

I’ve noticed that many survivors, especially those who have endured long-term abuse, come in during this time not because the violence is new, but because their tolerance for it has changed. The “new year, new me” mindset, while often commercialized, can also ignite courage. It’s a chance to reset, to say: This year, I will not carry the same hurt.

One teenage patient told me, “I don’t want to bring this into another year.” He had been assaulted by a family friend during a New Year’s gathering and came in alone, with tears in his eyes but a voice filled with resolve. That night, we walked through the forensic exam together and although he came in with his bravery on his own; he didn’t want to be alone for it. So when he asked me to stay until his exam was over and even until his ride came: I did.

Tips for Staying Safe This Winter Season

If you or someone you know is planning to travel or socialize during the holidays, here are a few safety tips I’ve shared during advocacy shifts:

• Share your location with a trusted friend or family member when going out, especially if you’ll be in unfamiliar spaces.
• Drink below your usual limit, especially when you’re in a new setting or around people you don’t fully trust.
• Check in with someone hourly, particularly if you’re alone at a party, out on a date, or staying somewhere new.
• Choose shared transportation options like Lyft Shared or Uber Pool where available. Avoid isolated routes or empty subway cars late at night.
• Trust your gut. If something feels off, it probably is. You do not need to justify your discomfort.
• Make an exit plan. Whether it’s a signal to a friend, a rideshare app already queued, or a phrase that tells someone you need help, small plans can make a big difference.

These are just some of the safety planning tips I’ve shared however they are easily adaptable depending on each cases situation and your location! It’s important to brainstorm these ideas so in the event that you find yourself in a situation you can make an effective decision.

For Healthcare Workers: How to Spot the Hidden Strain

To those in clinical settings: listen for the unspoken.

A patient who is overly anxious, vague about an injury, or reluctant to speak in front of a partner may be signaling more than what’s written on the chart (charts unwritten… do you get it?). This season is not the time to assume all is merry and bright. It’s a time to ask careful questions and make space for disclosure.

Resources like the National Domestic Violence Hotline and local advocacy programs can help connect patients with long-term support, even if they’re not ready to take action immediately.

Holidays in the Shadows

One of the hardest parts of this work is knowing how many people suffer in silence. Not everyone who experiences harm will end up in an ER. Many will stay home, keep quiet, or tell themselves, I’ll just wait until after New Year’s.

But for those who do come in, I hope they are met with compassion—not judgment. That they are offered options, not ultimatums. That they are reminded: their pain is valid, their fear is understood, and their future doesn’t have to mirror their past.

Looking Ahead

As we wrap the year, I invite readers, especially those in health, advocacy, or public service—to remember that trauma doesn’t take a holiday. It hides in plain sight, even under mistletoe. But healing, too, can be found in quiet acts of care: a warm blanket, a silent presence, a moment of choice restored.

Let’s end the year with eyes open, hearts steady, and a shared promise to show up—for real.

— Advocate in Scrubs

Resources

• National Domestic Violence Hotline
• RAINN (Rape, Abuse & Incest National Network)
• NIH: Effectiveness of Trauma-Informed Care Implementation in Health Care Settings: Systematic Review of Reviews and Realist Synthesis
• CDC – Intimate Partner Violence Fast Facts
• American Psychiatric Association: Seasonal Affective Disorder