Charts Unwritten

“Are you going to stay with me?”

She asked in a whisper, barely audible over the fluorescent hum of the emergency room. Her gown hung loose around her shoulders, and her fists were clenched—not in anger, but in fear.

I told her, “Yes.” I didn’t need a badge or degree to know that presence was part of care.

As a crisis volunteer advocate, my role is not medical — but it is vital. I sit beside survivors of sexual assault during forensic exams, safety planning, and moments when they’re asked to retell their trauma under sterile lights. What I’ve learned in those moments is that presence itself is clinical.

Presence is what anchors people during that time of emotional free fall. It’s what slows time in the middle of medical chaos. It’s what gives patients permission to breathe again — especially when their trauma has made even that feel unsafe and unlike themselves.

Sometimes survivors don’t want the Sexual Assault Forensic Exam (S.A.F.E). Sometimes they do. Often, they just want someone to bear witness to their story. And when they ask, “Will you stay?” what they really mean is, “Will you see me and not flinch?”

We talk a lot in healthcare about assessments, orders, protocols — all of which are important. But presence is harder to measure. It doesn’t fit neatly into a flowchart. It won’t show up on an audit or a performance metric. But it saves people, too.

In one case, a young woman had been assaulted by someone she trusted. She agreed to the SAFE exam, but halfway through she started trembling. The physician paused as the survivor looked at me for reassurance. I asked, “Do you need a break?” She took a deep breath and then nodded. I helped her sit up, handed her a blanket, and told her we could pause as many times as she needed. I reminder her that we were her for her and that she makes all the choices. That moment didn’t require medical expertise. It required empathy, pace, and respecting her autonomy.

There is no training that fully prepares you for what it feels like to sit in those rooms. You learn by witnessing. You learn by honoring silence. You learn by watching someone go from afraid to grounded — and knowing your presence helped.

The first time a survivor squeezed my hand and said, “Thank you for not leaving,” I realized: this is medicine, too.

Trauma-informed approaches in emergency settings reduce patient distress, increase cooperation, and improve clinical outcomes. According to SAMHSA, integrating trauma-informed care increases patient satisfaction and lowers risk of re-traumatization. And yet, presence — one of its core principles — is rarely emphasized in clinical training.

We don’t need to be saviors. We don’t need to have all the answers. But we do need to be willing to hold space. To sit beside someone in the worst moment of their life and say, without words, “You are not alone.”

Presence isn’t a soft skill. It’s a stabilizing one.

It earns trust when the system has failed. It tells the patient: “You matter enough for someone to stay.” And that? That’s medicine, too.

— Advocate in Scrubs