Content note: This piece contains references to human trafficking and may be triggering. Please prioritize your well-being when deciding to read further.
“Shoulder pain” was listed as the reason for the visit in the schedule. I was behind and still learning to use an unfriendly EMR so I didn’t read through her previous visits and barely skimmed the problem and med list. With plans to finish this appointment in 15 minutes, I pulled up to the front of my brain the focussed shoulder exam and charged in to meet her.
I launch into the visit, asking questions while palpating and moving her shoulder simultaneously. I am already formulating a prescription for topical diclofenac when she says, “That’s not why I have shoulder pain.”
“I have shoulder pain because I was chained to a wall.”
There are moments in one’s medical career that are seared into your brain’s memory vault because those moments were either so supernaturally good or so horrendously bad that your brain refuses to relinquish those memories to natural degradation.
Everything in me screamed, “Don’t ask. Just move on.” However, I am trained to ask, to console. So I go back to basics and start with the open ended question, “Tell me about that.”
She is a survivor of human trafficking. Her mother sold her to the sex trade when she was a single-digit age. She is one of many wives for a man 25 years her senior. She has lived on a compound for most of her life but in her late teens, became suspicious that not all was right. She started to ask questions and was punished, chained to a wall for months, her shoulder pulled back in prolonged extension, external rotation and abduction. After several attempts, she escaped with the clothes on her back and she has been hiding since. She has all sorts of chronic pain, especially pelvic, from the abuse she has sustained. It is too horrific to describe so she will leave it up to me to read the details in the reports from her gynecologist who had to reconstruct her.
We talk for a bit, make a plan and finish.
After she left, I returned to my office to finish the chart. In my SOAP note, under A for Assessment, I typed, “Chronic traumatic rotator cuff tendinopathy. Survivor of human trafficking.” As I plucked the letters on the keyboard, I felt them, a torrent of tears on the edge. So I closed my office door and let them come, the sobs a sign that my heart finally caught up with my brain.
