We are called to a young woman in her thirties. Our computer screen sends it to us as a possible broken arm.
As we arrive at the house we are met by the rather excitable husband. He is all sweetness and light, thanking us for turning up so quickly, saying how worried he is and smiling at us a lot.
His wife is in bed, hidden under the duvet, she's fully clothed so we remove the cover to speak to her. She's not very communicative and every time she says something she looks at her husband for approval.
My crewmate is attending, so she's the one carrying out the assessment, but from across the room even I can tell that the bruises around her wrist are from a hand grabbing the arm. Bruising from fingertips is really rather obvious.
We ask what has happened and she tells us that she slipped over in the bathroom and banged her wrist on the radiator, something that doesn't explain this pattern of bruising, she also tells us (after conferring with the husband in their native language) that it happened earlier today. She's obviously not happy, no-one is ever happy about hurting themselves, but this is something unusual.
We move them down to the ambulance after raising an eyebrow at each other to make sure that we both know the suspicious situation.
In the ambulance my crewmate asks about any analgesia, if she's taken a painkiller for the pain. The patient says yes, she took some last night.
Oh, asks my crewmate innocently, I thought you hurt yourself this morning.
More muttered dialogue in a language we cant understand before we are told that the painkiller is for a problem the wife gets on only two nights of the year.
If this were a 'Casualty' or 'E.R.' script I'd be laughing at the screen for the scriptwriter having such an obvious cliché while making it all too obvious.
As it is there is little that we can do - we handed the patient over to the triage nurse and made our concerns known to her, then delegated any decision upwards by noting our concerns on one of our 'vulnerable adult' forms. I'm not sure these forms are designed for this purpose, but we do what we do and if someone in the upper rungs of management wants to throw it in the bin it's up to them.
He is the thing, we have no idea what happened - no-one was volunteering information and we are only with the patient for a few minutes so it's not really appropriate to start investigating. Did the husband do this to his wife? Was it an assault in the street that they are ashamed about? Was she trying to hit the husband and she got the bruising while he was restraining her?
Who knows, I can't judge. I'm not the police so the best we can do is draw it to someone else's attention within the confines of patient confidentiality. All I am, as one politician said, is a taxi driver with bandages.
