Ligature Marks


I couldn't see them, but I knew they were there. I could see her face. It was not really blue, but ashen gray, especially compared to her body. I saw the length of rope EMS brought in with her, twisted and knotted. I could even imagine the scene where they had to hold her suspended body while another person cut the cord that she hung from the shower rail. They were buried beneath her jaw, only visible when we tipped her head back to cut her neck and the frothy blood poured out onto the bed. Cutting her cricoid membrane was our last ditch attempt to reverse what she had done to herself with that rope, and magically she might come back. She was only a teenager, and they are so resilient. As we did it, I held strong to the fantasy that it just might work.

Ligature marks are a neat term for such a gruesome scene. And the scene is neat compared to the messy minds and emotions that led to it. The clean medical language sticks in my head, like a mantra. Ligature marks, ligature marks, ligature marks. The mantra reminds me that I need to think about it, all of it, just not now. And perhaps I need that, just as much as I need the clean sterile medical language that boxes it all in. I certainly need to put that package aside when the next patient rolls in, and the next and the next. What good would it do to hold on?

Closing down seems to keep me functional, steady. That robotic ability to switch off emotions seems like a prerequisite for my work. What good would it do to cry and scream back at her parents on the phone when they learn her fate? Or scream through the halls of the ED, or worse yet not to enter again, either physically or emotionally, for fear I might be blown over.

Days later I am haunted, now even by the words. I am haunted that I can't unpack that neat box, and yet I haven't let it go. I want to feel overwhelmed. Instead I feel fine, in that numb, disturbing way.

Beyond my own life is the connection we have to each other, her friends, her family, my colleagues, me, because now she is part of my life too. I passed by the school she attended and in one of the buildings saw a drawing that looked like her face and then realized how many others are haunted as well. She is not alone; we are all here, thinking of her. If only she could see that.

There is a danger and privilege I have in my job. I see some of the most disturbing things life has to offer and some of the most beautiful. It is tempting to box up those potentially overwhelming scenes in neat words, pack that box in some closet never to be opened. But life doesn't stop bringing new and different overwhelming scenarios. Over time those boxes can stack up in my closets, in my home, and pour out the door. I risk becoming more numb to everything around me. Unless I am able to keep my heart open to the devastating, I won't be able to keep my heart open to anything. I need to find a way to stay open, safely, for my patients, for myself. Perhaps that is why I do it. To challenge my heart to bear the most gruesome and yet still be forced to be whole, because how else could I heal?