Two doctors I work with were recently asked to testify in court. I knew it was a case involving domestic violence and I knew I wanted to see what it was like to testify: One day I’d like to work with families in the foster care system and that will likely mean having to testify in court. So I asked my clerkship director and with her support, the clerkship coordinator went above and beyond rearranging my duties so that I could attend the court case.
One the day of the case, I was to meet my two attendings in front of the courthouse before the case started at 1:45 PM. Shortly after 1:30, we realized that the case was being tried in another city, and we rushed back to the car to drive north. When we finally arrived, I walked into the courthouse and felt as if I had stepped into a television show. The jurors were a diverse group and one of the ladies in the second row was asleep. The defendant, a balding middle-aged man, sat looking at his expensive watch. The defense attorney had polished leather shoes. The district attorney was double-checking her notes. Everyone turned to stare at me. It was a public trial, and I was the only member of the public to show up.
I sat from my squeaky seat in the back of the courtroom as first one doctor testified and then another was cross-examined by the district attorney and the defense attorney. The case was rather clear-cut. A woman was being treated for kidney cancer when she reached out to her doctor to report that her husband had assaulted her. The doctor was out of town and arranged for her to see a colleague for medical evaluation. At that time, she had large bruises on numerous parts of her body. Her story and her physical exam findings were consistent with abuse. A CT scan done two days earlier for her kidney cancer showed no broken ribs. A repeat CT two months later, also for her cancer, showed that she had a healing fracture in one of her ribs, exactly where her large painful bruise was.
The defense attorney had three strategies when it came to cross examining the doctors. His first strategy was to suggest that family medicine doctors aren't qualified to diagnose a broken rib because they aren't orthopedic surgeons. My attending quickly corrected his ignorance in explaining that treating many types of broken bones are within the scope of family medicine practice. The second strategy was to suggest that the bruise – and fractured rib – were at about the same height as a door handle. The defense attorney was implying that the woman might have simply run into a doorknob. His third strategy was to suggest that one of the chemotherapeutic agents could cause easy bruising. Because my attendings were being cross-examined, all they could do was answer the question – and easy bruising was possible. No one had the chance to explain to the jury that easy bruising isn't the same as easy bone breaks. This woman’s rib was broken from severe blunt force trauma.
Occasionally the judge would interrupt to interpret the legal jargon for the jurors. The sleeping juror eventually woke up. A few times one or two jurors would whisper to each other or glance at me, as if wondering whether I was monitoring them. Perhaps I was. Perhaps the public should. After all, this is our justice system. This is our tax money. And these are our neighbors.
I don’t know what the final verdict was.
Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.
Natalia Birgisson is a fourth-year medical student at Stanford. She is in her second year off and writing her first novel, which is described on her site.
Photo by Joe Gratz