Content warning: This story contains descriptions of intimate partner violence and serious physical injury, which some readers may find distressing. If you or someone you know needs support, 1 Tok Kaunselin Helpim Lain offers immediate tele-counselling and referral services across Papua New Guinea: +(675) 7150-8000.
It is not often that one encounters a patient whose survival seems, at every stage, unlikely.
She had been stabbed in the chest by her husband. She had lost more than a litre of blood. She had endured delays in reaching care, travelling by sea and land from a remote island to the province’s only referral hospital. By the time she arrived, she was in pain, pale, breathless, and fragile. Days later, she would undergo major surgery. Many in her position would not have survived.
Yet she did. The year had only just begun. Clinics had reopened, elective cases were filling the operating list, and the emergency department had returned to its familiar state of overcrowding and urgency. The demands of triage and the care of critically ill patients were constant. Amid that routine pressure came a referral from the outer islands.
She sat quietly on the acute bed, anxious but composed. Sweat ran down her face as she struggled to breathe through the pain. She spoke only limited English, and her mother, who had accompanied her, became both guardian and interpreter. Even before investigations were done, the severity of her condition was visible. The pallor of severe blood loss was plain in her eyes, her hands, and the drawn expression on her face.
Her story emerged in fragments. After a violent argument over land, her husband had stabbed her in the right upper chest. Somehow, she had managed to escape and seek help from neighbours. From there, she was taken first to a nearby aid post and later to a health centre, a journey that itself took time. At the health centre, the wound was bandaged, and she was given analgesia and antibiotics. But with limited resources and no immediate transport available, there was little more that could be done. A dinghy was eventually secured, though only after a day’s delay. In the context of major chest trauma, such a delay can easily be the difference between life and death.
When she arrived at our hospital, a three-way bandage still covered the wound. A chest X-ray confirmed what clinical examination had already suggested: a massive right haemothorax – a dangerous build-up of blood in the chest cavity. It was astonishing that she remained alive, even more so that she was still sitting upright and speaking.
After explaining the procedure, we inserted an underwater seal chest drain. Dark old blood, thick and tar-like in appearance, quickly collected in the bottle. The intervention brought some relief, but not enough. She remained profoundly pale and weak. Her haemoglobin returned at 4 g/dL, a level consistent with life-threatening anaemia and a very real risk of multi-organ failure if treatment was delayed further.
Over the following days, she received blood transfusions, close observation, and supportive care in the surgical ward. Physiotherapy was commenced early. But despite drainage, it became clear that a large volume of retained clot remained in the chest. Blood that has settled and organised within the pleural cavity cannot always be removed by tube drainage alone. Without further intervention, the risk of infection, lung entrapment, and long-term complications rises significantly.
The decision was made to operate. It was not an easy decision for her to accept. Understandably, she was fearful. She had already endured violence, pain, and an exhausting journey to reach care. To then face the prospect of major surgery, in a setting already marked by physical and emotional trauma, demanded courage of a different kind. Thanks to the generosity of volunteer blood donors, she was able to receive enough blood to proceed safely to theatre.
The operation went well. The retained haematoma was evacuated, and she returned to the ward to continue her recovery. The days that followed were painful, but steady progress came. She got out of bed. She walked. By the third postoperative day, the chest tube was removed, and her wound was healing well. Throughout it all, her mother remained beside her — quiet, constant, and attentive.
She was referred to our Family Support Centre team for counselling, psychosocial support and extended support upon discharge, recognising that recovery from gender-based violence extends beyond physical healing alone.
She was eventually discharged home within a week. When she returned for review two weeks later, the change was striking. The fear and exhaustion that had marked her admission had given way to something lighter. She smiled. In medicine, we often rely on laboratory values, imaging, and clinical signs to measure recovery. But sometimes, a smile says enough.
This case has remained with me, not only because of the severity of her injury, but because of everything it revealed beyond the operating theatre. It reflected the realities of practising in remote and resource-limited settings, where distance, transport delays, limited blood supply, and late presentation all shape outcomes as much as the injury itself. It also exposed the human cost of gender-based violence, especially for women in rural communities, where access to safety and emergency care may be dangerously limited.
Her survival was remarkable, but it should not take a remarkable survival for these stories to matter. Many women do not make it to hospital. Some do not survive the journey. Others never seek care at all.
As clinicians, we treat the wounds before us. But cases like this remind us that the work cannot end there. Gender-based violence is not only a social issue or a legal issue; it is also a public health emergency. It reaches into homes, villages, and hospitals alike. Preventing it, responding to it early, and ensuring that survivors can access timely care are responsibilities that extend far beyond the bedside.
She survived.
Many others may not.
These stories must still be told.
The next article in this series will discuss what health workers must do as frontline personnel to manage GBV survivors?
This story is shared with careful consideration for survivor safety and dignity. Identifying details have been withheld to protect privacy and minimise risk of harm or retaliation. If you or someone you know needs support, 1 Tok Kaunselin Helpim Lain offers immediate tele-counselling and referral services across Papua New Guinea: +(675) 7150-8000.
This content is provided for general information purposes only and does not constitute medical advice, diagnosis, or treatment.
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