Are There Weapons in the Home?

August in Philadelphia is balmy and long. It's certainly no place for flannel. But my patient slouches in the chair before me in jeans and a flannel shirt. She seems to be used to it—like she doesn't feel the oppressive heat draping the tiny exam room, lapping our foreheads and the smalls of our backs. She looks like she doesn't wish that the air conditioner were cranked higher, like the rest of us do. She looks, quite honestly, like she's been wearing that flannel since winter—like it's the only shirt she owns.

Her coffee skin is even and flawless; her black hair is smoothed into a tight bun. Lanky legs cross loosely beneath her, and she politely closes her flip phone as we begin our conversation. We talk about her medical problems, her medications and allergies, her surgeries and vaccines, and her homelessness. Dismissed from the foster care system at 18 years old, she tried her best to return to where she came from, but that didn't last long. Mom was too ill and too addicted and, as it turns out, too dangerous. So she lands herself here on this sweltering August day, respectfully indifferent toward my presence, as I conduct her intake exam in the homeless shelter's tiny, crowded clinic.

I run through a list of social history questions that roll off my tongue out of habit.

“Do you smoke?”

“Do you drink?”

“Any other drugs?”

“Were there weapons in your home?”

She looks down at her lap, hands wringing and tight, and with near-immediate cadence murmurs, “Everything's a weapon.”

It takes me a moment to realize what's been said and a few more to understand the necessity of the silence that follows. (It will take me months to realize the bravery in these words and the number of patients she will help just by her answer to this question.)

“Tell me,” I muster, though I almost hope she won't.

My patient relays a story from earlier in the summer. The first in her family to graduate high school, she assumed her mom would be proud. As she finished getting ready for the ceremony on that late afternoon in June, her mom arrived home staggering and drunk. In a moment of confusing disappointment in her mother and fear that she would miss the ceremony, she called her old foster parents to come pick her up and take her to graduation. Mom overheard the phone call and lunged into the kitchen, slapping the phone out of her daughter's hand, snarling in rage at her lost chance to bring her daughter to something wonderful, to be publicly proud. And so she picked up a broom and swung at her daughter's face. And when her daughter ducked, mom wielded a kitchen knife. And when her daughter screamed and ran, mom threw a shoe after her. And when the shoe struck her daughter and caused her to stumble, mom pummeled her to the ground, clasping her hands around her daughter's throat. Suddenly, lights were flashing, sirens screeching. Someone called the cops. Mom was pried off of her daughter. They both lay panting.

Broom. Knife. Shoe. Hands. She's right. Everything is a weapon.

Months later, I that realize there may not be a better way to ask the question. I could ask for specifics: I could ask about knives, but most people use them for food and not each other. I could ask about brooms and shoes, but then I might as well ask if her mother has hands. So I still ask the question, in its original form, but not for the same reason. I ask it because, if my patients are suicidal or homicidal, having a firearm in the home increases their chance of acting on their thoughts. But now I follow it with a few other questions: Has anyone ever hurt you physically, emotionally, mentally? Has anyone ever kicked, slapped, hit, or threatened you? These are the scarier questions to ask, and often the scariest answers to hear, but I believe, because of this young woman, that I am now asking the right questions and hope that I know what to do with the answers.