I once treated a patient for a minor GSW to his leg. He was a drug dealer in the neighborhood and, gauging from the substantial roll of money in his pocket, successful in his chosen field. At the end of my shift, he beckoned me over.

“Don’t worry about anything around here, Doc. I got you,” he told me—and he meant it. In that way, we were a team. So, I was never physically harmed in the South Bronx.

It wasn’t until afterward, when I was working one day at Andrew Johnson’s smaller community hospital location, in South Philadelphia, that I encountered my first violent patient, a young man whose mother had brought him in heavily intoxicated. (Although, at twenty-nine, he was technically an adult, in this neighborhood it was a cultural norm for grown men to come to the ER accompanied by their mothers.)

That evening had been peaceful until he was rolled into the department vomiting. The two night nurses who were planning Girl Scout events for their daughters and the evening clerk who was surfing the Web stopped what they were doing to register and triage the new arrival. The patient was deposited in the room kitty-corner to the doctors’ station. After safely dumping her son off for the ER staff to deal with, the young man’s mother left, and the triage nurse kept his room dark to encourage him to sleep off his intoxication. His was a simple case: I would examine him, prescribe medicine for nausea as well as intravenous hydration, and discharge him back to his parents in the morning. He likely needed none of these treatments; routine intoxication is typically best “treated” by simply kneeling in front of a toilet bowl. But because the young man had been brought to the hospital, we were obligated to provide the medical show the family expected.

“Sir, may I examine you?” I asked.

“Suuuurrrree,” he slurred as he moaned and clutched his stomach. He seemed well enough and cooperative.

I told him I would examine him quickly and then the nurse would give him medication for his vomiting. He leaned forward; his lungs were clear. He slumped back; the heart sounds were normal.

“Okay, now open your eyes.”

I was inspecting his pupils with the otoscope—the ophthalmoscope head was missing, but really, any light source would have done the trick—when, out of nowhere, a fist came careening toward my face. There was no context to his violence in that moment. There was no good reason and no appropriate justification for it. Being drunk never changes a person, but it does grant their shadow selves free rein to step forward.

I heard my glasses fall to the floor and then slide across the linoleum. In the half-lit room, I saw nothing but a smear of the patient’s blond hair and pink skin. As my head jerked, I sensed movement, but I didn’t know if it was him or if I was simply readying myself for the next blow. In that same second, I reflexively flung my right arm forward with every ounce of force I could muster, the otoscope still in hand. When it made contact, I heard a crack and a thud as the patient’s body reeled back onto the stretcher.

Without my glasses, I was essentially blind—I don’t mean blind in the way of needing reading glasses for the morning paper, but blind like I couldn’t get to the sidewalk without a walking stick or a guide dog. I knelt carefully to pat down the floor, and luckily my hand reached my glasses, which were right against a cabinet, still intact. I pushed them on and stood. The patient was still lying on the stretcher, his eyes closed. He was breathing, and I didn’t see any blood. But I did see a small, red circular impression in the middle of his forehead where the otoscope head had made contact.

At that point, the nurses and the other attending physician had rushed into the room to see if I was all right.

The other attending on shift was Dr. Crist, a six-foot-four retired military man with a voice as big as his stature. He surveyed the scene.

“Well, we’d better add a head CT to his orders,” he said.

He continued that he would assume care of the patient, and in his clear, understated way, he declared, “There’s no fucking way we should come to work for this shit. These idiots coming in here thinking they can do whatever the hell they want to! Who gives a shit if he’s drunk? He’s just a lowlife. Why the fuck do these people bring in their shit family so we can take care of them?!”

I just stood there, my face throbbing. I couldn’t answer Dr. Crist’s questions. They’d been rhetorical, anyway. I appreciated his expressions of rage; my own anger was too choked up in my chest and bound with shame. I didn’t know then the exact source of the shame, but I knew what I felt: I was ashamed that a man had struck me in the face; that the blow had left purple welts on my nose and cheek that hurt when I put my glasses back on; I was ashamed that I couldn’t scream at the patient or pummel him the way I believe a man who harms a woman deserves to be pummeled. Maybe most of all, I was ashamed that I had been made to feel so weak in my position of supposed power. I was a grown-up now, a doctor, not a child witnessing my father’s violence at home.

Big Hector, a nurse whose nickname describes him perfectly, asked if I was okay. The other techs and nurses did, too. They called Security as well. My interaction with the Philadelphia police was brief. An officer took my statement, and we completed the necessary paperwork for the department so that the patient would be banned from care in our hospital system. I declined to press charges, given that it would require a lot of my time to do so and because while I was sure the man’s violence had had nothing to do with his inebriation—violence never does—I had doubts about whether the charges would stick in a man with a documented history of intoxication.

Because the incident happened at the end of my shift, I could go right home, something I badly needed to do. When I got to my apartment, I took a naproxen and went to bed with the conviction that I would not dream about what had just taken place.

And now, almost two years later, I was faced with another yellow alert, another reminder of how little power we physicians actually have. Despite my efforts, I couldn’t stop thinking about the physician who’d been assaulted by this patient I was about to see. I had tremendous respect for this doctor I’d never met, for the restraint it must have taken for her, after being violated, to calmly put down her scalpel and walk away. I would like to think I would have done the same. I suppose I had, with my inebriated patient—doing just enough to ensure my safety, and then leaving. After all, it was about survival, not retribution. She was lucky she hadn’t accidentally killed her assailant when he groped her. But if that had been her reflexive response when under attack, she would have been in the right. It infuriated me that in the world of medicine, a female health care provider could be attacked without consequence, without any means of redress. It was as if patients were permitted such assaults. Why was it that the woman must quietly walk away while the aggressor is allowed to return to the emergency department at any time with the expectation of being serviced?

I stood there in the staff lounge wishing it were easier to be human, wishing we could shed our binary views around gender and power, views that have never served humanity well. I longed for our society to move closer to a harmony where the yellow alerts would fade away so that when I clicked on a patient’s history, I would see just another gray computer screen.

It turned out there was coffee in the break room. I touched the side of the pot to find it was still hot. I poured some into my cup and added cream and sugar to the grainy brown brew, thin and watery and likely at least five hours old. In any other circumstances, it would have been unpalatable, but toward the end of a night shift, it was ambrosial. I inhaled—caffeine and a hint of motor oil—and took the first sacred sip.

Now I was prepared for the patient I had no choice but to see.

It was true that I didn’t know him at all, so was it fair to judge? I had to admit that there might have been extenuating circumstances to explain this patient’s degeneracy—after all, I knew nothing more than what had come up in the notes. Maybe he had been abused as a child. It is not uncommon for boys who are abused to become abusers themselves. It is never a justification, of course, but it is an eventuality that deserves compassion. (For all I knew, he had gotten therapy since the assault and was now a fund-raiser for the Rape, Abuse, and Incest National Network. It was a long shot, but it was possible.) It still felt appropriate to make the patient wait, but I knew that there would eventually be other patients to see after him, and it wouldn’t be right to delay their care.

I had squandered six minutes, and there was still only one patient in the ER. I grabbed the male nurse who’d been assigned to the patient, Mike, and we headed over to his room.

On the way, Mike grunted under his breath, “I can’t believe this guy is allowed to come back here. It’s shameful.”