Best American Science Writing

Reading the Wounds
How doctors treat torture survivors -- and what "counts" as torture?

"Mr. A, I need you to take your shirt off.” Dr. Rajeev Bais stretched a pair of latex gloves over his hands. He reached into his pocket and pulled out a paper tape measurer, wound like a tailor’s into a coil. Mr. A sat before him, on an exam table draped in crinkly white paper, at Elmhurst Hospital in Queens, New York.

“I’d like to measure the scars on your back and arms,” Bais said, walking around the table. He moved like he talks, gracefully and deliberately, with an ease that inspires trust. Bais has brown eyes, and what’s left of his black hair is buzzed short. Two gold charms his mother gave him rest near his collarbones: Ganesha, the Hindu elephant god, and Om, the symbol for the sound of the universe.

Mr. A silently slipped his arms out of his sleeves. Bais surveyed his upper body for evidence of cuts, deep bruises or other effects of physical abuse. He zoned in on the arms.

“There’s some scarring here, near your elbows,” Bais said, unrolling his tape measure. “How did that happen exactly?”

“That’s where the cords were,” Mr. A told him.

Bais wrote in his notebook: 5.5 cm by 1 cm linear shaped hyperpigmented scar just superior to the antecubital fossa.

“What about your back?” he asked. “And your shoulder?”

Four small, dark ovals the size of nickels clustered around a thin, straight scar on the left side of Mr. A’s lower back. Bais found two larger, misshapen circles, like stretched-out quarters, on Mr. A’s left shoulder.

“The wooden sticks had sharp objects on them,” Mr. A said.

3cm by 3.5 cm, Bais wrote. Raised.

Bais catalogued six other scars of varying sizes and shapes on Mr. A’s arms and back. When Mr. A removed his pants, Bais found more scarring on the thighs. He knelt to measure a long, uneven mark near Mr. A’s left ankle.

“How did it heal?” he asked. “Was there any bleeding or pus?”

“It bled a lot,” Mr. A answered. “And it swelled up.”

“How long did it bleed?”

“A few months, but not all the time.”

Bais had studied to be an emergency room physician—one of those George Clooney types, suave under pressure, whose days are built of short, intense encounters with car crash survivors, stabbing victims, and people with failing organs. But now he was encountering a kind of stress he had not learned about in medical school.

In their off hours, Bais and his colleagues become forensic physicians: interviewing asylum seekers who say they have been tortured, listening as they explain, over two or three or four hours, what happened to them back home. Then, with physical exams, Bais searches for the scars that can corroborate such stories. If, at the end of all this, the doctors believe the patients’ stories, they write what may be the key to an asylum case: a medical affidavit, the closest thing to proof of torture there is.

Despite the many horror stories Bais has seen, he remains shocked that, actually, torture is rarely unique. There is a set of common practices, and those practices leave distinct interior and exterior scars. Bais and his colleague, Lars Beattie, have taught themselves what those scars might look like, and how to explain torture to judges, who grant the coveted right to remain in America only to refugees who can prove “a well-founded fear of persecution.” The medical affidavits they write are based on a simple idea: that the body tells a story, one that might save a patient’s life. The irony is that this is a modern inversion of precisely the philosophy that brought torture into the world in the first place: that truth can be coaxed from the body.

Bais made a few more notes and told Mr. A he could get dressed. Then he stepped out of the examination rooms and took a deep breath.

Full story.