Two tearful middle-aged women rushed into the rooms. They had just been hijacked in broad daylight, in one of Johannesburg’s leafy suburbs. It happened shortly after the one woman had dropped her dog off at her friend’s house for a play date. As she was about to reverse out the driveway, a vehicle cornered her car, trapping her. She told us how she was repeatedly pistol-whipped, kicked, bitten and punched by three men. She fought back ferociously, and, mercifully, in the end, the assailants scattered and she was left, battered, bitten, bruised, but alive.

In these circumstances, I focus on facts. I concentrate on the presenting symptoms and signs, promptly relieving pain, elucidating and treating all the injuries as efficiently as possible, and, all the while, remaining calm and kind. The drama of the story comes later. In her case, she was given analgesia, all wounds were cleaned and dressed, she was X-rayed, CT scanned, put onto retrovirals, and referred to a trauma counsellor. She returned a few times for review, dressings and blood work, and slowly the full story unravelled.

Living in South Africa, we are aware of the risk of being hijacked, and we are repeatedly advised not to fight back or antagonize the hijackers, to calmly give them what they ask for, and never to commit the sin of looking them in the eye. We believe that we will behave in this manner, in these circumstances. To her surprise, she did the opposite. She responded to being attacked and in grave danger, by instinctually defending herself fearlessly and fiercely. Nothing can prepare us for the trauma of a hijacking, nor can we predict how we will respond in the same circumstances. Her friend was not physically harmed, but she experienced a unique trauma. She had been walking out with our patient, saw what was transpiring, and pressed the remote to close the gate, abandoning her friend to her fate outside the gate with the three hijackers. She remained safely inside the gate. She immediately ran into her house, where her young daughter was, and called Armed Response. Her actions, no doubt saved our patient and perhaps both of them, as well as her daughter.

The friends came in together for one of the follow-up visits, and I was pleased that they had attended a therapy session together. How do we begin to understand and deconstruct all of the emotions here? The second-guessing, guilt, blame, anger, fear. There is no way to know that what we choose to do in a situation like this will have the best outcome. The emotional trauma that followed for both women long-outlasted the physical injuries, and there are scars that will remain forever. I wonder what the cost of an incident like this is, on them, their families and households. It is just one small example in a world full of these, and worse kinds of stories. And what of the hijackers and their story?

I am always left a little bereft by these incidents, with a naïve wish that the world was not always this way.