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The scalpel and the pencil After years of treating the victims of domestic violence, this Russian surgeon is sketching patients’ injuries and collecting their stories

Source: Meduza

Ruslan Mellin has a talent for reconstructing people’s faces with both the scalpel and his pencil. For the past nine years, he’s worked as an oral and maxillofacial surgeon at the Belyaev Regional Clinical Hospital in Kemerovo, often treating patients who have suffered violence at home — usually women. Mellin also listens to his patients’ stories and sketches portraits of their wounds (to protect the victims’ identity, he models the drawings on consenting colleagues, but the injuries depicted are quite real). Additionally, Mellin sketches portraits of the abusers themselves. His work will appear later this summer as part of the “Violence in the Flesh” exhibition opening at the Kemerovo Medical University. Meduza takes a closer look at Dr. Mellin’s work in the operating room and on paper. 

Ruslan Mellin

surgeon

Working the late shift, Ruslan Mellin is used to getting a handful of emergency cases every night — between four and five patients with facial injuries, he says. In the past, these people were usually men who’d been in brawls. When the pandemic began, however, Mellin noticed that more and more of his patients were women with cheekbone fractures. The new trend cut across social status, he says, just as much as it was shocking to witness. After all, says Mellin, bruised and battered men are a familiar sight — ubiquitous and celebrated in popular culture — but a woman’s mutilated face is something else.

The woman and the ax

Though obscured, this image may upset some readers.

With the artist’s consent, Meduza is obscuring part of this image, where Mellin did not change the patient’s identity.

One of the most savagely injured patients Mellin ever treated was a 28-year-old woman whose employer attacked her with an ax and then locked her in a basement for roughly a month. She never knew her parents and grew up in orphanages and prisons. Mellin says she stole to survive, but it was her decision to find a job as a live-in caretaker that was nearly fatal. One day in 2013, her employer returned home drunk and came at her with an ax, striking her in the head, back, and arms. Somehow, she survived not only the assault but also the next several weeks, trapped in the cellar. When she finally escaped, she spent another two weeks living on the streets before the police caught her and brought her to the hospital.

The woman’s bones had healed wrong, necessitating an osteotomy, whereby Dr. Mellin had to break them again to correct their alignment. Some reconstructive plastic surgery was needed, too. Mellin was relatively new to this work, and he says he committed himself to perfecting his abilities in this field after working with this patient. 

Mellin doesn’t know what became of the woman. He doesn’t know what happens to most of the patients he treats for injuries inflicted by abusive domestic partners. Before she was discharged, the woman told him that she had a place to stay. Years later, Mellin says he realized that she’d likely lied to him, just to comfort him before she was discharged. 

The man and his rings

Three or four years ago, Mellin treated a woman in her late 20s with all the facial injuries he’d come to recognize as the result of a beating. This time, he had to perform an osteosynthesis — rejoining fractured bones with titanium screws. 

Her husband assaulted her regularly, gradually escalating the level of his violence over the years until he exploded at her in front of friends and their own children. After he discovered that she’d been saving money to leave him, he dragged her from the dinner table by her hair and beat her. Before the attack, he made a point of wearing every heavy ring he owned, wanting each blow to hurt as much as possible. The visiting couple apparently watched in silence. In fact, the man — a family friend — even claimed along with the abuser’s mother that the woman had arrived home already beaten. 

As with Mellin’s other battered patients, the woman’s fate is unknown. He says he hopes the assault case went to court, but the police had yet to press charges against her husband when he was treating her.

The disappearing pair

About two years ago while Mellin was working the late shift, a man brought a severely malnourished woman into the hospital. Her condition was severe and the man complained that she had refused to eat for the past two months. While doctors examined the woman, her companion didn’t let her speak, interrupting her constantly and answering questions for her. The patient was about 40 years old, but she looked no younger than 85, says Mellin, who soon discovered the reason for the woman’s supposed loss of appetite: she’d suffered a fractured and completely displaced lower jaw. The damage was so severe that no ordinary blow from a fist could have caused it; she’d been hit with something heavier. The injury made eating almost impossible.

But Mellin was never able to treat this patient: the man who brought her to the hospital quickly carried her away after learning that her injuries would be reported to the police, as required by law. Doctors aren’t permitted to hold people against their will, Mellin explains, and there are exits everywhere in his hospital. He has no idea what became of the woman.

The little girl’s cheek

Most of the children who come to Dr. Mellin need his help because of sports injuries, but sometimes the evidence points to violence at home. In early 2018, a woman brought in her two-or-three-month daughter who had a pronounced hematoma on her cheek. The mother was apparently an HIV-positive drug addict who had not observed the precautions necessary to prevent spreading the disease to her child, meaning that the baby was also likely infected with HIV. 

The woman claimed that the girl’s wound had appeared all by itself, though this was impossible. Mellin told Meduza that he and his colleagues essentially had to trick the mother into admitting the true cause of the baby’s wounds. Like Hugh Laurie’s fictional diagnostician on the television show “House,” Mellin says doctors can trust only their critical thinking skills when working with patients.

Mellin and the other physicians tried to avoid subjecting the child to surgery, but an operation was ultimately necessary to release the pus and blood that built up under the girl’s cheek. Her recovery was slow and painful, but Mellin and the other surgeons stayed involved throughout the process. Later, they alerted the police, and Mellin says he thinks child services eventually responded, but he isn’t sure what happened in the end.

He seemed so caring

In the summer of 2018, Mellin treated a woman about 30 years old with a severely bruised face. X-rays showed a major fracture of the bone along her left cheek and eye socket. Upon closer examination, Mellin realized that the injury had displaced the bone significantly, and multiple contusions of soft tissue made the matter only worse. “In other words, no place on the woman’s face was alive,” says Mellin. She’d suffered a concussion, as well. To mend her injuries, Mellin used an intraoral surgical approach, avoiding incisions to the skin on her face. It was more difficult, but the process would cause no visible scarring. After 10 days, the patient had recovered enough to go home.

During the woman’s post-surgery recuperation, Mellin watched her interact with the man who had inflicted this brutal damage to her face and head. The man was caring and doting — a display that Mellin ultimately concluded was less about conveying affection than expressing power. The woman seemed to tolerate his attention, but, once alone with Mellin, she asked the doctors to document her injuries in careful detail, as she intended to take her case to court.

A month later, when the woman’s treatment was finally over, she shared more of her story, revealing that her abuser was a jealous man with a senior position in Kemerovo’s city government. When he wasn’t threatening to beat her up, he’d often remind her about his friends in high places. The woman’s smashed face — the injuries that brought her to the emergency room — could have cost him his job, if the beating became a public scandal. He couldn’t have that.

In the end, however, the woman forgave him and withdrew her police report. In return, he apparently promised to leave her alone. 

Fixing the law

In November 2019, lawmakers in Russia’s Federation Council introduced draft legislation designed to curb domestic violence. The initiative won the support of speakers in both chambers of the Parliament, though the women’s rights activists who participated in the legislation’s development have criticized the text that ultimately reached lawmakers. Meanwhile, the Russian Orthodox Church opposes the draft law, arguing that the recriminalization of violence at home propagates an “anti-family” agenda. So far, the bill has yet to come before State Duma deputies.

Dr. Mellin says lawmakers need to adopt the legislation now, but he acknowledges that victims won’t utilize any legal protections until they’re confident the system works and abusers get the punishment they deserve. 

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Interview by Stanislav Kuptsov, illustrations by Ruslan Mellin

Summary by Kevin Rothrock