HELP ELLA! THEN ME!

  1. 20

    Regular customer at the ED. Is her story what she is saying or not saying? Could it mean life or death? Unwary nurse finds out!

    HELP ELLA! THEN ME!

    HELP ELLA! THEN ME!

    She sat quietly as I drew her bloods after inserting a heplock. The ED was packed and as evening Manager, I had noticed that two of my nurses were struggling to play catch up with the volume of patients needing lab and line. So I had pulled a few in to get them started and decongest the backlog.

    “Ms. Williams, I have noticed that you have come 11 times in the last 3 months for the same complaint. Can you tell me what is going on?” She looked around fearfully and started taking about her GI and Gyn symptoms. As she talked, I sensed there was another story under that layer that she was not telling. I casually started asking her about her family and support systems. Her eyes lighted up when she talked about her 4 year old Ella and a stoic expression came over her when she talked about her boyfriend Brent.

    “Ms. Williams many times when we have GI symptoms, it is a response to stress in our lives. Is anything happening that is causing stress to you and Ella?” The tears started falling hard and her shoulders shook although her head nodded no. I pulled her into a room that had just been vacated and had her sit on a chair as I quickly prepped the stretcher. Once she sat on the stretcher, I closed the door, pulled up the chair next to her and held her hand.

    “Ms. Williams, please tell me what is going on so that I can help you.” Her eyes red and puffy she started talking slowly first, then in a torrent. I learned that she was being physically, emotionally and sexually abused by her boyfriend Brent. Ella was not his child and recently he had begun to sexually abuse her as well. He beat her up severely when she tried to protect her child. The only time he allowed her outside the house by herself was when she had a Gyn problem and had to be seen in an ED. She had no primary care doctor and no insurance. He threatened to kill Ella “Piece by piece” if she reported him.

    “Ms. Williams please allow me to help you. Where is Ella now?”

    “She is with him in the house.”

    “I am going to get the social worker Pamela come in to help you. Thank you for telling me. Is this really why you came to the ED?”

    “Yes. I was hoping someone would ask. Help Ella, then me!”

    I stood up, gave her a hug and turned to go. "Nurse Annie, take this with you. I don’t need this anymore.”

    “What is that?” I eyed the package.

    “It’s two bottles of pills. I was going to kill Ella and myself tonight.”

    I took the packet from her shaken. “Have you tried before?”

    “No.”

    “I am glad you are not going to anymore. Let me get Pam here for you.” I walked out with the packet and found Pam and updated her. Pam helped her. Got the cops, state and child protective service involved. He was arrested without incident.

    Ella was transported to the hospital for an initial examination. Since we had an advocacy center for pediatric sexual abuse, the detailed exam along with the psychosocial interview of child and mother were done there. It’s a one stop shop. The survivor(s)/families have a team that conducts medical evaluation, forensic interviews, behavioral health and treatment services in a safe environment. The child’s forensic interview is conducted by a specially trained interviewer who asks open ended questions to the child while the rest of the team observes behind a one way mirror. The family is gets connected to help they need. The last I heard they were doing good and Brent was in jail.

    I eyed the bottles on my desk. There were enough pills to kill an elephant. She had been gathering them and hiding them over the last year as she planned the murder /suicide. I marveled at how God used me to save her. This was payback for a time when I was 18 and sat at a table with 50 pills in front of me and 2 glasses of water getting ready to kill myself. I thanked him for sending a friend into the place I was and stop me from committing suicide. As I went to the bathroom and flushed Ms. Williams’s pills down the toilet, I remember how my friend talked me out of it and how we flushed the pills down the toilet so many years ago. The good lord saved my life by sending my friend to help me. I remember asking her how she knew I was in danger and where to find me. She insisted that there was a persistent voice in her head that kept telling her to find me and would not stop till she found and helped me. I in turn, have had countless opportunities to make a difference in other lives and save many as a nurse. I feel that beyond the stresses of working as a nurse, we have a calling to be of help. Sometimes all you need is to help a coworker who is drowning in work to save a life!
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    About spotangel, BSN, MSN

    Mother, wife, nurse, writer. Loves God above all!

    Joined Mar '12; Posts: 183; Likes: 785.

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    20 Comments

  3. by   3ringnursing
    This is one of my favorite articles you've written.

    Although it didn't leave a smile on my face - and it was chilling to the extreme, the lives you managed to save by looking outside the box was incredible.

    When you save one or two lives you never really know how many more inadvertently you end up saving in a domino effect later on.

    I hope that rat b*s*a*d rots in jail for eternity.

    God bless the ED nurses.
  4. by   macawake
    I feel that beyond the stresses of working as a nurse, we have a calling to be of help. Sometimes all you need is to help a coworker who is drowning in work to save a life!
    I agree that nurses are often in a situation where we can help people and due to the nature of our work, we are in a good position to notice/identify if a person is being abused, especially when it involves vulnerable groups like children, the elderly and individuals with disabilities or impaired cognitive functions. That's why we are mandated reporters.

    After reading your story I'm feeling sad but also a bit incredulous. I have worked with victims of domestic violence, pediatric sexual abuse victims and encountered many of the perpetrators of these crimes. In part during my nursing career but primarily in my previous career. Neither the perpetrator in your story nor the two victims are typical. In my experience it's unusual for a perpetrator to sexually abuse/assault both adult women and preschoolers. It's not impossible, but it's very rare. The adult victim's reaction to the abuse is also somewhat outside of the norm (but again, not impossible).

    “Ms. Williams, I have noticed that you have come 11 times in the last 3 months for the same complaint. Can you tell me what is going on?” She looked around fearfully and started taking about her GI and Gyn symptoms.
    Is anything happening that is causing stress to you and Ella?” The tears started falling hard and her shoulders shook although her head nodded no.
    Ms. Williams, please tell me what is going on so that I can help you.” Her eyes red and puffy she started talking slowly first, then in a torrent. I learned that she was being physically, emotionally and sexually abused by her boyfriend Brent. Ella was not his child and recently he had begun to sexually abuse her as well. He beat her up severely when she tried to protect her child. The only time he allowed her outside the house by herself was when she had a Gyn problem and had to be seen in an ED.
    He threatened to kill Ella “Piece by piece” if she reported him.
    “I am going to get the social worker Pamela come in to help you. Thank you for telling me. Is this really why you came to the ED?”

    “Yes. I was hoping someone would ask. Help Ella, then me!”
    “Ms. Williams please allow me to help you. Where is Ella now?”

    “She is with him in the house.”
    "Nurse Annie, take this with you. I don’t need this anymore.”

    “What is that?” I eyed the package.

    “It’s two bottles of pills. I was going to kill Ella and myself tonight.”

    I took the packet from her shaken. “Have you tried before?”

    “No.”

    “I am glad you are not going to anymore. Let me get Pam here for you.”
    I eyed the bottles on my desk. There were enough pills to kill an elephant. She had been gathering them and hiding them over the last year as she planned the murder /suicide. I marveled at how God used me to save her.
    I went to the bathroom and flushed Ms. Williams’s pills down the toilet
    You said that the mother/Ms. Williams' partner had recently started to sexually abuse the child, but the mother (your patient) had planned on murdering her child for a year? She'd come to the ER eleven (!) times in the past three months with GI/Gyn complaints. Had she been leaving her four-year-old at home with the man that molested her the previous ten times, just as she did the on the eleventh visit when she finally confided in someone (you)? She'd left her child with the molester but never asked for help when she had the chance during the ER visits, but just because you asked, she finally did? On the eve of the planned murder/suicide? Frankly, I wish God would have stepped in a bit more promptly, he was cutting it a bit close. Who knows what the child had to endure during her mother's eleventh ER visit.

    As I started off by saying, I have experience with sexual offenders and their victims. I'm well aware of the complicated dynamics that exist between a victim of domestic abuse and the perpetrator of the crime. For an outsider it might be difficult to understand why the victim doesn't simply leave her (or his) tormentor, but it's not that easy. It's not easy psychologically, and the time when the victim decides to leave (and attempts to) is usually also a very dangerous time for her (or him). That said, your patient left a child that she was supposed to protect with the child's molester and she had also been planning on killing the child for an extended period of time according to your account. The mother was actually also a threat to this child.

    You wrote that you flushed the pills the mother had planned to use in her child's murder and her own suicide, down the toilet. That's not something I would have done. What did you do to make sure that if the mother ever got involved in a new abusive relationship (sadly, not an uncommon pattern), that she'd be equipped with better coping skills and would be in a better position to fulfill her parental obligation to keep her child safe? Did you share the murder/suicide plan that the mother had spent a year plotting with anyone so that it could be addressed? I hope you did, but since you decided to flush away the evidence I worry that you didn't?

    From reading many of your previous posts, it seems you derive happiness from helping people and there's absolutely nothing wrong with that. If helping people is done for altruistic reasons, it's an admirable act in my opinion. I have however previously and am doing so again in this thread, questioned whether your judgment is always optimal. I don't really think I got through to you the last time I voiced my concerns, but I'm hoping I will this time.
  5. by   verene
    Spotangle, you stories while inspirational on the surface often given me pause about your practice and your interactions with patients. There is nothing wrong with wanting to help people - I imagine that is why most RNs because nurses. Nor in believing in a higher power and viewing your work as service.

    However your stories always focus on how God placed you in the right place at the right time and contain evidence of practices which may be less than safe or therapeutic for your patients. I've refrained from commenting in the past, but in this case I really wonder about how much you focus on your patients and THEIR SAFETY AND NEEDS rather than your "God Given Powers."

    Did you relay your concerns about the patient's mental health to anyone? In your story it sounds like you left an actively suicidal/homicidal patient by herself in an unsecured room with no one else aware. Did you pass on to social work that this mother is a threat to her child's safety? Was the mother evaluated by a mental health professional and/or attending physician to determine if a psychiatric or medical hold were necessary for her safety and that of her child?

    Why did you take the pills to your office? Why did you flush them? This is not proper storage or disposal protocol for any facility I've been in. This makes it sound like you hid the mother's SI/HI from others and destroyed evidence.

    In how you share your stories you seem to have a savior complex, one that impairs your clinical judgment.
  6. by   Purple_roses
    To echo what others have said, the ending to this is unsettling. Ella was essentially transferred from an abusive parent to a homicidal one, and healthcare/social has absolutely no idea about this.

    Also, you are being placed in these situations because you work in an emergency department. You placed yourself there. There isn't anything supernatural about the fact that you're seeing emergency patients in the emergency department.
  7. by   NurseCard
    I suspect that, for dramatic purposes, the writer may skew things just a tad.
    Writers do that sometimes. Not saying that it's a good or bad thing that she
    does this.
  8. by   KelliBSN2006
    What is it with all the haters? This is why they say nurses eat their young. You didn't get the point of the story. You were not there in the busy ER... I assume by your reply you have never worked in a busy ER, if you had you wouldn't be so harsh and judgemental. In a perfect world there is enough staff and time to properly follow up on every patient you triage in the ER. My hat is off to this ER nurse for for asking the right questions, taking the patient in a private room and building the trust needed to save lives.
    It is not a crime to believe in a higher power, you make it sound like it is. Do you think anyone wants to share a story if their judgment is going to be critized so harshly? No one knows what we would have done, we were not there. Nursing is the #1 profession for bully's. I am tired of hearing negativity. I loved this story. Who are you to judge this RN? What a heavy burden you must carry on your back, I would hate to have the job of judging others.
  9. by   Luckyyou
    Quote from KelliBSN2006
    Nursing is the #1 profession for bully's.
    I think I just rolled my eyes so hard I saw my brain.
  10. by   dee.searching
    Your articles are always a blessing and an inspiration to me. Thank you.
  11. by   spotangel
    Wow! Some of the comments from the "caring profession" are unreal ----!
    First of all, peace to all!
    Few clarifications.
    Safety- The patient was in a contained area with 2 RNs at all times. When I left the room, I informed the primary RN of what was happening and she could see the patient very clearly through the glass door that could not be locked while awaiting social work.
    Follow through- The social worker worked alongside the team as she was medically cleared and followed our protocols of notification to Psychiatry, state, ACS and the police dept. The advocacy center that is affiliated to our hospital works specifically with survivors of sexual abuse and the contact person spoke to the patient while she was in the ED.
    Medications- This was discussed with the attending physician, hospital chief pharmacist , ED management team and PD .Since it was a mixed bag of pills and it had not been used and was not needed as "evidence", the plan was to flush it down the toilet.
    Confiding- Why did she confide in me? I honestly don't know. She had been collecting the pills as her way out but once her child got involved and she could not stop her being abused the second plan hatched.
    Spirituality- To date, I have not had one patient complain when I have spiritually uplifted them with words of comfort and hope while I tended to their physical and medical needs. I have been an RN for 28 years. I am very comfortable talking about God's love and mercy as I have experienced it firsthand.
    I have always felt that all my experience as a nurse and as a human being can be used to help someone in physical or mental distress. I am still like a child filled with wonder and awe when I see how people who are strangers one minute connect to us nurses and we are able to help them at a deeper level than they anticipated.
    To the judges-Don't be so quick to judge. There is always more to the story than you think or that has been written. I may not be your cookie cutter type of nurse and am no saint, but I am not this uncaring "Godzilla" that is smoking spiritual pot constantly!
    Just a human being trying to survive this no so friendly world like the rest of us!
  12. by   Susie2310
    Quote from macawake

    You said that the mother/Ms. Williams' partner had recently started to sexually abuse the child, but the mother (your patient) had planned on murdering her child for a year? She'd come to the ER eleven (!) times in the past three months with GI/Gyn complaints. Had she been leaving her four-year-old at home with the man that molested her the previous ten times, just as she did the on the eleventh visit when she finally confided in someone (you)? She'd left her child with the molester but never asked for help when she had the chance during the ER visits, but just because you asked, she finally did? On the eve of the planned murder/suicide? Frankly, I wish God would have stepped in a bit more promptly, he was cutting it a bit close. Who knows what the child had to endure during her mother's eleventh ER visit.

    From reading many of your previous posts, it seems you derive happiness from helping people and there's absolutely nothing wrong with that. If helping people is done for altruistic reasons, it's an admirable act in my opinion. I have however previously and am doing so again in this thread, questioned whether your judgment is always optimal. I don't really think I got through to you the last time I voiced my concerns, but I'm hoping I will this time.
    The patient's boyfriend wouldn't let her out of the house alone unless she was going to the ER for a gyn problem and it sounds as though she couldn't call for help from her home. It sounds to me as though the patient was gathering the courage to ask for help during those previous 10 visits, but being a victim of abuse had had her confidence destroyed to the point that she needed a nurse/physician to gain her trust first and ask her if she is being abused; she couldn't initiate the conversation herself. I have seen this before and know that this happens sometimes.

    As far as leaving Ella behind with her abuser during those ER visits, I imagine it was massively stressful and painful for the patient to do this, and my guess is that as she knew her abuser wouldn't let her take Ella with her when she went to the ER, she knew the only way she could summon help for both of them was to go to the ER alone. This makes sense to me. Also, the patient was planning to kill herself and her child; she was absolutely desperate.

    I don't see the situation the OP described as exaggeration or fabrication at all; these situations occur.

    I found this a very useful article on the very unpleasant topic of abuse that we have a good chance of encountering in our work as nurses. The 11 visits to the ER for the same complaint alerted the OP that there was another problem that hadn't yet been addressed with the patient, and she cared enough to try to find out what that problem was. It illustrated how important it is to be ready to listen to a patient with an open mind, and how important it is to have the willingness to step out of our comfort zone to ask difficult questions while showing caring, to help rescue a patient and her daughter from abuse.

    Abuse is sadly a very common problem, and unfortunately very often goes undetected. Good for the OP for bringing our attention to this.
    Last edit by Susie2310 on Sep 10
  13. by   macawake
    Quote from KelliBSN2006
    What is it with all the haters? This is why they say nurses eat their young. You didn't get the point of the story. You were not there in the busy ER... I assume by your reply you have never worked in a busy ER, if you had you wouldn't be so harsh and judgemental.
    Since you didn't quote the post you're responding to, I have no idea if your post is aimed at me or at someone else. It doesn't really make a difference, my reply to you still applies. Labelling people whom you disagree with "haters", while at the same time failing to address the actual opinions you disagree with, is no doubt convenient and comforting. It saves you the effort of having to ponder whether the opinions you object to, might actually have merit. Perhaps I/we aren't getting the point, but you know what? It's also possible that we are.

    I have in fact been an ER nurse. I have also worked slightly over a decade in law enforcement.


    Quote from Susie2310
    Abuse is sadly a very common problem, and unfortunately very often goes undetected.
    Trust me, I don't need to be informed about this.

    Quote from Susie2310
    The 11 visits to the ER for the same complaint alerted the OP that there was another problem that hadn't yet been addressed with the patient, and she cared enough to try to find out what that problem was. It illustrated how important it is to be ready to listen to a patient with an open mind, and how important it is to have the willingness to step out of our comfort zone to ask difficult questions while showing caring, to help rescue a patient and her daughter from abuse.
    This is (ER) nursing 101. In fact it's such a basic follow-up question to ask that I am shocked that it took eleven visits before someone finally connected the dots. I can give ER nurse 1 and ER nurse 2 a pass, but by the patient's third visit a clear pattern of the same complaint was established. A pattern that should have set off alarms. Frankly, I question the third, fourth, fifth, sixth, seventh, eighth, ninth and tenth ER nurses' competence (I'm assuming that nurse one through ten, weren't all the same individual, but that the patient was seen by different nurses on the various ER visits).

    I apologize in advance for this piece of cynical sarcasm, but since this poor patient had on more than half a dozen occasions met nurses who were either uncaring or surprisingly blind to the obvious possible scenario, I guess it's fortunate that she met the only one who managed to see it, mere hours before she was planning to commit murder.

    I've noted that some posters in this thread find OP's post inspirational. To me it isn't. For someone who's a novice nurse, completely unaware of domestic violence and sexual abuse the post could be viewed as informative and educational. For me personally, the woman and the child in OP's story had already suffered too much for me to feel any inspiration.

    I never felt particularly happy when I managed to send a abuser/rapist/molester to jail. I'd feel a certain grim satisfaction that they wouldn't be in a position to inflict any further harm on their victims (at least for the time being), but I was always acutely aware of the pain they had already inflicted. Sometimes those wounds would never properly heal in their victims.

    Quote from Susie2310
    I don't see the situation the OP described as exaggeration or fabrication at all; these situations occur.
    I'm not going to share whatever conclusions I've arrived at, because I don't see anything helpful coming from that. But rest assured that whatever conclusions have been drawn, were not based on one single thread, but based on the sum total of accounts in several different threads.


    Quote from spotangel
    Wow! Some of the comments from the "caring profession" are unreal ----!
    Unreal? The reason I replied to your post is the same reason I will challenge nurses who for example express an anti-vaccine viewpoint. They reject science and I worry that their poor understanding of scientific research may do harm. I've seen some things in some of your posts that I think pose a risk. You can agree with me, or not. But the reason I post, is that I care.

    I bear no ill will towards you. You might not realize it or feel it, but I actually tried to be as gentle as I could when I identified which aspects of your post bothered me. I was trying to reach you and reason with you, not tear you down.

    Quote from spotangel
    Few clarifications.

    Safety- The patient was in a contained area with 2 RNs at all times. When I left the room, I informed the primary RN of what was happening and she could see the patient very clearly through the glass door that could not be locked while awaiting social work.

    Follow through- The social worker worked alongside the team as she was medically cleared and followed our protocols of notification to Psychiatry, state, ACS and the police dept. The advocacy center that is affiliated to our hospital works specifically with survivors of sexual abuse and the contact person spoke to the patient while she was in the ED.

    Medications- This was discussed with the attending physician, hospital chief pharmacist , ED management team and PD .Since it was a mixed bag of pills and it had not been used and was not needed as "evidence", the plan was to flush it down the toilet.

    Confiding- Why did she confide in me? I honestly don't know. She had been collecting the pills as her way out but once her child got involved and she could not stop her being abused the second plan hatched.

    Spirituality- To date, I have not had one patient complain when I have spiritually uplifted them with words of comfort and hope while I tended to their physical and medical needs. I have been an RN for 28 years. I am very comfortable talking about God's love and mercy as I have experienced it firsthand.
    You're doing it again, adding lots of information that would have been helpful to have from the beginning. I won't rehash this in detail, but you know from our previous discussion that changing/evolving narratives, give me pause.

    How come you added the gruesome and unnecessary information that the boyfriend threatened to kill your patient's four year old child piece by piece (threatening to murder a child is horrific enough, the graphic details aren't needed) , but failed to clearly express that you didn't leave a patient who'd voiced homicidal and suicidal ideation, alone? For any new nurse, unfamiliar with the ER and the patient population your post concerns, that information would in my opinion have been valuable. They could benefit from learning how to address a situation like the one you've described.

    It's quite possible that the baggage I carry from having met/seen so many victims of ugly crimes affects my perception, but to me including lurid details like the threat of dismemberment of a young child, lends a sensationalist slant to your post.
  14. by   silasmwambia
    Are you jelous that she is such a wonderful nurse. I can read something behide ur fierce criticism of her. Please stop. The article is ment to encourage someone not to meet your individualized parameters. Who made you her judge and who r u to judge her so harshly. I can tell this is a good nurse who finds joy in helping. You sound like many I have come across who thing everyone else is beneath them.
    Write your perfect article.maybe we will read but leave others a lone. You are a little too much.

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