October: Breast Cancer and Domestic Abuse

[Ruby Vee, BSN]

Breast cancer - at least mine, anyway - is fairly straightforward. You either have it or you don't. The mass is malignant or benign. When you're diagnosed, things happen. You get a referral to a surgeon and a radiation oncologist and you're evaluated for treatment options. Things progress in a cookbook-like fashion - at least that's how it seemed to me. You do this, then you do that and then this and we'll re-evaluate then. People are empathetic, everyone tells you how brave you are. I never FELT brave - I was just putting one foot in front of another, doing what my doctors told me to do. And now, five years later, hopefully it's over.

Domestic abuse is different. It's not all that straightforward. Everyone gets angry and yells, so when is it abuse? He has never HIT me, so how can it be abuse? Yes he calls me names sometimes, but is THAT abuse? If he's a little controlling, well that's marriage, isn't it? Of course no one WANTS to be in an abusive relationship, and sometimes there's a little denial built in. You think that your mother "fell down the stairs" often and wore long sleeves in summer and sunglasses at night. THAT's abuse. Your relationship is nothing like THAT. You don't want it to be abuse because then you have to do something about it . . . get him into a program or maybe even leave.

When you're living with an abuser, no one calls you brave, few are empathetic. Either they don't know about your situation because you and he are so good at covering it up, or they do know (or suspect) and they don't understand why you don't just LEAVE. They say things like "If some man tried to do that to ME, I'd let him have it!" "I'd never put up with THAT." I said things like that when my colleague was brought to our ER covered in blood and bruises after her SO attacked her with an ax. She was late coming home from work because her patient coded at change of shift. I said things like that when another colleague was beaten to death by her husband on Christmas because she didn't have enough of his favorite beverage on hand. I didn't get it. Now I do.

What I didn't get until recently was that even if he doesn't hit you, you might be living with an abuser.

It starts gradually. He yells a lot, but he's under a lot of stress. He has a temper. He throws things sometimes. It isn't a big deal as long as he's not throwing things at ME, right? And then one day you realize that he's been yelling at you every day, sometimes three times a day. He blames you for things that aren't your fault or are actually HIS fault. He's NEVER at fault. You cannot bring up a grievance with him because he "goes ballistic" no matter how carefully you choose your time or your words. Nothing is a problem unless it's a problem for HIM. You don't bother him with things that might need fixing around the house because he'll tell you it's not a problem, or it's your fault, or he'll just have a tantrum about how useless you are and how he has to do EVERYTHING. He screams at you and calls you names, and you have no idea what set him off. You tried very hard to do everything the way he wants it done.

And then the day comes when you dread hearing his car in the driveway, his key in the lock. Is the house clean enough? You don't dare let him catch you reading a book or listening to music - hurry quickly and find something to do so you look busy when he comes in the door. You've come from the hairdresser's and she's cut your hair too short and you start trying to explain how it's not your fault before he can explode. You're still thinking it might be your fault - maybe if you had told the hairdresser more specifically. Maybe if you kept the house cleaner, were a better cook, were thinner or more attractive he'd be happy with you and he wouldn't yell so much. There must be SOMETHING wrong with you to make him talk to you that way.

One day he brags that you're so stupid he can get you to do whatever he wants just by having a tantrum. You realize that you're doing your hair the way HE likes it, not the way you like it. You're able to leave the house without a hassle if you're going somewhere HE approves of. You want to go to the bookstore (which he disapproves of) but you say you're going to the gym (because he approves of that.) You're getting ready to go to an important job interview and he starts screaming and smashing dishes . . . you cry all the way to the interview and you don't get the job. He doesn't want you to go to school or apply for a promotion or whatever because HIS needs come before yours. You realize that he's willing to drive you to your radiation therapy appointment (because he doesn't blame you for having cancer) but not to physical therapy after you get your knees replaced (because if you weren't too fat you wouldn't have needed a knee replacement.) You wonder what will happen when you're older and sick and need him . . . and you hope that whatever you get, it will be on the "approved" list.

And then one day someone on allnurses.com recommends a book about verbal abuse and you pick it up, just for a lark and you read it. And all of the things they describe in there - it looks just like YOUR relationship. YOU are in an abusive relationship. He's controlling, he's manipulative, he's nasty to you . . . but at least he doesn't hit you.

At least he doesn't hit you, but he criticizes your body and refuses to have sex with you until you lose 50 pounds. At least he doesn't hit you, but he leers at other women in front of you, and tells you how hot they are and how not you are. You feel ugly and stupid and lazy and . . . all those other things he tells you you are.

And then you look in the mirror one day and you realize that you no longer recognize yourself. This person isn't who you are. Your partner tore you down, damaged you emotionally, made you doubt and disrespect yourself.

But at least he doesn't hit you. Until he does.

[VivaLasViejas, ASN, RN]

Wow. What a powerful article. I'm just sorry you went through that. You are so strong, it's hard to believe it happened to you. But then, it can happen to anyone.

[amoLucia]

Am tearing up on this one. Powerful reading, should be something for all nursing folk to read.

[Beth1978]

Wow, this is so true and valid. There are different levels of abuse, some of them contain an aspect that women approve for whatever reason.

[UrbanHealthRN, BSN, RN]

Right now I've got multiple women on my caseload who are currently facing abuse from their partners. These words have come at a right time and are reminding me not to minimize some of the warning signs that I've either observed or had reported to me.

[Ruby Vee, BSN]

Breast cancer - at least mine, anyway - is fairly straightforward. You either have it or you don't. The mass is malignant or benign. When you're diagnosed, things happen. You get a referral to a surgeon and a radiation oncologist and you're evaluated for treatment options. Things progress in a cookbook-like fashion - at least that's how it seemed to me. You do this, then you do that and then this and we'll re-evaluate then. People are empathetic, everyone tells you how brave you are. I never FELT brave - I was just putting one foot in front of another, doing what my doctors told me to do. And now, five years later, hopefully it's over.

Domestic abuse is different. It's not all that straightforward. Everyone gets angry and yells, so when is it abuse? He has never HIT me, so how can it be abuse? Yes he calls me names sometimes, but is THAT abuse? If he's a little controlling, well that's marriage, isn't it? Of course no one WANTS to be in an abusive relationship, and sometimes there's a little denial built in. You think that your mother "fell down the stairs" often and wore long sleeves in summer and sunglasses at night. THAT's abuse. Your relationship is nothing like THAT. You don't want it to be abuse because then you have to do something about it . . . get him into a program or maybe even leave.

When you're living with an abuser, no one calls you brave, few are empathetic. Either they don't know about your situation because you and he are so good at covering it up, or they do know (or suspect) and they don't understand why you don't just LEAVE. They say things like "If some man tried to do that to ME, I'd let him have it!" "I'd never put up with THAT." I said things like that when my colleague was brought to our ER covered in blood and bruises after her SO attacked her with an ax. She was late coming home from work because her patient coded at change of shift. I said things like that when another colleague was beaten to death by her husband on Christmas because she didn't have enough of his favorite beverage on hand. I didn't get it. Now I do.

What I didn't get until recently was that even if he doesn't hit you, you might be living with an abuser.

It starts gradually. He yells a lot, but he's under a lot of stress. He has a temper. He throws things sometimes. It isn't a big deal as long as he's not throwing things at ME, right? And then one day you realize that he's been yelling at you every day, sometimes three times a day. He blames you for things that aren't your fault or are actually HIS fault. He's NEVER at fault. You cannot bring up a grievance with him because he "goes ballistic" no matter how carefully you choose your time or your words. Nothing is a problem unless it's a problem for HIM. You don't bother him with things that might need fixing around the house because he'll tell you it's not a problem, or it's your fault, or he'll just have a tantrum about how useless you are and how he has to do EVERYTHING. He screams at you and calls you names, and you have no idea what set him off. You tried very hard to do everything the way he wants it done.

And then the day comes when you dread hearing his car in the driveway, his key in the lock. Is the house clean enough? You don't dare let him catch you reading a book or listening to music - hurry quickly and find something to do so you look busy when he comes in the door. You've come from the hairdresser's and she's cut your hair too short and you start trying to explain how it's not your fault before he can explode. You're still thinking it might be your fault - maybe if you had told the hairdresser more specifically. Maybe if you kept the house cleaner, were a better cook, were thinner or more attractive he'd be happy with you and he wouldn't yell so much. There must be SOMETHING wrong with you to make him talk to you that way.

One day he brags that you're so stupid he can get you to do whatever he wants just by having a tantrum. You realize that you're doing your hair the way HE likes it, not the way you like it. You're able to leave the house without a hassle if you're going somewhere HE approves of. You want to go to the bookstore (which he disapproves of) but you say you're going to the gym (because he approves of that.) You're getting ready to go to an important job interview and he starts screaming and smashing dishes . . . you cry all the way to the interview and you don't get the job. He doesn't want you to go to school or apply for a promotion or whatever because HIS needs come before yours. You realize that he's willing to drive you to your radiation therapy appointment (because he doesn't blame you for having cancer) but not to physical therapy after you get your knees replaced (because if you weren't too fat you wouldn't have needed a knee replacement.) You wonder what will happen when you're older and sick and need him . . . and you hope that whatever you get, it will be on the "approved" list.

And then one day someone on allnurses.com recommends a book about verbal abuse and you pick it up, just for a lark and you read it. And all of the things they describe in there - it looks just like YOUR relationship. YOU are in an abusive relationship. He's controlling, he's manipulative, he's nasty to you . . . but at least he doesn't hit you.

At least he doesn't hit you, but he criticizes your body and refuses to have sex with you until you lose 50 pounds. At least he doesn't hit you, but he leers at other women in front of you, and tells you how hot they are and how not you are. You feel ugly and stupid and lazy and . . . all those other things he tells you you are.

And then you look in the mirror one day and you realize that you no longer recognize yourself. This person isn't who you are. Your partner tore you down, damaged you emotionally, made you doubt and disrespect yourself.

But at least he doesn't hit you. Until he does.

I wrote this six days before I left my husband. I've been through a physically abusive marriage and come out the other side, but the verbal and emotional abuse was so much worse, so much more destructive. He never actually hit me, but he threw things, threw things at me and then he threw ME. I am eight months and five states away from being the person who wrote this, and I am starting to remember who I was before him, starting to become that person again.

When I left him, I had no where to go. I stayed with friends, technically homeless. I'm still staying with a friend, but it's home now. I took what I could fit into the trunk of a rental car -- the smallest rental car. My family's antiques, my car, our house, our boat . . . all gone. I had my photos on a thumb drive, my clothes and my dog. I'm in my 60s, starting over from scratch. I own a down comforter now, a crock pot, a butter dish and my mother's silver. My collection of pots and pans, mixing bowls, tupperware and all those bits and pieces that make up a kitchen are in my past. It's not easy, but I can do it. I will do it.

For all those who say "Why doesn't she just leave him," think about getting up from your computer with the clothes on your back and leaving with only what you can fit into the trunk of a rental car. Running. Could you do it? Would you do it? Leaving isn't easy. It's possible, and often it's better than the alternative, but it's not easy. Think about that -- what would leaving look like for you?