You could instantly tell something was wrong
A nurse's intuition / insight are essential aspects that can allow one the ability to make a difference in someone else's life ... You could instantly tell something was wrong. Perhaps it was because her husband answered all the questions, the way he treated her, or the faint purplish bruise still visible under her heavy make-up. Something was wrong.When she entered the clinic with her husband, you could instantly tell something was wrong. Perhaps it was because her husband answered all the questions directed at her when she was being registered at the front desk in GYN, the way he seemed to treat her or what appeared to be a slight purplish bruise around her right eye that was still faintly visible under her heavy make-up.
When the patient was being roomed, the husband insisted on accompanying her, stating, "I don't want my wife to be examined without me being present". The staff informed the husband that all MD's have a chaperone. But, the husband refused to wait in the waiting room and insisted on being in the exam room during his wife's GYN exam.
One of my Senior RNs came into my office and said, "I think we have an issue". "There is a husband who was very loud all the way down the hall. He also seemed intimidating / over-bearing toward his wife". The RN insisted she had a "hunch" there was something not quite right going on between the husband and the wife. I asked her to be more specific. The RN said she suspected that the husband may be abusing the wife. She thought she noticed a faint bruise on the wife's right eye and one on her arm, when she passed them in the hall. She said the patient had heavy make-up on her eye so that bruise was faint. She stated, "I've seen this sort of thing before. Based on how the husband and wife are interacting, I have a feeling this is domestic intimate partner abuse." Based on the RN's cursory assessment, I felt it was essential we get the patient alone to make sure she was safe and further assess if she truly was a victim of domestic violence / intimate partner abuse.
As the husband would not leave the wife's side, in order to get the patient out of the exam room and away from the husband while she waited to see the MD, I had the RN give the patient a wrap-around gown and inform the patient that we "needed a urine sample". The RN had also grabbed a domestic violence / intimate partner prevention referral brochure from the acrylic wall holder in the restroom, and hid this brochure in her lab coat pocket to give to the patient after she got her out of the room. The husband wanted to come with the wife, but I stepped in and reassured him that his wife would be right back. I asked him to stay to watch her purse. He reluctantly agreed.
The RN actually took the patient to another exam room at the far end of the hall instead of the restroom. The RN told the patient why she actually pulled the patient out of the 1st exam room into a 2nd exam room. The RN said she noticed the patient had bruising under her make-up around her right eye and on her arm. She asked, "How did the bruises occur?" "Were you in an accident?"….."Or did someone do this to you?" She discussed the information with the patient on the DV/ IPA prevention brochure and asked the patient if everything was okay at home. The patient stared at the RN in silence, then her bottom lip started to quiver. The patient remained silent for what seemed like a minute.
Her lips quivered more, then the tears started to flow. She could barely speak. Then she blurted it out…"It's been going on for two years." "When we first got married he was very loving, but everything has changed, he changed." The patient was now crying so hard, the nurse had difficulty understanding her. The patient continued, "He is having financial troubles with his business." "And, now, everything I do makes him mad." "I don't know what to do." "I'm embarrassed to tell my family." The RN was silent. She said, "How often does he hit you?" The patient stated, "It started out just once in a while, now it's progressed to a couple times a week" "I never know what will set him off", she continued to cry. The RN said, "Do you have other bruises on your body?" The patient answered "yes".
The RN told the patient she needed to inform her Nurse Manager, then cautiously opened the exam room door. The RN checked down the hall to confirm that the husband wasn't standing outside the 1st exam room at the far end of the hall. The RN then motioned to me. I instantly knew what occurred when I walked in, based on the look on the face of my RN and the crying patient. The RN quickly filled me in on everything. By this time, the patient's make-up was running from all her crying, so her bruise on her right eye was becoming darker under her eye as her make-up came off. I gave the patient some tissue and held her hand and told her we were sorry this happened to her, but it was important for her to get help so this doesn't continue. The patient nodded her head between sobs. It was a very difficult situation. I told the patient, "Violence is never okay". "We're here to provide you with resources to help you."
The standard required domestic violence/intimate partner abuse procedures were followed. Information was reviewed again with the patient regarding her rights as a victim and the patient was seen by the MD in the 2nd exam room she was in away from the husband. The couple had no children.
By this time, the husband started to cause quite a ruckus when his wife didn't return to the exam room, so standard procedures regarding this sort of incident were followed. The patient contacted her aunt and uncle and was able to go stay with them. The aunt and uncle were shocked by the news, and kept thanking us for stepping in. The patient was also referred to a therapist specializing in domestic / intimate abuse with follow-up with her physician. The husband went home separately.
A few months later, beautiful flower arrangements arrived for both my RN and myself, along with a box of chocolates for us to share. Attached to the chocolates was a thank you note to the both of us. These were from our patient.
It said, "Words can't express my gratitude for the help you both provided. You are truly angels. You don't know how much you have changed my life. I am feeling more confidence in myself every day. I am separated from my husband and am getting divorced. I plan to look for a new "healthy" relationship. Thank you from the bottom of my heart."Last edit by Joe V on Jun 119Jun 11 by ChristineNThis was a good catch and this woman may literally owe her life to those nurses.
The other detail I found interesting is that the clinic had a protocol for dealing with suspected cases of intimate partner violence. How many health care facilities actually have such policies and how many nurses are actually comfortable identifying signs of abuse (and most of the time it is not as obvious as this incident)7Jun 11 by SeattleJess(Wiping tears.) Wow. What a miracle. (And you are an excellent writer - your telling of this tale gripped me and didn't let me go. Even after the end of the story, it's still with me.)
It really is a miracle you and your colleagues were able to step in and to do such a clean and effective intervention. I worked with DV victims in the court system for years and it was heartbreaking work. The abusers don't break her arm on the first date; no, they are "sweet" and the abuse starts with verbal abuse and then escalates. The abuser lives in the world of control; the victim lives in the world of relationship. His goal is to control; her goal is to repair the relationship. He gradually undermines her self-esteem and mental functioning. It's so sad that the woman begins to crack and it can look like she is the crazy one. Other women can comment about how "lucky" she is to have such a funny, kind and considerate husband.
The heartbreak is that recovery after that first intervention is often not a linear path; it takes time for a woman to unlearn.
The Verbally Abusive Relationship, by Patricia Evans, is a must-have reference book. It can help women to make that critical conceptual shift that is so important to recovery. Read it, recommend it, pass out copies!
(Rarely, the abuser is a woman and sometimes the victim is a man. I never encountered that situation myself.)7Jun 11 by RschIVF40Thanks for the feedback! ...I've worked in the field of Women's Health / Fertility for many, many, many years. This actually does happen more than you think. Sometimes the abuse is not physical, but rather verbal. I've seen this as well in the Fertility field, i.e. where the husband / male partner, will blame the wife / female partner, for not being able to get pregnant, and/or having recurrent miscarriages, and then verbally abuse the wife / female partner. The stress of not being able to conceive is difficult enough without having to deal with verbal abuse from the person who should be supportive through the process.
In response to ChristineN, if your particular clinic doesn't have Domestic Violence / Intimate Partner Abuse protocols in place, if you check out information on the CDC's website, there are a number of helpful tools available. Here's the link below to the CDC's website for reference. The best place to post information on DV/IPA brochures / posters is actually in the women's restrooms as that is the one area where a female may access the information without being overseen by her abusive partner. I believe there are examples of protocols as well..Hope this helps!
Intimate Partner Violence|Violence Prevention|Injury Center|CDC8Jun 11 by liebling5I survived DV for years and hid it from my co-workers/family. My ex appeared very charming to most people. I thank God every day that I got away and got help. It's true that it takes the woman years to break the cycle of emotional pain and co-dependence. Now, I can recognize the patterns of build-up from verbal to physical abuse. I advise those who tell me about any type of abuse how to get help. This is an important topic that is not discussed often enough. I'm glad this situation ended well for the patient. You are literally a life saver