Domestic Violence: "Are You Safe At Home?"

[Ruby Vee, BSN]

I was taken by surprise by the question, although I shouldn't have been. As a nurse, I know it's a standard question on the standard intake forms, although it is often skipped over and almost always asked without expectation of a real answer. And because I wasn't prepared to answer, I gave the truthful answer and then burst into tears. No. I wasn't safe at home. In fact, I was so unsafe that I had walked away with what I could carry -- and my dog. I walked away without my medications, my glucose testing supplies or my CPAP. I didn't have clothes beyond a couple of changes of underwear, or toiletries or makeup. I didn't even have a credit card. I did have a driver's license, insurance card, social security card and passport.

I will never forget the look of horror on that MA's face when she did a quick double take and realized that she had before her a patient who had actually answered that she was not safe at home. My primary care provider, when she appeared, seemed to have no more idea of what to do with the question -- and my answer -- than the MA. It was a good thing that I knew what I wanted.

"My husband is abusive," I told them. "I had to leave without my medications, my glucose testing supplies or my CPAP. I need prescriptions for all of that, since there are no refills. I'll need a hard copy of the prescriptions, since I don't know where I'll be living." Or even, although I didn't say that, where I'm going tonight.

In the end, I left the office with a requisition for lab work and an appointment for a physical next week. The PCP didn't feel comfortable authorizing even a 30 day refill without the labs, the physical and another sleep study. I was pleasant and cooperative, even though I could feel my stomach sinking down to my toes and my bowels turning into water, and went straight to Quest to have my blood drawn. I left the PCP's office without the phone number of the local women's shelter or legal aid, and without any kindness, sympathy or reassurance. From Quest, I went to the bank.

At the bank, I found kindness, sympathy and reassurance. Go figure. I have always heard that banks are cold and completely lacking in soul. In reality, that described the PCP and her staff. My credit cards were reported as lost or stolen, the account numbers changed and new cards were over-nighted to my best friend's address, a thousand miles and five states away. Even without an ATM card, I was able to get cash from my savings account, and the bank manager arranged for me to rent a car without an actual credit card. I'm not sure how that was even possible, although I think it involved a close relative who worked for the car rental company, a relative who brought the car to the bank. It was also the bank manager who invited my dog in the back door and gave him Milk Bones and a dish of water and who looked up the phone number for the women's shelter and called to inquire whether they could take me (and my dog) for the night. They couldn't.

I left the bank manager's office late in the afternoon, much calmer and filled with hope for the future, and began the thousand mile drive to my best friend's home. When I stopped for coffee and a sandwich a few hundred miles later, I pulled a wad of cash and a withdrawal slip out of my pocket. No matter how many times I counted the cash, there was still over $200 more than what I had actually withdrawn from savings. A small slip of paper in between the brand new bills, said the bank staff been taken with my adorable dog, and asked me to "Pay it forward." As I sat there sobbing, the waitress brought me an unordered slice of pie and the bill, charging me only for the coffee.

A week later, I was back in my PCP's office having left my dog with my best friend and driven a thousand miles back in the rental car. My labs were normal, my exam was normal, but the PCP was still fixated on having the name of a pharmacy so she could electronically transmit my prescriptions. I left her office with no sympathy, no phone numbers for domestic violence shelters or legal aid programs, nothing beyond the basic prescriptions.

One of the neighbors kept watch for my husband while I grabbed some clothes, my laptop, my purse and my mother's wedding rings. When I returned the rental car, one of the staff drove me to the airport to fly back to my friend's city. Glucose testing supplies are cheaper from Amazon than they are at the pharmacy with my insurance. I could replace my CPAP from an online supplier without another sleep study since I already had my prescription on file with them. The pharmacy near my friend's home wasn't covered by my insurance plan, so they gave me a few days of pills and looked up a pharmacy that WAS covered by my insurance and transferred my prescriptions there.

It's interesting to me that none of the people who were kind to me, who helped me when I needed help the most were required to ask me if I felt safe at home. The bank manager certainly wasn't obligated, nor the car rental company, the waitress at the truck stop, my neighbor or even my best friend. The MA who did ask was totally unprepared for the answer, as was my PCP. Why did they even ask? Because they had a box to check.

If you're required to check that box, give some thought to what you can do for someone who ISN'T safe at home. Is there a women's shelter in your area? Is there a free or low cost legal group and can provide help obtaining a restraining order? Will the local police department accompany the woman to her home so she can safely pack a few things to take with her? Is there a boarding kennel or vet's office who will take a pet overnight if the women's shelter cannot? Are there taxi vouchers or bus tickets to help her with transportation? If she has had to leave without her phone, can you call a friend for her? Can you give her drug samples for a few days? Write that hard copy without harassing her? Does your office have a slush fund to give her a few dollars to "rent" a table at Starbuck's or Panera so she can sit and think, regroup or wait for a friend to come and get her?

I didn't get any help from the first place I expected it, but I did from the last place I could have conceived of. Be like the bank manager, not my (former) PCP.

[canoehead, BSN, RN]

Thanks Ruby,

For sharing your story and a lot of ideas that will help my next patient.

[pixierose, BSN, RN]

Great post, Ruby.

I ask this question upon every admission; male, female, young, geriatric ... I've learned a great deal from the amazing social workers that I work with about the resources in our area. And I'm still learning.

But the answer "yes" still takes my breath away momentarily.

Anyone can be kind and compassionate; being a caring human being and doing the right thing shouldn't be that difficult. Sadly, many forget the human connection to health care.

[Tenebrae, BSN, RN]

I think there can be that intial "oh crap" feeling when we ask that question and the person responds in the affirmative.

That said. Knowing how hard it can be for women to leave, and often it takes the smallest things to send someone back to their abusers, for the love of God when someone answers in the affirmative to that question.

Why would the next question not be "how can I help you?" or "what do you need?

[Lunah, MSN, RN]

I remember a fortune cookie that was particularly wise: Never begin something without considering how it will end. By that same token, don't ask the question if you aren't ready for the answer. Shame on your former PCP and MA! Part of the privilege of getting to ask such an intimate and important question is knowing how to provide the compassionate assistance that may be required.

[ICU-BSN]

I am so sorry for what you went through Ruby. I am glad that you safely withdrew from your situation. Thank you for this post, it was very insightful. You are correct, I'm not sure WHAT my response or actions would be and this has given me something to think about and points to formulate a plan should i ever experience this with a patient. Thank you for sharing.

[Tenebrae, BSN, RN]

I didnt think this would become so relevant in my own life so quickly

Found out today one of my care staff is in a domestically abusive relationship which all came to a head in the middle of the work day.

Fortunately we were able to get her out and to a safe place, however this whole thing was confounded by the fact that the abuser also works in the same work place

My ability to remain professional was sorely tested today

I really hate people who think its ok to hurt other people.

[Buckeye.nurse]

Thank you for sharing your story Ruby Vee! I too was in an abusive relationship in my younger years. I went to the same ER 3 times for injuries (twice for a severely bleeding nose that I thought was broken, and once for a broken hand). I was never questioned further after giving suspicious reasons for the injuries, and was never offered help. Luckily, I eventually left my abuser, but I wonder if I might have left sooner if a medical professional had questioned my stories more thoroughly (and then offered help and resources!). One of the reasons I stayed so long is that I didn't have a clue as to where I might go.

Now, as a medical professional, I take the safety at home questions very seriously. I've only had a patient answer no once--and when it did it took me by surprise--but the "No" answer ended up involving social work (who, by the way, are freakin' amazing), case management, our manager, and security.

[Daisy4RN]

Thank you again for sharing your personal experience. I have had patients who answered that they were not safe and I was happy to assist. I know your posts will help many people. Hope you are well and happy!!