Domestic Violence: The Elephant In The Room

October is Domestic Violence Awareness Month. It is a conversation that is difficult on either side and for every participant. But it's a conversation that could save a life. Maybe your patient's life. Maybe your best friend's or your sister's. Maybe yours. Nurses Announcements Archive Article

October is Domestic Violence Awareness month. It's a topic that has been addressed online and in print, but one that is excruciatingly difficult to bring up in a face-to-face conversation. I know this as a nurse, because it is awkward and uncomfortable to initiate the conversation with my patients, but I also know this as a survivor.

Recently, when I visited my oncologist, she brought up the topic in a perfunctory sort of way. "Do you feel safe at home?" she asked me, in exactly the same sort of manner she had asked me if my penicillin allergy is still current and if I'm taking my meds daily. She didn't make eye contact and it was clear she desperately wanted my answer to be in the affirmative because she wasn't comfortable discussing a negative. I don't blame her. It wouldn't have been comfortable for me either - on either side of that conversation. The thing is, I haven't always felt safe at home. My parents were violent and, like many survivors of childhood violence, I grew up to be a survivor of the more commonly thought-of domestic violence. Thirty years ago, I lived with a man who hurt me.

In the 1980s, no health care practitioner asked me if I was safe at home. And I wouldn't have known what to answer if one had. Domestic violence occurs at all socio-economic levels, in all strata of society. But it's one of those dirty little secrets that no one wants to admit to. I doubt you will ever encounter a man (at least not in our culture) who admits to beating his wife. (Or to being beaten by her, for that matter, because such things, while more rare, do happen.) And no one wants to be the woman who admits to being beaten. It's stigmatizing.

Thirty years ago, just before I married my abuser, I had a colleague whose live-in boyfriend commonly blackened her eyes when dinner wasn't ready on time. We all saw the black eyes. We all discussed her situation in hushed whispers so Donna wouldn't know we were talking about her. Then there was the day she showed up in our ER, left hand hanging by a thin shred of skin. Her partner had attacked her with an axe. It wasn't until then than Donna was willing to admit to being in an unsafe situation. She was scared to death he would kill her - and rightfully so. I remember discussing the situation with my friends and my soon-to-be husband. "No one would get away with that with ME," I proclaimed arrogantly. "If a man lifted his hand to me, I'd leave him." And I meant it. I thought I knew better. And I DID know better - until I didn't.

It started off slowly enough. He was transferred two thousand miles away from my friends and family. I made new friends, slowly, but that isn't the thing you discuss with a new friend. He became increasingly verbally abusive. He started throwing things. He started throwing things in my direction, which advanced to throwing things at me and then to throwing ME. There was a perfect impression of me in the drywall of our hallway, left when he slammed me against a wall. During one memorable fight, he threw me down a flight of stairs - the concrete stairs of our stoop. That could have killed me. It didn't, but it scared me. I went back into the house, packed a bag and flew to California to stay with my best friend for two weeks. I was too stupid or too ignorant to know how dangerous it was to go back into that house and pack a bag. I didn't understand that leaving is the most dangerous time for a woman. And I was too stupid not to go back when he agreed to get counseling.

Even in the counselor's office, it was excruciatingly embarrassing to admit that *I* was "an abused wife." Imagine how difficult it would be to tell your oncologist or your gynecologist or your PCP such a thing. I felt stigmatized, I felt "less than." It was now my dirty little secret, one that I didn't want anyone to know. And when it did come out, reactions were pretty much what I had envisioned. There was a lot of chest beating and proclamations that "I'd never let a man beat ME." Or "Why didn't you just leave him?"

I didn't leave him for myriad reasons, some valid and others not so much. I didn't want to admit defeat, that my marriage had failed. I had the first divorce in my extended family. I'm pretty sure I wasn't the first wife who endured physical violence. Our lives, finances and possessions were entwined. If you think that's a trivial reason, try to imagine yourself, right this moment getting up from your computer and leaving your home. Don't change your clothes, don't pack a bag. Just get up and walk out of your home with what you're wearing (flannel pajamas and comfy slippers? Ragged jeans and a T shirt) and what you can grab on your way out without slowing. Imagine that you might never be allowed to return to your home. What treasures are in that home that you'll never see again? Your grandmother's engagement ring that she gave you as she lay dying? The family Bible? Your photo albums, your purse, your dog? Your child maybe? Think about that for just a moment.

It's easy enough to SAY that things aren't worth your life. Your children, maybe but not Grandma's ring. But if you haven't lived it, you have no idea what it FEELS like. And until he actually tries to kill you, you may not get it that he might literally do so. Even if you know it in your head, it may not penetrate to that visceral level that demands action.

I left after my then-husband tried to strangle me to death. And because I met him through a blind date arranged by friends, I told those friends exactly why I left him. Then I had to endure dozens of rounds of "He's such a kind, gentle man. He would NEVER do such a thing. You must be making it up." "He's such a friendly, HUMBLE man. He'd never do that." We have all heard the rounds of praise heaped upon the head of a domestic abuser, the disbelief that "someone I know would do such a thing." Anyone who has read this board for more than a month knows that to be true. The knee-jerk expression of those beliefs is just one more type of abuse that the survivor of domestic violence has to face. I lost all of OUR friends, most of mine and even some family members because I finally found my backbone and wouldn't tolerate those kinds of comments, that kind of abuse.

It's not fair that a survivor of domestic violence has to lose her family, her friends, her reputation and her most treasured belongings. It's not fair that she has to listen to people who know HER postulate on how she must be making it up because they KNOW he "isn't that kind of man." None of it is fair.

October is Domestic Violence month. If you are in a relationship where you don't feel safe, make a plan. You don't have to leave right now if you're not ready. But have a copy of your insurance card, your social security card, your birth certificate, your passport somewhere safe where you can get to it but he can't. Keep extra keys. Have your own credit card and bank account, keep some cash. Park your car where it cannot be parked in. Keep your gas tank full. Know a safe place to go and at least three different routes to get there. Know who you would call to pick up your kids at school or daycare if you can't get to them. Have a plan. Please have a plan. Domestic violence doesn't just happen to other people. It can happen to you. It can happen in the wee hours of a holiday morning, on a Monday evening when he's had a bad day at work or his football team is losing or just before you're supposed to show up at your sister's wedding. Don't become a statistic.

For other articles in this series about domestic violence please read:

Domestic Violence: What Leaving Feels Like

Domestic Violence: Rebuilding


References

Bruised All Over - Nurses play role recognizing and stopping domestic violence.

Specializes in Psychiatry, Community, Nurse Manager, hospice.

It's extremely distressing for me to hear the author call herself stupid, multiple times. The shame is obviously still there.

It's extremely distressing for me to hear the author call herself stupid, multiple times. The shame is obviously still there.

I know. Ruby is the ANTI Stupid. :sorry:

I was thinking about this the other day. (Domestic violence, I mean.)

We have this question on our admission form, "Are there situations in your relationship where you are afraid or concerned for your safety?"

We also have an extensive flu/PNA screening form. Y'know, on the flu/PNA screening, there are instructions what to do if the answer is "Yes."

There are no instructions about what to do if the abuse/neglect screening answer is "Yes."

I thought about it, and I really don't know what to do if I get a "Yes" answer. Not in any helpful way, I mean. I know to report it, but does that really help an abused woman who only has the clothes she came in with?

We should have some sort of Underground Railroad that we can call. A representative would swoop in, give the victim money/clothes/instructions, and put them in some kind of DV protection program.

I have family who have needed such a thing.

I agree. I have had women in the clinic I suspected were abused. Once I called DSS. Once I called the police, because she was also raped and in shreds. I've also had women in the clinic refusing to go across the street for a rape kit, because of the shame, fear, what have you. Dammit.

And the kids. I've called CPS and referred many others to SW or Psych since I've been here. The kids are almost easier, because I MUST report. I am a mandated reporter.

The women do have the right to refuse treatment, and often do.

Specializes in Hospital medicine; NP precepting; staff education.
I agree. I have had women in the clinic I suspected were abused. Once I called DSS. Once I called the police, because she was also raped and in shreds. I've also had women in the clinic refusing to go across the street for a rape kit, because of the shame, fear, what have you. Dammit.

And the kids. I've called CPS and referred many others to SW or Psych since I've been here. The kids are almost easier, because I MUST report. I am a mandated reporter.

The women do have the right to refuse treatment, and often do.

I've come across the women refusing to report thing even after I've made referrals and called for case management. The lady ended up leaving because CM took too long to come down.

I documented, documented, documented. And the result was the CM called the police for a welfare check. I don't know what happened after that. Still bothers me.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Thank you for sharing.

My sister left her abuser after nearly 12 years of marriage. We (her family) never knew the extent of the abuse until she moved to SC to live near our mum. She then finally opened up. She explained to us that she didn't leave him sooner because he played the "your grandma wouldn't have left your grandpa when he was sick" card. (He had a bad back). He did a good job on playing the guilt card. She finally said "enough" and walked out, leaving all her possessions. We were lucky in that when my sister went to go get her stuff (after 6 years and a divorce) she was able to get it. But, she told me that it would have been worth it to let him keep our grandmas stuff in that house. She started to live again.

I have asked patients if they are abused, and the standard reply is "no". I have had a wife of a patient pull me aside and tell me she was abused by her husband. She used her husbands hospitalization to escape. She was in her 70's. Sometimes we forget that even the elderly can be victims of DV. SC has a very high rate of death r/t DV. Asking is a good start but it isn't enough, is it?

No, it's not enough. I wish I had answers, but I don't know what would be enough.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I was thinking about this the other day. (Domestic violence, I mean.)

We have this question on our admission form, "Are there situations in your relationship where you are afraid or concerned for your safety?"

We also have an extensive flu/PNA screening form. Y'know, on the flu/PNA screening, there are instructions what to do if the answer is "Yes."

There are no instructions about what to do if the abuse/neglect screening answer is "Yes."

I thought about it, and I really don't know what to do if I get a "Yes" answer. Not in any helpful way, I mean. I know to report it, but does that really help an abused woman who only has the clothes she came in with?

We should have some sort of Underground Railroad that we can call. A representative would swoop in, give the victim money/clothes/instructions, and put them in some kind of DV protection program.

I have family who have needed such a thing.

At the very least, we need some instructions about what to do if the abuse/neglect screening answer is "yes." You could start with asking the woman if she has a plan. It's an old, old book but Ginny NiCarthy's "Getting Free" helped me all those years ago. I wonder if it's still in print or on Kindle.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

I just checked -- Ginny NiCarthy's book is still in print on Amazon, and is also available in the Kindle format. I know there are much newer books that have more up to date information. But NiCarthy's book is what enabled me to start planning my escape.

Specializes in Addictions Nursing, LTC.

Thank you, Ruby, for speaking so eloquently for those of us who can't.

I wish my kids knew the person I was before.

I wish my dad had lived long enough to see me get out.

I wish the wonderful man I'm married to now didn't have to pay for the actions of another. I wish he didn't have a broken wife.

I have so many regrets, and I do feel stupid. Not only from being reminded incessantly how stupid and worthless I was, but for the countless times I told myself how stupid I was for being afraid to leave, for all the times people told me I was stupid for staying, and for allowing my fear to affect the lives of so many other people.

Thank you, everyone, for sharing. One day I hope I'll be able to share mine, in hopes that it might help someone. I'm just not there yet.

Thank you, Ruby, for speaking so eloquently for those of us who can't.

I wish my kids knew the person I was before.

I wish my dad had lived long enough to see me get out.

I wish the wonderful man I'm married to now didn't have to pay for the actions of another. I wish he didn't have a broken wife.

I have so many regrets, and I do feel stupid. Not only from being reminded incessantly how stupid and worthless I was, but for the countless times I told myself how stupid I was for being afraid to leave, for all the times people told me I was stupid for staying, and for allowing my fear to affect the lives of so many other people.

Thank you, everyone, for sharing. One day I hope I'll be able to share mine, in hopes that it might help someone. I'm just not there yet.

(((((pecas)))))

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Great discussion! Thanks, Ruby for posting your story and getting some discussion going about this sensitive topic. And thanks to others who have shared their stories. Talking/writing about it can be therapeutic.

Here is another article along these same lines that was posted by another member last year.

You could instantly tell something was wrong

Specializes in 15 years in ICU, 22 years in PACU.

Do we really ask patients in front of the significant other if they feel safe at home? and expect an honest answer???