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.

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

Sometimes we have to. Sometimes the patient insist the family stays. Or they are bilingual. Or a minor.

It's easier on night shift. 9/10 times the patient is alone. I usually don't let the family in until I've asked, anyway. The rest of the time, I kick the family out. It hasn't been an issue yet.

Specializes in Cardicac Neuro Telemetry.

Thank you, Ruby for getting this discussion going. Thank you to ALL who shared your stories. Hugs to all....

Specializes in Family Practice, Med-Surg.

I did my Master's project on domestic violence. I didn't understand why I was so fascinated by the subject. One day I picked up "The Verbally Abusive Relationship" by Patricia Evans. I got it. I was severely verbally abused. I was confident my husband would not lay a hand on me, and we are still married, 40 years in December. He has never laid a hand on me. But, I have been suicidal. Years ago I was a conservative Christian (I am now quite liberal). I couldn't get a divorce, it's the easy way out, don't you know? We have been slogging it out with incredible therapists for 13 years. My husband no longer blows up at me. He finally learned it was unacceptable. He always knew it because he was never abusive in public. He would blow up on his birthday, on holidays, if he was cut off in traffic, just any old time. I was always walking on eggshells. I stayed with him for the sake of the kids (mistake). Now I stay for other reasons. For some reasons I still care for him even though the quality of our relationship is mediocre. I don't want to split our assets. I don't think his life expectancy is long.

Think long and hard before you marry. I wish I had divorced him when it first occurred to me 38 years ago. Make sure your mental health is good. Vet him with family and friends you think are wise. Observe his parents marriage. Read some books. Get some therapy.

Not as serious as a husband who beats you? But when does it cross over? My youngest son was also abused verbally. He has been severely depressed half his life and has PTSD. He attempted suicide twice this summer. Don't make the mistake of overlooking verbal and emotional abuse because you are not being hit.

I grew up in a home where DV was an every day event. When my mother's BF was done with her he would start on me. It was physical, it was emotional, it was everything. I was the only adult in that house and I was responsible for caring for my younger sibling. I was also expected to take the beatings so he wouldn't get any (which I would have done anyway because he would have prob. been killed with that was done). I went without food, heat, etc. I will never forgive my mother for allowing the things to go on in the house that did. That is my right as a survivor as well.

That being said I know how tough it is to leave. You can do EVERYTHING right, and it is still not enough to stop someone. DV is not taken seriously enough. We tell women to leave, but do not help them. Most often they need to escape, and get far If you know someone who is suffering reach out to them. Offer to be an ear if they are not ready to leave, offer to assist with a bus fare/plane ticket/cab ride the heck out of there for them and their children. So often they don't have a cent to their name so they cannot afford to simply get away. Help them come up with a plan if they are ready. If you are comfortable with it, allow them to stay at your home (just know there are risks involved with this). Help them rebuild the self esteem that has been chipped away from them for years. It is simply not enough to say walk away.

As a nurse, if you have a suspicion, don't just ask carelessly. Look them in the eye, let them know you are only there to help, even if they aren't ready to leave that night.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Thanks for sharing your story!

I have one of my own.

Some years back, I was engaged to a military cop. We were together quite some time before the abuse began so very slowly, gradually and subtly.

He began by complaining when I went out with friends or called family back home. He wanted me to spend all my time with him, all my energy ON HIM.

I acquiesced. I began making excuses to friends for not going out with them and stopped calling family back home.

Then, we had a pretty lively argument. It ended with him pushing me. I landed on my back. He was instantly sorry and helped me back up, crying big tears, telling me how sorry he was. I believed him and shrugged it off.

A couple more pushes here, a shove there, always ending with tears and heartfelt apologies.

Meantime, I was literally isolated from all my friends, except for ONE who he happened to like, maybe cause she was gay. He liked her a lot. He would not have liked her so much if he knew she was all the time, trying to convince me to leave. I brushed off her concerns.

Then one night, I will never forget. His eyes were dark and he appeared to be in a rage. He picked a fight with me and at first was just yelling, which I was used to. Then it happened. He grabbed me by the neck and choked me. I was losing consciousness. I was scared out of my mind, but I remember thinking, if I got out of this alive, I would leave. For good.

And just like that, he dropped his hands. But he started walloping me in the back and sides. Then all of a sudden, he stopped it all. He left the house.

I called my friend and told her what had happened. I ran across a 4 lane highway to get to her house, with just the clothes on my back.

A couple hours later, he came banging on her door, demanding I come out. I called 911. The cops came and he convinced them nothing was wrong. And I am sorry to say, they believed him cause he was a cop and left.

Meantime, with a policeman there, I moved out.

But that was not the end of my ordeal.

I had an unlisted number, but he got hold of it and called me dozens of times a day, late at night, all hours and threatened to fire bomb my car and apartment. No one would help me. It was awful. I went to his commander who ordered him to stop harassing me. But that made him angrier. He followed me everywhere I went and threatened me every chance he got.

Then one day a good friend of mine heard my plight. He was a Hells' Angel rider but a really, really soft hearted man and he was enraged that I was being hurt and threatened by any man.

So one day, with a few of his friends, he visited the guy and they surrounded him and basically, did what I know was not legal, but was unaware at the time------------they threatened to break both his legs if he did not stop bothering me. Now I am NOT advocating for threats or bodily harm, this was done without my awareness at the time.

But it worked. He never bothered me again. Because bullies like this, when confronted, often back down and cower. And that was what he did.

It scarred me for a long time and it took a very long time to trust again. I had been raised by a very abusive father who physically and mentally tormented me, so it was what I knew. So I repeated the cycle by finding the most abusive, clever con man who turned my head with pretty words and acts. But I deep inside, felt it was what I deserved.

My father let me down as a daughter, and I repeated the cycle. But I got out of it and resolved never to put any kids I had in that position.

With a lot of counseling and good friends, I have gotten well and know what I will and won't tolerate. I am married to an amazing man now, and my life is wonderful. He is an amazing dad to our kids. My daughter worships the ground he walks on.

GET OUT! It's hard, but It can be done. But it ain't easy to escape domestic violence. There are APPs on phones now and other tools to help people escape their violent partners.

I see patients who I know are in such situations and the anger in me rises like you would not believe. I always report what I am sure is a domestic violence situation and sometimes, it helps, but most times, not. It's hard to escape. I know that.

I pray for all who are in such situations, that they find a way out and live good lives.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Do we really ask patients in front of the significant other if they feel safe at home? and expect an honest answer???

Yes, sometimes we do. I'm sure we don't expect an honest answer, and sometimes I don't think we want one.

Specializes in allergy and asthma, urgent care.

Thank you to Ruby for writing this article, and to all the others who have shared their stories. I was verbally abused for many years by my alcoholic ex-husband. It took years for me to finally kick him out and get on with my life. I understand how hard it is to leave, especially if you have no support, no money, and no place to go. I had all of those things and still couldn't do it, until the day he threw a chair at me. That was it for me.

I hope that all who are in such situations can find a way out.

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.

Not to sound glib, but isn't that what a SW consult is for? I feel like addressing domestic violence in a situation like this is really outside of a nurse's ability. Aside, of course, from offering emotional support and acting as an advocate. But it seems our advocating in this case really just amounts to making sure the patient gets in contact with the appropriate social work staff.

Not to sound glib, but isn't that what a SW consult is for? I feel like addressing domestic violence in a situation like this is really outside of a nurse's ability. Aside, of course, from offering emotional support and acting as an advocate. But it seems our advocating in this case really just amounts to making sure the patient gets in contact with the appropriate social work staff.

Nooooot, really. I will always try to get SW involved, because they are the liaison between us and the community resources. What about a new admit to the floors at 0300 on a Saurday? SW is not on the premises and may not be until Monday.

I'm in a school now, and I am a mandated reporter. I have called CPS for familial violence against a minor (fancy!) without SW or Psych being on board.

I feel like DV is enough of an emergency that you can't always wait for SW, especially concerning a rape, or like LadyFree being shot, or these women who were strangled. Call DDS, the police, whatever, just escalate it. SW can get involved later.

I've been doing some reading and came across this. The Boyfriend Loophole:

[COLOR=#2c557b]UltraViolet | President Obama: Keep guns away from violent abusers. Close the "boyfriend loophole."[/COLOR]

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President Obama: Keep guns away from violent abusers. Close the "boyfriend loophole."

When a survivor of dating violence files for a restraining order, her abuser shouldn't be able to buy a gun.

But because of something called the "boyfriend loophole," abusers in at least 35 states can still legally purchase guns--simply because they didn't live with or marry their targets. So it doesn't meet the legal definition of "domestic violence." The effect is shocking: Half of all women killed by intimate partners are killed by dating partners.

Here's the good news: If we act fast, President Obama can close this loophole with an executive order--without congressional approval. Right now, the administration is considering a number of executive orders to curb gun violence, and if we show widespread public support, closing the "boyfriend loophole" will be one of them. Will you add your name?

Tell President Obama:

"Take executive action to close the 'boyfriend loophole' and prevent abusers from easy access to guns."

Thank you so much for writing this article.

I left an abusive relationship 6 years ago and it took a long time to start to feel like myself again. Before that I never thought it could happen to me. It started with verbal jabs and then just escalated.

The first time it got physical I just started to cry- I was worn down by then. He made threats about what he would do if I left.. graphic ones..and honestly I was ashamed that I allowed this to happen. I say "I allowed" because, at the time, I thought it was my fault. Yes, this person managed to convince me I was wrong.

I was in a different part of the state from my family so kind of isolated from them. I finally told them what was going on. Long story short, someone in my family helped me get away and I moved forward.

I'm graduating soon and thankful I got out before it was too late.

I don't talk about it much and I almost didn't post. But I hope this thread helps someone. No one has the right to hurt you.

If there's more awareness, especially in healthcare, there is at least a better chance of getting help for someone who needs it.