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.

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.

You have a point about certain cases not being able to wait for a SW consult. The patient could be discharged home right back to an abusive situation before SW could respond.

It would be nice to see hospitals have wider power to intervene in these cases. And since the nurse is going to be the only person having any face-time with a patient at 0300 on a Sunday, I guess that does imply we have a role

Perhaps a new standard of asking the DV question only when significant other is not around would be a start? Maybe more people would speak up if they didn't have to say no to avoid further abuse.

Perhaps a new standard of asking the DV question only when significant other is not around would be a start? Maybe more people would speak up if they didn't have to say no to avoid further abuse.

This sounds easy, but the abuser is often hovering and the patient is speaking the words I want him to be here. Even if he did leave the room while you did an assessment your patient may be too terrified to speak...or so used to the abuse that it feels normal.

We need more education on how to pick this up, and how to best help the patient.

I don't know how, though.

Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

There's only so much a nurse can do. In my area, I experienced the following: I did disclose to the nurse the way my injury occurred-a blow to the back of my head, by my significant other. They did X-rays to r/o a fracture and called the police. This was their mandate, so I was told. Police came and did a welfare check around 9/10pm.

He and I both assured the police nothing was wrong.

Eventually, I got out. It was hard and long, but I eventually left.

I appreciate the protocols put In place to protect us DV victims. But I had to be in a place that made me need to get out.

I didn't want to live in a shelter. I had no real income. Dv is tough.

Us nurses can only do so much.

Specializes in Pediatrics, Emergency, Trauma.
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."

I wonder if I live in such a state.

I told the courts about the gun...the sheriffs department never went by to pick the gun up or search it.

Granted, it is a city of millions and they do get thousands; however, there is no excuse when the agency that is supposed to get involved, doesn't get involved. :madface:

Specializes in Dialysis.
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.

Often, the abuser is a time checker/clock watcher. She was probably terrified...

Specializes in Family Practice, Med-Surg.

I did my Master's project (thesis) on domestic violence. Nothing I did research on prepared me for the real world. Ask the victim when the husband is around? Sometimes he is sticking like glue to the patient and she wants him to stay. Sometimes he is scary to you. Sometimes he is such a charming narcissist that no one suspects him.

i always wonder about the first grade teacher who " fell down the stairs" and was in a persistent vegetative state. She was one of my first patients as a student in the 70's.

I made it a point to ask my patients in primary care. None answered yes, but many told me later. Think about the mechanism of injury and keep a high index of suspicion.

Thanks for sharing. Lot's of the elderly are victims more then we know.

As a male victim of domestic violence, I would like to correct your assumption that female on male domestic violence is rare. Ovee 2 years ago, my ex girlfriend asked to borrow my phone to call her doctor. She went through it and blocked and deleted a bunch of people on instagram, then went through my text messages and found one from a platonic female friend asking if I wanted to go hiking that day. I replied that I couldn't go that day. Over this text message, she physically attacked me, ransacked my house and stole my moms iphone. She would not stop throwing books, lamps, computer monitors etc at me and I was in my house, so I called the cops. They then arrested ME because she turned the whole story around on me and said I hit her. I almost lost my LVN license over this, but fortunately she did not show up to my trial. The DA would not drop the charges even though we had a recording of the 911 call where she can be heard admitting to hitting me and contradicting her police report in numerous other ways. I found out thay statistically speaking, men who call the cops on abusive SOs are more likely to be arrested than helped.

Thank you Ruby for bringing attention to this. To everyone who has shared their stories, you are very brave and I am happy you were able to get out. To those of you who have gone through this or are still, please know you are wonderful and do not deserve it.

I will not completely share my story because it would be too long to fit in to a post. We all have spoken about DV between partners, and some have touched briefly on child abuse. Often physical abuse is accompanied by verbal and mental abuse.

My abuse started at the age of 2 when I was sexually abused by my aunt's boyfriend for 2 years until I was 4. When I was 7 my father remarried and my stepmother abused me physically, verbally, and mentally. Her daughters would also do those things, plus one would sexually abuse me. After the divorce my father started physically abusing me. He sat on me one night and started strangling me because I wanted to go to the hospital to be with my dying grandfather. I went through many verbally and emotionally abusive relationships with men.

The biological father of my twins used to lock the 3 of us into the bedroom when he would leave for work and take my cell phone. I took the abuse so he didn't hurt them, but one day it wasn't enough. One boy was crying and he had enough and walked over and held a pillow over my son. After I stopped him he held a loaded gun to my head and threatened to kill me. It took me a few days to get my affairs in order and that was the last time I saw him, and the last time anyone laid a hand on me.

I am now married to man who isn't always NICE because he too came from a bad family, but he is by no means abusive. He loves my boys as though he are his own and would give his life for them. We are lucky.

Specializes in Family Practice, Med-Surg.

Frenchxtoast,

Sorry for over generalizing. We should more appropriately call it partner violence, then it includes female on male, female on female, and male on male, and male on female.

Specializes in as above.

if his/she strikes you ONCE, and says, I am sorry, it wont happen again, its time to leave. He/she/it will do it again. Stop making excuses, start looking for an out. He/she has learned this behaviour from their parents, usually the dad. If booze is causing it, LEAVE. If he/she is jobless, they are acting out, time to leave.