The Bravest Thing I've Ever Done

October is Breast Cancer month. It is also Domestic Violence Awareness month. I've been through both, and breast cancer is not the hardest thing I've ever done. Nurses Announcements Archive

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In 2012, I was diagnosed with breast cancer. From the moment I was diagnosed, I was never in doubt about the next step. The first step was to call a surgeon, and here are some recommendations. At the surgeon's office, I was presented with a plan (and two back-up plans in case the first one was too awful to contemplate) and a Nurse Coordinator to help me follow the steps and negotiate the health care system. I'm a nurse; I can negotiate a health care system -- but when you're blindsided with a potentially terminal diagnosis, your critical thinking and organizational skills go right down the rabbit hole.

There were steps -- breast cancer these days has distinct treatment plans for this type of tumor and one for that type of tumor and another for this stage or that stage. Once you enter the system in the Breast Center, you follow the "recipe" -- one step after another. There's rarely any doubt about what to do next, and if there is, the Nurse Coordinator steps up to help you out.

Domestic Violence isn't like that. There's no "cookbook" approach: if he does this, then you do that. There's no coordinator to help you navigate the system unless you are fortunate enough to have either a good domestic violence program or shelter near you, or unless you have wealth enough to hire an attorney. And the attorney won't help you deal with the emotional fallout.

In 1985, I married after two years of dating "Tom". We had fun together, were able to problem-solve and to negotiate and compromise when the rare problem surfaced. We had (or so I believed) similar values, hopes and dreams for the future and styles of dealing with finances. I could not have been more wrong. The day after our marriage, he announced "Now that we're married, I don't have to be on my best behavior any more." And he wasn't. Turns out the similar values, financial style and dreams for the future were all an act, a mask if you will. The mask dropped the day after we married, and things were never the same again.

It took me nine or ten months to recognize a pattern. First he started getting angry more often, and over things that wouldn't have bothered him in the past. Then he started shouting at me, swearing at me and calling me names. He started throwing things when he got angry -- an empty or nearly empty Kleenex box, the oven mitts, a dish towel. Then he started throwing things in my direction and by the summer after our autumn wedding, he was throwing things AT me. The things got bigger -- a full Kleenex box, a coffee cup, the calendar. And, by autumn, he threw ME. At that point, I could no longer dismiss his behavior as "a bad temper" or "not knowing how to argue constructively," but I hesitated to label it abuse. After all, our relationship had been so wonderful at first -- he was charming and funny and seemed so evolved. We talked about everything, and he seemed to understand my point of view. He LOVED me, he thought I was wonderful. When a colleague of ours came to the emergency room after a beating from her boyfriend, Tom spoke out against domestic violence and men who would do such a thing. This man couldn't be an abuser!

But he was. He threw me down the cement stairs of our front stoop, he slammed me up against a wall so hard I went through it. He locked me in a bedroom to prevent me from leaving the house and, while we were on vacation to celebrate the fact that there hadn't been an "incidents" for a year and that the marriage counselors believed our marriage had been saved, he nearly strangled me to death.

There is no recipe for dealing with domestic violence.

There is no ambiguity in whether or not you have cancer. Either the biopsy is malignant or it is benign. You have cancer or you don't. There are so many shades of domestic violence, so many levels as it ramps up, that it can be ambiguous. If we have an argument and he curses at me and calls me names, is that abusive? Or is it only abusive if he does it more than once, or if I'm CERTAIN that I haven't provoked him in any way? If he's screaming at me every evening because I haven't cleaned the kitchen "properly" is that abusive, or is it that I need to take more care in cleaning the kitchen? If he throws the calendar at me because we've created a scheduling conflict between two equally important events, is that mere frustration with the situation, or is that abusive? When he punches you, slams you through a wall or even locks you in a room, that's pretty unambiguous, but most of the time, it has taken so many steps, so many little escalations, that you're well practiced in discounting or making excuses for the behavior. "He's just frustrated," or "He's just had an awful week at work," or "He's just got a bad temper."

A good friend recently told me that any time I have to say "he's just . . . " or "she's just . . ." the behavior is a problem. Or maybe the person is.

When you have cancer, and you're putting one foot in front of the other, following the prescribed steps to get the cancer OUT of you, people are constantly calling you "brave." Following the treatment plan isn't all that brave, comparatively. It's just what you do when you have cancer. There really aren't many decisions to be made. You do what the doctors tell you.

When you leave your abusive partner, or when you're staying long enough in the situation to get your ducks lined up in a row and your safety plan ready to be implemented, that's brave. Stepping off into the unknown without a safety net -- that's incredibly courageous. But no one tells you you're brave. They tell you you're stupid to have gotten involved with him in the first place, or you're just "creating a lot of drama" over something that is "really no big deal." People tell you that you should have left sooner, or if you're staying to ensure that you can get your children or pets safely out of the situation, they tell you that you should "just leave." And no one who hasn't been through it seems to understand how very difficult it is to "just leave." That is truly the look of bravery.

Fighting cancer isn't the bravest thing I've ever done. Leaving my abusive partner was -- it was both the most difficult and the most courageous thing I've ever done. It's been over thirty years now, and it was the bravest thing I've ever done until last year, when I had to do it again. But that is a different story for another time.

Specializes in Pediatrics Retired.

Since I read this I can't get one of my favorite Dixie Chick songs out of my mind...sallyrnrrt

Specializes in Psychiatric nursing.

Thank you so much for this. xoxo

Specializes in Trauma, Teaching.
Since I read this I can't get one of my favorite Dixie Chick songs out of my mind...sallyrnrrt

Oh, my....

Glad it didn't come to that for you Ruby! You are wonderful person.

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

#MeToo Ruby! But we're better now!

As others have said (in much more eloquent terms than me), thank you so much for writing this courageous, important, powerful piece.

I'd like to point out that as nurses, we have an invaluable opportunity to help victims and survivors of abuse! Perpetrators often perpetuate the cycle of power and abuse by cutting their victims off from their external support networks like friends and family. Consequently, healthcare providers may be some of the only people who interface with survivors.

In my nursing program, we actually did an entire lecture of recognizing and addressing suspected abuse. You can integrate these concrete steps in your daily practice:

*Recognize the signs and symptoms: repeated injuries with stories that don't add up, the abusive partner answering most or all questions for the injured partner, the injured partner raving excessively about how wonderful the abusive partner is as a facade, the abusive partner refusing to let the survivor participate in certain activities (i.e. ambulating off the unit, breastfeeding or holding a new baby skin-to-skin, etc.), or just something seeming 'off' about the relationship dynamics.

*Understand that most victims will not voluntarily bring up an abusive situation, and many will deny it even when asked directly; therefore, it may be helpful to use phrases like, "In case you ever do feel unsafe, here is where you can find resources."

*Realize that seeking a way out could put the victim in immediate danger; for instance, if the abusive partner finds the survivor in possession of a pamphlet about leaving a domestic abuse situation, the abusive partner may lash out, causing the violence to rapidly escalate.

*Consequently, provide non-traceable resources if possible. One excellent strategy is to put signs or posters in the women's restroom/stalls with information about who to contact or how to move forward. You can contact your local health department, women's support shelters, or domestic/sexual violence non-profits for resources. I know we healthcare workers love our handouts, but realize that these can be a dangerous liability.

*Consider ways to get the potential survivor alone. Abusive partners may be domineering and refuse to leave the bedside. Try to seize any opportunities where the patient may be going off the unit, for instance, radiology or the PT gym.

*Similarly, know that in extreme cases, abusive partners may even require their victims to carry an open cell phone line with them when they're apart in order to listen in on the survivor's conversations. If you plan to have a private conversation off the unit, you may request that the patient not bring a cell phone with them (citing policy or equipment concerns).

*Know that you can't force an abuse survivor to leave, even if the survivor discloses the abuse. Partners who attempt to leave are at a very high risk of falling victim to an explosive, dangerous outburst of violence. Therefore, it is essential that the survivor has a safety plan in place before the abuser becomes aware of the plan. Survivors must choose when to leave and do so on their own volition. In a case where the survivor is not ready to leave, opening an investigation into the suspected abuse can create mistrust and ultimately lead to further violence. (Elder abuse and child abuse are exceptions, as we are mandated reporters and by law must notify authorities of suspected abuse.)

I recently heard of a patient who was admitted to the hospital for bilateral broken legs after 'falling down the stairs' inexplicably. She was an adult but depended on her parent and step-parent to care for her due to her injuries. The staff expressed concerns because the parents refused to leave the bedside, including the step-parent watching intently during baths, bedpan use, and perineal care. These factors together suggested a high risk of physical and/or sexual abuse. Despite concerns, the patient was discharged home with her family. Soon after discharge, she committed suicide.

As nurses, we have the opportunity to make a difference. We've probably all seen that family dynamic that makes our hair stand on edge and just 'doesn't seem quite right.' In extreme cases, we as healthcare workers may be among the few people who interface with survivors. We can act as a resource not only for patients whom we suspect are experiencing abuse, but for family members as well (like the parents of a pediatric patient or the children of a geriatric patient).

I know we're all crazy busy with a million things to do, and the last thing many of us wants to do is get tangled up in a messy, stressful social situation when we're falling behind on our med pass. However, these interventions can help save lives.

Specializes in LTC, Assisted Living, Surgical Clinic.

Thanks Ruby from another who has stepped off into the unknown without a safety net. ❤️

Specializes in School Nursing.

As I read your story, I have found myself nodding in agreement over and over. I wish I had been as brave as you. I waited until he cheated on me for a year, and found indisputable proof (which I read over and over to convince me). I had seen texts and pictures during that last year, but my mind kept finding reasons to deny it. He only pushed me once, but I still have the holes in the bedroom door to remind me of how lucky I was. We have been divorced for five years, and he has found reasons to call me, although I am not allowed to call or text him (not that I would want to). He continues to verbally abuse me, criticizing my clothing or telling me the house was not clean enough (He knows I am a bit of a hoarder and do have clutter.) One of our children is 12 so I have six more years I have to deal with this.

I am so glad you were able to escape (and not unscathed, as it remains in your memories). Kudos to you for sharing. I am very glad I read this today.

Specializes in Geriatrics, Dialysis.

Thank you being brave enough to share your history of abuse. If it helps even one person this article may truly become a life save.

Specializes in ICU; Telephone Triage Nurse.

Leaving is courageous because it is both difficult and scary. Where do you go? How to start over? How to not repeat the same pattern again if you take a chance on another relationship?

I had a past experience with an unhealthy relationship, and watched my mom struggle with an abusive relationship with my father. It's not as cut and dry as those outside of the relationship believe it to be. Sometimes cutting off your own arm would be easier than making a clean break.

My deepest respect to you for breaking free from two unhealthy relationships. And hugs.

Specializes in LTC, Rehab.

I've been too tired from long shifts last night and tonight to read and respond properly, but I just want to say that I'm sorry you went through BOTH of these traumatic events, and - maybe I missed it (see above) - but I hope you're ok now re: the breast cancer.

I got the 'brave' comment from a friend or two when I had bladder cancer, and as I told one friend at the time, similar to what you said, "Hey, I'm not sure bravery really enters into it much. You have to do what you have to do when something like this comes up".

Specializes in Medsurg/ICU, Mental Health, Home Health.

I'm so very proud of you, Ruby! And very thankful that you were able to get away. I know the world (and this board!) wouldn't be the same without Ruby Vee!

Your experience is horrifically similar to that of my mom, regarding her first marriage. Although she was able to leave him years before I was born and my dad is not the one who abused her, it's evident that I was brought up by a woman who'd suffered domestic violence. For example, I have always made sure that I am one hundred percent financially independent should I need to leave my husband.

But I digress.

I can't imagine how difficult this was. My best friend is dealing with a domestic abuse situation right now and I fear the worst for her as she can't seem to leave and not "go home." She's embarrassed, spiritless and I fear the worst but there is not a thing I can do and I can absolutely see how she would want her husband to change, want him to be how he was, or how she thought he was.

Again, so proud of you, Ruby. I stand in awe of your stories always, and I'm fortunate that you were strong enough to leave so that I can hear them from you!

Specializes in Adult Primary Care.

Thank you so much for sharing your story.

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