I let one slip past me

[AliceTrout]

Before I was a nurse, I was a domestic violence advocate for the county. I would get a page from the PD whenever they were on scene, and I would provide assistance and outreach to the victim. I had received substantial training and certification for this volunteer position, and I felt comfortable that I could recognize a person in distress fairly well.

When I went to nursing school, I remember learning all the different ways we can screen for DV, and being a perhaps a little too complacent (smug?) thinking I already knew this stuff. I had accurately identified DV in patients before, and been able to find them assistance.

But a few weeks ago I let one slip by and I can't stop thinking about it.

She was admitted for suspected intentional OD. History of drug and alcohol abuse. Lots of run ins with the law, failed attempts at rehab, problems with social services etc. My other patient that night was a very precociously ill patient that was pretty 'busy'. My admit, let's call her Sheila* for the sake of simplicity, was lethargic but pleasant and cooperative. She looked like far older than her true age.

I brought her husband back to help me with some basic admission information, and when I was done I gave him a card with the ICU visiting hours and offered to show him the family room. He freaked. Stated he had never spent a night away from her, and could I please make an exception. Before I could say anything more, my charge interrupts to tell me that a consult hadn't been made to nephrology yet and that I should page them. At this point, the man sees all the wounds I had listed on the communication board for Sheila, looks back at me and the charge nurse, and back to the board again...freaks out again.

"You have to call someone about all that"? He said panicky, pointing at the board

Again, before I could answer, the ventilator starts alarming in my other patients room and the monitor starts blaring...I dash in there to fix the problem. Afterwards I go back to Sheila's room, where the husband is now in bed with her, whispering into her ear, holding her hand. It seemed sweet if not annoying. I told him I needed him to collect her items and go home and get some rest. Again he gets anxious, begging to stay. I remove her jewelry and ask him to take it with him. He keeps telling me how he just bought her this ring, it was expensive, he just got it for her - "right baby"..on and on.

Finally....I chase him off. He asked me to come and get him from the family room the moment he could come back again. I tell him I can't promise as I basically shove him out the unit doors. Meanwhile Sheila has a good night. She becomes more alert, and comes across as a very kind, sensitive, polite, but meek woman. I like Sheila. So, in an effort to please her, I ask her if she would like me to get her husband now that it is visiting hours again. She says no. Well, she had told me she has 7 boys at home, so I chalk it up to her enjoying the relative respite the ICU might be offering her in comparison to a house full of boys.

I give report. I go home. I sit down for dinner. And BAM I realize it. So many red flags. He won't leave her side. His paranoia we were going to call someone. Not wanting him to visit her. Her wounds. The gifts of jewelry. Countless other obvious red flags I completely missed. A wave of utter shame/disgust/horror washed over me as I grabbed the phone to call the unit.

It was too late. She was discharged home AMA...the husband had made a big scene and taken responsibility for her ingestion so they decided they couldn't keep her on a suicide hold. She was after all "just another junky".

Sorry Sheila. I really am. I failed you and I am so sorry.

*It goes without saying her name is NOT actually Sheila

[nutella, MSN, RN]

I think you are too hard on yourself.

When you are a nurse as opposed to a DV volunteer, your focus and radar is not set on "DV" so to speak.

Looking back there were signs but it sounds like nobody else had picked up on it either.

And you probably know that even in case you had noticed and reported it as suspected DV she probably would have gone home with him again. Over the years, I have seen people seek help for DV and everybody jumps into action only to have the victim contact the perpetrator days later and go back home because "he/she regrets it, things will change, he/she is sorry..." and so on.

It is very sad when people get abused that way.

I am sorry it keeps you busy.

[calivianya, BSN, RN]

Over the years, I have seen people seek help for DV and everybody jumps into action only to have the victim contact the perpetrator days later and go back home because "he/she regrets it, things will change, he/she is sorry..."

This is exactly what I see the most.

I particularly "loved" an admit I got a couple weeks back - SO called 911 for a respiratory failure. SO came with the patient to the hospital. The patient gets admitted, and there is a security alert on her chart... about the SO, because the last time she was there, it was because he beat her half to death, even to the point of giving her a brain injury.

...Which got everything really complicated.

He was the only person who knew she was there, he was in fact the person who called 911 and accompanied her to the hospital, but he was her abuser. She was vented/sedated/paralyzed, totally unable to communicate, so we didn't know who else to call. We had the physicians sign emergent consents for days because we wouldn't call the only person we had contact info for. We kept hearing multiple reports of him trying to sneak into various units looking for her because we made her a no information patient and moved her so he would have no idea where she was. Security had to escort him out several times from random floors, once or twice with him screaming about how we couldn't do that to him because he was her only contact, blah blah blah.

Then, her lungs got better, she woke up, and we extubated her. After all of that drama keeping him away when he was just about ready to tear down the whole hospital to find her just so she could be safe, the first thing she asked was where he was, because she wanted to see him.

Like the PP said, these people are just about impossible to help.

[Libby1987]

You showed up, forgive yourself a possible miss and credit yourself for all that you did do.

[Brandidrn]

We r human stop beating yourself up u were trying to just get what u had to to ensure she was stable in an ICU setting and had to prioritize. U also weren't the first person to have taken care of her. Let me tell u my daughters were being abused by my babysitters kids and I missed all the signs, well I blew them off as other reasons, for almost a year. God bless u for what u do!

[CrunchRN, ADN, RN]

They are devious. You should not doubt yourself.