A nurse's intuition / insight are essential aspects that can allow one the ability to make a difference in someone else's life ... You could instantly tell something was wrong. Perhaps it was because her husband answered all the questions, the way he treated her, or the faint purplish bruise still visible under her heavy make-up. Something was wrong.
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When she entered the clinic with her husband, you could instantly tell something was wrong. Perhaps it was because her husband answered all the questions directed at her when she was being registered at the front desk in GYN, the way he seemed to treat her or what appeared to be a slight purplish bruise around her right eye that was still faintly visible under her heavy make-up.
When the patient was being roomed, the husband insisted on accompanying her, stating, "I don't want my wife to be examined without me being present". The staff informed the husband that all MD's have a chaperone. But, the husband refused to wait in the waiting room and insisted on being in the exam room during his wife's GYN exam.
One of my Senior RNs came into my office and said, "I think we have an issue". "There is a husband who was very loud all the way down the hall. He also seemed intimidating / over-bearing toward his wife". The RN insisted she had a "hunch" there was something not quite right going on between the husband and the wife. I asked her to be more specific. The RN said she suspected that the husband may be abusing the wife. She thought she noticed a faint bruise on the wife's right eye and one on her arm, when she passed them in the hall. She said the patient had heavy make-up on her eye so that bruise was faint. She stated, "I've seen this sort of thing before. Based on how the husband and wife are interacting, I have a feeling this is domestic intimate partner abuse." Based on the RN's cursory assessment, I felt it was essential we get the patient alone to make sure she was safe and further assess if she truly was a victim of domestic violence / intimate partner abuse.
As the husband would not leave the wife's side, in order to get the patient out of the exam room and away from the husband while she waited to see the MD, I had the RN give the patient a wrap-around gown and inform the patient that we "needed a urine sample". The RN had also grabbed a domestic violence / intimate partner prevention referral brochure from the acrylic wall holder in the restroom, and hid this brochure in her lab coat pocket to give to the patient after she got her out of the room. The husband wanted to come with the wife, but I stepped in and reassured him that his wife would be right back. I asked him to stay to watch her purse. He reluctantly agreed.
The RN actually took the patient to another exam room at the far end of the hall instead of the restroom. The RN told the patient why she actually pulled the patient out of the 1st exam room into a 2nd exam room. The RN said she noticed the patient had bruising under her make-up around her right eye and on her arm. She asked, "How did the bruises occur?" "Were you in an accident?"....."Or did someone do this to you?" She discussed the information with the patient on the DV/ IPA prevention brochure and asked the patient if everything was okay at home. The patient stared at the RN in silence, then her bottom lip started to quiver. The patient remained silent for what seemed like a minute.
Her lips quivered more, then the tears started to flow. She could barely speak. Then she blurted it out..."It's been going on for two years." "When we first got married he was very loving, but everything has changed, he changed." The patient was now crying so hard, the nurse had difficulty understanding her. The patient continued, "He is having financial troubles with his business." "And, now, everything I do makes him mad." "I don't know what to do." "I'm embarrassed to tell my family." The RN was silent. She said, "How often does he hit you?" The patient stated, "It started out just once in a while, now it's progressed to a couple times a week" "I never know what will set him off", she continued to cry. The RN said, "Do you have other bruises on your body?" The patient answered "yes".
The RN told the patient she needed to inform her Nurse Manager, then cautiously opened the exam room door. The RN checked down the hall to confirm that the husband wasn't standing outside the 1st exam room at the far end of the hall. The RN then motioned to me. I instantly knew what occurred when I walked in, based on the look on the face of my RN and the crying patient. The RN quickly filled me in on everything. By this time, the patient's make-up was running from all her crying, so her bruise on her right eye was becoming darker under her eye as her make-up came off. I gave the patient some tissue and held her hand and told her we were sorry this happened to her, but it was important for her to get help so this doesn't continue. The patient nodded her head between sobs. It was a very difficult situation. I told the patient, "Violence is never okay". "We're here to provide you with resources to help you."
The standard required domestic violence/intimate partner abuse procedures were followed. Information was reviewed again with the patient regarding her rights as a victim and the patient was seen by the MD in the 2nd exam room she was in away from the husband. The couple had no children.
By this time, the husband started to cause quite a ruckus when his wife didn't return to the exam room, so standard procedures regarding this sort of incident were followed. The patient contacted her aunt and uncle and was able to go stay with them. The aunt and uncle were shocked by the news, and kept thanking us for stepping in. The patient was also referred to a therapist specializing in domestic / intimate abuse with follow-up with her physician. The husband went home separately.
A few months later, beautiful flower arrangements arrived for both my RN and myself, along with a box of chocolates for us to share. Attached to the chocolates was a thank you note to the both of us. These were from our patient.
It said, "Words can't express my gratitude for the help you both provided. You are truly angels. You don't know how much you have changed my life. I am feeling more confidence in myself every day. I am separated from my husband and am getting divorced. I plan to look for a new "healthy" relationship. Thank you from the bottom of my heart."
