By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor
She lived in a trailer with her boyfriend and her three children, all under the age of five. He beat her up regularly.
Every few weeks she came in to see me at the health center where I worked as an NP in urgent care. Sometimes she would come in with bruises, but most of the time it was for the less obvious sequelae of violence—unexplained chest pain, palpitations, anxiety attacks, back pain, relentless headaches. There was a policy in urgent care that you couldn’t ask for a particular provider. So she would call to speak to me directly and when the operator put her through she’d know I was on and would come in.
I’m not sure why she came to trust me over the other providers. Maybe she could sense that I understood and didn’t judge her, though I had never told her about my own history of domestic violence. But it was probably because I listened. There was not much else I could do. She had gone to a counselor when I encouraged her to, but that didn’t last long—it was hard for her to find transportation for the 30-minute trip into town. I prescribed SSRIs, and after trying some different ones we found one that worked well for her. I helped her slowly cut back on the anti-anxiety medication she had relied on too heavily for so long.
It was all complicated by chronic neck and back pain. I got her in to see a neurologist, which eventually led to two surgeries that left her in more pain than before and with terrible sciatica. Still she came to me at each step for advice on what to do. The neurologist wants to do another MRI—should she do it? Now he wanted to do another surgical procedure—what did I think? And there was pain management thrown in on top of everything else.
Of course I knew that she wasn’t going to get better as long as she was with her boyfriend. We talked about that a lot. Read the rest of this entry ?