By Karen Roush, MS, RN, FNP-C, clinical managing editor

All rights reserved. Photos by author.

All rights reserved. Photos by author.

It’s the end of October—Domestic Violence Awareness Month. I want to tell you a story about a patient I had in the Adirondacks in upstate New York.

The young woman was back for the third time that month. The previous week, complaints of vague abdominal symptoms had brought her in; this time, it was frequent headaches. Even as I performed a neurologic exam, I suspected I wouldn’t find  anything.

“So, how’s everything at home?”  I asked, after assuring her there was no sign of a neurologic issue.

“Same,” she told me. “Yesterday I forgot to get his cigarettes and [expletive]! you’d a thought I killed someone.”

“Did he hurt you?”

“No. Just twisted my arm a little. I’m fine.”

But she wasn’t fine. She suffered from anxiety, headaches, chronic back pain, and irritable bowel syndrome. She had been through numerous diagnostic evaluations, including invasive procedures, and had tried multiple medications.

She was 25 and had three children. I’d brought up the subject of intimate partner violence after her second visit, but it wasn’t until she’d been seeing me for a few months that she felt safe enough to talk about it. Her husband controlled the money, kept the keys to the car, isolated her from friends, and verbally and physically abused her. The abuse was pervasive and she felt helpless and hopeless.

Every option I discussed with her was countered. She had no money and no access to it. She had no skills and couldn’t support three children on minimum wage, especially with babysitter costs. She had no transportation in a rural area where stores, health care facilities, and places of employment were at least 20 miles away from her home. She couldn’t move back in with family—her father had told her she needed to learn to be a better wife. The unknown of a shelter was more intimidating to her than the situation she knew.

And so she accepted violence as part of her life. Had accepted it so completely that she didn’t consider having her arm twisted as being hurt. She didn’t call the police because she was afraid social services would take her kids away if she did. She had called once when they were first married and the officers had taken him outside and talked to him for a few minutes and then told the two of them to work things out. When he came back in the house he held her against the wall by the throat and told her if she ever called again it would be the last call she ever made.

Think about her the next time you wonder why your patient “chooses” not to leave her abuser. The next time you’re frustrated with seeing the same woman again and again for violence-related symptoms and injuries and think she’s beginning to waste your time.

Every time that patient came in, we talked and explored options. I believe it helped her cope even if it didn’t result in her being able to leave, gave her some sense of hope that one day she would figure out a way to get out.

I would like to give this story a happy ending. I can’t. But I implore you again, in another blog post in yet another October—ask every woman about abuse, develop a trusting relationship with her, be the person, maybe the only person, who treats her with compassion and empathy. Help her hope.

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