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. I would offer suggestions, but each one was met with a reason why it wouldn’t work. Not excuses—real, legitimate reasons.
She couldn’t make him leave because the trailer they lived in sat in his mother’s backyard. She couldn’t go to her own family because her mother lived with an abusive man who refused to have the children around and her brother was a drug addict whom she didn’t want to expose the children to. Without skills or an education she couldn’t find work that would cover childcare expenses. If she did find work, she couldn’t hold the job long because of her health issues.
There were lulls in the violence. I would see her when she came in for med refills. The hardness in her face and the deep midnight-blue bags under her eyes would be diminished; you could almost glimpse the pretty, spirited woman she once was. But too soon she would return, her face drawn, hard, tightened by pain and fear and hopelessness.
It’s the cycle of abuse that traps so many women. Until the abuse stopped she would go on living with disabling pain and overwhelming anxiety. With disabling pain and overwhelming anxiety she couldn’t work enough to support herself and her children. If she couldn’t support herself and her children she couldn’t leave her abuser. Until she left him she would live in disabling pain and anxiety . . . and on and on and on.
I liked her. She was outspoken. She would let the obscenities fly when talking about her boyfriend or her pain, but never treated me disrespectfully. And though she failed more than she succeeded, she struggled to be a good parent. She was tough, a survivor. And she wanted to be better; she wanted to have a good life. She never gave up hope that someday he would change or she would be able to leave. Someday the pain would ease.
I moved away and left the clinic after 5 years. I think about her often. Wonder if she was able to finally break the cycle and make a good life for herself and her children. Wonder if she is still alive.
I hope you will think about her too. Her story is not unique. The details may be different but her struggle, her hope, and her pain are shared by too many women.
On International Women’s Day let’s think about them, here and in India, and the DRC, and Darfur, and every place where women live lives shadowed by violence. (See this month’s editorial.) And let us pledge that we will do something, one small or large thing, to help them reach that better life. Even if it is just to be the nurse they trust, someone who creates a place they can feel safe.