A Nurse’s Heartbreak/The Complexities Surrounding Emotional Abuse/Words Wound

UnknownNothing broke my heart more than watching #whyIstayed trend on twitter a few months ago. The story I’m about to tell you is true, although I have changed the names of those involved to protect their anonymity. To this day, it remains one of the saddest experiences of my nursing career. 

 After I graduated from my medical center’s nursing school and sat for my boards to become a registered nurse, a highly coveted job opened in the labor and delivery unit and by some miracle, (and possibly, the fact I had worked my way through nursing school as a tech in the same labor and delivery unit) I was hired for my dream job.

Today, however, I was not going to be enjoying said dream job. No one was in labor and the patient census was low on the obstetrics ward so I was going to be floated to the only other “clean” floor in the hospital. Yes, that’s right. I was going to the psych unit.  

“Hi there,” said the nurse in charge, tossing me a chart as I folded myself into the nearest chair at the empty report table. “I’m going to have you specialing a patient today.”

Specialing a patient is a psychiatric term which meant I would be accompanying a patient at all times throughout his or her day for the purposes of protection and observation. Oh, joy.

“Your patient is Beth Ann Monroe. She’s a sixty-year-old, married, white female, a retired dietician, and mother of four adult children. She’s been with us for the last two weeks.

“The chart says she’s here for her third suicide attempt in fifteen years.” I cocked my eyebrow in protest. “This is way out of my comfort zone.”

“Don’t worry,” she said as I skimmed the chart. “Beth Ann is going to be released today.”

“I don’t understand. Why are we specialing a patient who is well enough to be discharged?  She shouldn’t be going home if she’s a danger to herself.” I felt my shoulders begin to knot and creep up next to my ears.

“Relax. The patient’s husband is a prominent judge in town. Administration wants us to dot all our i’s and cross all our t’s with this case,” replied the charge nurse. “I am giving you a very simple assignment. We’re confident we’ve got the right therapy in place for Beth Ann now.”

I wanted to ask the woman why they hadn’t managed to put the appropriate care in place the last two times Beth Ann was here, but I thought it best to hold my tongue.

The charge nurse pulled a tape from an envelope and flicked it towards me. “Last month, Beth Ann gave her eighty-six-year-old mother these audiotapes for safekeeping. When she was admitted to the hospital, her mother brought them in to us. Listen to a few minutes of that tape. The judge’s charming public persona does not go home with him at night.”

I popped the tape into the recorder beside me. A loud male voice screaming a steady stream of profanity ripped through the air. It was very unnerving. Finally the swearing turned into language I could actually comprehend. “You’re so f*#king stupid! I don’t care what you think. I’ll go wherever the hell I want, Beth Ann, whenever I f*#king want! I told you I’m done talking to you. Now get the f*#k out of my study!”

“I’ve heard enough,” I said, snapping off the recorder. 

I realize from time to time, we all get angry enough to say hateful things and do mean things to the people we love, but judging by the mound of tapes sitting in front of the charge nurse, we weren’t talking about isolated hurtful behaviors from the judge. 

 “We now know that Beth Ann is in an emotionally abusive relationship. She’s married to a very angry man,” said the charge nurse.

I had to agreed with her there. The man certainly did sound angry. “I really don’t have any experience with stressed-out angry men,” I said, hoping my greenhorn status would get me out of this assignment.

“Stress and anger issues don’t cause abusive behavior and it is not an excuse for it either,” said the nurse tersely. “Abusive behavior is about power and control. Some men use emotional abuse as a way to handle their anger, frustration, guilt, lack of self-control, and possibly even low self-esteem. None of what has happened is Beth Ann’s fault and I’ve think we’ve finally gotten that across to her.”

“Where’s she going after she’s discharged?”

“Home.”

“Home? Is that a good idea?” I asked.

“Beth Ann wants to go home and this time we’ve got excellent aftercare lined up for her. She’ll have a different therapist who specializes in abusive relationships and no more marriage counseling.”

“No more marriage counseling? By the sounds of what I just heard, they need marriage counseling, and lots of it.”

They do, but not the traditional kind of marriage therapy. Traditional therapy assumes both people are equally responsible for the problems in a relationship. The only thing marriage counseling succeeded in doing in the past was to make Beth Ann feel worse about herself than she already did.”

“I really don’t feel qualified or comfortable to care for this patient. Don’t you think it would be better to have a more experienced nurse with her?”

“You’ll do fine. Beth Ann is in a really good place now and she’ll enjoy having you as her nurse. I should mention that when she was first admitted she was extremely anxious and had some problems with elocution, but in the two weeks she’s been with us, these problems have improved significantly.”

I sighed and nodded. Anymore arguing with the charge nurse and I’d risk insubordination. Specialing a patient wasn’t hard and I’d done it before. I’d stay with the patient during her daily activities and have therapeutic conversations when the opportunities presented themselves throughout the shift. 

Still, I couldn’t help but have misgivings about this particular case. What did I know about emotional and relational abuse? I had grown up in a stable, loving family, and I was only twenty-one years old. For Cripe’s sake! Beth Ann was sixty and had clearly been suffering emotional abuse for longer than I had been alive. I was out of element…out of my depth…out of my comfort zone, and honestly terrified I’d say or do something wrong to make her situation worse.

I stepped out of the report room fervently hoping the charge nurse hadn’t made the biggest mistake of her career to find a thirty-something-year-old woman waiting for us at the front desk. “Who is Beth Ann’s nurse today?” she asked.

“That would be me,” I said, smiling and stepping forward to shake the woman’s hand. Scowling, she read my name tag, then she shoved the photo album she carried underneath her arm into my open palm. “Please give this to my mother. I want to remind her who she is supposed to be.”

That being said, the woman spun on her heels, stalked over to the locked exit, and waited for a staff member to buzz her out.

I was glad the woman was leaving. Even as a novice psych nurse, I knew hostility wasn’t therapeutic.

“I’ll take that,” said the charge nurse, relieving me of the photo album and placing it on the desk next to the unit secretary. “I’ll check to see if it’s okay with the doctor for Beth Ann to have it. In the meantime, I’ll take you to meet your patient. She’s waiting for a group on intimate partner abuse to begin.”

I don’t know what I was expecting when I saw Beth Ann, but certainly someone frumpier and more depressed than the woman I saw. She was a petite, well-dressed, gray-haired, grandmotherly woman. She smiled as we approached and greeted me with a warm handshake after the charge nurse introduced us. Relief flooded through me and I finally relaxed. 

Beth Ann and I entered the group and sit in a circle of five other women. The group leader started by asking the women to share what living with emotional abuse had done to them.

“My guard is always up and I’m anxious all the time,” began Beth Ann. “I’m not allowed to have a different opinion. If I have a different opinion, I’m disloyal and not to be trusted.” The other women in the group nodded their heads as if they understood exactly what Beth Ann meant.

“I don’t want to see my friends or family anymore. I’d rather be alone. It’s the only time I feel safe,” said another young woman.

“Me too,” agreed the woman sitting next to me. “The only time I don’t piss anyone off is when I’m sleeping, but sleep is impossible. I don’t ever feel safe enough to sleep.”

“I’m depressed and on the verge of tears all the time,” confided a woman on the other side of Beth Ann. “I find myself wishing for my death on a daily basis.” Empathy dripping from her fingertips, Beth Ann reached for the woman’s hand and squeezed it.

There was a constant lump in my throat as I listened to what these women were saying.  They were experiencing unimaginable pain, shame, guilt, despair and anxiety. 

The group leader passed around a list of things that were considered emotional abuse. She told us emotional abuse was learned behavior and a choice. It follows a pattern which is repeated and sustained. If left unchecked, the abuse will get worse, not better. The object of abuse is to gain power over you. The abuser doesn’t care if the power is in the form of your adoration, your fear or even your loathing. If they can make you dance to the tune they’re playing, it feels good to them.

This was astounding information to hear. And had the group leader really just said emotional abuse was a learned behavior? I was having a hard time wrapping my mind around that kernel of wisdom. I supposed that it could be true, but it was hard for me to comprehend because my father was a kind, gracious, gentle man. He hadn’t attended any type of school where men learned to behave badly.

EMOTIONAL ABUSE

1)   Verbal abuse

2)     Harassment

3)   Belittling

     4)    Swearing, vulgar language, insults

      5)     Yelling and screaming

      6)     Intentionally embarrassing you in public

      7)     Blaming their abusive/unhealthy behavior on you or others

      8)     Threatening to take your children from you

      9)     Jealously, excessive possessiveness, and interrogation

    10)    Withholding affection

    11)    Humiliating you and ridiculing you

    12)       Spiritual abuse/Putting down your culture and spiritual beliefs

    13)       Silence and withdrawal

    14)    Symbolic aggression (such a slamming doors, rolling eyes, slumping, and                      intimidating gestures)

    15)      Controlling everything, steamrolling over you

    16)    Gaslighting

    17)    Starting rumors about you or telling false stories about you

    18)      Controlling and allowing you no access to the finances

    19)    Isolating you from friends and family

    20)       Picking fights

At the bottom of the page was another list with the most prevalent types of physical abuse.

1)   Kicking

2)   Biting and spitting

3)   Pushing

4)   Choking

The behaviors listed on the paper were overt behaviors, but what the group leader wanted to talk about next were the more covert behaviors that these women had experienced.

One of the ladies shared that her husband never let her finish a thought or a sentence. He constantly interrupted everything she said and later became furious with her when she honestly couldn’t remember the point she had been trying to make to him when she began the conversation.

Another woman talked about how her husband told jokes and stories at her expense when they were out with friends and family. She’d begged him countless times not to share these things because they weren’t accurate and painted her in a bad light, but he wouldn’t stop.

If she made the mistake of calling her husband out on these jokes or stories in public, he’d look at her as if she were crazy and tell her she was being stupid or overly sensitive.  Everyone laughed, except her. He’d tell people she was overly sensitive and emotional.  “Jeez, Helen, the man can’t even tell a joke without you jumping down his throat,” they’d say.

“The shame of the whole matter is the few people I confided the abuse to…they didn’t really believe me,” continued Helen. “My husband was absolutely charming to them, and even when those same people caught glimpses of the abuse, they refused to take a stand. No matter how outrageous I considered his behavior, they’d ignored it. They didn’t want to be involved. They often told me what I was experiencing were petty squabbles that every couple had and I was over-reacting. They’d tell me if I ignored his behavior, he’d stop it.”

“What did those experiences teach you?”

“I don’t know.”

“You do know,” prodded the group leader. 

Helen shifted uncomfortably in her chair and sighed. “Eventually I didn’t want to go out anymore. I didn’t want to be around people. I didn’t trust anybody. I guess I wasn’t really sure if I even trusted myself. Maybe I was the overly sensitive mess my husband insisted that I was and…maybe I actually was the one victimizing my husband, as he claimed. It made me feel crazy.”

The group leader leaned forward so that she could look directly at Helen. “It made you feel crazy because it’s what we call crazy-making behavior. It’s designed to make you feel shame and bewilderment. Repetitive inappropriate communications with someone you trust and his enlisting people to help him reinforce that to you caused severe emotional pain and scarring. Because no one called your husband on his inappropriate behavior and communications, it served to perpetuate the cycle by reinforcing to your husband how much in control he is during these situations.”

My heart ached for Helen. The courage it took to broach the subject with another a person, only to have those people trivialize and minimize what you were experiencing. It would have wrecked me, too.

The group leader decided further explanation was in order. “Denial is an integral part of emotional abuse. Friends and family often minimize and deny what is happening.”

“But in all fairness,” said Beth Ann, “how can they understand what is happening to you, when you can’t even understand why you’re being treated like the enemy? I’ve always had my husband’s best interest at heart. He knows I’m not his enemy.”

The group leader shook her head slowly side to side. “He doesn’t know that. Generally, an abusive man considers almost everyone his enemy, even the ones closest to him. You see, it’s about power and control. Think about it, if someone is your enemy, your goal is to diminish your enemy’s strength. You must render the enemy powerless, helpless, and weak. You must control your enemy so that he cannot control you.”

“That’s just sad,” sniffed one of the women.

As I continued to listen to how the threads of these women’s lives had unspooled and tangled into unrecognizable knots, I wanted to sob. The common theme I kept hearing from the women in the group, was none of them were truly believed. Many had tried to get help from clergy, friends, family, psychiatrists, social workers, and therapists. In some shocking instances, the women were even blamed for provoking the abuse they were suffering. The self-worth of these women had been completely annihilated. They felt useless and worthless and, to my horror, some of them even believed they deserved what they got.

My head throbbed. The energy it took to sit there with a relaxed, interested look on my face was enormous. I wanted to cry, but more than anything else—I wanted this soul-shattering group therapy session to end. However, our fearless group leader still wasn’t done. She went on to inquire why the women stayed in their relationships.

“I stay because he hasn’t hit me. If he hit me, I’d leave him and be able to get custody of my children,” declared one woman.

“I have no idea what would happen if I left and I don’t want to find out,” said the woman next to me.”

“I’d lose my children,” said the woman sitting by Beth Ann.

“Because in between the bad times, we have some really good times,” said Helen.

“I know he can be better and change back to the person he was,” insisted someone else.

“Forty years,” whispered Beth Ann. “I’ve been with him for forty years.”

“What I think I hear you saying is that you’ve invested too much time in the relationship for you to leave. Is that right?” asked the group leader.

“Yes, that’s right. I want his horridness to end, not my relationship. I love my husband.” Beth Ann eyes glazed over with tears as she dropped her gaze to the balled up hands in her lap.

I pretended to scratch my eyebrow and stole a glance at my watch. Thirty more minutes until group ended? I’d never survive. Surrounded by all this aching and grief, I could actually taste the pain these women endured and it left my tongue dry and thick.

I’d rather all six of these women were screaming in the throes of labor because at least I’d know what to do for them and what to say to them. I could comfort them in all the little ways I knew and assure them their pain was temporary. I knew how to keep laboring women focused on the end goal, the light at the end of the tunnel, the prize for all the pain they endured. Here in this group, I felt I could do nothing of any significant value.

These ladies seated in the circle around me were veterans and heroines in the private war waged on them daily. They endured unimaginable metal anguish and they were broken shells of their former selves. Although I didn’t have the slightest idea how to act around these women, I knew it was important to be present in the moment with them. I could do that much. I could listen without judgment, believe them, and respect them.

Our group leader decided to end the group with a lesson into the possible roots of domestic abuse. She felt very strongly that the roots of domestic abuse, both emotional and physical, were established by the pervasive attitudes that existed towards women for centuries.

Historically women were treated as property. Women couldn’t own anything and women had no right to vote, because what we thought wasn’t important. A man could use physical force, if necessary, in relating to his wife.

She read a paragraph from a book published in 1881 by Harriet H. Robinson called Massachusetts in the Woman Suffrage Movement to illustrate her point. “By the English common law, her husband was her lord and master. He had the custody of her person, and of her minor children. He could ‘punish her with a stick no bigger than his thumb,’ and she could not complain against him.”

She said some men were simply modeling the behavior they had been taught by their own fathers and their fathers before them. For some men, the abusive behavior was a defense mechanism to reduce their own emotional stress in a relationship and maintain control. 

The group leader went on to say that children who see or hear their mothers being abused are victims of emotional abuse as well. Growing up in such an environment is terrifying and severely affects a child’s psychological and social development. Male children may learn to model aggressive behavior while female children learn that being treated badly is just a normal part of relationships.

I began to wonder if the group leader had an off switch I could push. I just couldn’t take in more words, but still she went on.

“Men can further devastate their families by not providing attention in a sensitive and responsive manner, by being detached and uninvolved, by choosing to interact only when necessary and by treating people like objects, not human beings. That’s all for this morning’s session. This afternoon, we’ll talk about fully becoming our authentic selves, acknowledging and expressing our anger, and pursuing our own interests and needs…even if it opens the possibility of displeasing others.”

Thank God! Hallelujah! Praise Jesus! The group had ended! I felt guilty for being relieved, but it was excruciating to be around all that suffering. How did the group leader do this everyday? Did she come with a Teflon interior or had she just become desensitized over time? My interior was Velcro and I was sure it would take weeks to peel my heart free of the pain I’d experienced while sitting there in that group.

The charge nurse tapped me on the shoulder and I rose to face her. She was holding Beth Ann’s photo album. “Two patients were just admitted to Labor and Delivery. I’ve been told they’ll need you back if they have another admission.”

I tried not to look too cheerful about the possibility of returning to my floor, but inside I was giddy.

The charge nurse turned to Beth Ann. “I have something for you. It’s from your daughter, Beatrice. She thought you’d like it.”

“Thank you. I’ll take it back to my room, if that’s okay with my shadow here,” said Beth Ann.

“Sounds like a plan to me,” I replied.

We quietly strolled back to Beth Ann’s room. She pulled the bedside table towards her with one hand and motioned for me to sit on the edge of the bed beside her.

I watched as Beth Ann turned page after page of her life and her memories. When she done, she drew in a deep breath and fixed a steady, unflinching gaze on me. “It’s funny.  I look at these pictures now and all I see are lies. Lies I told myself and lies I told my family. My life started off so perfectly. I don’t know how I ruined it all.”

Okay, this was exactly what I was afraid was going to happen. I didn’t know whether to ask Beth Ann to explain further or let her know right away she wasn’t the one who ruined anything. I needed to say something remotely therapeutic and say it now. So I said, “I’m not a full-time psych nurse, but I do know none of this was your fault. Your husband has to learn how to handle his stress and frustration in a constructive way. That is his responsibility, not yours.”

“So they keep saying here, but I can’t help thinking if I had been a better woman, a better wife, or if I had given my husband more love and attention—more understanding, he’d handle his frustration in a different way. My priest seems to think so too.” She turned here attention back to the photo album and traced the tips of her finger over the faces of a family portrait. “Bottom line, I failed him and I failed my children.”

“No. No you did not,” I said, shaking my head emphatically. “Your priest is wrong.”

Just then, the charge nurse appeared in the doorway. “Your unit has two more patients in labor. I need to send you back.”

I looked at Beth Ann. All I wanted to do was to pull her to me, give her a hug and will all my strength into her, but I barely knew her and it didn’t seem like the right thing to do.  Instead, I whispered, “I admire you. You stay strong.”

Sometimes someone else’s belief in you when you’re feeling weak and defeated is an incredibly powerful thing and it was all I could offer Beth Ann.

Another nurse arrived to take my place. Beth Ann smiled and waved to me as I left her room. I walked back to the locked exit with the charge nurse. I told her about the exchange between Beth Ann and myself as she unlocked the door for me to leave. “I know I’m not an experienced psych nurse, but I get the sense Beth Ann is not remotely ready for discharge,” I said emphatically.

“I’ll tell her team what she told you. Don’t worry, they won’t let her go if she’s not ready,” the charge nurse assured me.

I headed back to the labor and delivery unit to finish my shift. Thank God it was Friday and I had the weekend off and Monday, too. I felt as wrung out and crushed as the clothes my grandmother put through her old-fashioned wringer washing machine. 

I was just beginning to get back to my normal self when I reported to work on Tuesday. I changed into scrubs, washed my hands, collected a cup of coffee and headed to the backroom. It was still early so I’d have plenty of time to read the morning paper someone had graciously left on the counter.

I flipped through it, scanning the headlines to see what interested me. Then I saw it. Beth Ann Monroe’s smiling face staring up at me from the obituaries. My hand began to tremble and my coffee spilled over the edges of my cup and onto the paper. I watched as it seeped over Beth Ann’s neck and head. 

I covered my mouth to hold in my screams and headed for the nearest bathroom. I just made it before my body unleashed the most ugly fit of crying I’d ever experienced. I held onto the sink, rocking back and forth over it like a mad woman. “What did you do, Beth Ann? What did you do?” I said out loud between long choking sobs.

For the longest time I blamed myself for Beth Ann’s death, but as the years passed and I gained more life experience, I realized what happened to Beth Ann did not fall solely on my shoulders; rather it was a group effort by all of us, all her friends, family, doctors, nurses, therapists, mental health workers, clergy, and even society at large.

We fail women when we do not protect and value them. We fail women when we treat them as worthless and powerless. We fail women when we don’t listen to them, or believe them. We fail woman when we don’t support them. We fail women when we trivialize and minimize their experiences. And above all, we fail women when we don’t teach our sons to treasure and respect the women in their lives.

As a writer I know how powerful and merciless words can be. We can’t just hurl them about indiscriminately. Words have the power to wound deeply. Some people will heal from those wounds, but others will not. I think we could all agree, the world would be a better place if words were not wielded like weapons.

I could do nothing to help Beth Ann, but I can honor her memory in the only way I know how—with words.

The Lamentations of Beth Ann

 I’m so tired of living in constant strife,                                                                              And you blaming me for what’s wrong with your life.

You’re so wrapped up in your anger and resentment,                                                   That you choose to forgo what could be contentment.

You devalue, demean and deliberately hurt,                                                                  And refuse to believe that you treat me like dirt.

You value control above all things and all else,                                                             But you fail to realize what you’ve done to yourself.

No attempt means no failure, so you don’t even try.                                                     You checked out of life without a goodbye.

It’s still not too late to assess and repair,                                                                      And stop playing your game of soul solitaire.

I go through each day unseen and unheard,                                                          Unloved and unhappy. It’s more than absurd.

When will you see through all your blindness,                                                             What I wanted from you was a little kindness?

Still, you can’t hurt someone who no longer exists,                                                      Who died a slow death by your words, not your fists.

L. L. Reynolds

14 thoughts on “A Nurse’s Heartbreak/The Complexities Surrounding Emotional Abuse/Words Wound

  1. This is the kind of writing that changes the world! Keep bringing attention to these types of situations. Keep shining a light in dark corners so those who are not victims will see the pain and decide to do something about it for those who are not strong enough to do something themselves. You did what you could in the situation and now you are doing what you can by spreading the word that stuff like this is happening and needs to be addressed. Keep up the good work!

    • Thank you, Kara. I hope one day there will be no more dark corners left in our world.

  2. Phew! I saw so many women and men that I’ve known reflected in your words. That was an intense read. It’s not often that a blog posts makes me cry! Thank you for sharing…

    Tui, aka @TuiSnider dropping by from #MondayBlogs

    • I happy this touched you, Tui. It meant so much that you left a comment for me. Thank you, thank you, thank you!

  3. Haunting, sad, but beautifully told. Thank you for sharing this.

    I’m part of a collective of women who write for Sisterwives Speak (sisterwivesspeak.com). We are all about this kind of support and awareness. If you’d ever consider writing for us, we’d be honored to have your words.

    • What an extraordinary offer! If my words can go out into the world and change even a small piece of it, I’d be honored to write for you. Thank you very much.

  4. Oh, LL. I know this pain, but not to such a degree.

    I was floated to a psych ward (out of my cardiac unit) and worked with a group of teenagers for the day. I was only 20, and I interacted with so many teenagers in pain. Two of them were sisters, and their fathers had used them to gamble at poker. Everytime he lost, his friends got to rape them at 10 years old. Others had terrible, unspeakable things done to them, and it was all perpetuated by a cycle of shame and violence in families that had never been broken.

    I always think of those kids and wonder what happened to them. Now, I think I’m glad that I will never know.

    Thanks for sharing this. This would have been so difficult. I love yer guts, friend.

    • Beautiful Katie, you’re back. So happy to get your comment. We nurses can only help shoulder the burdens of our patients for a small time and hope it is long enough for them to take a breath and soldier on. Its terrible when it wasn’t enough.

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