Why Domestic Violence Victims Don’t Leave

A powerful story of Crazy Love–frequent battery with loaded guns held to her head, getting married five days after being choked to the point of being unable to breathe or speak, just as the bruises were beginning to fade. The marriage lasted for 2 and a half years, with daily beatings, punches to the head, until a “sadistic” episode of violence made her decide to leave instead of being killed.
70% of domestic violence homicides happen after the victim has left, “when the abuser has nothing to lose.”
Leaving a bad situation escalates the risk of the situation turning deadly.

When do you leave, when you’re already caught?

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Imaginary conversations

The voices in my head– 

she said-

Tell me to hurt myself

To flip the furniture

to yell and scream.

The voices in my head–

she said–

stay in my head

i know they are me.

You are in charge–

I said–

they are visiting you

not directing you.

Insight supported by medication

not psychosis.

The voices in my head–

I said–

are my own voice

amplified.

Observations

filtered into words

Screaming to be heard.

My first time seeing a dime bag

“Look what the patient dropped,” the medical assistant says.

I see a teeny tiny ziplock bag filled with a powdery crystallized slightly off-white substance.  Coffee sweetener gone bad, is the first thought that comes to mind. In a teeny tiny zip lock bag.

“What is it?” I ask, not knowing, cocaine heroin ground up methamphetamine.

What comes in powdery crystals, in dime sized bags?

“It’s heroin,” she says. “I worked in a pain clinic. I’ve seen it before. What do we do?”

What do we do? Medical school didn’t prepare me for this.

My gut response, my initial plan: give it back to the patient and provide information on addiction centers.

Except he has left without being seen.

Which means we are left holding a dime bag of heroin.

I do not want to call the police.

In my clinic, I take care of everyone. I take care of illegal immigrants, asking all uninsured patients their immigration status to see if they qualify for health insurance, but not changing the work I do as a doctor to support their health.

I take care of illegal drug users, asking all my patients routinely if they use drugs. The information is for me to understand their health care needs and risks.  AA? smoking cessation counseling? Information on drug treatment centers? HIV and hepatitis screening?  I take care of patients who I know are actively abusing tobacco, alcohol, marijuana, cocaine and heroin.  I do not report their use to the police.

But there is the physical evidence of the dime bag. With the heroin. I don’t want to keep the heroin in the clinic. I also don’t want to give it to the police and be forced to file a report to turn my patient into a criminal.

The MA and I create a plan.  Tell the clinic manager. Empty the bag into the toilet. Place the empty plastic bag into the sharps container. Do not report it to police.

Do not chase down the patient.

Pretend it did not happen, we did not see.

“Look what the patient dropped” says the MA.

There is no patient. There is nothing that dropped.

I see nothing.