Back to Work: On Varicose Veins, and Domestic Violence Screening

It was hard to go back to work after our niece’s murder. She was killed in a domestic abuse homicide, in June. I took off five days to spend with my husband’s family, for all the memorial services, the wake, the funeral. It was hard, very hard.

The first morning back in clinic, I saw a lovely patient of mine, a society maven, a warm-hearted woman who has used her position and wealth to back many good causes. She wanted to talk about her varicose veins. Should she see someone about them? Was it worth it to get them treated, when it was really only a cosmetic issue? And what would work? I sat and talked with her through this decision, as if it were a decision to have a prophylactic mastectomy or something. I took it seriously, because she took it seriously. But inside, I kind of wanted to scream, Do we really need to waste our time on this? Really?

Angel’s wake was so fresh in my mind: such a hot sunny day, and the line of mourners extending a half-mile down the broiling asphalt road. The next day at my brother-in-law’s house: watching Angel’s essentially orphaned daughter Sunny, being handed from relative to relative, everyone desperate to give her love, to not let her feel loss… And yet, her mother has been taken from her. All these images coming to me as we sat and talked about sclerotherapy versus laser therapy for those pesky varicose veins.

It’s gotten better. I’m falling back into the comfortable daily grind of clinic. And, I’m certainly more careful in my domestic violence screening.

I’ve always been uncomfortable with the idea that I was SUPPOSED to ask about domestic violence at every well visit. I often forgot, or asked in such a way that probably was not useful, like, Does your partner hit or hurt you? When, there is much better phrasing that captures more at-risk women: Do you feel safe in your relationship or Is there anyone in your life who makes you feel unsafe are examples.

Since Angel was murdered, I always ask in this better way. I am acutely aware that she was never actually hit before she was murdered.  I have been very surprised– even in the few weeks I have been back, three women have shared that yes, they are afraid, they do feel unsafe. Honestly, before all this, I have had only one person answer Yes to the Does your partner hit or hurt you question.

I recently saw a physician as a new patient. She was newly divorced, and had just moved to the area. I asked her, Were violence or threats of violence a part of your divorce? Are you scared at all of your ex?

I have never asked that before. I have seen multiple newly divorced women, and I never specifically asked about that. And she startled, and answered, Why, yes.

Turned out her ex had stalked her, harassed her, threatened her. He had spied on her, became enraged when she was starting to date again. She stressed several times, Well, he never actually hit me or anything. As she described this, I felt a chill down my spine: It was so similar to Angel’s story. There was no actual violence– she was never physically harmed, prior to her death. But the control issues, the stalking and harassing, accusations and threats– that was all there had been to herald her murder.

I sat staring at this woman, a colleague and a professional, and I was sincerely concerned for her safety. I told her, You are in danger; this behavior can certainly precede real violence, and you should be aware of that. I gave her the contact information for our domestic violence organization, and we went over a safety plan. If he followed her across state lines, she was to call for help immediately.

I don’t know if  that helped her. Hopefully her ex moved on and she can relax. I guess the point is to identify as many people as possible who are at risk, and give them the alert, let them know they are in danger, really, and give them any information and resources they need.

And so, life goes on. I’m back in the full swing of clinic. As a family, we’ve gone to the beach, we’ve had social gatherings, we’ve gone shopping. Angel’s death is like a shadow behind it all, an ugly fact that will never go away and never be set right. But it also informs my approach to patient care, and, sadly but hopefully, helps me to be a better doctor.