Thursday, February 22, 2018

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Featured Stories

Breaking The Silence: Domestic Violence

Written by  Susan Dubuque

Breaking the Silence, an OurHealth special feature, explores medical and social issues that can be devastating to the individuals and families they affect. In each feature, we address topics no one wants to talk about. That is, until now.

We bring these conditions into the light and dedicate the stories to the courageous patients and families living with them and the healthcare providers and researchers who commit their lives to treating and seeking solutions to these enigmatic problems.

Star’s husband sang “Eeny, meeny, miny, mo” as he aimed the gun at her and their two young daughters, one after another. Then slowly, slowly, he lowered the gun.

This scene is real — not the stuff of made-for-TV movies. And it is only one example of the horrendous abuse Star Myles suffered at the hands of her husband for nearly 15 years, culminating in a night of terror when he knocked Star unconscious and shot her in the head.

Here is Star’s story.

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At first, it was flattering. “He was one of the most popular boys in school, and he was interested in me. He was a senior, and I was just a freshman.” That’s how Star Myles begins her saga of years of living with fear and abuse. He was attentive and affectionate, and soon they became a couple. “I was the envy of all the other girls at school,” says Star. If only they knew the real story.

Her new boyfriend expected — demanded — that she spend every spare minute with him. Without realizing what was happening, Star gradually became cut off from her friends. No more giggling in the halls between classes or trips to the mall with her girlfriends.

Within the first year of dating, his attention turned into possessiveness, and affection grew into jealousy. Star remembers several vivid examples. “One day, my boyfriend walked into my classroom at school and demanded that I come with him. I was so horrified that I picked up my books and papers and practically crawled out the door.” And it didn’t stop there.

“When I was still in school, I had a part-time job at Krispy Kreme. Every day, he would sit in his car in the parking lot where he could see me while I worked. He would stay there for my entire shift.”

It wasn’t long before the control and emotional abuse turned physical. “He would push me, hit me and choke me,” recalls Star. “One time he dragged me down to the James River and threatened to drown me.

“I was a good girl and a good student,” she says. “I always earned A’s and B’s in school. I wanted to go to college and become a registered nurse.” It’s not surprising that Star’s grades started to slip. She then became pregnant and delivered her first baby at age 17.

After the birth of the baby, the abuse continued. By this time, Star was completely isolated from her friends and even her family. “It seems astonishing that I would put up with this treatment, but I was so ashamed and embarrassed. I didn’t want anyone to know how bad things were,” she says.

“In 2000, when I was 18, we moved in together,” says Star. “I was determined to provide my daughter with a family — to create a home for her.”

Star had a second child four years later, and five months after that she and the father of her children married. But being a father did nothing to mollify him. The abuse intensified. Now fearing for her children, Star tried to leave. “I took my two girls and went to my grandmother’s house, but my husband showed up and starting beating me right in front of my grandmother,” she says. Feeling completely helpless and without anywhere else to go, Star returned home.

Star was a hard worker and for eight years she held a responsible job with a financial company. But her husband’s domination even extended to the workplace. “He bought me a cell phone and insisted that I stay connected with him on the phone throughout my work day.”

Star was the primary breadwinner for the family. “My husband worked as a security guard, but he spent all his money on alcohol, cigarettes and going out with his friends. I wasn’t allowed to spend any money on myself. I couldn’t buy clothes for work or have my hair done, or my husband would accuse me of trying to ‘look good’ for other men.”

On several instances, neighbors called the police when they heard shouting and fighting coming from the couple’s apartment. Finally, in January 2011, Star had had enough. She called the police herself. She had recently given birth to her third baby, and the final straw was when her husband tried to shove her down the stairs while she was holding the newborn. It took every bit of strength she had, but Star signed a restraining order.

The court date was Feb. 14. “Since my husband had no record, the judge just fined him $200 and told him he had to take an anger management class. It’s amazing, but he actually got mad at the judge and stomped out of the courtroom,” says Star.

Out of the blue, just a few days after Valentine’s Day, Star’s husband sent her flowers at work. That was the first and only time in all the years the couple was together that he sent her flowers.

That gesture of warmth and kindness was short-lived. On Feb. 22, Star was at home studying for her state boards to become a licensed practical nurse. Through all the turmoil at home and while working a full-time job and caring for her children, Star had continued her studies. She completed all the course work and just had to sit for the exam. Soon she would be on her way, completing the first step toward her goal to eventually becoming an RN.

The thought of Star advancing professionally was more than her husband could bear. He picked a fight and became even more aggravated when Star ignored his sniping and continued studying. He lashed out and spit in her face. “I tried to defend myself, and I knocked his glasses off his face,” recounts Star. “That really set him off.”

As the argument escalated, Star entered her oldest daughter’s bedroom while holding her 1-year-old baby in her arms. “I thought that in the presence of the girls, my husband would get himself under control and just leave,” she says. But nothing could be further from the truth. In a fit of rage, he struck Star in the head with the butt of his gun — a .40-caliber Glock — and then shot her in the head. The baby dropped from her arms, and Star collapsed on top of her.

Star’s oldest daughter, age 11, called 911 and carefully followed the dispatcher’s instructions until the emergency squad arrived, saving her mother’s life. Star was rushed to VCU Medical Center’s trauma center, where she remained in intensive care on a ventilator for more than a week. She has endured 15 surgeries since the shooting and spent many months recovering from her massive injuries that included a traumatic brain injury, the loss an eye and a shattered jaw.

The road to recovery has been long and arduous. Star was unable to care for herself or her children for more than a year. She stayed at her grandmother’s home, and her mother — who was unemployed at the time — became her caregiver. Star’s husband’s aunt stepped forward and cared for Star’s three daughters while she healed.

It has been five years since “the incident,” as Star refers to the shooting, and the entire family has come a long way. “I genuinely believe that God saved me for a reason,” says Star. “It wasn’t my time. I still had a lot of work to do.”

“First, I had to forgive my husband. There’s no time to waste dwelling on anger or hatred.” Then she arranged counseling for her children. “They experienced so much. I want to make sure they can move past this and not carry the scars throughout their lives.” Star’s husband is now serving 50 years in prison without chance of parole.

Star credits Sgt. Carol Adams, a Richmond police officer, with her emotional recovery. Sgt. Adams witnessed the murder of her own mother as a teenager, and in 2014 she established the Carol Adams Foundation to provide emotional and financial support to victims of domestic violence. The foundation provides shelter and transportation to individuals trying to escape from a dangerous spouse or relationship. Star and her three daughters, now ages 6, 12 and 17, are living in a house owned by the foundation. “I have been on disability since the shooting,” says Star. “Being able to live in this home gives our family stability and has allowed me to get back on my feet financially.”

According to Star, her blessings don’t stop there. A group of volunteers came to the house to build a deck. Among them was Robert Irving, the assistant commissioner of field operations for the Virginia Department of Motor Vehicles. Irving quickly recognized Star’s drive and determination, and he encouraged her to apply for a part-time position at the DMV to help ease her back into the workplace.

Despite years of living in terror and being subjected to unbelievable abuse, Star maintains a positive attitude and giving spirit. “I was so filled with embarrassment and shame. And I felt trapped. Now, I am committed to helping others who are in a similar situation.”

Star lives her mission by serving as a volunteer with VCU Medical Center’s chapter of the Trauma Survivors Network. “When a patient who has suffered a violent injury comes into the hospital, I go visit them. I let them know that they are not alone and that there is help out there. I want to help others find the strength and courage to escape from violent relationships.”

When it comes to strength and courage, there is little doubt that Star Myles has plenty to share.

It’s time to stop whispering about domestic violence. Let’s have a frank and open conversation about this issue — exploring the prevalence, warning signs and resources available to help those in need.

If you think domestic violence rarely occurs, think again. If you see domestic violence as physical injury, take a closer look. If you believe domestic violence could never happen in your neighborhood, check the facts.

Domestic violence — also called intimate partner violence — is a repetitive pattern of behaviors to maintain power and control over a spouse or romantic partner. The behaviors can include physical, verbal, emotional or psychological abuse; sexual violence; threats; intimidation or economic deprivation. Domestic violence can happen to anyone regardless of age, race, sexual orientation, religion, education or income level. It can occur with couples that are married, living together or dating. Both men and women can be victims, and both can be abusers.

The statistics are staggering. Nearly 48 million women in the U.S. experience physical violence by an intimate partner every year. Fortunately, our community has an abundance of support services. Bonnie Price, director of forensic nursing, leads a team of 10 forensic nurses who provide 24/7 coverage at all Bon Secours Richmond hospitals. “Our team is trained to intervene in cases of domestic, sexual, child or elder abuse, as well as human trafficking,” says Price. “Our team serves 23 counties and cities across Central Virginia.

“Our referrals come from a variety of sources,” Price notes. “We may receive a call from the police or EMS squad telling us that a suspected victim of abuse is on the way to the hospital. The emergency department or inpatient staff may alert us. And sometimes the patient may ask for help directly.”

The signs of abuse can be subtle or overt. “But there are some indicators that alert our team to go into action,” says Price. Here are a few:

  • The injury doesn’t match the story, such as a black eye that is supposedly caused by “running into the door.”
  • The partner does the talking for the patient and is unwilling to leave the patient alone with the healthcare professional.
  • The patient has injuries in various stages of healing.
  • The patient has a history of suspicious injuries.

“Sometimes the bruises and injuries are on parts of the body that don’t readily show — we call this the ‘bathing suit area,’ ” says Price. And not all abuse is physical. “Domestic violence is about control. That may be controlling the money or limiting where the victim goes and who the victim is ‘permitted’ to associate with. Sometimes just threatening physical harm — or worse yet, threatening to harm the children — is enough to maintain control over the victim.”

The forensic nurses, working in tandem with a member of the Regional Hospital Accompaniment Response Team, visit identified patients. RHART is a collaboration of organizations including Bon Secours Richmond Health System, VCU Medical Center, YWCA of Richmond, Safe Harbor, Hanover Safe Place and other domestic violence and rape crisis programs from throughout the area. During this initial visit, the nurse and RHART volunteer conduct a “danger assessment” to evaluate the frequency and severity of the abuse and whether the pattern of abuse is escalating. Other factors considered are if there is a presence of alcohol and drugs, if the perpetrator has ever threatened to kill the victim and if there is a weapon in the home.

This care team offers support, information and guidance. “If the patient is willing to report the assault to the police or initiate an order of protection, we will guide them through that process,” says Price. “If the individual is ready to leave the violent situation, we will connect them with vital resources in the community.”

But why do they stay?

“If you live in a safe and relatively happy home, you may be quick to judge and wonder why individuals living in dangerous and threatening environments just don’t leave,” says Caitlin Shiflett, victim advocate for VCU Medical Center. “There are many reasons why someone would remain in a frightening and abusive relationship, but perhaps the most pervasive is fear.” Abusers might repeatedly threaten to hurt the victim, their children, a pet, friend, family member or even themselves if the partner leaves.

“Emotions other than fear can serve as powerful barriers to leaving,” adds Shiflett. “An abuser may call the victim names, put them down and play mind games. As a result, the victim may have low self-esteem and at some level even feel to blame or that they deserve the mistreatment. They may also feel ashamed of their situation and embarrassed to ask for help.”

Financial control is a very real part of an abusive pattern. Victims might be dependent on their abusers for financial support and worry about taking care of themselves and their children on their own.

Victims might also feel compelled to stay with an abusive partner for the sake of their children. “A victim may not want to break up the family, or perhaps they fear that the partner will take the children away or hurt the children if he or she is not there to protect them,” says Shiflett.

Sometimes friends and family are not supportive of a victim leaving. “They may not understand or believe the seriousness of the situation,” observes Shiflett. “They may feel angry that the victim has left before and gone back. Or they may fear for their own safety if the victim comes to stay with them.”

Sadly, lack of knowledge of where to turn could be the most common reason why victims remain. “Abusers are likely to cut off their partner from family and friends in an effort to exert more control. The victim might feel that there is no one to turn to and nowhere to go,” says Shiflett. “They may not be aware of the many resources available in the community to help abuse victims escape.”

Women are at greatest risk when attempting to break free from an abusive relationship, and they might make repeated attempts before successfully escaping. “At this point, the abuser is losing control and may become irrational,” says Bonnie Price. “It is imperative that the victim have a plan to leave safely, such as identifying a place to go, assembling important papers and stashing away a little money. We work with the regional hotline to help locate shelter beds, arrange transportation and assist the victim in successfully separating from a dangerous home and relationship.”

Breaking the cycle of domestic violence

The effects of domestic violence are deep, far-reaching and long-term. Research clearly indicates that children who live in a home marked by domestic violence are far more likely to become abusers or victims of abusers themselves as adults. The Centers for Disease Control and Prevention conducted the Adverse Childhood Experiences Study — one of the largest investigations ever carried out to assess associations between childhood maltreatment and later-life health and well-being. The study findings revealed that children who personally experience or witness violence are at far greater risk for suffering from a variety of mental health problems, drug and alcohol abuse and chronic diseases, including heart disease, diabetes, cancer and the like.

“Most people perceive intimate partner violence as a relationship issue between two people. In fact, it is a public health issue affecting all society,” says Kellie Carlyle, PhD, an associate professor in VCU's Department of Health Behavior and Policy. “Laws can offer some protection, but what is really needed to break the cycle is a fundamental shift in values and in how we talk about sex and violence. We must all be mindful of how we talk about relationships, especially to children. A common example is to not teach a little girl that a boy hitting her means he likes her. The accumulation of these messages creates a context that allows intimate partner violence to happen and aggression in intimate relationships to be normalized.”

Here are some additional keys to social change when it comes to preventing intimate partner violence:

  • Education. Learning about healthy relationships must begin early. One positive example is a program sponsored by the CDC called Dating Matters — a comprehensive teen dating violence prevention initiative that focuses on 11- to 14-year-olds in high-risk urban communities. The program includes preventive strategies for individuals, peers, families, schools and neighborhoods.
  • Know the signs. Abusers and victims of domestic violence can go to great lengths to cover up their dysfunctional and dangerous relationships. To further complicate matters, every relationship is unique. But there are common signs that can indicate an unhealthy and potentially abusive relationship. [insert sidebar: Recognize the Signs of Domestic Violence]
  • Speak out. “You don’t have to be a healthcare professional to ask a relative, friend or co-worker if they feel respected in their relationship,” says Dr. Carlyle. “That simple question opens the door to conversation. It lets the individual know that they deserve to feel respected and that someone is concerned about them. Don’t worry — it isn't your responsibility to know how to solve the problem if an abusive relationship is disclosed. Just look the other person in the eyes, let them know that they are worth something and guide them to a hotline.”
  • Get involved. Our community has many wonderful programs that support abuse victims, enabling them to break free and regain control of their lives. Reach out and get involved. Learn what you can do to break the cycle of domestic violence. It’s everyone’s problem, and we can all play a role in the solution.

Recognize the signs of domestic violence

Domestic violence can take many forms, and the abuse can be physical, emotional, sexual, psychological or economic. The first step in helping a friend or family member in trouble is to recognize what domestic violence looks like. Not all the signs will be present in every abusive relationship, but if you notice a pattern of behaviors, there could be a problem.

   Source: Virginia Department of Social Services Office of Family Violence

Domestic violence by the numbers

  • 1 in 4 women will experience domestic violence during their lifetime.
  • 1 in 7 men will be victims of severe violence by an intimate partner in their lifetime.
  • Up to 10 million children are exposed to domestic abuse in their homes every year.
  • Every 9 seconds in the U.S., a woman is assaulted or beaten.
  • More than 3 women are murdered by their husbands or intimate partners every day in the U.S.
  • 18.5 million mental health visits every year are due to intimate partner violence.
  • The cost of intimate partner violence in the U.S. exceeds $5.8 billion per year — nearly $4.1 billion in direct medical expenses and $1.8 billion in lost productivity.
  • Only 21 percent of female victims and 6 percent of male victims disclose abuse to a medical professional at some point in their lifetimes.
  • Men who as children witnessed their parents’ domestic violence are 2 times as likely to abuse their own partners as men raised in nonviolent homes.
  • Women who are victims of domestic violence are 8 times more likely to be killed by their partners if there is a firearm in the home.
  • 98 percent of domestic violence victims also suffer from financial abuse or deprivation — a significant barrier to victims being able to break free.
  • A woman is 70 times more likely to be murdered in the few weeks after leaving her abusive partner than at any other time in the relationship.

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Expert Contributors

Kellie Carlyle, PhD, MPH, Associate Professor, Department of Health Behavior and Policy and Affiliate Faculty, Institute for Women’s Health, VCU Health School of Medicine

Bonnie Price, DNP, RN, SANE-A, SANE-P, AFN-BC, Director, Forensic Nurse Program, Bon Secours Richmond

Caitlin Shiflett, MSW, Victim Advocate and Project Empower Coordinator for the Injury and Violence Prevention Program, VCU Health

Resources

Carol Adams Foundation
   thecaroladamsfoundation.org
   (804) 218-2866

Hanover Safe Place
   hanoversafeplace.com
   629 N Washington Hwy, Ashland, VA
   (804) 752-2702

The James House
   thejameshouse.org
   6610 Commons Drive, Suite C, Prince George, VA
   (804) 458-2840 (24/7 crisis line)

LGBTQ Partner Abuse and Sexual Assault Helpline
   866-356-6998 (available Monday-Friday, 8 a.m.-8 p.m.; 24/7 after July 1)

National Domestic Violence Hotline
   ndvh.org
   800-799-SAFE (7233) or 800-787-3224 TTY (24-hour hotline)

Safe Harbor
   safeharborshelter.com
   2006 Bremo Road, #201, Richmond, VA
   (804) 249-9470

Virginia Domestic and Sexual Violence Action Alliance
   vsdvalliance.org
   5008 Monument Ave, Richmond, VA
   (804) 377-0335

Virginia Family Violence & Sexual Assault Hotline
   800-838-8238 (24-hour hotline)

Virginia Home for Boys and Girls
   vhbg.org
   Therapeutic Resources
   (804) 270-6566, ext. 159 (available 8:30 a.m. - 4:30 p.m.)

YWCA of Richmond
   ywcarichmond.org
   6 N 5th St, Richmond, VA 23219
   (804) 612-6126 (Greater Richmond Regional Hotline)