In the ER, Nurse Holmes quickly sets her priorities concerning Lucy:

1. treat the tissue injuries
2. check on the status of the embryo
3. investigate into domestic violence
4. assess danger
5. determine appropriate intervention
6. address perpetrator with facts
7. arrange follow-up
8. document
9. report incident according to state law

It is determined that Lucy’s pregnancy has not been threatened by the incident creating the injuries. Physician’s orders are given for measures to prevent urinary tract infection, heal vaginal tissue, and reduce swelling in the perineum. Nurse Holmes then broaches the subject of domestic violence:

Nurse: "I am concerned about the painful injuries you have and the risks to your baby from rough sex. Tell me about your relationship with Frank."
Lucy: "Frank is not a bad man; he just gets carried away. If it wasn’t for him I don’t know how I’d get by."
Nurse: "Why do you think Frank gets carried away?"
Lucy: "He feels frustrated with his job and just needs to let off steam. He has been recently demoted and feels quite depressed."
Nurse: "Has Frank forced sex on you or refused to stop when you told him he was hurting you?"
Lucy: "I don’t think he can control himself."
Nurse: "Has Frank hurt or threatened you or tried to control you in other ways?"
Lucy: " No."
Nurse: "Do you feel safe in this relationship with Frank?"
Lucy: "I have never felt safe with a man. I don’t know what that is like.
Nurse: "How is your four year old doing?"
Lucy: "He’s not a happy kid. Just recently he has started wetting the bed at night."

Nurse Holmes explains to Lucy that the incident leading to her injuries is a crime labeled domestic violence and that she and her unborn baby are not deserving of such abuse. She also explains that the tension of domestic violence often causes children in the home to have problems.

In a separate, private room, Nurse Holmes speaks to Frank:

"From the doctor’s exam the baby seems okay. We are concerned about Lucy however, because of the severity of injury to the genital area and the bruises on her body. Sexual activity against a partner’s will, or in a manner rough enough to cause injury, is a form of domestic violence and a criminal offense, reportable by law in this state. We advise you to support Lucy in following through with her appointment for prenatal care. We also want you to consider your need for some form of behavior modification therapy if the pattern between you and Lucy cannot be stopped."

Lucy and Frank leave the ER, arm in arm, with much to think about. Nurse Holmes sits down to carefully write her nurse’s notes.

The U.S. Department of Justice has an Office on Violence Against Women. Click here to access the Toolkit to End Violence Against Women. There are 16 chapters in the Toolkit, and at the end of every chapter there is a link for Resources. For example, click here to access the resources for the Health and Mental Health Systems