We were working with a patient living through extreme domestic violence. There was some concern that she might also be experiencing verbal abuse during the appointment itself. The security guard was asked to stay alert to the situation. Under their breath, the nurses were venting fantasies of retributive violence against the perpetrator. The counseling session was long -- such sessions invariably include attempts to verify that the patient is making as free a choice as she possibly can, discussions about involving the police, explanation of what resources exist that could support a patient (and any children) in getting away from the perpetrator.
All too often, the counseling sessions also include a heartbreaking resignation by both parties that today is not the day that things will change. We've talked (and rambled) about partner violence before, and there are lots of informative reference materials online, so I know you know about the insanely cruel catch-22 of trying to escape violence and stay safe and not go homeless or hungry. A lot of times, no counselor (including one at a DV crisis center or a specialized police unit) is in a position to "convince" someone to leave their abuser. In these times, no matter how much you've tried it will probably feel like you haven't done enough to help.
And sometimes a patient is terribly unhappy with the idea of having an abortion, but never wanted to become pregnant in the first place and had little or no choice in it. I think about this every time I hear people oppose legal abortion on the basis that "most" women are "coerced" into choosing abortion. This twists a lot of situations into one word, when actually "I don't want to but feel I have to" can mean so many different things -- including "I don't want to, but my experience tells me I'll be in greater danger if I don't, and promises of support from the system won't make a difference." Whether the abuser wants her to have an abortion or doesn't want her to have an abortion is ultimately immaterial to whether we, the abortioneers she seeks out, act on the woman's own decision to have or not have an abortion. (Certain people seem to think that if a woman weighs the situation and decides to have an abortion, and this is also what her abuser wants to happen, then we should cut off her reproductive rights to spite his face. No, the punishment for violent partners isn't an unwanted baby! It's jail time.)
It's really draining to hear outsiders say things like "So your solution is that we should have legal abortion instead of fix the system to support women?" Duh, no. Why are such people always assuming you can EITHER support addressing systemic problems OR support assisting someone who has an immediate problem and faces limited possible approaches? Total false dichotomy. I favor doing both of the above, because both are needed! How is that difficult to grasp?
The patient wasn't happy about having an abortion, but she was firm in her decision. She wasn't happy with her abuser, but not confident that she and her kids would be able to survive if she left him, either. Despite our staff's efforts, this was not the day that she could decide to find a safer life.
If you know someone is abusing children, in many cases reporting is mandated and there are channels for it and the kids get "taken away" (sometimes out of the frying pan and into the fire, sadly) and they may gain state protection in the form of an undisclosed placement location or something like that. If you know someone is abusing an adult, that isn't usually the case. She cried in the recovery room and everyone was worried and angry but we had to discharge her into the care of the person who was hurting her, because she's an adult and that's what she told us to do. It sucked.