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Join us on this episode as we welcome Chloe N. L. Lee, a psychiatry resident, to share her harrowing experience of intimate partner violence (IPV). Chloe opens up about the abuse and challenges she faced in breaking her silence. We delve into the unique barriers physicians, especially women, encounter when confronting IPV and its impact on their personal and professional lives. Discover the importance of validation, support, and creating safe spaces within the medical community. Chloe’s story serves as a rallying call to break the cycle of silence and empower survivors.

Chloe N. L. Lee is a psychiatry resident.

She discusses her KevinMD article, “It can happen to you too: Women in medicine also experience domestic abuse.”

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Transcript

Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Chloe Lee. She just graduated medical school and is going to be an upcoming psychiatry resident. We’re going to talk about her KevinMD article, “It can happen to you too: Women in medicine also experience domestic abuse.” Chloe, welcome to the show.

Chloe N. L. Lee: Thank you so much for having me today.

Kevin Pho: So we’ll get into your article and story in a little bit, but first off, just briefly share your journey to where you are today.

Chloe N. L. Lee: Sure. So I graduated literally two weeks ago. I’m about to start my intern year in psychiatry. There was nothing else like psychiatry for me during medical school, and I’m just really excited to start my career.

So I wrote this piece drawing on personal experience that was enormously challenging, but I felt like it was a story that needed to be told, because this is a problem that crosses all boundaries. It happens not only to our patients but also to us. And so I wanted to get those conversations started, because I felt like it was a really, really important topic of conversation, and I felt like the shame and the stigma surrounding being a provider who is in a domestic abuse situation is something that is really hard to deal with, as someone who’s gone through that situation myself. So I really just wanted to get this conversation started and to dispel stereotypes and myths about what an abuse victim looks like and the idea that abuse does not happen to medical professionals.

Kevin Pho: So let’s talk about your article and have you share your story. It’s titled “It can happen to you too: Women in medicine also experience domestic abuse.” So why don’t you go ahead and share your story?

Chloe N. L. Lee: Yeah. So get ready for a wild story. This was something that took up probably over two years of my life, and I learned new elements about it as recently as a couple months ago.

So I was in a four-year relationship, and my then-partner was engaged in, in my opinion and also in the opinion of clinicians who are aware of this story, pretty egregious sexual misconduct. About three years into our relationship, he started soliciting prostitutes during the pandemic while actively caring for patients on inpatient units, and he went on to have a several-months-long affair with a nearly 50-year-old prostitute out in San Francisco. And believe it or not, those are the least problematic things he did. He went to a different hospital later and had sexual relationships with not one but two very young female staff in that hospital who were in junior roles. One was a receptionist in his department, and the other was a 19-year-old research intern. So pretty troubling behavior.

And then it just got progressively weirder and darker. He returned to our side of the country, and a patient filed a sexual harassment complaint against him. It was reported that she ran out of the room screaming, because she alleged that he had exposed himself to her. I found directions in his phone to a massage parlor, which was a front for prostitution and also was charged last year with human trafficking. And a past partner of his alleged that he had sexually assaulted her and then subsequently harassed her for a while when she tried to leave him. So I’m just giving you the facts, and you can interpret them as you will. I will not draw conclusions for you, but his behavior, in my opinion, was wildly inappropriate and, in fact, predatory.

So why am I telling you all of this? I’m telling you this to establish a context. This is someone whose objectification of women and whose inappropriate and, in fact, illegal conduct both inside and outside the professional environment speaks to a person whose driver is coercive control, and that is the crux of my experience with him.

So as I stated in my article, the sexual misconduct was actually the least of my problems. My partner was very emotionally abusive and actually got to a point where he started to become physically abusive as well. And that is an element of the relationship, excuse me, I’ve got my notes up here, that I took a very long time to actually be open about and to disclose openly to my family, to my friends. I struggled with a lot of guilt and shame. I also struggled with a lot of embarrassment, because, as I mentioned before, I’m going into psychiatry, and I went through this existential crisis when I was dealing with the aftermath of all this, thinking, “I’m going into the field of medicine that is supposed to be dealing with human behavior. How did I not see this coming? How did I walk directly into it? Does this mean I’m going to be a bad psychiatrist?” So I was struggling with all of that, and I was struggling to tell anyone what was going on with me.

I could see profound disrespect and actually contempt, disrespect is a really mild way to put it, but contempt for me, and I do believe that my then-partner saw me as disposable, as expendable. He was constantly critical, and literally nothing was off the table, from my physical appearance, I was told that I was physically not desirable to him, to how I speak. He told me that speaking to me is like deciphering a question stem on Step 2 of the boards, which was not flattering. I was perpetually walking on eggshells in my home, and I was anxious pretty much all the time. My goal every day was, “Don’t make him angry,” because I never knew what was going to happen if he became angry.

So about a month before I left him, the incident that I discussed in both of my articles happened. He came home kind of late. I didn’t expect him to come home late, and I asked him where he was, and suddenly I was on my back on our bed and his hands were around my throat. I have very clear but discrete memories of that. What I remember is the silver ceiling light above me just swinging lightly, and I remember what it felt like to have his hands around my neck, and I remember kicking. He will tell you that he pushed me down by my shoulders, and that is very demeaning to my experience with him. And that was not the first time he had been physical with me, but it was the time that was probably the most lethal.

And for a long time, I was minimizing what that act was. I had this conception of intimate partner violence in my mind that you have to be physically bruised, you have to be in shock, you have to have some kind of lasting damage, you even have to be dead. And I’ve worked with patients who have abuse histories. And I didn’t have any bruising. I didn’t lose airflow during that time. So I kept minimizing it to myself when I was alone, but this immense fear kept building up inside me, and I couldn’t explain that fear response.

And then a month later, I found him harassing a stripper for her number on Instagram, and I just said, “All right, you know what? Enough’s enough. I’m done. I don’t think the situation is going to get better.” I stayed. I didn’t leave him right away. I kept hoping that things would get better, that things would change for the better eventually, but things were getting progressively worse and, in fact, very dangerous for me. So I made the decision to leave a month after that incident. And after that, I started speaking to other women and speaking to other physicians, and I found out the full extent of what was going on, and I just thought, “Oh my God, I’m very lucky that I got out of the situation.” And that’s the story of how it all started.

Kevin Pho: So you were going through medical training during this entire time, is that correct?

Chloe N. L. Lee: Yes, yes.

Kevin Pho: Tell me some of the emotional toll that his behavior had on you as you were going through this training and as you were going through this relationship.

Chloe N. L. Lee: That’s a good question. Thank you for asking that. That was hard. Like I said earlier, I felt like such a fraud, particularly when I was on the psychiatry unit. I actually remember, before this incident, before the relationship started to devolve into what it became, I actually had a female patient who was reporting intimate partner violence. She reported two incidents during which her husband had gotten physical with her, but more than that, he was also showing signs of coercive control. He wouldn’t let her associate with anyone outside of their church community. He would put her down frequently. He would control her every movement.

And I remember thinking at the time, “How can anyone possibly stay with something like that?” I wasn’t trying to judge her, but I think my thoughts came across as judgmental, at least in my mind. I kept thinking, “You are worth so much more than this. You deserve so much better. Why are you not looking for better for yourself? Why are you not fighting for yourself?” And then I ended up in the same situation about a year later, and I understood why.

It’s very easy to judge a woman, and I understand anyone can be an abuse victim, but I’m coming from the perspective of a female clinician. It’s very easy for an outside party to look in and say, “Why is she staying with that? Why wouldn’t she just leave? I would leave immediately.” I used to think like that too. And then I went through it, and I thought, “It’s really not that easy to just leave like that.”

Kevin Pho: So give us some insight, just from after living through this, for those people who aren’t familiar or not in that situation. Why isn’t it so easy? Is it because you love the person?

Chloe N. L. Lee: The reality is I did love my former partner very much. I do not at this point. I mean, given everything that he’s put me and other women through, now I’m several months out, I’m looking back on it, there’s no way I could have any feeling for him. But at the time, I was holding on to this feeling of safety and security that I’d had with him at the very beginning of our relationship. And it’s not like I was coming home and getting beaten routinely. Something would happen, and then he would come back and he would apologize. He would cry and make this very dramatic demonstration of remorse.

I think that’s another thing that we as a society have preconceived notions about. We think that remorse looks like sobbing and begging for forgiveness. I’ve seen that play out multiple times in my own abusive relationship, and none of it was sincere. Ultimately, none of it was sincere. This person thought so little of me that he put his hands around my throat. And every time that display happened, though, that preconceived notion is what clicked in for me, and I thought, “OK, he’s clearly very sorry. He snapped. This is not who he is. Things are going to get better.” And then after a year of this happening, things just never got better. But when you have that emotional attachment, you cling on to this hope that things are going to get better. “Tomorrow is going to be better” is what I kept telling myself. And then finally, you come to this realization that it’s never going to change.

Kevin Pho: Now, during the relationship, when you’re going through these difficult moments, tell me the support systems that you had. Tell me who you shared this story with during that time.

Chloe N. L. Lee: Yeah, there were two physicians in particular who were instrumental to my healing process. I had a tough time disclosing this to my family. I actually disclosed this to those two physicians before I spoke to my family, the full details, rather, of what had happened to me, before I spoke to my own family. I was afraid that my family was going to judge me. I was afraid that they would think, “You got together with this guy, and we don’t think much of your judgment.” I was afraid my friends were going to judge me.

So the first physician, who I alluded to in my second piece, is a good friend of mine from college, and he is himself a resident right now. And I just desperately wanted someone to talk to. I started talking to him about this, not the abusive component of the relationship, but certainly the red flags that I was seeing. I started talking to him six months before I actually made the decision to leave, and it was very clear from this man’s tone and his body language that he thought I should leave, but he didn’t explicitly say that. What he did for me was something really important. He asked me, “What do you need from me right now? Do you need me to tell you what I think you should do, or do you need me to listen to you?” And I said, “I just need you to listen.” And he didn’t tell me what to do. And when I finally came to the decision half a year later that I’ve got to get out of this, he was really supportive.

What that first statement did for me is it provided this sense of emotional security that I was missing for the longest time. It made me feel like, “OK, this is a safe person. This is a safe person who I can go to. I can talk to this man about deeply personal things that are giving me enormous feelings of guilt and shame.” And ultimately, it made me far more comfortable to make that disclosure. So I think that’s actually a really important lesson for all physicians: Patients don’t open up to you if they sense judgment. And ultimately, I’m really, really grateful to that person, because you made me feel safe to disclose something pretty terrible and then to start writing and to find my voice.

The second physician who helped support me during this is a specialist in trauma. She’s a psychiatrist, and I pretty much just want to be her when I grow up. But she ran my narrative medicine seminar in fourth-year medical school, and she helped me realize that coercive control was at the center of my experience, and she validated that the situation was dangerous. I think I said that I was minimizing what had been done to me. I just kept thinking, “Well, I didn’t lose airflow. I’m not dead. I wasn’t bruised.” And I was expressing as much to her, and suddenly she cut me off, and she said, “No, Chloe, you could have been unconscious within six seconds, and you could have been dead shortly thereafter. You were very lucky that you were alive right now.” And that was chilling.

So at this point, we have two physicians who don’t know each other, who are in totally different fields of medicine, who are agreeing that this is a dangerous situation. And one of them is now providing me a lot of really solid information on what she and the local domestic violence advocacy center that I worked with termed non-fatal strangulation. That is the exact term for what it is my partner did to me. It does not reach the level of felony strangulation because there was no pressure applied, but what it was was an act of violence that was really not acceptable. And one of my domestic violence counselors, who was another great support system, summed it up very nicely. She said, “What he did to you is practice murder. He did not kill you in that moment, but he showed you that he was willing to.” And that was pretty chilling and validating.

Kevin Pho: So how are you doing today?

Chloe N. L. Lee: Better. I would say I’m better. Part of the reason I wanted to have this conversation is I wanted to normalize physicians talking about their traumatic experiences and acknowledging that they are not OK when they have trauma, and that is OK. To be perfectly honest with you, I still have bad days. There are nights where I either don’t sleep, because I can’t fall asleep or I can’t stay asleep, or I have nightmares of being attacked or of my then-partner saying the things he used to say to me, and I wake up panicking and checking my surroundings to make sure that I’m safe. And those are not great days. But I would say that those days are slowly decreasing in number, and where I am right now is a much better place than where I was, you know, even six months ago. I wouldn’t say I’m ecstatically happy all the time, but I would say that I am content. I’m content, and I’m not afraid in my own home anymore.

Kevin Pho: Tell me about the decision that you made in terms of sharing your story so publicly and wanting to use your story to normalize the conversation and reduce the stigma. So tell me about the decision that went into that.

Chloe N. L. Lee: Yeah, it started from multiple conversations with different people whom I encountered on my rotations. So I did away rotations at, I want to say, three different hospitals, in addition to doing rotations in the local area and at our teaching hospital. And at almost every single one of those institutions, women who were not patients, women who were health care providers, social workers, physicians, and nurses, had stories of their own intimate partner violence experiences.

I remember I did a rotation in New York City, close to home for me, and I was talking to the social worker on the team, and I don’t even know how it came out, but somehow I found myself just spilling this whole story. And she was the sweetest thing, and she said, “Oh, honey, I’m so sorry that happened to you.” And she said, “I had a similar experience. I had an ex-husband who would throw things at me, and I’m small, and I was always afraid of him.” And then I go to another hospital, and another psychiatrist told me, “I also had a partner who was engaged in sexual misconduct and who was really unkind to me.” And one of my friends who’s in psychiatry had a husband who was physically abusive to her. And I realized that this is an experience that is not as fringe as I initially thought it was.

It does not surprise me that domestic violence exists in our society. What surprised me is the rates at which it happens to medical professionals, to medical professionals by medical professionals. So I wrote for your website. I also wrote a piece on Doximity that I tongue-in-cheekily entitled “The man who mistook his wife for a doormat,” because I think I’m funny. And I received an overwhelmingly positive but also really heartbreaking response to that piece, where women in medicine started sharing with me their own experiences of abuse. They would say, “My story is your story, but it lasted for a lot longer.” Some had kids involved. Those are probably the hardest stories to hear. And then some also told me, “I struggled with so much guilt and shame. I tried to tell someone, but I wasn’t believed.”

And then I just kept thinking to myself, well, having all these conversations, this is really a problem. This is such a problem. We are really afraid to talk about this, and there’s something very wrong about that. There’s so much guilt and shame where it shouldn’t be. Honestly, it should be on our abusers. Our abusers are the ones who should feel ashamed. We shouldn’t feel ashamed. And so I decided to just put myself out there, and I just said, “You know what? If me sharing this horrible thing can make someone feel less lonely and less isolated, then what I’ve gone through isn’t totally senseless, and maybe it’ll make me a better physician in the long run.”

I remember feeling so isolated and miserable in the aftermath of this. And when these women started sharing their stories with me, and to be clear, I’m not glad that this happened to them, but when these women started sharing their stories with me, I felt less alone, and that did wonders for me. Just emotionally, mentally, it did wonders for me. And so I’m hoping I can kind of pass that forward and keep this conversation.

Kevin Pho: We’re talking with Dr. Chloe Lee. She’s a psychiatry resident. Her KevinMD article is titled “It can happen to you too: Women in medicine also experience domestic abuse.” Chloe, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Chloe N. L. Lee: Thank you. So I think I’ve emphasized ad infinitum that people in medicine can be abused and people in medicine can be abusers. And the final thing I’d like to leave your audience, it’s something that I struggled to figure out how exactly to say, but I think I’m going to say it: “First, do no harm” does not just mean don’t actively engage in harm. It also means don’t turn a blind eye to harm when you see it being done.

If you think of more prominent cases of abuse and misconduct, not necessarily sexual, but certainly misconduct within medicine, the names Larry Nassar or Christopher Duntsch, Michael Swango are coming to mind. These are ethically compromised former physicians that did unspeakable damage to patients and to their families. But they didn’t have access to those vulnerable people by themselves. They enjoyed years of institutional complicity that allowed them to have access to their victims, and by the time they were held accountable, there were countless lives that were irrevocably damaged.

And we as physicians have a responsibility to say that that is unacceptable. In medicine, it’s not OK. It is unacceptable, and we need to take a hard line. We need to take a hard stance and say it has no place in medicine, through our actions, not just our words. Otherwise, it’s just lip service. And that is ultimately something I hope stays with clinicians who may be watching this video right now.

Kevin Pho: Chloe, thank you so much for sharing your story, time, and insight. Thanks again for being on the show.

Chloe N. L. Lee: Thank you so much.