The sound of my husband's footsteps up the stairs to our kitchen startled me. Would I have time to finish preparing the roast and get it in the oven before he saw that I had bought a different cut of meat than he'd requested?

A voice behind me said, "What's that?"

"Our dinner," I answered.

"They didn't have it. I got this beautiful boneless rib-eye instead."

"Why didn't you go somewhere else?"

"Because I didn't feel like it. If you don't want to eat here tonight, you don't have to."

"Don't you ever talk to me with disrespect again," he replied, and whacked me firmly on my buttocks.

As he walked away, I thought, that's it, the end of my marriage. I had finally had enough. I felt a sense of relief and resolve.

As I look back over the tumultuous 18 years of my marriage, I can only wonder why I stayed so long, suffering through verbal and physical abuse, substance abuse, serial adultery, and profligate spending. My husband and I had no kids. As a successful physician, I made plenty of money and was well-regarded in the community. Why wasn't I able to leave this marriage sooner?

Probably because, as with most abusive marriages, I didn't recognize my husband's harsh behavior as abuse. Also, appalling incidents alternated with "honeymoon" periods where my husband was contrite, cooperative, and loving. When I'd asked my husband for a divorce, 10 years into the marriage, he became very remorseful and begged me to go to couples counseling. We did, and things got better, but only for a while. I wanted to believe that the change would be lasting, but the so-called cycle of abuse is just that—a pattern of behaviors that tend to recur.

In addition, the whole idea of moving out and filing for divorce has its own set of stressors. If you've been in a marriage for many years, even if you don't have children, you share friends, a home, a church, and other major aspects of life. Making a change—even a desperately needed change—can be overwhelming.

Early in our marriage my husband threw me down on the bathroom floor and kicked me in the stomach, and from time to time over the years he'd shoved me. But much of the abusive behavior was verbal and emotional in nature: putdowns, threats, belittlements. I never suffered injuries that required medical attention, so I never had the opportunity to tell my story to another physician.

I did see a therapist, however, and I had a good support system, including many wonderful friends and a caring family. I knew that if I left that support system would be there for me, and I think that's part of what gave me the courage to leave.

Working through the pain of an abusive marriage has made me a better physician, though. I can pick up on subtle hints and comments thrown my way when I ask patients, "How is your marriage?" and "Do you feel like you're walking on eggshells when your spouse is home?"

I've watched female patients leave abusive marriages. One to two years later, many of these women display increased self-esteem, satisfaction with new careers, and a healthy support system with other women. They look back on their divorce as the best thing that ever happened to them.