Imprisonment I: Memories of Ward D

It must surely be a tribute to the resilience of the human spirit that even a small number of those men and women in the hell of the prison system survive it and hold on to their humanity.”
― Howard Zinn, You Can’t Be Neutral on a Moving Train: A Personal History of Our Times

I begin a discussion on a most un-Christmaslike subject. At the risk of becoming the target of numerous virtual attacks, I dive into the subject of incarceration.

My first exposure to jails came during my internship at a busy County Hospital. I grew up in a lower middle-class neighborhood, but we were steps away from several undesirable slums. I knew darn well how to size up a stranger long before I went to Med School, but I had never been face-to-face with someone who had taken another person’s life.

Ward D provided my introduction. County inmates who repeatedly complained of any kind of ailment were sent to Ward D. Minor conditions were treated expeditiously. If we felt that we needed more time and tests to decide, there were jail cells available in the ward for inmates to sleep in. The extremely sick ones had to be admitted to the hospital, which meant that they were shackled to their beds (at least one hand and one foot), and a full-time guard had to be placed on their doorstep. I cannot begin to imagine the expense this entailed.

It did not matter if you had a heart attack or a life-threatening pneumonia: you were tied down with steel or leather restraints. Every once in a blue moon our chief resident felt compelled to ask the guard to remove at least one restraint, because a patient’s lungs needed to be drained, or frequent repositioning was mandatory. We did not always get our wish: it depended on the guard and how much animosity he felt towards the inmate.

The first few times that I had to go into that place I was terrified. My first case was a gentleman who could have easily crippled me with one flick of his wrist. I still remember the deep, soul-less eyes that, when focused on mine, felt like my body had been invaded by an alien force. He complained of pain, not localized to any part of his body. He wanted me to prescribe narcotics.

“Come on, doc. You can do it. Just one prescription.”

A deep, soft, plea. Except that it was clear to me that this was a threat. If his hands had been free, I could tell that I would have been executed on the spot had I not complied with his request.

I ordered some tests, only so that I could have an excuse for getting out of that place. The results would arrive after my shift was over.

There were lighter moments. A man in his late teens was brought in at 2AM to receive treatment for multiple bruises and a mild laceration. The police report said that he had fallen while he was being arrested. He gave me a different story.

“I was at home, sitting on my couch, watching TV and minding my own business. I was talking to my mom.”

A sad story followed. Without warning, his front door was torn down by several plain-clothes detectives on a narcotics assignment. His mother was pushed aside, and he was thrown to the floor and handcuffed. Someone read him his rights.

Once the commotion died down, it became clear that the officers had the wrong address. No matter: they continued to search the apartment, overturning some furniture. Unfortunately for my patient, he was smoking a joint at the time, and he had a tiny stash of marijuana in one of his bedroom drawers.

The young man was indignant. He told the officers that he was harming no one; that he was a peaceful person. When they told him that they would take him in anyway (otherwise they would have had a lot of explaining to do), he said something that included the words “rotten pigs” in the middle of a sentence. This is where he acquired the multiple bruises and the laceration. And the “resisting arrest” charge.

“They beat the shit out of me,” he cried.

I wanted to smile and cry at the same time. I kept my mouth shut, closed his laceration, and did my best to soothe him. I said nothing to the officer who brought him in. When I walked out of the ward I felt as if I were collaborating with a tyrannical regime. I was ashamed.

There was the slick business executive. Or so he told me. He had told the prison nurse that he had been diagnosed with tuberculosis a few weeks earlier. He was sent to our hospital immediately, where a chest film indeed showed active disease.

He was an appealing man. Bright; articulate; apparently caring. He was in on a felony charge of passing a (large) bad check. He told me that he was taking the rap for his brother, who had numerous prior arrests and would be in deep trouble were he to be found guilty again. He had his own business; a loving family; everything to lose.

I empathized with him. Before I left the room, he had a request.

“Can you ask the guard to unshackle me? I cannot sleep on my back, and my secretions will not let me breathe at night. Can you please?”

I told him that I would make a call right away. I called his prior physician in order to get more information on when he had been diagnosed, and what medicines had been used to treat him. There was no HIPAA law in those days, and doctors freely exchanged information with other doctors on the phone, without a written request.

I was lucky enough to find the other doctor without delay. She specialized in Public Health. I knew about her because I had seen her on TV a few times.

I explained where he was, and I asked for her guidance.

“First and foremost, do not unshackle him,” she said.

A horrifying story followed. This gentleman had been detained numerous times. He knew that he had tuberculosis, but he had never followed up on his treatment. Tb is a chronic disease; it progresses slowly or not at all. People can be ambulatory and functional when they are infected, so they can infect hundreds of other individuals that they come in touch with. Much like Covid-19 does now.

My patient had not followed up with numerous appointments with the Public Health service because whenever he got arrested, he knew that all he had to do to get a warm bed and hot meals was to tell the prison nurse that he had tuberculosis. Once in the County Hospital, he was able to talk an unsuspecting intern or resident like me into unshackling him. From there it was relatively easy for him to exit through a window, or to wait until the policeman had to go to the bathroom.

She continued her account. After he last escaped, my patient went home to his girlfriend. He hugged and kissed his six-month-old baby, who became infected and died of tuberculous meningitis within weeks. Although he was made aware of this, he did not show up at the hospital, or for the funeral.

“He is a horrible man,” she concluded.

I hung up. A feeling of panic and relief came over me.

There were other encounters. Each one illustrated the enormous complexity that criminal behavior and its punishment introduces into our lives. We buy guns; we pay for alarm systems; those who can afford it lock themselves into “gated communities,” a form of inside-out jails, in order to feel safe. In the United States, none of these measures has helped to make us more secure; less afraid.

What is the answer? I will share what I know and feel in subsequent blogs.

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