Several years ago I took the position of physician assistant at the maximum security unit of the Santa Fe (New Mexico) State Penitentiary. I remember all too well my first entry into the prison. When the guard (or correctional officer, shortened to CO) accompanying me clanged the steel door shut behind me, closing me in, I realized what the inmates there must have felt when they first arrived. The sound had a finality to it. Unless the inmate had to be taken to the Santa Fe hospital, in all likelihood he was there for the rest of his days. I, on the other hand, could leave at the end of my shift and enjoy all my freedoms.
Providing medical treatment to dangerous prison inmates is only slightly different than treating you or your family. The difference is, they have nothing to lose. If they are in there for murder, one more murder means nothing. So when an inmate is brought in to sick bay to be seen by the physician assistant, the COs bring them in chained and shackled. Ankles and wrists are bound by shackles, and both are tied together with a belly chain. All that, plus the accompanying CO, prevents the inmate from acting out.
You can well imagine the challenge of examining someone who is trussed up in chains. Deciding to have the CO release some or all of the locks holding the inmate turned out to be a learning experience. Often the CO helped with the decision. If I asked him to take off the chains and he said it wasn’t a good idea, I’d respect his statement and do my best to work around the obstacles.
I learned another valuable pointer from one of the COs. After I’d asked him to take the shackles and chain off the inmate so I could examine him, he turned to the inmate and told him that if he screwed around with the doc (that was me) he’d never be brought to sick bay again. That turned out to be the biggest gun in my arsenal. No inmate, not even the ‘lifers’ wanted to face the reality of never being seen by a medical person again, which meant for the rest of his life. I have to say, I never had a problem with a single inmate. Of course, that could have changed on any bad day.
The first thing the inmates did when they heard there was a new ‘doc’ in sick bay was to make an appointment to be seen because of some terrible, unrelenting pain. I had an overflowing line-up of inmates for the first two or three weeks. They would count off their symptoms to me, clearly pleading their case to be given pain pills to ease their symptoms.
When I listened to their symptoms and did my exam, the decision to treat them with anti-inflammatory medication like ibuprofen (Motrin, Advil) or the stronger naproxen sodium (Naprosyn, Aleve) rather than pain pills became a no-brainer. They would offer up a list of places around their bodies where they hurt. Most of the time the multiple locations never fit a diagnosis. What was left was muscle pain, so they got anti-inflammatories for their trouble. Truth to tell, I never prescribed pain pills to any inmate. After a while they caught on and stopped trying to con me into giving them some.
I did have one inmate who thought if he saved up a bunch of ibuprofen and took them all at once, he’d get high. It made him violently ill and threatened to shut down his kidneys. He didn’t try it again. Some of them learn from experience. Not all, though.
Of all the injuries I had to treat, the worst was when an inmate got carried into sick bay with multiple stab wounds. The stab wounds were delivered by way of a shank, a homemade knife made from a screw driver, a piece of flat metal stolen from somewhere in the prison, or sneaked in by a friend or relative on visitors’ day. They were usually strong but thin, so they created puncture wounds rather than cutting tissue like a knife would do.
The first time I saw such a victim, with thirty or more puncture wounds in his chest and abdomen, I couldn’t imagine that he’d survive. But survive he did, after a healing visit to the hospital. He never came back to sick bay because of another shank attack while I was working there. Maybe he learned a lesson and avoided another confrontation with the shankers.
I learned more medicine working in that prison than all the other places I’ve worked. I remember early on thinking if I had a problem I wanted to discuss I could call the doctor who signed off on me. So when an inmate was brought in with his forearm laid open to the bone, blood everywhere, I called the doctor. His response? “Why are you calling me? Stitch him up!” Then he hung up.
I stitched him up.
Charles M. DuPuy has traveled the world, seen Africa as a Peace Corp volunteer, been a saleman and a farmer, and a magazine writer and editor, and an EMT. later he studied for and became a physician assistant which took him from pediatrics to geriatrics, and from Maine to the Santa Fe, New Mexico penitentiary where he worked in the maximum security unit. Retired now, he draws on his lifetime experiences while writing suspense novels. His first published novel, EASY KILL, is the first in the series, featuring his kick ass heroine, E.Z.Kelly. The second in the series is due for release in the Spring.