What it’s like to work at a prison hospital

I write a lot about surreal happenings in and around the hospital because I feel like if I don’t get them down on paper, maybe, they didn’t happen, and in my head, I know that they did, so I must create some solid proof of this fact. I have said this before, and I’ll say it again, the only thing that makes this job survivable is the surreal unrealism that surrounds us on a daily basis.  You laugh in order not to cry, that sort of thing.

When I was a third year resident, I rotated through a certain infamous state institution as the “medical senior,” which sounds really fancy, but is secret code for “the bitch.” Said state institution is one of those places that stands isolated atop a scenic hill, amidst beautiful greenery, and has murky urban legendry and old wives’ tales floating in the moat that surrounds it, along with alligators and seahorses.

It’s block shaped, and made of solid red brick, the walls lined with barred windows. Inside, when I first walked in, I was surprised to find it’s clean, but decorated very a la One Flew Over Cuckoo’s Nest.  Puke green dotted epoxy festively adorns the floors, and the walls are covered by sensible washable matching tile – in case someone does, indeed, puke. I imagine.

The place had 8 different kinds of psychiatric units. You’d never know you needed that many, but once you start listing them, it makes all the sense in the world, for all the different flavors of crazy out there: regular lock down psych; geri psych; med-psych (when they have a medical problem too); behavioral psych; addiction psych… these are some of them.

The crown jewel of the place, though, was the prison ward.

A tiny window with a push-out pull-in drawer marked the spot right next to the steel door with one of those wheels on them, like a bank vault. You’d hand in your ID–why? Oh, so that in case there was a hostage situation, the police would know who’s in there–and your phones before going in. Once that was done, the door would open, and you’d step into a tween room. The door behind you would close, and the metal bars in front would then open. Then, the guards would lead you down the hallway halfway, with a second set of guards taking over at the halfway point to take you to the end, where the doctors sit.

The guards were special.  I always say there is a fine line between the prisoners and the guards, and it all depends which way to decide to direct your personality traits.  I’m not saying all the guards were shifty, but plenty were, either from birth or acquired after years on the job.  As a relatively cute girl (if I do say so myself) I wasn’t sure whether to be more afraid of the guards or the prisoners, but I generally wore my best pajamas, tubesocks, and buttoned my white coat from toes to nose. Just in case.

It was mostly guys, but once, there was a female prisoner.  She didn’t look much like a female, but she came from a ladies’ prison, so I know it has to be true.  She needed a special convoy, and bathroom accompaniment for her activities of daily living.  I guess that makes total sense, but it was bizarre in the moment when there was a sentry posted outside the communal shower.

Another time, there was a young man, not a prisoner, who’d sneak out to the corner, or rather, to the bottom of the scenic driveway, where there was a known druggie pit stop, and sell off hoarded percs to the folks getting out of the methadone clinic.

There was a posse of these really frightening looking old men who’d hang out in the “solarium” and have quiet conferences.  One was shaggy and had a very typical Southie accent, and really bad venous insufficiency, with malodorous non healing wounds on his legs that he refused to keep elevated as instructed; and the other was more of an Italian type gangster, with graying hair he’d slick back with water for absence of gel.  I don’t know what they conversed about in hushed tones there in the solarium, but honestly, I do NOT want to find out.  I suspect they knew where Whitey Bulger was before the FBI did.

Another young prisoner would lick and spit into his IV thereby inducing horrendous life-threatening blood infections, which ended up in him developing a severe case of MRSA endocarditis (an infection of a heart valve), but at least it kept him out of jail. We figured this out after the third episode of shaking chills and profound sweats, and MRSA in the blood, directly temporally related to placement of a central line catheter. Lo and behold, IM antibiotics put an end to the problem.

My favorite case of me not being able to keep my mouth shut was when a prisoner arrived with epididymitis (testicle infection), which is basically an STD. So, you’ve yourself an STD, I told him. His response? How’m I gonna have that, I been incarcerated for 2 years. I think I said, Well, stop having sex in prison…. I may have said, “ass sex,” I’m not sure. Sexual harrassment doesn’t apply in the prison hospital.

The prisoners were pretty funny, but so were the nurses.  The most common answer to any question in that place was, “yes, I think I remember somebody said something…” in a distinct tropical accent.  I think they liked giving the IM shots to the endocarditis guy because he was so obnoxious, and I also think they were just afraid of the two mafia men in the solarium as I was, so no one wanted to approach them for bandage changes or to force him to elevate his legs.

One day, the team all got to talking.  As the “medical senior,” I lead a crack team of 4 random interns collected from indentured hospitals in the area, 1 PA student and several pharmacists around, and technically answered to an attending, most of whom were questionable at best, mostly because they didn’t care, and therefore best avoided.  But this one day, we all got to talking; we were discussing tatooage.  The prisoners’ tattooage.  The subject of that omni-present tear tattoo came up, and I said that it means they’ve killed someone.  The attending just would not believe me.  She just couldn’t.  You see, because our delicate medical sensibilities must be protected, we weren’t really allowed to know what our patients did, lest we allow personal feelings affect our clinical sense.

(This worked most of the time, except when you’d be taking care of the sweetest little old man and his cancerous prostate, and then suddenly find out that he’s been incarcerated for the past 40 years, and has 40 more to go.  What does one think in those circumstances?)

But the tear tattoo really got under this attending’s skin, so she went as far as to ask of the patients.  The one she picked happened to be a young kid, who was in after having been caught “partying” by the cops, and while at the pound, or the holding cell or whatever they call it, he was discovered to have an IV line from a previous hospital stay somewhere else, unclear exactly what happened there, but we can only assume that the “partying” took place directly via the conveniently placed IV access.

The kid was a punk.  I gotta say.  Skinny weasly little punk, whose main problem and crime probably WAS his punkedness; I can’t imagine that his ass killed anyone, he was probably in for possession, but there it was, a distinct tear tattoo.  So, when she asked him if it’s true that it meant he’s killed, he acted mostly embarrassed and refused to talk.  Then, we googled it, and much to her chagrin, yes, it was true.  The punk kid, though, I’d bet he was a poser.

I considered moonlighting there when my rotation was over, but the prospect of staying overnight at this place was too much for me, no matter how brave I was.

This story has not point other than the fact that if a whole place can be one giant iceberg of surreality, maybe a whole country can too, and maybe, there is still hope for survival.