One Sunday afternoon I was asked to see a young man on B Wing.
He had been ill for the past few days with diarrhoea and vomiting, and looked extremely unwell. He was clearly in a lot of pain as he struggled to get onto the examination couch.
He was a tall, slim Sri Lankan man in his early twenties.
I introduced myself, took a history, and then after looking in his mouth I gently placed my hand on his abdomen and found that it was rigid and very tender. He was feverish, pale and sweaty, and I suspected he may have peritonitis, possibly resulting from a ruptured appendix.
He needed to go to hospital as soon as possible, and so the nurse arranged an ambulance.
As I was typing a referral letter the deputy governor entered the room.
He was very intimidating. Always immaculately dressed in a smart suit, white shirt and plain tie, and he wore the shiniest shoes I have ever seen.
I saw the shoes before the face, and I knew it was him!
He was strict, well-spoken and an absolute stickler for the rules. In fact, I was so intimated by him that I usually looked at the floor whenever he was heading my way. Because his shoes were so highly polished that I could virtually see my reflection in them, I had nicknamed him Shiny Shoes.
He scowled, looked at his watch and then back at me.
‘Doctor Brown,’ he began, in his well-spoken voice. He always addressed me formally. ‘The prisoner has been unwell for the past two or three days. Why are you sending him out on a Sunday afternoon?’
I understood the problems he was facing. He was already understaffed, and two officers would be needed to accompany the young man to hospital. He murmured something about having to shut three of the wings down if the prisoner went to hospital, which meant hundreds of men being deprived of their precious association time.
More pressure.
More guilt.
But this time I stood my ground, looked him firmly in the eye, and explained that the prisoner might have peritonitis, and could not wait until tomorrow to go to hospital, as it was potentially life-threatening.
The prisoner groaned, but lay very still, grimacing in pain.
Shiny Shoes put his hand in his pocket and narrowed his eyes. ‘Doctor Brown, couldn’t he simply have gastroenteritis? Aren’t diarrhoea and vomiting symptoms of that too?’ His tone was firm and icy.
A flame of anger flashed through me, and I repeated in an equally icy tone that the patient needed to go to hospital today!
In that moment I hated my job. I was well aware of the risk of prisoners faking an illness so that they could try to escape, but I was sure that wasn’t the case.
Silence. Eventually, Shiny Shoes glanced at the prisoner and then back at me. ‘You’re putting me in an awkward position here, Doctor Brown. You wouldn’t be the first doctor to make a misdiagnosis.’
I remained silent but kept looking him firmly in the eye. It was a terrible position to put me in, but I wasn’t going to be intimidated.
He radioed the switchboard, and confirmed that the young man would be going to hospital, and that the ambulance should be called.
‘If you’ll excuse me, Doctor Brown,’ he said curtly, and then made a sharp exit.
As soon as he had left, I felt the pressure ease. I didn’t dislike Shiny Shoes, and I knew he was also under an enormous pressure, and that he was very good at his job. I just wished he thought I was good at mine!
I went back to the man’s side. He was retching and groaning, and the blue roll of tissue beneath him had almost disintegrated with sweat. I tried to reassure him that everything was going to be fine, but there was nothing I could do while we waited for the ambulance to arrive.
Soon two prison officers arrived at my door, one holding a pair of handcuffs.
‘He doesn’t look good, Doc!’ the officer exclaimed, quickly handing the cuffs over to his colleague. ‘You can be cuffed to him!’
‘Don’t worry, he’s not contagious,’ I told them.
They didn’t look convinced.
‘You’re going to have to take my word for it,’ I snapped. I’d had quite enough for one day of trying to convince people I was telling the truth.
*
It wasn’t just the emergency hospital transfers that caused problems for the doctors. Getting prisoners to their scheduled hospital appointments could also be extremely difficult. Sometimes there simply weren’t enough prison officers available to escort them. As a result, they would often miss their appointment, and have to have it rebooked, sometimes more than once, causing a further wait of maybe three to six months before they were seen. It made managing their illnesses much more difficult.
One day, on finding a prisoner I was concerned about had missed their appointment for the second time, I couldn’t help but moan to Sylvie.
‘It’s not the Scrubs’ fault,’ I said. ‘It’s the lack of staff.’
She nodded. ‘I’ve seen a lot of doctors leave because they get so frustrated by it. Coffee?’
I could have murdered one.
‘Sorry, I can’t,’ I replied. ‘I’ve got to go to the Seg and see someone who tried to set fire to his cell.’
Sylvie wished me luck and smiled encouragingly. ‘Doc, don’t let this place get to you.’
‘I know. It just feels like an uphill struggle at times.’
*
To be locked in a very small cell for twenty-three hours a day must have been hard to cope with. Sometimes, when the prisoners were walking round the exercise yard outside the Seg, which was at a slightly lower level, I would see their heads bob up at the doctors’ office window.
‘’Ello, Doc,’ they’d shout, anything to start up a conversation, desperate for a bit of interaction.
Living in such extreme isolation obviously took its toll on some of the inmates, and occasionally caused them to suffer from anxiety and panic attacks. Others would compulsively pace around their cell, or clean it repeatedly, while others spent hours doing press-ups.
The prisoners in the Seg were seen on a daily basis by the duty doctor, accompanied by a nurse and a prison officer. They were also visited regularly by Chaplaincy and the Independent Monitoring Board. Whether they chose to see me when I came knocking was another matter.
The prison officer would lead the way, thump his fist on the hatch in the door to announce our arrival, open it to check all was okay inside, then unlock the door. Sometimes a shout came back, ‘I’m, having a crap!’ so we would move on to the next cell and return at the end of the round.
‘Doc’s here’.
I was not allowed to go in the room without the officer’s permission. Most of the time I didn’t need to.
Sometimes a prisoner wanted to engage, possibly to ask for medication. Often I was ignored completely. Occasionally, I might wish I had been, as a tirade of abuse was hurled at me.
If a prisoner was extremely dangerous, the door could not be unlocked and the consultation, if there was one, had to be conducted through the hatch. Even that was not always possible, if there was a risk of having urine or faeces thrown, or of being spat at. In that case the conversation would be conducted through the tiny gap at the side of the cell door. On the very rare occasion that a very violent man needed to be seen, a sign saying ‘three man unlock’ would be placed below the name and number outside the cell, and the door could only be opened when there were three officers outside the cell on standby.
Most of the prisoners would be lying on their backs, arms folded behind their heads as they stared at the ceiling, without saying a word. Others would hide under their sheets, and I would look to see if they were still breathing.
I was advised to not enter the dingy cells if I could help it. Ed told me it was better to stand at the door, protected by an officer. The lighting was very poor in the doorway, though, so if I needed to examine a prisoner for any reason, I would have to go towards the far end of the cell, where light came through the small window, but that was only if the officer allowed it.
I knew I was in for some trouble as soon as I walked onto the Seg that day. The banging of fists on the cell doors echoed up and down the corridors and over the two floors.
Terry was on duty. ‘You’ve got your work cut out for you today, Doc.’
He chaperoned the nurse and me along the landing, the sounds of our shoes on the metal gantry drowned out by the noise of the prisoners’ protest. I stood back as Terry knocked twice and then yanked back the hatch. He did not unlock the door; it was too dangerous.
‘The Doc’s here,’ he shouted.
I gingerly stepped forward, bracing myself for what I was going to see in the cell. One of the challenging things about working in prisons was never knowing what might be waiting on the other side of the door.
In this instance, it was a young, skinny man, running up and down his cell, totally naked. He seemed to be completely wild, thrashing his arms around and shouting nonsense. He suddenly stopped in his tracks and locked eyes on me. He looked as if he was possessed. His eyes were fierce as he stared at me through the small hatch in the door.
‘Nah, she can fuck off!’ he barked, momentarily aware of our presence, before he continued his rant.
There was clearly no point trying to have a conversation with him.
I suspected he may have been using spice, a synthetic cannabinoid that can have devastating effects on the user, before being moved to the Seg, which would explain his wild behaviour. He carried on running up and down his tiny cell, thumping his fists against the wall as he went, screaming a continuous stream of expletives.
Terry slammed the hatch shut as I walked on to the next cell. My heart went out to the officers working the Seg that day, as they certainly had their hands full. If he had used drugs, there was no way of knowing when he might calm down.
There was a particularly vicious batch of spice going around the prison at that time, and the effect it was having on people was terrifying. Some became acutely psychotic, others had fits, some lost consciousness.
Stopping drugs from entering the prison was a never-ending problem for the officers, especially Govenor Frake, who was in charge of Security.
Sometimes drug packages were chucked over the prison walls into the grounds, but most of those would be discovered by the prison staff – although some would be picked up by prisoners, sometimes even the red bands. A red band prisoner once confessed to me that he was being threatened by another prisoner, and told that if he failed to get the parcel one of his family would get hurt.
I also learned that drugs and phones were smuggled in on visits, and that Govenor Frake had once caught someone with three phones and a number of bags of cocaine in her vagina. ‘It must have been bigger than a clown’s pocket,’ she’d said with a harsh laugh.
Another way spice was getting in was on letters addressed to prisoners, as it could be sprayed onto the writing paper, which was then cut into small pieces and smoked. I’d looked at Terry in disbelief when he’d first told me that, and I remember feeling quite naïve at the time.
Terry banged on the next cell door. ‘Doc’s here!’ he shouted.
No reply.
‘This one is a self-harmer. You’ll be lucky to get anything out of him,’ he informed me.
I peered through the hatch into the dark cell.
The man was sitting on his bed with his back against the wall, half in the gloom, half in the shaft of light coming through the window. He was Afro-Caribbean, his long black hair hanging loose past his shoulders.
His arms were glistening with what looked like blood.
I turned to Terry, perturbed. ‘Is that blood all over his arms?’
Terry nodded. ‘More than likely, Doc. You can’t stop him. We’ve tried everything. It’s like a bloodbath in there.’
‘We need to open the door!’
Terry frowned. ‘I don’t mind opening it, but you’ll have to wait at the door. He’s in here because he’s too dangerous to be anywhere else.’
Strangely, I wasn’t afraid. I just wanted to check if he was okay.
Terry unlocked the door and the key scratched as it turned in the lock. He yanked on the handle, releasing the door. A sharp, sour smell of old blood blended with sweat poured my way.
The prisoner didn’t even look up. Instead, he continued to slice at his already open wrist wounds with his overgrown fingernails.
Terry wasn’t exaggerating, the cell was covered in blood. The sheets, the washbasin, he’d even smeared the walls with it.
‘Can’t you do anything to stop him?’ I asked Terry.
He shrugged. ‘It’s impossible to stop him doing it. As soon as his wounds get stitched up he’s at it again.’
I knew serial self-harmers would use just about anything to cut themselves – from their fingernails, to the edges of a yoghurt pot, to the metal of their bed frame. I also knew that they often reopened the same wounds over and over again to prevent them from healing. The question of why he was doing it was the biggest problem of all. I hoped Terry could give me some insight.
‘He’s Jamaican, waiting to be deported. He doesn’t know when, could be months away, could be years.’
That’s all Terry needed to say. I’d learnt that foreign national prisoners were some of the most volatile of all in the Scrubs. A lot of the prisoners I’d met were pretty pragmatic about their sentence – ‘they’ve done the crime, they’ll do the time’ – but foreign nationals often didn’t know what the ‘time’ would be, nor if and when they might be deported, and that made it very hard for them to cope. There was a high rate of self-harm amongst them, and some were full of hatred, bitterness and anger.
I glanced at the name underneath the prison number pinned to the door.
‘Josef,’ I said softly.
Nothing.
I wanted to try to get Josef to engage with me, and I hoped that even a brief conversation might help him to take the focus away from cutting his arms and his legs, and on to something else.
I said his name again, more gently. But still nothing. Instead he continued to pick at his cuts.
Terry stepped in. ‘Doc wants to know if you need anything.’
Josef slowly turned his head towards us, staring blankly through his greasy strands of hair. His flat, empty expression was so sad and I really wanted to understand him and be able to engage with him. But Terry grew impatient, slammed the door shut and locked it.
He looked at me sympathetically. ‘Warned you, Doc. He’s a waste of time. Some people just don’t want to be helped. He won’t talk to anyone.’
I refused to believe that anyone was beyond help. I was determined to persevere, and to try my very best to show him that I cared and wanted to help him.
We arrived at the next cell.
‘Mind the hatch, this one likes to throw shit!’ said Terry.
I tensed, preparing to jump out the way.