Learning Curve

Prison has been a very interesting rotation both because it’s a prison but also because it’s my very first rotation. I have found that I’m not only naïve regarding medicine but also naïve when it comes to prison life.

First off, everything is under lock and key. When I arrive at work I must place all my belongings into a locker, then proceed through a very sensitive metal detector (I have to take out my bobbypins each day in order to avoid the “beep”!), and finally I’m granted access to the official prison by the sergeant on duty at “master control.” The Sarg also gives me key ring with a single key on it. Each staff member has a particular key ring assigned to them with varying numbers of keys ranging from 1-30ish and varying in size from small to comically large. If you’re very important, you have many keys and jingle as you walk. As for me, my one key unlocks the door to any bathroom in the facility. Whoopdy-doo. Literally EVERYTHING is under lock and key. It’s pretty annoying. The bathroom, every door (even those separating hallways), cabinets with sutures and needles obviously but even cabinets with gauze and gloves. It becomes a problem for me when I’m trying to get from point A to B and come across an area determined to be needing more security than my mere bathroom key will allow access to. At this point I need to turn around, go back through the 3 doors I just unlocked, and look about for 1 of the 2 guards in the unit to escort me to where I need to be. Thankfully everyone seems to understand and is pretty patient with me. I think I only had one or two eye rolls when I was doing a sterile procedure, dropped the scalpel on the ground, and needed someone with higher access than me to go open doors A-Z and cabinets 1, 2, and 3, in order to bring me a second scalpel. This one I made sure not to drop.

Secondly, I recently marveled at the narcotic procedures in place at the prison. Understandably every prisoner is trying to claim “the worst pain I’ve ever had. It’s real bad” so that they may get 5 days worth of opioids. Rumor has it that oxycodone pills cost 3x as much in the pen as they do on the street. Not a bad way to make some money while in prison. This demanding market has led some prisoners to pull some pretty painful stunts in order to be written for a short course of narcotics. When they come to pill line to take their prescribed dose for the day, they will take the pill, perform a “cheeking” movement and then show the nurse their empty mouth. Then, back at the unit they can reproduce the pill and sell it to the buyer. The new procedure in place to dissuade this action is to crush the pill and dump the pieces into a cup w/ 1-2 oz of water that the prisoner will then drink infront of the nurse. It seems to be working so far but I have no doubt some new creative drug smuggling ploy will surface sooner than later.

Lastly, the inmates are certainly creative. These guys embody the saying “necessity is the mother of invention.” The inmates have invented a particularly gross method for voicing their anger, disappointment, or irritation with staff. It’s called “getting a milkshake.” It seems to occur mostly in segregation unit (aka the hole or isolation) where there is a steel door with a cuff port opening at waistlevel which allows for handcuffs to be put on or removed as well as passing of food, medications, paperwork, ect. between staff and prisoner. New officers or personnel aren’t used to interacting with a steel door so more often this new person will bend down and put their eyes at the cuffport level to view the inmate and see in the cell and make sure there’s no trouble going on behind the door. It is at this moment that the milkshake comes. The prisoner will fling feces and other bodily fluids that he has carefully collected on his side of the door the past day or two through the cuffport. Inevitably the face of the staff member takes the brunt of the blow. Obviously this earns the inmate some serious punishment (it’s an additional 5 years to the man’s sentence if he is found guilty of staff assault) but some people may be willing to pay this price. Yuck.