The Prison Doctor

by Dr Amanda Brown

  ‘I have a beautiful girlfriend. I have a loving family. I have a mother . . .’ His voice faltered, trembling. ‘I have a mother who is very disappointed in me. She thinks I’m guilty. She says she can’t understand why I would have committed fraud, when we have so much money already.’

  He was on the edge of tears as he looked up at the small barred window, and stared out of it, no doubt imagining the freedom on the other side.

  He then turned to me. ‘I’m from a very wealthy family, you see. We have companies and properties all over the world.’

  Which was just as I had predicted. I suspected his crime must have been fairly serious, bad enough to warrant being refused bail – he would have had enough money to have paid for it otherwise.

  ‘Well, hopefully they will come and visit you soon,’ I said.

  Azar nodded.

  ‘I’m not sure if I can face my mother. When she makes up her mind about something, it’s very difficult to persuade her otherwise.’

  I nodded.

  ‘I can’t bear the thought of being without Jazmin.’ His voice cracked again.

  ‘Your girlfriend?’

  ‘She’s so beautiful!’ he exclaimed, reaching into his bag for what I assumed was her picture.

  Just as he was pulling out a little bundle of photographs, the officer in charge poked his head into my room.

  ‘We got an emergency, Doc, someone you got to see.’

  I looked at Azar apologetically as the officer ordered him out of the seat.

  ‘Move it!’ he said, gruffly. He was one of the three burly officers who had restrained the noisy guy earlier.

  Azar looked panicky.

  ‘It’s going to be okay. Deep breaths if you feel overwhelmed,’ I said as he was being led away. He looked back at me.

  ‘Keep calm,’ I mouthed.

  And with that he disappeared. But I knew that, because of his diabetes and the length of time he was on remand, I would most likely be seeing a lot more of him, which pleased me as I’d warmed to him.

  Chapter Eleven

  One of the prison officers, Ed, needed my help.

  He’d phoned the doctor’s office asking me to come to the Seg immediately.

  As I arrived, he was pacing around, looking anxious and angry. From the way he was behaving it clearly wasn’t a Code Red or a Code Blue crisis, but nevertheless something serious had happened.

  ‘Thanks for coming so quick, Doc,’ he said.

  I peered up the metal stairwell to the cells above.

  ‘Where do I need to go?’ I placed my foot on the first step.

  Ed stopped me in my tracks.

  ‘Not up there, Doc, we need you in the obs room.’

  The observation room was reserved for prisoners who needed to be watched twenty-four hours a day on CCTV. There was nothing in the room at all.

  Ed grimaced. ‘Prepare yourself.’

  I followed behind him, dreading what I might be about to see.

  The door to the cell was open and I could see the backs of several officers crammed inside.

  ‘So,’ said Ed. ‘This idiot has gone and stuffed some razor blades up his arse!’

  I wasn’t sure I’d heard correctly. ‘Sorry, what?’

  Ed explained that it wasn’t as unusual as I might have thought. The prisoner was using the razors as a last-ditch attempt to prevent being transferred to another prison.

  ‘By stuffing razors up his arse, he’s effectively concealing a weapon, which he could then attack staff or inmates with. The other prison will refuse to take him if he’s armed.’

  I was speechless. The lengths that some of the prisoners went to was incredible. Prisoners might resist a transfer for a variety of reasons, such as not wanting to be moved far from their family, making it more difficult for them to visit. They may have enemies in the other prison, or possibly owe money to people there that they cannot repay. Some, on the other hand, may be dealing drugs and be owed money in the Scrubs.

  This case must have been something along those lines, for the prisoner to have taken such extreme measures.

  ‘Has he wrapped them in anything? Clingfilm?’

  I hoped so, otherwise he could be bleeding internally.

  ‘He won’t say’.

  I asked Ed if he had any spare surgical gloves. I’d used my last pair on a prisoner in E Wing, and hadn’t had a chance to grab more. He disappeared inside his office then re-emerged with a large pair of black plastic gloves that looked a bit like gardening gloves. They would have to do. I’d tried to find some in the tiny Seg doctor’s office, but there weren’t any. I did, however, find a roll of disposable white plastic aprons. I pulled one off, tied it around my waist, and put on the gloves Ed had found.

  In the observation room, the prisoner was kicking off again. The three officers inside were wearing restraint uniform – which looked like riot gear; thick black overalls and a black helmet with a visor to protect their faces.

  A deep voice shouted, ‘I’m staying here! I’m not fucking moving to that hell-hole! Try and make me and I’ll fucking sock you one.’

  Ed was having none of it. It was easy to tell why he was in charge of the Seg; no one messed with him.

  ‘Shut it!’ he shouted.

  There was a foul smell in the small room. Their shouts bounced off the walls, becoming deafening.

  ‘Don’t kick me!’ the prisoner shouted.

  Ed sighed. ‘No one’s going to kick you, Clarke. The Doc’s here; she’s come to take the razor blades out of yer arse. Don’t want you bleeding to death, do we?’

  The prison officers parted, revealing a scrawny little man, writhing around on the floor like a worm. He was white, around 35 years of age, with tattoo sleeves on both arms.

  He glanced up at me, standing in the doorway wearing an apron and two oversized black gloves. He suddenly froze with sheer horror. ‘No!’ he screamed. ‘I’ll take them out myself!’

  Thank God for that, I thought (not that I’d have been permitted to do a rectal examination without his consent).

  ‘Wise choice, mate!’ said Ed.

  I flashed Ed a relieved look as I pulled the gloves off, the latex making a snapping noise as it left my skin.

  ‘Don’t tell me you’ve got somewhere you’d rather be,’ he joked as I headed for the exit.

  *

  As it was lunch time, I returned to the doctors’ office. Zaid, one of the other locum doctors, was there, looking as stressed as I felt.

  ‘I need a cigarette!’ he said. ‘Fancy keeping me company?’

  ‘Definitely!’

  We took it in turns to unlock our path to the courtyard outside Reception.

  It was wonderful to be greeted by sunshine. I closed my eyes, craned my neck to the sky and bathed in the summer warmth, lapping up the fresh breeze.

  ‘Not here, AB.’ Zaid interrupted my moment of escapism. His nickname for me was my initials.

  He took a left, leading me alongside A Wing. The narrow strip of land between the prison and its formidable walls reminded me of a wasteland in an apocalyptic film. Strewn with rubbish it was hardly a scenic view, but it was the best the Scrubs could offer.

  Zaid reached into his pocket and pulled out a packet of cigarettes. He tugged one out of the box with his mouth, and cupped his hand around the end as he lit it.

  We stood there in silence as he sucked the smoke deep into his lungs, his face a picture of contentment.

  Finally, he spoke. ‘So how bad has your day been so far?’

  I rolled my eyes. ‘I had to go to the Seg to see someone who had shoved razor blades up his arse.’

  Zaid didn’t seem the least surprised. He glanced at me sidewise, blowing a ribbon of smoke into the air.

  ‘One of those,’ he said, also rolling his eyes.

  ‘How about you?’ I asked.

  ‘I had to attend a resuscitation on D Wing,’ Zaid replied. ‘Guy tried to hang himself. Didn’t succeed. And then I had to see someone who self-harmed by swall
owing a couple of batteries.’

  We were both silent again for a moment.

  It was a world away from the lunch-break conversations I’d had back at my old practice. I’d probably have been discussing the latest HRT medication, or new NICE guidelines.

  Zaid broke into a smile, showing off his perfectly white teeth. ‘While we’re out here, come and look at this,’ he said, beckoning me further into the wasteland.

  ‘It’s my favourite pastime,’ he said as we stepped over the piles of rubbish.

  There was a huge mound of earth, half a dozen rats whizzing in and out of it. They didn’t even blink at our presence.

  ‘Wow!’ I said.

  Zaid took a drag on his cigarette. We were both mesmerised by the sight of them scuttling to and fro. Most people would go somewhere nice on their lunch break. There we were, staring at vermin.

  ‘Better get back to it.’

  Zaid threw his stub onto the ground, crushing it out under his shoe.

  ‘Seen this?’ he said as we made our way back to the entrance gates. He pointed to a sign on the wall which I hadn’t noticed before. In big red letters it said: DON’T APPROACH OR FEED THE FERAL CATS.

  ‘Yeah,’ he said. ‘They’ve brought in wild cats to try and catch the rats, but they don’t seem to be too good at it!’

  When he’d gone I stood for a few more minutes in the sunshine. Then unlocked the gates and went back to work.

  Chapter Twelve

  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.

  ‘Do
c’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.