The Prison Doctor

by Dr Amanda Brown

  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.

  Chapter Thirteen

  ‘Doctor Brown, would you have a moment?’ It was more of a command than a question. There was only one person in Wormwood Scrubs who addressed me in that way.

  I slipped the keys I was about to use on the Healthcare gates back into my pouch, took a deep breath, and turned around to look directly at the deputy governor.

  He cleared his throat. ‘I just wanted to say, I’m sorry.’

  It was hard to disguise my surprise.

  ‘You were right to insist that the young man was taken to hospital. It was indeed a case of peritonitis.’

  I’d already heard a report from the hospital stating as much, and that the prisoner had been so unwell he had remained in hospital for two weeks. I hadn’t expected an apology from the governor himself though.

  ‘Thank you.’ I smiled. ‘I appreciate you telling me that.’

  The silence settled between us again, both of us unsure what to say next. I was rescued by Sylvie, who was dashing past.

  ‘You’re needed in B Wing,’ she said, breathlessly.

  I turned back to Shiny Shoes. ‘If you’ll excuse me.’

  ‘Doctor Brown.’

  He nodded in polite, old-fashioned recognition, and I chased after Sylvie into the adjacent wing.

  ‘What’s happening?’ I asked.

  ‘It’s the prisoner with diabetes, that’s all I know.’

  *

  Azar’s diabetes had been difficult to control as the food in the Scrubs was often high in carbohydrates. Although the prison tried to provide a suitable diet for diabetic patients, it wasn’t always available, and on many occasions his glucose level was so high the reading was ‘Unrecordable’ on the glucometer. This indicated that he was at risk of hyperglycaemic coma. Sometimes, too, due to the erratic diet and timing of his insulin, his sugar levels dropped too low, which could also lead to a hypogly
caemic coma.

  But I’d never had to visit him in his cell before. It had to be serious if he was too unwell to make it to the nurses’ room. One of the prison officers was waiting outside, ready to unlock the door for me.

  ‘How bad is he?’ I asked. I’d become quite attached to Azar.

  ‘See for yourself, Doc.’ The officer turned the key and opened the door.

  Azar was perched on the edge of his bed, his body tense, his face dripping in sweat, his breathing fast and shallow.

  A look of relief seemed to wash over him as he saw me enter his cell.

  His big brown eyes were staring up at me, pleading for help.

  Somehow, though, I did not feel this was diabetes related. I pulled out my stethoscope and listened to his heart and chest, while Sylvie checked his glucose level, which was normal.

  His heart was pounding at speed, but at least the rhythm was regular. Coupled with his sweating, hyperventilating and the way he was behaving, it was more likely that he was having a panic attack.

  I sat next to him on his bed.

  ‘Don’t be afraid,’ I said. ‘It will pass, and you’ll feel back to normal again soon.’ I was trying to reassure him; people can fear they’re going to die during a panic attack.

  I tried to get him to slow his breathing down by taking long, deep inhalations through his nose, and out through his mouth. I told him to copy me, breathing with him until, slowly, his breathing settled back to a normal rate.

  As he calmed down, I looked around his cell. It was immaculate. The pictures of his family were hung in perfectly straight lines. His clothes were folded so neatly they could have been on display in a shop. His toothbrush and toothpaste, razor and shaving foam were laid out within equal distance of each other. He was clearly obsessive about keeping things neat and tidy.

  It struck me that Azar might suffer from obsessive compulsive disorder.

  OCD is quite a common disorder, and can have devastating and crippling effects on people’s lives. Those who suffer from it often have an overwhelming urge to check things over and over again, perform certain routines or rituals repeatedly, and have obsessive thoughts. Commonly, someone suffering from OCD might wash their hands over and over again, or keep going back into the house to check all the electrics have been turned off before going out, or that the door is locked. Another typical symptom would be an obsession with cleaning, or having things lined up perfectly.

  Often the OCD worsens when people feel anxious or stressed. When someone’s life is spinning out of control, performing rituals or routines can be their way of scrabbling back some of that control. It wasn’t hard to see why a prisoner might suffer from it.

  ‘How are you feeling now?’ I asked.

  He nodded instead of speaking, his breathing now steady and his heart rate returned to normal.

  ‘Don’t worry. I’m not going anywhere. Just take your time,’ I reassured him.

  Azar screwed up his eyes tightly, trying to forget the world he was trapped in. I suppose a lot of the inmates close their eyes, wishing to wake up on the other side of the prison walls, often waking up in blind panic in the middle of the night when they realise where they are.

  I waited patiently until he was ready to tell me what had made him feel so panicky.

  A bead of sweat dripped into his eyes and he blinked it away. He reached for the folded towel by his sink, dabbing his face dry.

  He finally spoke. ‘It’s filthy in here!’

  I didn’t think that then was a good moment to break the news that his cell might have been the cleanest in the whole of Wormwood Scrubs.

  ‘I’m always cleaning, but it’s never clean enough.’ He was on the edge of tears.

  My heart went out to him. He’d been plucked from his lavish lifestyle and detained in custody. It must have been a dreadful culture shock for him, probably much more so than for a lot of the other inmates.

  He couldn’t control his fate – he was waiting to hear if he would be extradited. He couldn’t control his diabetes. It seemed as if he was channelling all his frustrations into cleaning his cell, and it was getting the better of him.

  He suddenly lurched forwards, grabbed a giant lump of soaked loo roll in his right hand, and began scrubbing a patch on the wall, so furiously the tissue quickly disintegrated between his fingers.

  His breathing started to speed up again and it looked as if he was heading for another panic attack.

  I touched his shoulder. ‘Come and sit back down,’ I said, being careful to keep my voice light.

  ‘Do you have any wet wipes?’ he asked, breathlessly.

  I always carried a packet, because I too was pretty fastidious when it came to cleanliness. But it would have been frowned upon for me to hand them over to a prisoner.

  Azar’s eyes were pleading, and it seemed like such a small thing to do to help someone cope. I rummaged through my bag and passed Azar the last few wipes I had left.

  As soon as he held them between his fingers he seemed to relax.

  ‘Thank you! Thank you!’ he was shaking, overcome with gratitude.

  In truth, I could empathise. I was also inclined towards obsessively washing my hands, in part due to my job. I hated the thought of handling dirty keys all day long. One of the first things I did on arriving in the morning was to boil the kettle, put the keys in the sink and pour boiling water all over them.

  Azar placed the wet wipes carefully on the side of his basin, no doubt ready to start scrubbing after I left.

  It was such a small gesture on my part, but perhaps they would be of some comfort. I was not able to do much to improve the prisoners’ lives, but sometimes little things seemed to make quite a difference. Many times I was told that just knowing that someone cared helped them to cope.

  I stayed with Azar a little longer to make sure his panic didn’t resurface, keeping our conversation light to avoid anything that might act as a trigger.

  But he insisted on telling me that his lawyer was coming to see him in the morning to discuss his case. Although I’d seen him many times now, I still didn’t fully understand what he’d been accused of. His case was very complex, and, quite frankly, I didn’t particularly want to know too much about it.

  His frown lifted as he said, ‘And my girlfriend is coming to visit me the day after.’

  ‘That’s wonderful,’ I said, beaming. I much preferred chatting about the positive things that carried the prisoners through their daily grind. A visit from a loved one, a hand-drawn painting from a child they could hang by their bed, a letter from a best friend or a partner. Those were the things that mattered in a place like the Scrubs.

  I checked my watch. I was running late as I needed to see someone on A Wing before lunch, so I said my goodbyes, promising that I would refer him to the Mental Health Team to help him manage his OCD, and that I would see him again soon. I wished I had more time to spend with patients, but I always seemed to be in a rush.

  ‘Try and stay calm,’ I said. ‘And if you find yourself feeling panicky again, do the breathing exercises.’

  The help I could give him was limited, but I hoped that knowing I cared and understood a little of what he was going through was of some comfort.

  *

  I quickened my pace as I headed off to A Wing, hoping I wouldn’t be called anywhere else before I got there, but running towards me were three nurses.

  ‘Code Red, D Wing!’ one of them cried.

  I turned around and joined them.

  It was the familiar panic. The adrenaline rush. The apprehension of what was to come. Racing along the corridors, unlocking and locking the many barred gates, dreading what grim sight awaited us.

  The nurse in front cleared a path through the prisoners who were wandering around during their association time. I could recognise many of the faces by now, and some I knew by name. They all knew mine, of course, it was easy enough to remember.

  ‘Hi, Doc!’

  ‘All right, Doc!’

  One after
the other they greeted me, stepping back to make room.

  ‘Like yer perfume, Doc!’ one prisoner said, sniffing the air.

  I looked back over my shoulder. ‘Thanks, it’s Escape by Calvin Klein!’

  The group loitering by the snooker table sniggered.

  ‘Gimme some of that!’ one of them shouted.

  It had become a running joke at the Scrubs. A lot of the prisoners found it amusing when they discovered the name.

  The nurse who was first on the scene had her back to us, blocking my view of the prisoner sitting on the treatment couch.

  A sickening indefinable smell hung in the airless room. I swallowed hard to stop myself retching.

  The nurse stepped to her right, revealing a truly shocking sight. Severe burns covered the man’s naked body. His chest and both arms were blistered and bright red, with some areas oozing watery fluid, suggesting deep second-degree burns.

  The prisoner was in his mid-forties and didn’t even wince as the nurse applied another water-gel dressing. He wasn’t speaking, just staring ahead with a glazed expression. He was in shock. Pale and sweating from the pain.

  I pulled one of the nurses aside. ‘Do we know his name?’

  She shook her head.

  ‘Do we know what happened?’

  The nurse flashed me a look. A knowing glance I’d now seen on a number of occasions, when alluding to someone who was doing time for a sex crime.

  ‘He was attacked by a gang while he was in the shower. They threw boiling sugar water over him.’

  ‘For fuck’s sake,’ I whispered under my breath.

  Sugar water was like acid in terms of the damage it caused to the skin. The prisoners used it because the effects were many times more painful and devastating than normal boiling water. The sugar glued to the skin, prolonging the time the burning water stayed in contact with the skin.

  In all the years I worked in prisons, I never managed to come to terms with the sickening brutality I witnessed at times.

  He was lucky the hot water hadn’t hit his genitals, which was no doubt where the gang had been aiming. The burns along his arms were probably from where he had tried to protect himself.

  My job was to prescribe strong painkillers for him, so that the nurses could give them to him without delay. Without a prescription they were not permitted to give anything stronger than paracetamol and ibuprofen.