The Prison Doctor

by Dr Amanda Brown

  Some of them managed to engage in a polite and coherent manner, but many were rude, demanding, angry, irritable, and just desperate to get medication to stop them feeling so dreadful. I understood and empathised but, honestly, didn’t relish the idea of working with such angry and abusive prisoners.

  To my astonishment I found that I enjoyed the work, and soon realised how lovely most of the women were when they were no longer feeling so ill from withdrawal. Their stories were awful and sad, but so touching and important to share. I began to understand more and more about the physical and emotional dependency they had on drugs.

  A lovely lady called Andrea explained that using heroin was like being wrapped in a warm blanket that made her feel safe and protected.

  ‘It’s like eating Ready Brek.’

  ‘Ready Brek? The breakfast cereal?’ I asked.

  ‘Yeah, you get that glow inside you. Like the advert, when they start glowing when they eat it. The feeling cocoons you, wraps its arms around you and makes everything feel safe. You can face your worst demons when you take heroin. It gives you strength. It’s your best friend. It’s your mum, your dad, it’s every family member you’ve got . . . all rolled into one, there for you. That’s what heroin feels like.

  ‘All my problems, depression, anxieties, it locks them away in a box. You can stand back and look at them from afar and think they will take care of themselves, when you are on heroin.

  ‘It gives you a false sense of life. Nothing is how it seems.’

  She looked up at me through her hollowed eyes. ‘It gives me the life I wish I had.’

  Her words clung to the air, turning it heavy with tragedy.

  What she hadn’t said, her reason for needing to be cocooned by the drug, was the elephant in the room. Something awful had happened to Andrea. She was painfully thin and her eyes were haunted. As she sat opposite me it seemed as if she was drained of any emotion or feeling, as if she was exhausted by life.

  I smiled at her. ‘How long have you been using now?’

  Andrea tucked a strand of her straggly blonde hair behind her ear. The roots were greasy, the ends were dry and split, and there wasn’t much left of it.

  ‘Twenty-five years,’ she said, quietly. ‘Although I’ve managed to stay clean for short periods of time.’

  Some of the women who use said they felt ashamed of their habit and lifestyle, and were embarrassed to tell me for fear I might judge them.

  ‘It’s okay,’ I reassured her.

  She relaxed a little and then rolled up the sleeves of her jumper and showed me her arms, which were scarred and discoloured.

  ‘I can’t inject here any more, I’ve done it so much that all the veins in my arms and legs are too damaged.’

  Fighting back the tears of shame, she slowly raised her finger and pointed to the tiny veins running underneath her eyes. ‘So I inject here, it’s the only place left.’

  I was horrified.

  ‘Oh, Andrea!’

  She shook her head, trying to shake the tears away and swallowed hard, determined to retain her composure. Many of the women I’d seen in Bronzefield struggled to let down their guard. I suppose so many terrible things had happened to them when they did.

  My job was to prescribe Andrea the correct dose of methadone to try to prevent the symptoms of heroin withdrawal which were making her feel so ill. But I also wanted to understand why she had started using drugs all those years ago. I asked her if there had been something that had triggered her to start using, or was it just the life she was leading at the time.

  ‘I started when I was twenty-seven,’ she said. ‘After I was attacked with a claw hammer.’

  I stared at her, shocked at what I was hearing.

  ‘I was doing a talk on computer programming, and the company that had contracted me out had put me up in a hotel in London. When I was walking back to the hotel in the evening, two men tried to take my bag off me. But I wouldn’t give it to them. Even though there was nothing much in there, I didn’t want them to have it.’

  Suddenly her voice started to crack.

  ‘Have you got a tissue, Doctor Brown?’

  I had come prepared with several packets. I rummaged in my bag and handed her one.

  She dabbed the tears that had collected in the corners of her eyes. Struggling to get the words out, she said, ‘I wished I’d just given it to them now.’

  I nodded sympathetically. It was all I could do.

  ‘When I wouldn’t give in, one of them pulled out a claw hammer. It all happened so quickly, he pulled his arm back and smacked it down so hard on my head.’

  I winced, imagining the horrifying scene.

  Slowly, Andrea titled her head forward and pulled away some of her hair to reveal a marked indentation in the top of her skull.

  ‘Oh my God,’ I whispered.

  ‘I felt so much pain, and then I didn’t feel anything. Just the blood trickling down my face. I remember that being warm on my skin.

  ‘I tried to get up but I couldn’t move my legs. They wouldn’t work. I thought the men had run off with my bag and left me there, but then I saw their shoes as they stood over me.

  ‘I wanted to scream but I couldn’t open my mouth, it just wouldn’t open.’

  Andrea’s hands were shaking as she nervously wrapped the tissue around her fingers.

  ‘One of the men wrenched me onto my feet, grabbed me by both arms and dragged me along the street. I couldn’t hold my head up and was barely conscious. I wanted to scream out but my mouth was clamped shut.’

  Tears were streaming down Andrea’s face, and they were welling in my eyes.

  ‘I must have blanked out at that point because I don’t remember how I got inside. When I opened my eyes I could see I was in a bedroom. It had a brown carpet and there were no sheets on the bed, just a stained mattress. One of the cupboard doors was open and I think there were clothes hanging in there. I tried to move my legs but they still weren’t working. I tried to move my hands and that’s when I realised, they had tied me to the radiator.

  ‘They must have heard me move, as the two men appeared in the doorway, speaking in a foreign language. One of them started laughing. He had a beard and short hair and as he approached me I could smell him. There was an evil stench of booze as he breathed over me.

  ‘He pulled at my jeans, tugging them down my legs, and I was helpless to do anything.’ Andrea shook her head, sobbing, clutching the tissue tightly in a ball. ‘I couldn’t do anything to stop him.

  ‘That blow to the head had paralysed part of my body. I could see it all happening to me but I couldn’t scream, I couldn’t move, I just had to let it happen.

  ‘He unbuckled his belt and unzipped his jeans and I knew what was coming. I could still close my eyes so that’s what I did. I shut them tightly and prayed it would be over soon.’

  Tears were streaming down Andrea’s cheeks and mine.

  ‘For three days they kept me there, raping me.’

  Her head collapsed into her hands as she sobbed and sobbed.

  I felt physically sick hearing her story. I don’t think I had ever heard anything quite so shocking. Whatever the reason Andrea was in prison, it took nothing away from the horror of what she had suffered.

  I handed her my whole pack of tissues.

  ‘Thank you.’ She sniffed, wiping her tear-stained face.

  For a moment we sat in silence – Andrea calming her emotions, me digesting the horror of what she had described.

  When she finally spoke, she told me how, when the men were finished abusing her, they dumped her in a side street, next to some bags of rubbish. She woke up in hospital in excruciating pain.

  ‘The surgeons had to take part of my skull away. I had to undergo major surgery. I was paralysed down one side of my body, and I was in hospital for months and had to learn to walk and talk again.’

  ‘I can’t get my head around this,’ I said. ‘Did they catch the men?’

  ‘No, the police never
found them, even though there was CCTV on the street. There had even been some witnesses.’

  I shook my head in despair.

  Andrea looked at me directly in the eye. ‘I guess I’m lucky to be alive. They could have killed me.’ And then she whispered, ‘Some days, I wish they had.’

  It was an awful thing to hear, but I understood. Andrea didn’t need to explain to me why she had turned to drugs – to numb the physical and emotional scars.

  ‘How long are you in here for?’ I asked.

  ‘I’ve been sentenced for eighteen months,’ she said.

  ‘Did you commit the crime to get money for drugs?’

  She nodded, sheepishly.

  ‘When was the last time you were in prison?’

  ‘Fifteen years ago, I spent six months in Holloway.’

  ‘You did well to stay out of prison for so long.’

  ‘Yeah, I’ve tried. I’ve had jobs.’ She sighed deeply. ‘But I always end up going back on heroin, and then I lose them.

  ‘The worst thing is the sleep. I still find it hard to sleep, as I still have flashbacks. And when I can’t sleep everything seems worse and I end up back on the gear just to take me away from it all.

  ‘I hate asking people for money, so I ended up doing lunch and dinner dates with people I met on the internet as an escort.

  ‘I could earn £110 an hour,’ she said, ashamedly.

  ‘For sex?’

  ‘Mostly it wasn’t actual sex, that only happened once. But it was better than being in trouble with the police.’

  Many of the women had told me that they had turned to prostitution to survive. One poor dishevelled soul had once said that she had been a prostitute for years, and matter-of-factly stated, ‘I’m a machine. I don’t feel anything any more.’

  One had even told me that her mother had sent her out for prostitution at the age of 14, to bring in money for the family; another that she had grown up in a brothel as her mum was a prostitute.

  It explained how Andrea had managed to stay out of prison for so long, despite not holding down a job.

  ‘But I had a big habit and I wasn’t getting enough money, so I turned to crime again.’

  Andrea had been in prison for two weeks and the 30ml of methadone was not holding her. She still felt sick, achey, had hot and cold sweats, diarrhoea and abdominal cramps.

  ‘I don’t really want to be on methadone,’ she said. ‘I wish I could go cold turkey as I know I’ve just swapped one habit for another, but I feel so dreadful. I think the only way to do it is to increase my meth and then try a slow detox when I feel stable.’

  I had heard such a plan many times, and had realised early on when I started working with substance misusers that they all had their own ways of dealing with dependency. Some told me they could never imagine a life off drugs, others said that they were tired of it and wanted their lives back. I learned too that only they could decide when they were ready to stop using.

  Very often their sentence was far too short to allow them to detox, and often the dose of methadone had to be increased – what’s known as ‘titrated up’ – to a suitable dose to keep them safe from possible overdose after release.

  I agreed to titrate the dose up and arranged to review her in three weeks’ time.

  She smiled weakly. ‘Okay, Doc.’

  Methadone is a green liquid which looks a bit like Fairy Liquid and I am told has a very unpleasant taste. Prisoners are given their methadone by the nurses at around 9 a.m., but if the dose is not sufficient it won’t hold them through the full twenty-four hours, which is what was happening to Andrea.

  In the past, all prisoners were expected to detox from methadone if they were due to remain in custody for more than three months, but this is no longer the case.

  ‘Thanks, Doc.’

  As Andrea got out of the chair, the tissue she’d been clutching so tightly fell to the floor. She bent over to pick it up, giving me a second glimpse of the dent in her head.

  ‘Thank you again,’ she said, her painfully thin body disappearing out of the door.

  I had eighteen months to get her back on her feet. With Andrea, I had something to work with, unlike many of the other women who flitted in and out of the prison.

  I couldn’t help questioning though: was prison the right place for Andrea? For Paula? For all these women who were committing petty crimes to feed their drug habits? If only there could be a better support system for them when they left prison, perhaps they wouldn’t need to turn to drugs again.

  I was seeing the world from both sides of the prison walls, with new eyes.

  Chapter Twenty-Four

  Suzanne was putting me in a very difficult position.

  ‘I can’t cope without it, Doc, please, you have to give it to me,’ she begged.

  I had been warned that the drugs wing in a women’s prison could be the hardest place of all to work, as so many of the women were emotionally unstable, as well as struggling with addiction. They would go to any lengths to get the drugs they had become addicted to. I realised how true this was, as they would so often tug at my heartstrings in a desperate bid to coerce me into prescribing what they wanted.

  Treating their heroin addiction was relatively straightforward using methadone. The drugs I desperately struggled with, however, were the highly addictive diazepam and pregabalin, due to the very strict rules that I had to abide by when dealing with them.

  Everyone had to be detoxed off them in prison, unless they could prove they were under specialist care and that they had been prescribed by a consultant within six months prior to being detained in custody.

  Pregabalin is used to treat epilepsy, general anxiety disorder and neuropathic pain. Unfortunately, it has proved to be highly addictive and countless prisoners have told me that the withdrawal symptoms experienced, if they suddenly stop taking it, can be much worse than withdrawing from heroin.

  Although some have it prescribed by their GPs outside, a great many also buy it on the streets, or off the internet, and take it in very high doses.

  It has become highly tradable in prisons, so many will buy it from other prisoners, but if their supplier suddenly gets released or transferred to another prison, or gets moved to Separation and Care, then their supply is cut short. They would then suffer terrible withdrawals, and beg me for help.

  Suzanne had been buying it on the wing, until her supplier had been released, and she was suffering from serious withdrawal symptoms, particularly overwhelming and crippling anxiety.

  ‘Please, Doctor Brown, please!’ she begged, sounding desperate. ‘I know I shouldn’t have got myself into this mess, but I need you to help me out.’

  I shook my head in despair. I hated seeing someone suffer but I couldn’t break the rules. From the state she was in, it was obvious she wasn’t faking it. She was shaking, sweating, crying.

  I also knew her background, and that her anxiety stemmed from her fear of leaving prison; she was going to be homeless, and was frightened that she would be attacked or raped on the streets, as she had been in the past.

  I had heard similar stories from so many women that I had no doubt it was true.

  She was deeply insecure and emotionally fragile, and I appreciated her honesty in telling me that she had been buying it illicitly, so I made a deal with her. I agreed to prescribe it on the understanding that she would be detoxed off it, and that I would not be able to ever repeat this if she fell back into illicit use.

  She agreed and thanked me profusely.

  ‘But please don’t conceal them and sell them,’ I said. I could give her one chance and one chance only.

  She nodded in agreement.

  ‘Look after yourself, Suzanne,’ I sighed.

  ‘God bless you, Doc,’ she replied.

  *

  I lifted the blind covering the small square window in the door, and peered through. There were at least a dozen women crowded outside my room in House Block One, shouting for my attention, but no nurse or
officer.

  Normally the nurse would be there to control the clinic, and to make sure that only patients on the list were seen at their appointed time.

  ‘Doctor Brown!’ one of the ladies shouted when she saw my face at the window. Then they all joined in. ‘Doc, doc, I need you to see me today!’

  I took a deep breath and opened my door.

  ‘Have you all got an appointment?’ I asked, almost certain that most of them hadn’t. ‘I’m really sorry, but if your name isn’t on the list, I can’t see you today.’

  They weren’t the sort to take no for an answer, hustling me until they got what they wanted. I swore under my breath.

  Becky, the prison officer, spotted I was struggling. ‘Break it up, girls,’ she shouted, coming over to my rescue.

  Becky was tough and very good at her job. Even though she was only 22, she had a ‘don’t mess with me’ glare, and could easily have been mistaken for a bouncer on a nightclub door. She had short brown hair with a shaved undercut and several piercings – a bolt through her eyebrow and another through her tongue. Her facial features were elfin. She had beautiful big Bambi eyes and a tiny pixie nose.

  She moved in front of my door, her arms crossed, her legs wide. ‘If you haven’t got an appointment, move on,’ she barked.

  ‘Thanks, Becky,’ I said, before slipping inside the safety of my room. I leaned back against the door and sighed heavily. My shift hadn’t even started and I was already feeling exhausted.

  I logged onto the computer, but the drama continued to unfold outside my door.

  ‘I’m not fucking moving until I see Doctor Brown,’ a woman screeched. ‘Doctor Brown!’

  ‘If you don’t move away I’m going to dock your earned privileges.’

  ‘Don’t fucking speak to me like that, you dyke!’

  ‘Right, that’s it . . .’

  All I could hear next was muffled cries, boots squeaking on the lino floor, and ‘Get the fuck off me!’

  The blinds rattled against the door as someone suddenly knocked on it.