This article was published in collaboration with Vice.
I’ve never seen so many hand injuries in my life. Sprained fingers, bruised and swollen flesh — all blooming around an abundance of tattoos.
Perspectives from those who work and live in the criminal justice system.
Inmates’ injuries almost inevitably stem from anger. They can’t make bail; their court dates are postponed; their family doesn’t pick up the phone when they call. So they punch a wall, or the steel doors of their cells. Sometimes they punch each other. (Incidentally, facial injuries are pretty common, too.)
But hand injuries are easy. An X-ray, an ACE bandage, seven days of Ibuprofen, and the inmate is sent on his way.
This is what I’ve learned as a physician at a city jail, where I work the urgent care line: There is a lot of minor trauma. There is plenty of acid reflux wrought by the greasy foods served at chow hall, and back pain exacerbated by the large concrete blocks that pass for beds here. There is anxiety masquerading as chest pain, uncontrolled blood sugars in Type 2 diabetics, and skin infections that evolve into abscesses.
These are common problems. They are, ultimately, easy.
I thought Jay1 would be easy, too.
Several days before I saw him, Jay had stumbled off the street into a local ER, driven to temporary madness by a cocktail of illegal uppers and downers. According to the discharge paperwork in his file, he detoxed for a few hours and then was bundled up and transferred here. And jail protocol — there’s a protocol for everything — mandates physician follow-up for any recently hospitalized inmate.
I hoped for a straightforward appointment. My shift was almost over, and there were still eight other patients on my list after Jay. His file detailed dozens of brief jail stints over the last few years; I skimmed it and then asked a nearby officer to call him down. Nonviolent inmates are permitted to wander the halls with relative freedom, so Jay would travel from his unit to the medical floor unescorted.
He entered the exam room sheepishly, and sat on the hard plastic chair facing me, arms crossed, head down. Like many of my patients, he was a young black man in a green jumpsuit and bright orange sandals. Black-uniformed officers wandered around in the hallway behind him.
For some reason, the exam room was set up so the inmate sat between me and the open door — between me and the bright red panic button. But I have never felt compelled to press it.
“Hi, Jay, I’m Dr. Moore. It looks like you were at the hospital recently. How are you feeling now?”
“Not good,” he responded, quietly, though he looked fine. Clean and clear-eyed. No telltale signs of withdrawal or stigmata from the various substances he’d apparently ingested and injected a few days before.
“Why’s that?”
“I’m in jail.”
I’d dealt with plenty of smartasses in here already. “But what happened at the hospital? How are you recovering from that?”
“You know, I was messed up. I don’t even remember most of it.”
Even though the ER never performed a confirmatory drug screen, Jay had admitted to using meth and heroin to the physicians there.
“I went there to get clean,” he continued, looking up at me. “I’ve been messed up for a long time. I just wanted them to send me to rehab.”
“Do you know when you get out?” Maybe this was just an overnight stay, or a minor probation violation. Maybe he’d be released soon, I thought.
“Who knows. I think I’m going to prison.”
If Jay had shown up on the doorstep of the ER simply disoriented and intoxicated, that would have been the end of it. Instead, he still had leftover drugs in his pocket, so the police got involved.
“I begged the cops not to search me. I begged them to just ignore the drugs. Just let me go to rehab, man.” Jay didn’t seem angry or sad; he had an air of contrition and resignation that was very familiar to me.
In residency, I’d spent one month shadowing physicians at the Administrative Maximum Facility in rural Colorado — the infamous federal supermax. I’d seen a similar expression on the face of a white supremacist there. He had WHITE POWER inked across his forehead, boasted a violent and prolific rap sheet, and was haunted by countless other demons he didn’t believe he could escape. He was due for release soon and told me through a glass partition that he planned on spending the rest of his life in a secluded cabin in the mountains. He’d simply accepted it, and would choose to live accordingly.
I wished that Jay had come in trembling from lingering heroin withdrawal. That was something I could treat: some hydroxyzine, some clonidine, a cup of Gatorade. Easy.
“You’re gonna lose Medicaid while you’re in here,” I told him. “You have to get insured again as soon as you get out. You have to establish care with a doctor. They can help you get into rehab.”
Besides the jail, I moonlight as a primary care doctor at a safety-net clinic, working alongside social workers, case managers, patient navigators, and psychologists. I’ve had my fair share of patients with addiction, and have guided them with varying success into community rehabilitation. All of those resources are scarce here, and there is no drug treatment. Only detox.
I glanced at his intake form, which listed all his diagnoses and medications. It was blank. “Looks like you didn’t give any medical history. Do you have any medical problems?”
“I’ll tell you, but please, please don’t just tell me to send a $7 kite to talk about it later.” Correctional health care may be constitutionally guaranteed, but every new appointment request (every “kite”) costs an inmate $7. “I’ve got hypertension. When I’ve been here before, they’ve put me on water pills.”
I got up and checked his blood pressure, which was elevated. Most inmates have high blood pressure. Easy.
“Can I get a low-salt diet, too? I always get a low salt diet when I’m in here.”
I scribbled the orders into his chart. Hydrochlorothiazide, daily blood pressure checks, and a low-sodium diet.
He stood up and quietly thanked me as he left.
It was the least that I could do. It was literally all I could do. Easy, I guess.
Alia Moore is a primary-care doctor in Colorado. She has worked at a city jail for eight months, and also works part-time at a local "safety net" hospital. Her research focuses on health care continuity for men and women being released from prison.
