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The Truth about when Patients are Prisoners (PAP series 2/6)

“People are People” Part 2 of 6

When I imagined being a doctor, I thought about delivering big healthy babies to nice married couples like Jamie & Paul Buchman from the sitcom Mad About You. When I thought about suturing wounds, I thought about repairing fingers cut by the slip of a knife while preparing homemade apple pie. And the patients I imagined looked like Rose Nylund (Betty White’s character in Golden Girls). I never imagined helping patients like Miss Rosa from Orange is the New Black. I never imagined caring for people handcuffed to a stretcher.

Physicians are required to “medically clear” people for jail if they are altered, have injuries or complain about things like chest pain or difficulty breathing. It was a bit shocking for me at first to hear the opening whoosh of the doors of the ambulance bay followed by a loud, HBO-worthy stream of profanity. But now greeting uniformed officers escorting a belligerent person into the fluorescent lit, polished austerity of the hospital is just another night at the office.

My dad used to love the police show COPS. (“Bad boys, bad boys, whatcha gonna do? Whatcha gonna do when they come for you?”) When I saw chases on TV, I was sure the guy that was trying to get away was indeed ‘a bad boy.’

I once took care of a man who was brought in after a chase. He had warrants in another state for unpaid tickets. Fat tears rolled down his cheeks when he told me he ran because his father was dying in a nearby hospital and he just couldn’t go to jail right then. When he found out I was going to release him to police custody, he took all of the medication police had brought from his car and left in his room. His desperation landed him in the ICU.

Police once brought in a woman weeping uncontrollably who collapsed with chest pain in the court-house after being sentenced to jail time for stealing food. She was old enough to be a grandmother to my children.

When I was in high school and read about theft convictions in my little local newspaper, I didn’t think about grandmas stealing food for their families. Bearing such intimate witness to her despair made my chest hurt. She was fine, medically speaking, but she was heartbroken alright. That “discharge to jail” was a hard one.

In stark contrast to the police-custody patients who arrive in their street clothes, prison-orange inmates arrive quietly, head down. Their canvas shoes are silent; the only sound is the faint clinking of the chain between their ankles. It’s an uncomfortable thing to watch a sick person shuffle by in shackles.

Most inmates just have ‘normal people problems’ like heart attacks and appendicitis. But every trauma center has a few special prisoners with thick medical records from self-inflicted emergencies. Swallowing scissors, nail clippers or other sharp items buys a trip to the operating room and a several day stay in the hospital.

It’s also common for these special patients to return with complications. Putting poop in your wounds can give you a hospital-worthy infection. And shoving things into your incision can buy a repeat trip to the OR. I once saw an inmate who tore open his surgical wounds with his own hands to get back to the hospital. (Prison must be really bad if it’s worth it to rip open your own abdomen for a few days away.)

The elephant in the room is always what these people did to deserve their steel cuffs. Google has made it pretty easy to find out. I have a tremendous amount of respect for the providers who don’t want to know. A nurse once told me,

“I don’t trust myself to treat him the same if I knew – so I don’t want to know.”

Not everyone is so noble. It does change your opinion of someone if you find out he kidnapped, raped and killed a young woman whose body was later found in the trunk of her car. That kind of thing sticks in your head while you lean over to listen to his heart under his watchful gaze.

Maybe I shouldn’t, but sometimes I just ask prisoners what they did to get in trouble. I have had one person get mad (and I was immediately apologetic), but most of them almost seem relieved to talk about it. Co-workers think I’m naïve, but I usually believe the versions they tell me.

A patient once told me her car was searched after a traffic stop and police found a bag of marijuana that contained enough to sell. She told me it was her son’s, but that he had a young child of his own and prior arrests and she was afraid he’d end up in jail for a long time, so she said it was hers. I believed her. I still do.

Prisoner hospital bills are paid by tax dollars. And depending on the crime, sometimes it’s justifiable to just release someone rather than cover the cost of a 24-hr guard and all of the patient’s medical expenses.

I once facilitated the release of a prisoner who presented with months of abdominal pain. Her CT scan showed metastatic disease – likely due to ovarian cancer. I spoke with the warden regarding her necessary hospitalization, possible surgical intervention, chemo, etc. He was not prepared to cover these costs. Several phone calls later, she was released. The guard removed her shackles and left. She was admitted and although I don’t know for sure, I suspect she didn’t survive longer than a year at the most.

Although I never imagined having prisoners as patients, these encounters have been some of my most memorable.

People are people – whatever their past – and it is a privilege to care for them.

“…He has sent me to bind up the brokenhearted, to proclaim liberty to the captives,

and the opening of the prison to those who are bound…” -Isaiah 61:1b (ESV)


This post is the last in a series about some of the parts of medicine that aren’t suitable for dinner-party chatter. Every post ends with what a privilege it is to care for people – because it is. It is a privilege to care for people with a wide range of penchants, pasts, body types, abilities, injuries, and life expectancy. Thank you for reading. 


Cover photo credit: Flikr, “Victor,” creative commons license.

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  1. padrooga padrooga

    I used to do mobile lithotripsy and when we hit this one particular town we would often get some prisoners. I’ll have to share some of those experiences with you…. It wasn’t always what I would have expected. Of me, or them.

      • padrooga padrooga

        Well, I like to think I’m pretty “tough-minded” about violent crime and so forth. Some would call that “conservative”, I just call it being responsible. When we’d get a prisoner on our “litho-truck” and get them prepped for a case, it disturbed me that they kept the leg shackles on. I was concerned for the same reasons I guess folks normally remove “jewelry” for surgery etc…I would ask the guards if the shackles could come off once they were under…It just seemed wrong and that somehow, once they were on the table, they were a human being, just like any other, no matter how despicable I might have thought their actions had been. I actually toured a prison once and when I saw human beings in cages… really in cages, even though they were murderers or had done other horrible things, I had a much more difficult time with it than I ever imagined I would. Really surprised myself on that one.

        Then other moments I’d notice how truly terrified some of these “tough looking” thugs were and realized how much of that was just bluster. On one huge, muscular guy, I saw swastika tattoos, the words HATE spelled out with a letter on each finger… and much much more…and as I was putting the ekg leads on him he looked at me, all 4’11” of me, and was almost in tears…and asked, “Is it gonna hurt?”. I was a bit disgusted with him, to be frank. My response surprised me… And to this day I’m pretty sure it was not appropriate, but my personality leaked through the filter…I said, “only if we let it”. He was going to be anesthetized of course, but I think I really slipped on that.
        Anesthesia/sedation, particularly “conscious sedation” was always tricky with many of them, as they had a really high tolerance for drugs. I would watch the CRNA’s struggle to maintain that balance of keeping them out of pain and keeping them breathing. Many times they kept moving and talking until suddenly, they had to be intubated. Moving around and wiggling during lithotripsy is never a good idea. Even talking is not so hot. Most patients got through the procedure without being intubated. Most prisoners, did not.

        • Wow. Thank you for sharing. You’ve definitely had some of the same thoughts/experiences I tried to convey in the piece – – compassion/justice/fear – – complex stuff. Thanks for sharing!

  2. Who knew when choosing medical school over anything else, it would lead you down such a tangled path of messy humanity. Yet, you do it with grace and ‘privledge’.
    When you ask a prisoner about their crime, I don’t see naivety, I see empathy. It is human and humane to yearn for understanding.
    Inciteful and fascinating post. I have seen prisoners ‘shuffling’ down the hallways of local hospitals, shackled, eyes averted, police presence all around. If they are young, my heart breaks. If they are older, I feel fear.
    I never, ever once considered the burdens placed on the doctors who treat them.
    You have once again enlightened us that prisoners are human beings, flawed but still worthy…or the true calling an ER Doctor must possess.

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