Stories from Inside: SCI 3

8.  Breaking my own rules

              I have twice broken my rule about not googling patients to find out what they were in for.  One, a thin, rather scruffy looking man, during his intake physical, said “I’m a neurosurgeon.”  I thought, yeah, right buddy!  So I googled him: he was indeed a neurosurgeon!  This is a story that isn’t mine to tell, except to say that he proved to me that there was life after medicine. In retirement I have found that to be true.

              The other time the inmate in question said: “That was when I won the Grammy!”  Now who could resist that line?  So I googled him and while he hadn’t won a Grammy, he had been nominated.  This was Jan Lewandowski, the Polka King.  He wasn’t making ends meet with his polka band so he started a Ponzi scheme and bilked 400 people out of millions of dollars.  There was a TV documentary about him, then a film documentary: The Man Who Would Be Polka King, and finally a movie, The Polka King, starring Jack Black, that I saw on Netflix years later. 

              Jan Lewan, his stage name, didn’t look like Jack Black, except for being short.  He was a thin, aging man.  But he still had the flamboyant personality and the possibly misplaced belief in himself that led to his legal problems.  Despite the number of people he’d cheated and the amount of money involved, he talked the judge into only a 7 year sentence, saying that he had to get out and get his band together again to repay all these people.  Excuse me, but hadn’t he started the Ponzi scheme because the band wasn’t making enough money to pay the musicians?  He was probably the only real celebrity I met in prison. 

9.  The Teacher

              Murderers are some of the nicest people.  Let’s face it: drug dealers (not the poor sods who are addicted that deal to support their habits, but the guys who don’t use drugs but make money of off other people’s misery), child molesters, rapists: those guys are the scum of the earth.  And having been held up once at gun point, I’m not too sympathetic with armed robbers either, or any robber who isn’t just stealing food he needs to eat.  But murder is a crime we can all relate to; who hasn’t been angry enough to kill someone?

             In Catholic school, we memorized the Baltimore Catechism.  They numbered the commandments differently, so “Thou Shalt Not Kill” was #5, not # 6.  According to the catechism then, the sins against the 5^th commandment are murder and suicide, but also fighting, anger, hatred, revenge, drunkenness, and bad example.  I was never sure how the “bad example” part fit in, but there is a very thin line between fighting, anger, hatred, revenge, and drunkenness, and murder.  It’s a line that is frequently crossed unintentionally, I suspect. 

              Inmates are high risk for suicide.  The most dangerous times are when they first arrive, when they are sentenced, and when parole is denied.  We tried to be aware of those times, and also the times when someone lost a family member on the outside.  It wasn’t just the mental health people.  Nurses would listen.  I would listen too.

              The teacher was in prison for murder.  I call him the teacher because that’s what he did.  He taught GED classes, he tutored, he helped inmates who wanted to learn French and Spanish.  He had been incarcerated for more than 20 years.  He had been an exemplary inmate, always willing to help, never in any trouble.  I got to hear his story when he was turned down for parole the second time. 

              He had been very young: 18, I think.  He was spending the night at his best friend’s house.  He woke up in the morning in their spare bedroom.  There was blood on his hands and the sheets.  He had a knife in his hand.  When he went to his friend’s room the friend was dead, stabbed to death.  The teacher remembered nothing about the evening.  Last thing he remembered was going to bed.

              The teacher had no doubt at all that he had stabbed his friend to death.  The evidence was overwhelming even to himself.  He just didn’t remember any of it.  His attorney arranged for psychiatric and medical evaluations.  The medical doctor told the teacher that this had been an unusual manifestation of temporal lobe epilepsy, that stabbing his friend had been part of an atypical seizure. 

              This explanation made sense to the patient, who could not understand how he could otherwise have stabbed his best friend.  He was started on medication for seizures.  20 years later he was still taking it.  His levels were always therapeutic.  He had never injured anyone else.  He never had a write up in the prison, never broke rules, did everything to be useful and helpful to all.

              But the parole board wants acceptance of guilt, remorse, a promise that it will never happen again.    The teacher couldn’t give them that.  He accepted no guilt.  This had been a seizure.  He could show remorse that this awful thing had happened, but he couldn’t accept responsibility for it.  He pointed out to the parole board that the levels of his seizure medicine were therapeutic.  He was taking medicine to keep this from ever happening again and would continue to take medicine his whole life.  But what if he didn’t?  What if he stopped taking it, or ran out and couldn’t get it filled right away, or couldn’t pay for it?  The parole board wanted the inmate to say “I did it.  I accept responsibility.  I’m sorry.  I will never do it again”.  They just couldn’t accept the teacher’s version of I will never do it again as “I will take this medicine for the rest of my life”.  It wasn’t enough.

              The teacher’s mental health records noted that psychologists and psychiatrists who had worked with him thought the original episode was some kind of youthful homosexual panic.  Whether his friend had actually approached him in that way, or whether the teacher was responding simply to his own feelings, they felt this had triggered the stabbing. The medical doctor, looking for an answer to reassure a frightened young patient, diagnosed temporal lobe epilepsy.  Temporal lobe symptoms frequently have bizarre behavior, but it would be more like repetitive chewing and swallowing, lip smacking or picking at things.  I once had a patient drive a car through a tent sale, just round in a circle, staring.  These seizures usually only last a few minutes.  Stabbing a young man repeatedly would be an exceedingly unusual activity for a seizure.  This gave the patient an easy out but kept him from working through other issues and kept him from accepting responsibility for his action.  The patient was beginning to realize that he might spend his life in prison; he might never be paroled. 

              So I heard his story that afternoon, after parole was denied.  We talked a while.  I doubt that I was helpful.  The teacher spent a few days refusing to substitute teach when asked, and generally not being helpful.  Again, I don’t know the end of the story (frustrating, isn’t it?).  But it did make me think long and hard about what I might have said to a patient that might have a negative impact later in life.  The teacher also made me realize how important it is not to protect someone from the opportunity to take responsibility for their actions.

9.  Biggest of the big 

              There was the 525 lb inmate: His cholesterol and triglycerides were so good, much better than mine!  I was jealous!  But in prison, never trust your friends!  His so-called friends took him to the gym (he had never worked out before ).  Our gym had really old -style machines, where the weights had to be added by hand.  For the leg press, you sat almost on the floor, knees bent while the weight was added, then the pins were pulled, so your first motion had to be to straighten your legs.  His friends figured, if he weighed 525, he should be able to leg press 625.  So they piled the weight on.  When they released the pins, AT couldn’t straighten his legs.  In fact the weight kept pushing his legs back further and further, till his hip popped out of joint!  There were two employees there whose job was to supervise the gym.  They said it wasn’t their job to tell adults what they could and couldn’t do!  Then what were they there for?

              The same inmate had bad varicose veins.  He ripped one open while in his second floor housing area.  With blood pouring out, it took a lot of men to help him down the steps till they could put him in an oversized wheelchair and get him to medical.  Another fun suturing job!  After that, the officers in the building realized how awful it would be if he had something major happen while on the second floor.  Four men would not be able to carry him down the steps.  So they insisted he needed to move downstairs.  He wanted a medical note to stay upstairs.  What a mess that turned into!

10. Seizures: real, fake and pseudo (psychogenic but not fake)

              Always listen to the nurses!  A patient with real seizures and fake seizures and probably pseudoseizures came in unresponsive.  The health services administrator (also a nurse) persuaded me to just put him in an infirmary room and walk away.  Ten minutes later he was standing at the door, tears running down his face, saying he had made a mistake.  He was the best seizure faker I ever met.  One of the funnier episodes was when we put him on the molded plastic bed in the suicide room.  He rolled over toward the wall, rolling off the bed and getting wedged in between the bed, which was bolted to the floor, and the wall.  He was on his side and he was stuck!  I would have loved to have a picture of the four of us who knelt on the bed, struggling to pull this man out of that tight space.  I was sure he was faking a seizure one day, keeping it up for several hours on a gurney in the middle of medical.  There are multiple criteria for differentiating seizures and pseudoseizures, and these, if not out right fakes, were at least pseudoseizures. He ended up on a ventilator when sent him to the hospital.  I still think that was just another of his usual fake jobs.  Of course, I could be wrong.  One of the challenges in corrections is distinguishing between seizures (which have a higher incidence in prison due to drugs and alcohol), pseudoseizures (involuntary seizures that are psychogenic in origin) and just plain fake jobs. 

10.  Where were you on 9/11?

              I was working at SCI.  At that time there was a cable TV in the 3 bed cell, and on that day, there were 3 patients.  They were watching TV until one of them called “Nurse, you need to see this!”  After watching for a few minutes,  the nurse got the TV we used for training videos, and we sent a patient up into the ceiling to hook our TV to the cable in the infirmary cell.  We were on and watching in time to see the second tower get hit and then both towers fall.

              A few weeks later a nurse on night shift lost her temper with the inmates in that cell, and went in and ripped the cable out.  I was really glad that hadn’t happened before 9/11. 

11.  Walkers

              A particular elderly gentlemen walked with a walker on his housing area, but needed a wheelchair to come any distance, like over to medical.  He was a curmudgeon, so younger, healthier inmates were not falling over each other to push him to the infirmary.  Until SCI banned smoking: suddenly he had more help than even he needed, with one young man pushing the wheelchair and one carrying the walker and a small crowd walking around him in case he needed something else.  You would be amazed at the amount of TOP (loose tobacco), rolling papers, and cigarettes that can be squirreled away in the hollow metal legs of a walker. 

12.  Religion

              Snoop Dogg said “Everyone gets religion in prison.  It takes about two weeks.”  We all saw that a lot.  I could never run a bible study in prison.  I would suspect everyone’s motives for being there. 

              The only time I ever remember mentioning God to an inmate (remember AS from Trust but Verify on the first installment of these stories? He also claimed to be a preacher.  I didn’t verify that claim.) was when AS got put in disciplinary segregation.  But segregation wasn’t what it used to be.  It was one of our overcrowded times.  There were four small seg cells off an anteroom, with all the doors open and about 14 guys sharing the space.  It may not have been segregation but I’m sure it was punishment.  AS swore he was innocent, that he shouldn’t be there.  He was going on and on about it, complaining about being in there with all these young men.  There was nothing I could do about it, except see that he was OK to go there.  So finally I said “Maybe you’re not there for you.  Maybe there’s some reason the Lord placed you there, some young man who needs someone to talk to or some guidance from an older person.”  I don’t know if he really was a preacher.  I do know that my comment stopped him dead, which was mostly what I wanted.

13.  Viagra

              I was working at SCI when Viagra first came out.  It was not something that I would have prescribed in prison.  However, the first (and only) innate to ask me for it was an older diabetic HIV patient.  He went out of his way to reassure me that he just wanted to use it to jack off while reading pornography.  He wouldn’t be having sex with anyone in prison; he wasn’t a fag.  Until that moment I hadn’t thought about Viagra and HIV.  It seemed to me that prescribing Viagra for someone who was HIV positive was like “cocking the pistol”.  I also didn't see why taxpayer money should prescribe a medication to improve erections!

              Later when I came to Tennessee, all patients followed by the central HIV clinic and the VA clinic routinely got 4 Viagra a month if their viral loads were undetectable.  Maybe that’s an incentive for taking the medication!

14.  Prison and the developmentally disabled.

              Sometimes judges seem to have no idea what it’s like behind bars.  We had a new intake, a mentally retarded man who had walked away from Stockley Center, the state institution for the mentally retarded, which was just down the road.  The police had to search for him and the case ended up in front of a judge, who sentenced him to one night at SCI, to “teach him a lesson”.  Really?  What lesson?  He is totally vulnerable, so he can’t be put in general population.  He was also totally frightened.

  So he spent one night in our infirmary and then went back to Stockley.  If there was a lesson in that, I don’t think it was one he was capable of learning. 

              We did have a DMR (Division of Mental Retardation) foster care patient.  I’ll call him FLK, for he was a cute, funny looking little man, who looked like a little kid.  He had been in this foster home, living with a family, for over 10 years.  His foster mother thought it would be so cute if he volunteered at the daycare that her grandson went to.  It was her grandson that he was found with in the bathroom, taking off his pants.  He was arrested for child molestation. 

              This man (and he was a man, though he was only a bit over 4 feet tall) had been taking diethylstilbestrol, a synthetic estrogen that was frequently used at Stockley to suppress an overactive male sex drive.  His foster mother gave it to him three times a day for years, but never understood the implications of what it was for.  If she had, I doubt she would have had him volunteer at a daycare center.

              Now he was stuck.  Because he was mentally retarded and didn’t understand his situation, he was unable to assist in his own defense and therefore could not be tried.  He would end up being transferred to the Delaware State Hospital and remaining there for the rest of his life. 

              While he was at SCI, his foster mother came to visit regularly.  FLK hadn’t actually done anything to her grandson, and if there was any way at all to get him out and back home, she would have done it.  She wouldn’t be able to see him much when he went to the state hospital, which was 90 miles away.

              He did end up staying at SCI much longer than anticipated.  On his intake physical, he was found to have a tumor in the back of his throat.  It extended from his nasopharynx all the way down past his vocal cords. So he spent some time with us getting worked up before he went to the state hospital.  His life expectancy, for quality or quantity, was not good when he left us. 

15.  Redemption

              BON had not been a good person.  He would have been the first to tell you that.  He sometimes told strange stories of driving a truck from Maine down to Delaware, with guns under the seat, coming to kill someone.  He had severe diabetes, with a peripheral neuropathy and bad foot ulcers.  I spent a fair amount of time debriding (cutting the dead skin off) the ulcers, trying to save his feet.  Most of the area I had to debride was numb, but not all.  He would say “Wait a minute.  Let me go away”, and he would absent himself from the pain.  He had been abused as a child and learned how to disappear from the pain he was feeling.  I think I could have done almost any procedure to him when he was “away”.  He spent weeks in the infirmary on IV antibiotics, which in our little infirmary was not easy.  He ended up doing a short stint in the infirmary at DCC when his chest x-ray, which was always abnormal, what interpreted as possible TB.  Our negative air-flow room wasn’t’ working so he had to go to DCC for TB isolation.  When the smears came back negative, I stopped in the infirmary to tell him.  He hugged me!  Which was wrong in so many ways and could have gotten us both in trouble, but he did it in the hall in front of officers and lots of people.  He was just so glad to get out of isolation!  That’s the only time I’ve been hugged by an inmate!

              We did lose the battle of the foot, however, and he ended up with a unilateral amputation.  With his neuropathy, there was no way he could walk with a prosthesis.  He was wheelchair bound.  He got released, after about 15 years in prison.  The prison had no social workers to help people make discharge arrangements, but there were some churches that assisted.  In any case, someone found him a room in a boarding home that was wheelchair accessible.  We heard that BON was shot and killed not long after discharge trying to defend his landlady from some home invaders.  You never know.

16.  My argument for gun control

              SP was an older man.  He was drinking, sitting at the kitchen table with his grown son, when they got into an argument.  SP, drunk, went in to the bedroom, got his shotgun from the closet and blew his son away.

              He went straight into the suicide room.  In the suicide room, aside from the molded plastic bed bolted to the floor and the hole-in-the-floor toilet that flushed from outside, the inmate was naked, with a paper gown and a paper sheet.  It was cold and miserable.  The officer in the infirmary checked on the inmate at least every 15 minutes.  If we thought the risk was truly serious, there would be eyes on the inmate at all times.  Most inmates decided to “contract for safety”, signing an agreement that they would not injure themselves.  Most people didn’t spend more than a day or two in the suicide room (and usually the second day was only because mental health didn't work the weekend: most people wanted out!).  

              This man was there for over a month.  He was going to kill himself.  He had killed his son.  He saw no reason to live.  We couldn’t keep him there forever.  He finally got transferred to DCC.  I don’t know if he finally did kill himself, but I wouldn’t be surprised if he did.

              The man and his son were drinking together.  Well, we’ve tried banning alcohol in this country.  That didn’t work.  If the gun hadn’t been available, SP would probably have punched his son, and been punched in return, and they would have shared another beer.  This was no assault rifle; this was a shotgun, that might have been in any country home.  A gun in the home is 43 times more likely to kill a family member or friend than it is to kill a burglar.  As I said above, there is a thin line between anger and murder.  Sometimes the presence of a loaded gun is what causes that line to be crossed. 

 I may actually have run out of SCI stories.  I’ll try on another day.