by Roderic Fabian
I've had a long association with prisons, a fact that has always been a considerable source of angst for me. It started when I was in medical school, where state prisoners were taken for their health care. Prisoners would be bussed down from prison units all over the state to be seen by the faculty, residents and medical students.
There was an incident when I was a resident, when a fellow carved a fake gun out of a bar of soap. He managed to bluff and disarm a guard while he was waiting to be seen by one of the residents. The resident opened the exam room door to find the prisoner holding a gun on the guard. He didn't even blink, but told the prisoner, "Give me that!" and the fellow handed the gun over. Something about the white coat, I suppose. We never saw that particular prisoner again.
I did an internship in Tennessee. A big state prison was located right in Nashville, and prisoners were brought to the Nashville General Hospital for care. There was one prisoner who liked to stab himself in the abdomen with ball point pens in order to earn a few days in the hospital. Sociopaths do that sort of thing a lot. If denied the ability to hurt someone else they hurt themselves. Most of the prisoners are sociopaths, even if incarcerated for non-violent crimes, and they tend to be fairly predictable. The sociopathic women are somewhat different from the men - less likely to be violent against others; more likely to be self abusive; much more likely to present with fictitious illnesses. A few prisoners stand out as being different; people that made a mistake and won't make it again if they get out of prison alive.
Years have gone by and things have changed. Texas now has the largest prison system in the world, and I often act as an attending physician in what is the largest, most modern prison hospital in the world. Something like five percent of the male population of Texas is locked up in the Department of Corrections, and Texas has enough bed space to be importing prisoners from other states, like Hawaii. Think of that. Get thrown in jail in Hawaii and end up in Texas. In Bexar County, no less. What a downer that would be.
Texas is famous for having a low recidivism rate, because being locked up in Texas is a distinctly unpleasant interlude in one's life, or so they say. With the guards constantly present it's not easy to get a candid opinion from the prisoners about what prison is like and what they've experienced. What I do know about Texas prisons is that there is little opportunity for education or rehabilitation, the work is usually hard and physical, it's hot in the summer, and prisoners are sometimes subject to violence from other prisoners. I assume that rape is a risk for some prisoners, and the HIV infection rate within the prison is high, which would turn incarceration for a non-violent offence into a death penalty.
I can't testify to what being in prison is really like, because I've never actually been to a prison unit, only to the hospital. A large number of prisoners injure themselves to get into the hospital, though. The hospital has air conditioning, and the prisoners actually get to lay eyes on a T.V. that works.
Alabama made a big deal out of reinstituting chain gangs, but Texas has always had worse than that. The prisoners say that the worst thing about it is that there is no such thing as low security or medium security. The entire system is high security, like Alcatraz. Getting to work on a chain gang would be a relief, except in the middle of summer. Until a few years ago, Texas prisons supported themselves. Prisoners were worked hard. Cotton was grown and cloth produced for uniforms. Grain was grown for food. Cattle raised for meat, all to be consumed by the prisoners or guards, or to be sold off. More recently, the prison population has been too large for the land available to support it.
The public often has the wrong impression of people in prison. Seventy to eighty percent are non-violent offenders. The rest are the violent ones, and these tend to prey on the others - sexual and physical assault is common . We can tell them apart from the others by how they are classified when they enter the hospital: class 3 or 4 is high risk, not to be seen by medical personnel without a guard present. These are the rapists and murders, and they are not as common as one might think. The crimes the prisoners were convicted for are not part of the record that doctors are privy to. One can find out by checking public records, but it's better not to do so. It tends to affect one's attitude toward inmates if, for example, a sweet looking little old lady was convicted for killing her family.
When I first started working in a prison hospital I had to go through an orientation program. Most of the orientation had to do with security. We were shown a variety of weapons that had been fashioned by prisoners out of common objects; a garotte out of shoelaces, a stiletto out of a spoon, a wicked-looking short sword out of a part from a toilet. We were also shown what sort of weapons could be made out of common medical instruments, such as a knife made from a reflex hammer, the moral being: don't leave instruments lying around.
We were required to sign a document that attested to the fact that we were aware that Texas had a non-negotiation policy. If we were taken hostage there would be no negotiation for us; the uprising would be put down, whatever it took.
We were also told not to ever tell prisoners what tests they were scheduled for and when, and when they would be discharged. This was to prevent them from planning escapes when they went to other parts of the hospital for tests, or of injuring themselves when they found out they were about to be discharged. One fellow slammed his hand in a jail door when he found out he was about to go back to his prison unit. That earned him 3 more weeks in the hospital. When he was discharged the next time he was told that he was going down for an X-ray. They wheeled him past the radiology suite and into a waiting bus. If he injured himself again we didn't hear about it.
If you've seen the movie "Dead Man Walking", then you know that death row inmates are treated very differently from other prisoners. A "normal" class 4 inmate gets an escort of 2 guards wherever they go. Death row inmates get 5 guards, all of them armed to the teeth. I'd never heard the term "Dead Men" to refer to death row inmates until I saw that movie. In Texas, they are simply referred to as DRI's, at least around the prison hospital.
Death row inmates may be on death row for as long as 15 years, and in the meantime they have to be kept healthy enough to kill. If a DRI gets too ill, such that he's no longer able to understand what's happening when he's executed or he's clearly no longer a danger to society, then his sentence is quietly commuted, and he's sent out to a nursing home or something similar at State expense. So, we occasionally end up caring for DRI's so that their minds can be clear and their bodies well when the State takes its revenge on them. I'm sure that it has occurred to more than one DRI that a severely disabling self injury might be one way out of death row, but they are denied any chance of being able to do that though elaborate precautions designed to prevent that sort of thing.
I have always been against the death penalty. If it turns out to be a mistake, it can't be corrected, and the justice system is a mess of human affairs that does not deserve the power of life and death. The process is inhumane, what with the long imprisonment leading up to death and the conditions on death row. It is arbitrary. It falls heavily upon the poor; those able to afford a good lawyer never get the death penalty. It is questionable as a deterrent, at best. It essentially panders to the public's thirst for revenge. It is morally repugnant to me, and this has caused me a lot of discomfort when dealing with men on death row. By acting as a cog in the machine, I essentially condone the policy. I have played along and done my bit to keep some of these men healthy. I can't say that I've made a lot of difference one way or another where the health of these men is concerned, and I'm certain that a protest on my part would make no difference in the short or the long run.
Years ago, a resident referred to a hopelessly ill patient as "a case you can't make a mistake on." In other words, no matter what one did the outcome would be the same. Or, to be more correct, the only mistake one can make is to hurt oneself by doing something stupid. Best to go along, then, when dealing with someone who's already dead.
I'd like to be able to say that I had made a protest against the system in some way. But, in fact, I have done no such thing, and I doubt that I ever will.
The last man on death row that I had contact with came in with a small stroke. He was rendered weak in one arm for a couple of days, but recovered fully, much to his own dismay. He was very soft spoken and polite. There was no attempt on his part to manipulate the physicans. He made no attempt to embellish his symptoms. He simply asked me what his prognosis was, and I was sorry to have to tell him that he could expect no recurrence of the problem to get him off death row. I got calls from the governor's office regarding the state of his health. I gave them a factual and truthful report without rendering an opinion as to whether he was fit to kill or not. He was executed on schedule about a month later. The paper reported that he'd killed a woman in a robbery in 1983.
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