2E12 (3)

But paradise is also gained as well as lost, and one can find joy in the most unlikely of places. At my “unlock” that afternoon, who should I see sitting there but Leonard. And it turns out the jokes on all of us. Leonard had been right all along.  He wasn’t confused. He HAD been scheduled for discharge: two days earlier just like he had said. The problem was that – for two days – no one got around to processing his papers (apparently it wasn’t a priority for any of them so they – the staff at SCJC/DF – never got around to it); so much for old-timers being out of it and confused. No one simply cared to process his paperwork so it sat on a desk.Whose desk I can not say.

But how incredibly mean is it to keep an inmate incarcerated when he has served his time and been released by the system simply because you don’t care and choose not to do your job. Nonetheless, there was a certain joy in his triumphant exit.

The game continued for me, and unfortunately I was not as fortunate as Leonard. Despite having spoken to the nurse, and having informed the facility, including their doctors and nurses of my condition and receiving assurances that they could accommodate those needs, they failed to keep their obligations. Just one day after speaking to the nurse-in-charge and getting her assurances that the items needed for rehab had been cleared, I got a note form the California Forensic Medical Group, Inc.:

 

“Dear Patient:

One of our providers has identified that you have requested special shoes.

Jan – per the facility commander your orthotic shoes were denied due to metal and hard plastic – this is now out of medical hands.

Thank you,

The Medical Staff”

 

Now mind you, “The Medical Staff” is Dr. Kadevari, the same guy who let a guard bully him into transferring me from the medical ward to the floor with an INR of 4.3. Granting them their safety issues, it really comes down to one unfortunate concept: human meanness, no more, no less. I had wanted to like the guy, or at least find some common ground, but his lack of advocacy for his patients made me sick. (And for the record, after eight tries that 75 year-old black woman, had obtained shoes without metal, without plastic, without shoe strings, and at the time she left them at the facility, had been cleared by the intake person.)

That is why I was starting to be more concerned about my bunky Mike and how we all were being treated. It wasn’t so much that there were omissions, or mistakes. It was more a concern that the oversights were by design. The meanness wasn’t the shortcomings of a flawed system, they were premeditated. The medical staff knew who I was, a doctor familiar with the system and the standard of care; and yet they blatantly continued to function with an attitude of unconcerned “negligence”, going so far as to push it in my face.

Mike, my bunky, is a baker by trade. I learned that in a conversation, our first real conversation about real issues in more than a month. It turns out he was in fact the “head baker” at a firm in Oakland, California. What was not surprising was his confession that he really disliked the role of “boss” to the other bakers. His role as “head baker” required managing people, and what part of his personality I could pick up from our brief conversations, demonstrated a passiveness that screamed “I don’t want to be in charge, of anything”.

Mike wanted no part of responsibility. He avoided a direct opinion on anything except his contempt for the “pecking order” that existed in E-module. That in itself was strange to me but at a certain level I understood him. The burden of leadership requires responsibility. Mike, for all intense and purposes, had quit life. He wanted no responsibility. He wanted simply to be left alone. He had, it seemed to me, lost the will to go on. Nothing seemed to matter and he took everything that happened, even to him, with indifference. That explained his unnatural sleeping habits and it also shed light on his medical problems.

Over the past eight days he had been having increasing bouts of explosive diarrhea, and on occasion had been unsuccessful in getting to the toilet, just six feet away. (By the way, get comfortable with another man having explosive diarrhea three feet from where you eat and six feet from where you sleep.)

I had suggested that he discuss it with the doctor. He had passively consented to do that and had even filled out an “inmate request form”. The problem was that he demonstrated no sense of urgency.  Here was a grown man, literally soiling himself daily, requiring daily changes of his linen and his clothes, and yet, he was content to have it addressed when someone, whoever, happened to get around to it.

I have to admit I understood his mood of learned helplessness. It is pervasive in the jail community. The medical decisions ultimately were made by cops with absolutely no medical training and getting what you needed, in terms of care had nothing to do with effort. If one of the guards “felt” like it, it might get done; if not, then too bad.

My concern for Mike, though, was bigger than just him. Make no doubt about it; I didn’t want him sharing whatever was causing his problems with me. But if in fact his diarrhea was bacterial or viral, in a closed space like a prison, it would spread like a “wildfire”.

He had also been demonstrating an increasing classic “pill-roll” suggestive of Parkinson’s, and had become increasingly more unsteady in his gait. I worried about his medications as a cause also. I didn’t want to press the issue too hard because then the staff and the guards would become combative. I also didn’t want them to isolate him somewhere where he would be ignored.

To make maters worse, he had another court date today. Two weeks ago he was looking at eight years in the penitentiary, now they are arguing for life. It was definitely taking its toll on him because if he wasn’t talking before, he was absolutely mute now and you could see the desperation in his eyes. He just looked to be in so much psychological pain that, for him, it had become physical. His soft mannerisms had been masked by a grimace. I recognized that it was not my problem, but he is after all a human being (and I am, after all, still a doctor regardless of where I happen to be sitting at the time).

He just kept repeating, “I’ll never get out of here.”

And I’ve got to admit, viewed that way, it is a bit devastating.

The younger guys don’t worry about time. They seem to pass it off as merely part of the game. But the older you get the more you sense the end and that puts a whole different light on the situation. Time becomes precious and you feel the pressure from the idea that time is slipping away.

“Unlock” today was even more interesting because the jockeying for alpha male – though completely passive-aggressive – was intensifying, along with the spectacle of it all. At what I like to call the lead table – it sits in front of the TV and the remote is usually sitting on it – sits Smitty, Mr. faux, born-again Christian, who uses scripture and the advantages that come with Bible Study to amass a following.  On the other side was Wayne, a career criminal without a doubt, who uses control of the remote to constantly fake the notion of democracy as he queries the room to determine the day’s entertainment. He has decided, quite astutely, that participation leads to commitment; and although you can see in his eyes that he cares about no one else, he is constantly acquiring converts by making them think they had a say in the decision-making process. Both of these guys absolutely hate each other, but find it necessary to stay in close proximity in order to keep tabs on the other’s movement. They are constantly in a non-argument as, daily they try to explain their positions on matters that took place weeks ago. Despite their posturing, the outward expression of tolerance, the animosity just below the surface continues to linger.

Today Smitty made their disdain for each other a religious issue. He took the opportunity to – loudly – quote scripture and beat his adversary over the head with it. Wayne was forced to retreat to the adjacent table and catch up on the news by reading.

Smitty, not wanting to look too pleased with himself, retreated to the showers. As I said before, the display is completely passive-aggressive. My bunky assures me – with a smile – that it has been going on since he got here, which is long before I arrived. He also suspects it will be going on long after we have left. I doubt it will escalate beyond where it is now because the goal is really the heart and minds of my younger colleagues, neither of the contenders want to appear too eager for the job. The goal is to be the wise old sage who offers guidance and counseling, not the boorish street thug who forces everyone into submission. Besides Smitty is in a wheelchair and Wayne can’t risk looking like a bully.

To be certain while I have absolutely no admiration for either of them – I think them both to be obviously manipulative and dishonest- if you engage in the art of courteanship, at least learn to be good at it; the art is in the subtleties. However, I do enjoy the spectacle from a few tables away. I appreciate their selfishness as pure drama, much more interesting than anything on television. I am sure neither ever heard of objectivism. And, like most people who have never taken the opportunity to define their values, they are not in a position to use them to make rational choices. Their egoism is not rational egoism – which I support and advocate – theirs is a pathologic egoism which creates a window of opportunity for destructive moralities. They are both knuckleheads who want to lead but have no philosophy, no code for which other men can analyze, judge and then choose to follow. The comedy is in the fact that neither of them knows this.

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