At night we could still hear him through the walls. Grunting and humming with every breath, talking with an imaginary friend, explosive bouts of gas, and then silence as the sequence repeated itself.
Gerald was replaced by a chubby white guy about 5’10”, 210 lbs. His right arm was in a sling from rotator cuff surgery, and he believed he was only going to be in jail a few days before being transferred. He didn’t really talk much and although we were all cordial, he was given his space. That’s sort of an unwritten law too. Guys in jail give you room if it looks like you need it. A lot of these guys have severe emotional problems, and much like the rules of the jungle, you give a predator a wide berth, plenty of room to roam around.
A few days later, right after we had been given our morning medications, Officer Bottoms came to our cell to let me know the doctor wanted to see me. Like most things that happen in jail, there was no warning and no schedule. What was to happen that day was out of your hands, and you were only informed of it when it occurred. I had spoken with the doctor before about my medications and hoped to share some of my concerns with him. I was taken to the common room where Dr. Kadevari was standing over a portable desk on wheels, writing in a chart. Dr. Kadevari was an internal medicine doctor of eastern Indian descent. I found him pleasant and knowledgeable. He asked me to take a seat while he finished his thought on a previous patient.
After a few minutes, he smiled. “How are you doing?”
“I’m doing fine,” I said, “but I’d really like to get out of this brace and start rehabbing. The nurse entered the room and whispered in the doctor’s ear.
They had a short conversation in private, and then he turned to me. “We need to discuss your Coumadin,” he said.
“I know,” I offered. “If I can get out of this boot and start ambulating, I’d like to reduce it. I think you’re right; the INR should be less than three. There’s certainly going to be some question when I first start to walk on it. I don’t want to bleed into the joint.”
“Well,” he said, pretty much ignoring me. “That’s what we need to talk about. Your INR is too high, it’s 4.3.”
I had been complaining to him that I was getting blood on the tissue when I blew my nose. Because I had developed a blood clot in my leg while on Coumadin, my personal physician had opted to keep the therapeutic value of my INR at 3.0 to 3.5. In Kadevari’s mind that was already frightenly high because of the risk of spontaneous bleeding-a worry, I might add that was always with me too. Kadevari had already lowered my dose and we had been waiting for the result. In fact I had been asking the medication nurse what the value was for the past five days, but no one seemed to know. A value of 4.3 would certainly explain the nosebleeds. “I’m not sure that’s accurate. So we are going to repeat it stat”.
“OK,” I said. “But let’s face it. Its 5-6 days later. The half life of Coumadin is only about 3 days. We should have repeated it when the value came back high, and abnormal.”
He scribbled in the chart, again ignoring my concerns. “What about the brace?” he asked.
I recognized that this was an attempt to change the subject. I was now pissed-off because I had been asking people every time they gave me a dose of Coumadin, what was the last value? They had ignored me for a week. Basically, no one had cared to check it. Hell, I was in jail and no one cared about me. Worst yet, the doctor now had egg on his face, because let’s face it: I’m a doctor too. To have a patient running around with an INR of 4.3 is criminal on his part, and he knew it and so did his nurse. That’s what she was whispering about. Kadevari though had worked at Solano County for a while and had become adept at putting people off. He asked again about my brace.
“I brought two braces with me that don’t have any metal in them,” I said, “but one laces up and I’m not sure that’s appropriate because of the strings. Bottoms here”, I pointed to the guard, “would be able to help us out with that.”
I turn to the guard who had brought me down the hall to the doctor, and he shakes his head from side to side “No, that won’t work. The shoe strings violate regulations.”
“I have another one,” I said. “It’s completely Velcro. It should be ok. But that’s not the complete issue. With the ankle fusion, my left leg is shorter and I need to wear shoes rather than slippers, so I need to get that cleared. If I don’t wear the orthotics my hips and spine will rotate and I don’t want back problems. I can make the call during my “unlock” and get all that here tomorrow.”
“Well, we might want you to see our podiatrist,” Kadevari said.
“Why?” I countered. “It’s all done. The orthotics was made special; they’re ready to go.”
“We just want to make sure there is not a conflict of interest,” the doctor said.
“Conflict of interest… What does that mean?” I asked.
From behind me, Officer Metzger who had now entered the room chimed in. She was obviously annoyed and disturbed though none of us knew why. “Is he done,” she said directly to Kadevari, “We’ve got more people to see.”
Dr. Kadevari was startled. He looked at me, then back at Officer Metzger. He was as confused as me about her outburst. She was red-faced and breathing hard, panting pretty much like an angry dog. “What?” he asked.
“Is he cleared to be out of the boot? He was out of it yesterday. Is he cleared to be out of the boot? If he is, we can get him out of here.”
There was that huge lesson in her statement that I had mentioned with Spencer’s case: someone is always watching. And the reason that they are watching is never about something beneficial for you, the inmate. It’s always to exact some pound of flesh: a chance for some guard to intimidate you; or an opportunity to invoke some rule (generally only in the mind of the guard) that strips you of some privilege.
The boot is a post-operative shoe that is secured with Velcro. I had taken it off to shower the day before, as I had done every day since my arrival) and in order to put it back on I had limped down the hall to a chair in the common room. That was why she was suggesting that I had been out of the boot-though her suggestion was somehow much more sinister. “That’s fine,” I said, “but it’s just not about the boot. It’s about the orthotics and the Coumadin.”
Kadevari says, “Yes, we can get him out of the boot.”
Metzger says to me, “Let’s go; you’re out of here.”
Now even Officer Bottoms is a bit confused as to Metzger’s behavior. He’s looking at me for some kind of indication as to what is going on. I’m his responsibility not hers. He’s the one who has escorted me from my cage. Unfortunately I have no way to help him. I don’t know what’s wrong with this obviously crazy woman. I stand and turn to Metzger and say, “What’s going on with you today? Where is all this anger coming from?”
She starts toward me and screams, “Sit down!”
“You just said let’s go. Which is it?” I said. “You want me to sit or to go. What I do know is that I’ve shown you nothing but respect and frankly I don’t know who you are mad at, but I’ve done nothing but treat you with respect.” I then turn to Kadevari. “Why can’t I just have the doctor send it in with his orders, it’s all done.”
Metzger then screams at the top of her lungs, “Because you are in jail, and I’m in charge.”
“I know that” I said. “Even Ray Charles could see that… But I was sentenced to 120 days, not death, and I’m not going to let you guys kill me. My INR was 4.3 and nobody did a thing. It’s a wonder I’m not bleeding from some orifice right now. You guys didn’t even know the value and I asked every day.”
I turned to Kadevari. “Wait a minute”, I said, “Are you saying to me that the conflict of interest means that you are challenging the integrity of another doctor? Why would he do that? He fit me for orthotics to balance my hips. You ought to be ashamed of yourself to suggest that he would do something improper though I can’t imagine what that would be. That’s just crazy.”
Metzger then shouts from behind me. “Let’s go. We are getting him out of here. There are other people who need to see the doctor.”
When I got back to the room, Shariff asked what all the screaming was about. I told him I honestly didn’t know. Metzger had lost it but I don’t know why it was directed at me. I haven’t done anything to her and up to that point hadn’t had any problem with her.
I do know the doctor let her make a medical decision. I do know that the INR I’d been asking them about all week was sky high and nobody did anything about it. They kept giving me Coumadin and now the doctor just got bullied by Metzger into a transfer, which takes me to my second lesson: the state of California is having trouble with the Feds about the condition of inmate medical treatment not because of money; it’s because the guards are making medical decisions not the doctors and nurses.
About one hour later, I met with the transfer specialist, Officer Paretta (sic). He asked if I had any problems going to any particular floor. I told him no.