Later that evening, after I had dozed off, I was awakened by the sound of keys jingling as the night shift guard was unlocking the door. “Adams,” he said, “the nurse is here to see you.”
It was the supervising nurse on the night shift, an RN with a lot of energy and confidence. “The doctor just wanted me to let you know that the INR from the blood they took earlier today was 2.9.” I thanked her and returned to bed and that would have been that except before she exited she repeated herself, “The doctor wanted to make sure you got that value.”
It was no longer an innocent comment. It was now a dagger. She obviously meant a whole lot more than she was saying. I am sure the doctor relayed to her that I mentioned to him earlier that the previously reported value of 4.3 was dangerously high and that for five days I asked the nurses what the INR was and nobody knew. The problem with not knowing is that the dose they were to give was dependent on that value: if it was greater then 3.0, I was to get 8 mg of Coumadin; if it was less then continue with the 10 mg. If you didn’t know the INR value, how on earth were you to determine the dosage?
Yet for five days the only value they had was 4.3. I was complaining of nosebleeds but still none of the medical staff – that’s including the doctor – bothered to look at it. So her remark was meant to suggest that they were. It was an “in your face” remark that she was use to directing at inmates, but the fact was, she was the boss and they had dropped the ball.
But here’s the catch. A value of 2.9 five days later, on a different sample, does not invalidate the previous result and their previous actions. The fact remains that the original 4.3 should have created red flags all over the place. The lab should have reconfirmed the value on the sample they already had, and the nurses should have held the medication and notified the doctor..
During my consultation earlier that day, Kadevari had suggested that he believed the value was spurious and should be repeated. Yet if that’s the case, he should have reevaluated the original sample, five days earlier.
What’s even more alarming is that he offered that he “didn’t trust the lab”.
My point was this: if you didn’t trust the 4.3, why would you trust the 2.9? If her making a special trip to my cell was to say this is the legitimate value, which is in actuality 33% off the previous value, who’s to say 2.9 isn’t 33% off? The only real evaluation of the validity of the INR would be to have two different people in two different labs run the test. If not, then you have to believe all the values, not just the ones you agree with.
I did not press the issue though, a discussion with her would have only been interpreted as confrontational, not a quest for answers. While I am amazed at our – people’s – level of irrationality and failure to think, I have come to believe that challenging people who harbor an anti-conceptual mentality, people who simply refuse to think, only worsens the matter. They cannot argue ideas because it becomes personal for them. It’s not about ideas, it’s about their whole belief structure and way of thinking.
Incidentally as a test, I presented that argument about the validity of the labs once again to the doctor the following day just to see if any learning had taken place on his part. I premised my presentation by saying, “I believe him to be a good doctor.” Unfortunately, he probably was not. It was not his training or expertise however that I objected to, it was his bastardization of his own convictions that bothered me. He knew the right thing to do, but buried that in an effort not to rock the boat. His response was merely to shake his head in agreement but his eyes stared off in the distance lost, like a deer in headlights, with no comprehension whatsoever of the gravity of the situation. I suspect he was dreaming of a time when he once gave a shit about his patients. His care was diminishing in quality not because of his training, but because people with no training were making decisions for him.
I then asked him about clearance to obtain a job while in jail. Dr. Kadevari informed me that I did not qualify because I had medical issues – oral NSAIDs, left foot orthotics, S/P ankle fusion – and certain medical issues prevented one from entering the program. He pointedly noted that the problem was the NSAID’s (which I’ll clarify to mean the alleve-whih by the way is an over-the-counter medication and is sold directly to inmates through Aramax). Dr. “K” went on to say, “While on the outside, doctors can suggest light duty, the prison has no such program.”
Then I said, “doesn’t it seem unfair that some inmates through no fault of their own are treated unfairly? Shouldn’t the law work equally for everybody? Shouldn’t all the inmates be able to work off time? No one chooses to be sick. No one says, “when I grow up I want to be a doctor, I want to have a family, and, by the way, I also want to have diabetes”.
The deer returned to the headlights. He had come to a dead end because of the irrationality of his argument, and now had created a problem for both of us. Don’t misunderstand me, my morality would argue in favor of the facilities’ and the doctors’ rationalizations: Why risk the added headache of employing those who might be a safety risk? No one wants someone to crash in an environment where they can’t get help, or are surrounded by people who can’t help them. I get it.
My question however was directed to his rationalization of the rule, not the rule itself. He had opened a can of worms and I suspect I was still harboring some anger over him allowing Metzger to make a “medical” decision.
The doctor, in order to justify his argument, had brought up the rules of outside world. He had also brought into our conversation a rationale he could not justify. We have developed federal laws protecting the feeble. Thus his statement for not granting those on NSAID’s the ability to work off time is in fact violating federal law – regardless of whether it is company, or jail policy. The rules were being applied unevenly.
Here’s the ludicrousness of the entire thing: the doctor allowed a guard who was having a bad day make a medical decision. He allowed her to force him to discharge a patient – me – from the medical ward over removing my left ankle boot to shower, when in fact; the issue had been an INR of 4.3. And now two days late, he uses a policy issue – people on NSAID’s can’t work off time – to make a medical decision.
I shook my head and let it go. I returned to my cell feeling unsatisfied.
On E module there were two “unlocks”, one in the morning and the other in the evening. This would be my first opportunity to get a look at my module mates. There were twelve of us in total on “the lower tier” and we were quite a lot. Everyone acknowledged my presence as the new guy on the block, but no one approached. They nodded but no one made any advances. After about twenty minutes an older black guy, bald and with a salt and pepper beard, approached me. “Hello brother,” he said and shook my hand. He then continued his prowl around the room acknowledging the other men in the module. There was an older white man with a long white beard and tattoos everywhere in a wheelchair. He was moving through the tables and at one point seemed to get stuck. I offered assistance; he smiled and shook it off. “Thanks anyway,” he said and continued on past without a word.
Three younger white guys, all with goatees and tattoos, sat at the table with him and began playing cards.
At the table next to them was an older white guy who was at least 70 years old to the eyes, but may have been younger, just weathered from years of hard living. He looked tired.
I later learned that he would be paroled in less than two weeks. “March 6,” he said, “March 6.” He had lived a tough life, in and out of jail mostly for his inability to “think before he acted”. At least that’s how he characterized it. He sat with the older black man, Wayne, who had introduced himself first, and who now controlled the remote to the TV. Wayne spent a great amount of his “unlock” time talking to the guys in the upper tier, who were still locked down in their cells. He had himself been in and out of prison most of his life, his longest stint being 16 years. He was 52.
No one spoke about their reasons for being in jail. It is sort of the equivalent of the conversations at fancy dinner parties – where middle-aged men stand around talking about their children or their golf game. “Do not ask about me specifically,” they are all thinking. “For I do not want to admit that I am not doing as well as I should be doing. And I certainly don’t want to confront the issue that I am not doing as well as I hoped” – or worse yet, and much more depressing – “I am doing what I hoped and I am miserable still. I do not want my profession and frankly, it does not want me either. So do not ask me about it, and I will allow you the same.”
The conversations here are dominated by how much time I have left to serve, and where do I go from here. Particularly interesting is what I like to call the mentoring program. SCJC/DF is really just a way-station, a halfway house as many of the inmates are merely waiting to be processed before being shipped out to places like Folsom or San Quentin. Those with a history of having been housed in those places spend a great deal of time counseling the younger inmates on survival techniques. It is a strange combination of perverted Christian doctrine and violence, “The Lord said turn the other cheek, but understand if someone comes at you in Quentin they’re going to be carrying a knife. Keep your hands free, try to back away and keep them in front of you. Most importantly, use your fists – use these.” There would then be a chorus of shadow boxing techniques demonstrated and then the conversation would return to scripture.