Memo To Health Services

INMATE COMPLAINT: My hand is fucked up.

HOW LONG HAVE YOU HAD THIS PROBLEM: Since 6-9-09

RATE YOUR PAIN (10 = WORST IMAGINABLE): 10


MEDICAL PROBLEMS YOU HAVE? CIRCLE ALL THAT APPLY:
Mental Health Problems.

This is written on one of the call-out slips we get in clinic from patients who can't come to see us in person. It's in pencil (more on that later), and scrawled in messy, but still legible, child-like writing.

One of the guards handed it to me, saying "I have a present for you."

The patient is in solitary confinement. We go over to see him, passing deeper into the facility through another layer of secure doors. We're in SHU, or Special Housing Unit, where inmates are kept to either protect them from other inmates or protect other inmates from them. In this case, to protect one from himself.

Back on June 9th, he stabbed himself in the hand multiple times with a pencil, and as I peek through the tiny window in his cell door, I see a pencil laying on his bunk.

"Is he supposed to have that?," I ask.

"We haven't been able to get all of them yet. It's the last one," says a female officer.

The PA opens the "trap." That's the small hatch in the door for passing meals, meds, and pencils, I guess. We're going to examine him through the trap.

"Let him take your temperature," says the PA.

A scruffy-looking Native American kid, 25-years-old, sticks his mouth up to the trap and opens.

"Under your tongue," I say automatically. I bend down to make sure I place it where I need it.

"Get your head up," the PA tells me. I raise my head a little.

"More. Keep your head higher. And step back a little," he tells me, not OK with my proximity to the patient.

His temp is 99.2. Not bad. He puts his hand through the trap and I'm warned again not to get too close as I bend down to look. It's red, swollen, and has two puncture wounds, one on each side of the back of the hand.

"We're going to give you some antibiotics. Are you allergic to anything?," says the PA.

The exam is over. The entire encounter is over. We walk away and are let back through the two locked doors that form sort of an air-lock between us and the main part of the facility.

I write up the note, prescribe Bactrim for 10 days, and imagine the meds passing through the trap on their way to my patient.