What I have learned as a jail doctor. And the case I will never forget.
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I’ve never seen so many hand injuries in my life. Sprained fingers, bruised and swollen flesh — all blooming around an abundance of tattoos.
Inmates’ injuries almost inevitably stem from anger. They can’t make bail; their court dates are postponed; their family doesn’t pick up the phone when they call. So they punch a wall, or the steel doors of their cells. Sometimes they punch each other. (Incidentally, facial injuries are pretty common, too.)
But hand injuries are easy. An X-ray, an ACE bandage, seven days of Ibuprofen, and the inmate is sent on his way.
This is what I’ve learned as a physician at a city jail, where I work the urgent care line: There is a lot of minor trauma. There is plenty of acid reflux wrought by the greasy foods served at chow hall, and back pain exacerbated by the large concrete blocks that pass for beds here. There is anxiety masquerading as chest pain, uncontrolled blood sugars in Type 2 diabetics, and skin infections that evolve into abscesses.
These are common problems. They are, ultimately, easy.
I thought JAY would be easy, too.
Several days before I saw him, Jay had stumbled off the street into a local ER, driven to temporary madness by a cocktail of illegal uppers and downers. According to the discharge paperwork in his file, he detoxed for a few hours and then was bundled up and transferred here. And jail protocol — there’s a protocol for everything — mandates physician follow-up for any recently hospitalized inmate.
I hoped for a straightforward appointment. My shift was almost over, and there were still eight other patients on my list after Jay. His file detailed dozens of brief jail stints over the last few years; I skimmed it and then asked a nearby officer to call him down. Nonviolent inmates are permitted to wander the halls with relative freedom, so Jay would travel from his unit to the medical floor unescorted.
He entered the exam room sheepishly, and sat on the hard plastic chair facing me, arms crossed, head down. Like many of my patients, he was a young black man in a green jumpsuit and bright orange sandals. Black-uniformed officers wandered around in the hallway behind him.
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