An objectively Reasonable Level of Care

The University of Texas Medical Branch is the healthcare provider for the eastern region of the TDCJ. Out west, the Texas Tech Health Sciences Center takes care of those inmates. In my transfer time, I was out in West Texas, and then I moved to my ID unit in the eastern region, so I’ve had a chance to experience both.

I’d say, hands down, that Texas Tech does a much better job overall, especially in the department of compassion, but also in health management. There was a big sign on the wall at Tulia T.F. It read, “You are not a prisoner here. You are a patient.” It was not only a nice reminder that someone, somewhere still remembered that I was a human being, but also mission statement that helped ”direct the greater level of service at every visit, minus one, I saw while I was in their care. But any system is only as good as its people, and in that vein, I share this story.

Anyone who has ever spent any time in any part of West Texas knows that the “wind comes sweeping down the plains.” And it does so just about every day, all year around. After I started having so much trouble with arthritis in my knees, I reluctantly gave up basketball for the less physically demanding sport of volleyball. So, when rec time came around, that is where you could usually find me. Some units have concrete pads under the volleyball courts, like my intake unit in Abilene. But most have strung up a net wherever they find a place in the rec yard, and that’s the volleyball court. The grass is worn away quickly by all the foot traffic, and it leaves a lot of dirt that those West Texas winds blow all over the place.

I had been to see the nurse practitioner (NP) there on my unit about my knee problems several times, and it looked like my next visit would be to the hospital in Lubbock to get surgery. My knee would be working just fine one minute while I was out playing volleyball, and then the next minute, while walking down the hall to chow, it would just crumble, and I couldn’t even stay on my feet. So, I was out there next to the volleyball court, calling the game instead of playing, and a gust of wind blew a bunch of dirt in my eye. It was a Friday, late in the afternoon. It’s not unusual to get a face full of dirt out there, and it’s not even unusual to get some in your eye. And most of the time, even if you can’t wash it out with a bottle or anything else, it’s gone by the next morning anyway, by whatever magic the eye does at night to cleanse itself.

Unfortunately, when I woke up the next morning, that grain of sand was still in my eye, and it was driving me nuts. It felt like a scratch, instead of debris, so I decided I better use the “walk-in”. The walk-in is only for urgent care. In ordinary times, you’re supposed to submit a “nurse sick call request”, and it is reviewed by the nurses, and they schedule you a visit, usually the next day. But, since my eye hurt so bad, I went in anyway to see if they could help.

It was Saturday morning, and, although I wasn’t aware of it until later, the nurse who’d come on duty that morning was having an affair with the captain who was also working that morning. When the call came for medical walk-ins, I started towards the infirmary, but the officer at the searcher’s desk redirected me to the captain’s office, which I thought was odd, but since you see all kinds of things in here, I didn’t put too much effort into trying to figure it out. The nurse, we’ll call her Ms. R, had her blood pressure machine, and that was about it. When she asked me what was wrong, I told her there was something stuck in my eye. She told me there was nothing that could be done about it, because she didn’t have anything to treat that with her. I later found out that not only was Ms. R NOT supposed to be doing triage out of the captain’s office, but she was bound by policy to take care of a foreign object in the eye immediately. Instead, she told me that I needed to submit a nurse sick call request. This was discouraging, because it meant that my eye probably wouldn’t be looked at until Tuesday. After all, the mail doesn’t even get picked up until Monday morning, and the lay-in -pass isn’t printed until that afternoon.

All weekend, I’m trying every trick I know to get this sand out of my eye- pinching the eyelid and fluttering my lashes, blinking a thousand times while my head hangs upside down- you name it. No telling how many bottles of water I squirted into my eye that weekend, but since I only have one good eye, anyway (long story), I needed it healthy. I get my request in to see the doctor, and I’m looking for the moment, but then fate intervenes. Sunday night, the officers wake me up at 10:30PM and tell me I’m on medical chain to Lubbock. That means I’m going for my knee surgery. You see, they never tell you exactly when you will be on the bus, because I guess they think you will tell your family or friends, and they will raid the prison bus, Fast and Furious style, and spring you. Too many movies, I say.

I’m woken up at 3:00AM after finally getting all my stuff packed and inventoried, getting to sleep by midnight. I eat breakfast, and then I’m stuck in a transit holding cell until the bus comes around 5:00. The trip to Lubbock is blessedly short, and the bus isn’t overcrowded like it so often is out here in the east. When I get to the hospital, a nurse asks me if I have any health issues. I tell her about my eye. She notes it, and moves on to next man in line.

That day, after about six hours of waiting in a room with 50 inmates and two TV’s blasting at full volume, I’m admitted and am escorted to my room. Thera is no TV, halelujah. What I do find there is a real honest-to-goodness hospital bed, and that big, fat scrumptuous matress looks so inviting, I want to jump in and go to sleep right away. There’s another one in the room, but it’s unoccupied, which is also nice. Another thing you crave in prison besides a decent sleep is solitude, because while you may be often lonely, you are certainly never alone. There’s always someone there to annoy you, be it an officer or another offender. Someone. So, I am really groovin’ this whole sleeping by myself in a comfy bed vibe I’m feeling.

I really did put my “travel bag” (a red potato sack with my Bible, my cup, a spoon, some paper, and a soduku puzzle book- the razor got repo’d at the first search. I didn’t find out why until I saw the first psycho being brought down the hall with two armed officers. He was wearing the whole Hannibal Lector get up) up and climb into the bed adjusting this and that and snuggling in. Just about the time I get comfortable, the door opens up, and, you guessed, it, I have a roommate. He was all right, but definitely a gangster, and so we really didn’t have anything to say to each other. Some of my best friends in here have been from the street gangs. (Shout out to myboy, D-Ray Smith from the Polytech neighborhood!) But when they put on the whole tough-guy front, I just clam up and do my own thing. I spent the next several hours trying to go ahead and get some sleep while this dude made every conceivable irratating racket you can possibly make in a stripped bare hospital room with no TV. It still amazes me the amount of noise this guy could make with nothing more than a bathroom (no shower, more on that in a minute) and an electric bed. Just when he finally settled in, the nurses started a late night parade to begin the preparations for our respective surgeries the next day. I was having my knee worked on. He was having his colon reattached to his backside.

Remember there’s no privacy in prison. There’s nothing embarassing about a knee, but the things they were doing to that, poor roommate of mine… well, better left unsaid. I tried to turn my, face to the other wall and rest, at least. They finally finished all their fussing and left us alone at about 10:00PM. Every single one of them was told about my eye.
You ever been so comfortable you couldn’t sleep? Well, neither had I until that night. It was utterly ridiculous. Here I am in this Cadillac-bed, and I can’t get to sleep! The more I can’t sleep, the MORE I can’t sleep, just thinking about how stupid it is. So, besides a few hours of comfort, the ol’ hospital bed was lost on me.

The next morning, at 5:00AM sharp, the nurses come busting into the room and tell us we need to get ready to go take our surgery-prep showers. I am shown to a shower room that is pretty much like a large closet with tiles and a shower head, which is fine with me. I haven’t taken a shower in private in two years at that point. I open the door to the closet, and the floor is covered in three-inch deep water littered with every imaginable piece of nasty medical debris that can fall off a human being during a shower. There were bandages, band-aids, pieces of tape, cotton swabs covered in blood. Just the look of it made me want to vomit. When I told them I wasn’t going to take a shower in there, because it was filthy, the officer had an inmate-janitor bring me a mop and bucket and said, “Well, clean it out then.” Even though I knew that was the janitor’s job, I started cleaning the closet out, just to go along. It took about thirty minutes for the mop to sponge out all the water and to get the trash swept up. Finally I got in to take my shower, and since the drain is still plugged, I’m making a mess all over again, but at feast I know it’s MY mess, and it’s bio-hazzard free.

I finish my shower and am taken back to my room. They bring us a pretty decent breakfast of scrambled eggs and real toast, which is a treat, because even though the menu on my unit says toast every other day, we only ever get plain bread) and no butter.

Not long after that, I’m taken to surgery. I’d used a pen to mark on my leg which knee to operate on. I think I read about that in Reader’s Digest, and I didn’t want to wrong leg messed with. The doctor actually seemed kind of pissed off about that, but, ah well. No more comfy hospitable bed, now. I’m put on a cold steel table in the shape of a cross, my arms resting on the cross-piece. They put the mask over my face, and a few minutes later, I’m…AWAKE! And the surgery went well. We didn’t find anything too bad in there, so we removed some clutter and closed it up. We’ll have to take your stitches out in a few days. I’m still groggy, but I thank the doctor for her work. Now, though, I am really, really ready for that comfy hospital bed. Surprise! There’s no more hospital room for you. Have you forgotten that you are an inmate of the TDCJ?

Apparently, hospital rooms are just for prep. Once I’ve had the surgery, I’m taken to a transit wing known as “the dungeon”. It’s called this because it is a long, windowless corridor with no light and no detectable human presence. When my door rolls, I discover that there is at least ONE other human my cellie. He is asleep when I come in, but he hears the door clang shut, which is the only possible way to close any door in prison since they’re spring-loaded locking doors. I go to turn on the light so I can make my (Oh, no!) steel bed with the lumpy, hard matress. As soon as I do, my cellie screams like a wounded animal, which, I soon find out, is exactly what he is. He is five days out from cataract surgery, but they botched the job, and now they have to keep his eyes permanently dialated until they fix whatever they broke the first time. Any kind of light, even through his closed eyelids, causes him crushing pain. On the other hand, I have to sit in the dark for who knows how long while I go through physical therapy. What a pair we made. His name was Charlie Brown. No kidding. He’s the first of three Charlie Browns I’ve met while in prison. Parents can be cruel.

Well, they weren’t even giving Brown any pain meds, so I finally got a note down to the law library and got the address for the NAACP, since Brown was black, and I figured they’d look out for their own by trying to get him help from the outside, because we sure weren’t getting any from the inside. I was there three weeks, and these people never so much as responded to his letter. (I really don’t want to chase this rabbit right now, but I’ve had similar experiences with LULAC and the ACLU. I’m not sure what they’re really after, but it doesn’t seem to be helping people who are really in trouble.)
Every single time the nurse would roll the pill cart down the hallway, I would tell them about my own eye, and the fact that every day, the pain was getting worse, and the area around it was starting to discolor. I knew by then that it was no ordinary scratch. Something was definitely wrong. On the third day, much to my surprise, they told me I had an appointment with an eye doctor. YAY!

When I get down there, and tell him my story, this guy hit the ceiling! He puts me in this machine that lightens the eye, and right away he sees the sand particle which has embedded itself in the side of my eyeball and has become badly infected. I get some eye drops that kill the pain, and he literally scrapes the sand out of my eye with a stick, kind of like a tongue depressor. He said when the drug wore off, I’d hurt, but compared to how I’d been feeling the past few days, it just got better and better. The antibiotic eyedrops he prescribed me took care of the infection, too.

I don’t know what this doctor called and said to the medical people back on my unit, but when I finally made it back, I get called down to the infirmary. The program manager wants to talk to me. I was kind of freaked out, still new at this prison thing. Anyway, I get down there and he starts apologizing profusely. He even made Nurse R come out and tell me how sorry she was.

And that’s the difference between Tech and UTMB. They really do treat you like a patient, and when they screwed up, they owned it and tried to make it right. I didn’t even file a grievance, because I thought it was so cool the way they handled it.
I don’t know how the health care contracts for Texas prisons are awarded, but if the whole shebang could be in Tech’s hands, I’d sure like to see that happen.

I titled this story “An Objectively Reasonable Level of Care”. That’s because that is the legal standard for what’s required of the prison system so they don’t violate the prisoner’s civil rights. But, this doesn’t mean that every time you go to the doctor, they should only try to meet that minimal standard. No, they should try their best. And, for the most part, Texas Tech always did. Maybe UTMB needs one of those signs: “You’are not a prisoner here. You are a patient.”