My Time in Jail

My first month of internship was done in a state hospital. It was an acute medical service that took care of the patients that other hospitals didn't want to take care of - the homeless, drug addicts, crazy people, and prisoners. Actually eighty percent of the patients there were prisoners.

Any prisoner in the state who needed inpatient medical services would be turfed to this hospital. And I'm not talking about people who spent a night in jail for being drunk. These were state prisoners. They were first brought to a local ER, where they would be triaged and stabilized, and then transfered to our hospital. I hesitate to call it a hospital, because it was more like a big building which had a few untrained doctors and nurses wandering the halls.

The 8th floor was the locked ward. In psychiatric hospitals, a locked ward just means that the windows don't open and the doors lock. In this state hospital, the locked ward meant that it was basically jail. To enter the locked ward, you had to leave your keys, cellphone, and ID in a little slot. You had to sign in and state whom you were visiting and for what reason. Then they would open the jail doors.

You would think that because it was a hospital with sick people that things would be a little more pleasant. But there was nothing subtle about this ward. The jail doors were basically what you would think of. Big thick rusted bars that slammed when they opened or closed. It didn't seem like an environment fit for sick people trying to recover from illness.

The ward itself was just a long corridor with rooms on either side. There were a few single rooms for patients who had communicable diseases (there were many of those patients), but most rooms had 6 or 8 patients in them. Towards the end was a nurses station which was also locked behind bars. The air had a musty stench. It wasn't the standard septic hospital smell that I have grown used to.

There were always 10-12 prison guards on the ward at all times. When you wanted to enter a room, there had to be a guard with you. If there wasn't a guard available and a patient was crashing, you were supposed to let them die. Twice a day, there was a count. I guess it was like a roll call to make sure everyone was accounted for. I never knew exactly what happened because everyone had to leave the ward for this. There was no messing around in this facility.

The interesting thing about working there is that the patients were actually quite friendly. In fact many of them were more friendly than some of the patients that I had in the outside world. I guess it was that they appreciated a change in environment. Many of them were quite elderly and had been in prison for decades, so you can imagine how a trip to the hospital to treat a little skin infection might be an adventure. If I felt comfortable, I would ask them why they were in jail. Most of them seemed to be sex offenders. Rarely I would come across a murderer.

The actual practice of medicine there was kind of a joke. The nursing and ancillary staff were pretty much the worst that I have experienced. Because it was a state hospital, they made a decent salary and got a pension after working there for only 15 years. So many of them were just sticking around for those 15 years. They didn't care much about patients or their job. When 5 o'clock hit, they were already in their cars going home. As a physician, I would order medicines or order tests to be done. I was lucky if they got done 3 days later--most times they didn't ever happen. Not a good thing in medicine. If it was something that was crucial, I had to do it myself.

I was on call one night and the nurse paged me because she wanted to move one of the patients to a private room. She said he was being disruptive to his roommates. It was not an uncommon request, so I said OK and fell back to sleep. Later that night, I wandered up to the ward to make sure everything was OK and found that patient passed out on the floor in a pool of vomit. Turns out he was being disruptive because he was puking himself to death. The nurse didn't bother telling me that he was vomiting, but just wanted to separate him so that she could go relax. Heaven forbid I should tell her to give the poor man an anti-nausea medicine and IV fluids--that would mean working.

There was another nurse, clearly very new, who would call me at 3am for the stupidest things. One of the standard orders for inpatients is tylenol PRN. If you read my blog about prescription writing, you know that PRN means as needed. In these cases, the physician has already approved the medicine as safe for the patient, so it is up to the nurse to decide if he needs the medicine.

She would call with the same question.
"Can I give Mr. so and so some tylenol? He has a headache."
"Yes, didn't I write a PRN order for it?"
"Yes, but I just wanted to make sure with you before I gave it to him."

At 3am, this is incredibly frustrating. Tylenol is a pretty safe drug-it's over the counter. That means even a lay person can decide if they need it. It doesn't require 2 doctor's orders.

In the end, my experience at this hospital was an interesting one. Not many people can say that they met a murderer, or was a prison doctor. I'm glad I had the experience, but I probably wouldn't do it again if I had the choice.