On Thursdays, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.
|James Cheverie, MD, the site medical director at Souza Baranowski Correctional Center in Shirley, Mass., sent in his reflections about a prisoner/patient. Jim presents the complexities of caring for people who have participated in acts of violence in the past in a humanistic manner.—Hugh Silk, MD
Prison House Call
“For after all it’s what we’ve done that makes us what we are” -Jim Croce
His crimes were horrendous. He found himself to be well suited for killing, and became a murderer for hire. It was one of the few things he was good at. Even after he was sentenced to life without parole and put behind bars, he found his services to be in demand, and he killed again. After all, he reasoned, how much more time could he get?
Notoriety had its appeal. In the distorted view of the inmate population, he rose toward the top of the food chain. Only by killing a cop could he have been more of a celebrity on the inside. He got a lot of respect from his fellow convicts. He got a lot of attention from the correctional system.
Over the years, the man grew more and more disillusioned about the people with whom he was doing time. He wasn’t getting the respect and reverence that he was accustomed to from the new breed of inmate. “Give me your old-time cons any day,” he would say. “These kids, they don’t even respect themselves.”
He grew old and frail. His lengthy sentence spanned the entire careers of some of the correction officers charged with his care, and they grew old right along with him. His old-school ways earned him a measure of respect from many of them. Yes, he was a con, they knew, but he did his time like a man, in contrast to the many boys they dealt with every day. They weren’t friends of his, but the officers did what they could for him.
I was asked to see him in his cell. He did not want to come up to the infirmary for fear that he would be admitted to the infirmary or worse, sent out to the hospital. I was a little apprehensive about making a “house call” on the lifer’s unit, but I went.
He had the tense, bloated abdomen, the swollen legs and the dusky skin of a patient with end-stage liver disease. He also had a painfully distended scrotum, the result of too much fluid allowed to be where it shouldn’t be. His block officers told of more and more frequent episodes of confusion, describing the times when he would come out to the medication line having forgotten to put on his pants. The scrotum affected his aim when he used the toilet. He didn’t like and often wouldn’t take his Lactulose. He refused to wear his TEDS stockings, thinking their appearance to be too feminine.
We had a long talk about his illness. By the time I met him, he knew his life was almost over. No hope for a cure was around the corner. A liver transplant was out of the question. He seemed at peace with his fate. All he could do was plead with me to allow him to stay on the cellblock for as long as he could. The intimacy of the prison setting gave me the rare opportunity to take part in a unique aspect of end-of-life care. The stone cold killer was humbled by age and disease, clinging to what was left of the normalcy in his life and his ability to control what he could. He wasn’t a friend of mine either, but like the officers, I said I’d do what I could to honor his wishes.
Of course, his liver ultimately did him in. When his condition worsened to the point where he became too much of a burden for the officers and nurses on the block, he was admitted to the prison’s infirmary. From there, he was shuttled back and forth between the infirmary and the hospital, and between the infirmary and the cellblock, as his condition waxed and waned. Asterixis, sudden onset blindness and extreme mental status changes led to his final hospital admission.
When the end finally came, word spread throughout the prison that he was gone. The outside world moved on, taking little notice, for his crimes took place so long ago. But among those who knew him in the end, they recalled not the nature of his crimes but the way he served his sentence and faced his final illness, with a quiet dignity worthy of admiration.