February 7, 2013

Rebecca Lubelczyk, MD, clinical associate professor of family medicine & community health and associate program medical director for UMass Correctional Health, shares a reflection about correctional health that captures the element of "family" in a prison setting that many of us would be ignorant of. I am also moved by the rallying of the friends and doctor at a time of need. We are indeed lucky to learn a bit more about prisoner health, friendships and the doctors who practice correctional health.—Hugh Silk, MD

A Cup of Coffee

His name was Abe but I called him Mr. Oldman despite my first-year interviewing skills course. I knew he preferred me to call him Abe, but the formality was a subtle reminder that I couldn’t get too familiar with my patients as they are inmates in our state prison system. Abe worked in our upstairs medical ward as an orderly. He did the laundry for our infirmed patient inmates, brought them their food trays, etc. He always greeted me when I arrived on the ward for morning rounds with a huge smile and a bright “Hey, Doc!” We’d exchange brief pleasantries and then both of us would get back to work. His two co-workers clearly respected him. He never acted as their boss as they were at the same pay scale, but there was a palpable seniority they assigned to him, in part because he was already 50 years old when they were born.

Now being 78 didn’t come without its health issues, and I knew his diabetes and hypertension had finally caught up to him when he was brought to the medical department after being found on the floor of his cell, unable to move or speak. Phone calls were made, officers were mobilized and Abe was quickly on his way to the nearest emergency room. After the ambulance left the prison perimeter, I made my way upstairs to conduct my rounds. His co-workers had already realized something was seriously wrong because Abe didn’t show up for work. Shock and concern shadowed their usual warm faces. I was in low spirits myself as I saw my charges for the morning. The ED called just before I was about to head downstairs to the prison clinic. It was a subarachnoid hemorrhage with no signs of trauma. He was awake, displaying mental activity but still having difficulty speaking. Though it appeared the bleeding had stopped, he needed a tertiary hospital. From his initial presentation to his eventual placement in a neurosurgical intensive care unit, Abe received care that was timely and efficient. Everything went right. Abe was going to be okay.

The following morning, I was settling in at the nurse’s workstation computer in the upstairs ward ready to do my orders when I heard a soft knock at the door. Plato, the youngest of the co-workers, stood in the doorway and gently asked, “Would you like a cup of coffee, Doc?” It was a simple question yet the answer seemed so complex. It is generally not advisable to accept anything offered by an inmate for many practical and security-related reasons. Most of the time, patient inmates don’t have anything to offer. After a stunted moment, I said, “Sure.” Plato’s smile filled his face again and I realized as he handed me the Styrofoam cup brimming with heat that his gesture was one of sincere gratitude. He wanted to thank me and offered one of the few things he had to offer—a cup of coffee.

I could not give Abe’s co-worker’s any updates on his condition, as sharing information about patient inmates with other patient inmates is against all forms of ethics and confidentiality. They knew he was being well taken care of and eagerly wanted to know when he might be able to come back to work. I too was wondering how long we could hold his job for him (and if he would be physically able to return to it), when I got the call from the tertiary hospital. Abe had died from a complication of his stroke. I had already made my upstairs rounds and was about to see the clinic patients, but I decided it was more important to let his “family” upstairs know. I approached the upstairs ward officer. I could tell from his solemn look that the officer from the hospital had already called. I asked if I could be the one to tell the co-workers. He said they already knew but I could certainly talk with them. I found Plato and the other worker sitting in the laundry area where Abe had been every day for years. I could offer few condolences since my voice was suddenly barely audible. All I could manage was to ask if they were okay. Plato looked up and nodded, his face full of grief. I headed back downstairs, all our eyes burning, even the officer’s.

Prison can be a dark place, a desolate place. But even within the gray concrete and stone walls, a community is formed. There exists an entire culture that has its own traditions, rules and values. Part of that value system is the respect they bestow on those who care. Many of them just want to know that you care and that they are cared for. It is a difficult respect to earn since much of their culture is pervaded with distrust. I hope I can continue to earn that respect and trust.

Each Thursday, 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.