It's a Lady's Prison

In case there is any confusion, I am definitely working in a women's prison. Our prison also houses boot camp for youthful offenders and a few adult men passing through on their way to other prisons (or waiting for colonoscopies). Nearly all of my patients are adult women age 20-74, with most of the women in their 30s-40s. (The lady in her 70s just showed up last week...I gave my first mini mental status exam in months.) Tomorrow the clinic will again turn into day one of boot camp as another crop of tachycardic teenage offenders arrive at boot camp.

My typical day will include chronic care visits, a few people with various medical complaints (usually pain), and a few procedures a week (skin excisions, joint injections). Since physical therapy is not often approved and getting a brace requires a small army, I will stick a needle in almost anything to inject steroids or to aspirate a joint. My biggest success story so far: uric acid crystals on an MTP aspiration! She's got the gout.


I had never aspirated or injected this joint before, but thought it might give her some relief. By some small miracle, my aspiration actually yielded some clear viscous joint fluid. I smeared it on a slide and slapped on a cover slip. To ship the slide to the lab, I put it in a big test tube. With the slide sticking out and the lid taped on, I was thinking "the lab is never going to accept this." But by a second stroke of luck, the lab did take my sample and spotted some negatively birefringent crystals. Her presentation of gout wasn't classic, so I was quite surprised to get the results. None of this has helped her symptoms yet, but she is following up tomorrow. Stay tuned.