Prisoners of many faiths can continue to celebrate their religious beliefs while doing their time. I receive many emails with lists of offenders who will be allowed a day off from work for religious Holidays; thus, a work Holiday proscription! These informative emails provide the prison staff with some information about the traditional Holiday practices. Occasionally, there is a special meal... or a fast. Some of these Holidays have included Native American Sweat Lodge, Wiccan Samhain, and Passover.
One can also purchase various religious items from the prison canteen to aid in her practices. Perusing this list is like taking a mini-lesson in comparative religion. A Buddhist meditation cushion and Sacred Path cards are the most expensive items on the list, setting you back about $58 and $40 respectively. Religious texts cost about $20. Other interesting items include Thor's Hammer, 2 oz. of Earth (68 cents), a prayer shawl, numerous herbs, and cedar shavings.
I frequently check my patients' canteen lists when they request that I prescribe medications that are available on canteen (mainly prilosec). I can't say I've seen a lot of religious items on their lists, but they do buy a lot of cup of noodles and something called "hot crunchy cheese," which can't be good for the old GERD.
So in case you were wondering, there is some shopping in prison! Looking forward to the horticulture hanging basket sale in a few weeks.
Tuesday, April 26, 2011
Monday, April 25, 2011
A Gravy Train with Biscuit Wheels...
Our new nurse manager is a capable, compassionate, and sassy Southerner with a lot of energy to whip our clinic into a well oiled machine. When I told her that it seemed like the prison nurses had a tough job, she told me that compared to other jobs she had, this one was "a gravy train with biscuit wheels" (except that with a Southern accent it sounds like "wils," which is even funnier. In fact, I have been laughing about this all weekend and every time I see her.) I started thinking that maybe my prison gig is also a gravy train with biscuit wheels and perhaps, in my four weeks left, I should adopt a better attitude. Sure, all my patients are not as pleasant as homemade mashed potatoes, but it's time for a new coping strategy....humor!
There are many funny moments in the prison clinic amidst the drama behind bars. One patient started our visit the other day by recounting a dream she had the night before about bags and bags of chocolate candy. Another patient told me the color red triggered her asthma. I replied, "Good thing I didn't wear red today." She then responded "um, I mean red dye..." (She now reminds me of this every time I see her.) There is a lot of construction on our campus right now withe a few pieces of heavy machinery strewn about. I heard during one lock down, some ladies were holed up in their cell houses looking out the window for the "bobcat," which they believed was loose on the prison campus. While I have seen various wildlife including rabbits and cats running through the yard, the only bobcats I've spotted are made of steel.
There are many funny moments in the prison clinic amidst the drama behind bars. One patient started our visit the other day by recounting a dream she had the night before about bags and bags of chocolate candy. Another patient told me the color red triggered her asthma. I replied, "Good thing I didn't wear red today." She then responded "um, I mean red dye..." (She now reminds me of this every time I see her.) There is a lot of construction on our campus right now withe a few pieces of heavy machinery strewn about. I heard during one lock down, some ladies were holed up in their cell houses looking out the window for the "bobcat," which they believed was loose on the prison campus. While I have seen various wildlife including rabbits and cats running through the yard, the only bobcats I've spotted are made of steel.
Monday, April 18, 2011
18 days and counting
As they say in prison, I'm going to "kill my number," which means serve my time until my maximum release date, May 19th. (Well, this is a self selected release date.) I will be starting a new job closer to Denver at a community health center where I can enjoy such benefits as sleeping in my own bed! And not getting up at 4:30 on Monday morning! My cell phone can even come to work with me. (Maybe I should go wild and get a smart phone...the flip phone was a big upgrade for me 4 yrs ago...)
I feel a bit ambivalent about leaving the prisoners without a doctor, but it's time to say adios to La Quinta and work closer to home. A primary care nurse practitioner is also departing the prison for a new job, leaving only the affable nurse practitioner gynecology specialist to deal with the medical needs of the ladies. Hopefully they can recruit (and retain) a provider soon. This was always a temporary position for me, which I let the inmates know, but I still always feel guilty leaving patients. With our residency transitions, I already have "broken up" with patients 3 times in my short career so far.
The demands of the inmates and this job are wearing on me. On my way out last week, two ladies brazenly stopped me in the yard with various demands. One stuck her tongue out and wanted a diagnosis for the coating on her tongue. The other woman irritably asked why she hadn't been scheduled for an appointment yet. Many of the prisoners lack boundaries, and I was not too happy about being asked to perform a tongue exam in the middle of the prison yard. (Although I could also imagine this happening on the outside in a grocery store or the gym...) Today I hopped aboard the "ambulance" golf cart and caught a ride out of prison, skillfully avoiding probing questions. Just 18 more walks out of the prison, and 4 more early morning commutes!
I feel a bit ambivalent about leaving the prisoners without a doctor, but it's time to say adios to La Quinta and work closer to home. A primary care nurse practitioner is also departing the prison for a new job, leaving only the affable nurse practitioner gynecology specialist to deal with the medical needs of the ladies. Hopefully they can recruit (and retain) a provider soon. This was always a temporary position for me, which I let the inmates know, but I still always feel guilty leaving patients. With our residency transitions, I already have "broken up" with patients 3 times in my short career so far.
The demands of the inmates and this job are wearing on me. On my way out last week, two ladies brazenly stopped me in the yard with various demands. One stuck her tongue out and wanted a diagnosis for the coating on her tongue. The other woman irritably asked why she hadn't been scheduled for an appointment yet. Many of the prisoners lack boundaries, and I was not too happy about being asked to perform a tongue exam in the middle of the prison yard. (Although I could also imagine this happening on the outside in a grocery store or the gym...) Today I hopped aboard the "ambulance" golf cart and caught a ride out of prison, skillfully avoiding probing questions. Just 18 more walks out of the prison, and 4 more early morning commutes!
Tuesday, April 12, 2011
Another day, another trichomonad...
A few things have changed since I started working in prison. My signature has become abbreviated from its full 19 letters to a squiggly line. I've also gotten better at telling people No. (No, you can't have a note to get out of work/a bottom bunk bed/neurontin/medical snacks...) Unfortunately, I may also be becoming more callous. Too many patients with "excruciating, shooting pain down the bag of their legs" last week almost put me over the edge.
One good thing that has changed is my skill in microscopy. I always found looking at slides of vaginal discharge to be rather time consuming and fairly low yield for diagnostic purposes. I mean, is there really clue cell in there or not? How come yeast never looks as obvious as it does in books? Somehow, I've gotten by. However, the number one prison kite is for "discharge, odor, help!" so I've had to make many a slide over the past few months. This slightly laborious process has occasionally been rewarding, like a month ago when I peered through the scope and saw the flicker of a tiny protozoan moving independently in the slide. Trichomonas!!! Finally! They always teach you to look for something moving on the slide, but usually the whole process is a big let down. Today I was very suspicious for trichomonas based on this patient's exam. I searched all over the tiny slide until I saw it, a trichomonad, ticking repeatedly under the cover slip with its flagella.
After I broke the news to the patient and handed her 2000 mg of flagyl, I called in a nurse to check out the slide. One of the nurses is studying to be a nurse practitioner so I thought this would be a good teaching moment. Then all the nurses came in to look and were fascinated, making comments like "look at it's little whip tail!" and "is that a phagocyte?" Even a prison guard wandered in to see what all the fuss was about. She started rattling off things she had seen under a microscope, which included an amoeba and a worm. She was happy to add protozoa to her list. I was happy to actually see something I could recognize and treat.
Check out this narrator's sweet Northern Ohio accent:
One good thing that has changed is my skill in microscopy. I always found looking at slides of vaginal discharge to be rather time consuming and fairly low yield for diagnostic purposes. I mean, is there really clue cell in there or not? How come yeast never looks as obvious as it does in books? Somehow, I've gotten by. However, the number one prison kite is for "discharge, odor, help!" so I've had to make many a slide over the past few months. This slightly laborious process has occasionally been rewarding, like a month ago when I peered through the scope and saw the flicker of a tiny protozoan moving independently in the slide. Trichomonas!!! Finally! They always teach you to look for something moving on the slide, but usually the whole process is a big let down. Today I was very suspicious for trichomonas based on this patient's exam. I searched all over the tiny slide until I saw it, a trichomonad, ticking repeatedly under the cover slip with its flagella.
After I broke the news to the patient and handed her 2000 mg of flagyl, I called in a nurse to check out the slide. One of the nurses is studying to be a nurse practitioner so I thought this would be a good teaching moment. Then all the nurses came in to look and were fascinated, making comments like "look at it's little whip tail!" and "is that a phagocyte?" Even a prison guard wandered in to see what all the fuss was about. She started rattling off things she had seen under a microscope, which included an amoeba and a worm. She was happy to add protozoa to her list. I was happy to actually see something I could recognize and treat.
Check out this narrator's sweet Northern Ohio accent:
Monday, April 11, 2011
Spring PrisonBreak II
Just so you know, this isn't turning into a travel blog (although that would be a more fun read than my recent posts...) I wanted to share some pics from my recent trip to CA and will bring you back behind bars at the end.
Zion National Park
Angel's Landing
Kolob Entrance
From Utah, to Anaheim...
We didn't get to go to Bahrain, but we did take a happy cruise around the world.
It's a small world, after all...........
This lively Huntington Beach street performer hammered a 4 inch nail up his nose, reminding me of the importance of regular tetanus shots.
As we made our way from the O.C. to San Diego, we stopped in San Clemente for a picnic with some goods from Trader Joe's. (How I have missed TJ since moving to Denver!) Walking toward the beach, we noticed some conspicuous orange jumpsuits the words "California Department of Corrections Prisoner" on them. Just a hard working prison work crew digging a hole on the beach. There was 1 guard for about 12 prisoners, who each took turns digging in the sand for unclear purposes. I'm sure you have to be a well-behaved inmate to get assigned to a beach work crew.
A few prisoners can't rain on my picnic.
In San Diego, the correctional system good times continued. Here I am in front of a jail cell in Old Town. There's no escaping this rusty steel box. Later that night, I watched my first episode of Prisonbreak. We also met some self proclaimed "bad guys" at a bar in San Diego while watching the San Diego State v. UConn basketball game. I overheard them talking about their brother who was doing time. A few pitchers of beer later, we nearly witnessed a brawl between one of the ex-cons and an old guy in sandals regarding whether or not the older guy was really from San Diego. (He bet against the Aztecs.) Later, he was kicked out of the Ye Old Plank Inn Bar and was told to "come back tomorrow." We, and the Aztec basketball team, were out.
Back through AZ and NM on the way home...
Vistas from Petrified Forest National Park. Warning: Don't take any petrified rocks or you'll be thrown in the slammer!
All good vacations must come to an end...
Zion National Park
Angel's Landing
Kolob Entrance
From Utah, to Anaheim...
We didn't get to go to Bahrain, but we did take a happy cruise around the world.
It's a small world, after all...........
This lively Huntington Beach street performer hammered a 4 inch nail up his nose, reminding me of the importance of regular tetanus shots.
As we made our way from the O.C. to San Diego, we stopped in San Clemente for a picnic with some goods from Trader Joe's. (How I have missed TJ since moving to Denver!) Walking toward the beach, we noticed some conspicuous orange jumpsuits the words "California Department of Corrections Prisoner" on them. Just a hard working prison work crew digging a hole on the beach. There was 1 guard for about 12 prisoners, who each took turns digging in the sand for unclear purposes. I'm sure you have to be a well-behaved inmate to get assigned to a beach work crew.
A few prisoners can't rain on my picnic.
In San Diego, the correctional system good times continued. Here I am in front of a jail cell in Old Town. There's no escaping this rusty steel box. Later that night, I watched my first episode of Prisonbreak. We also met some self proclaimed "bad guys" at a bar in San Diego while watching the San Diego State v. UConn basketball game. I overheard them talking about their brother who was doing time. A few pitchers of beer later, we nearly witnessed a brawl between one of the ex-cons and an old guy in sandals regarding whether or not the older guy was really from San Diego. (He bet against the Aztecs.) Later, he was kicked out of the Ye Old Plank Inn Bar and was told to "come back tomorrow." We, and the Aztec basketball team, were out.Back through AZ and NM on the way home...
Vistas from Petrified Forest National Park. Warning: Don't take any petrified rocks or you'll be thrown in the slammer!
All good vacations must come to an end...
Wednesday, April 6, 2011
Two pieces of chocolate cake, yes please
Since returning from my roadtrip, I've had a rough few weeks. Perhaps there was an influx of demanding inmates (or a release of some of the nice ones). Maybe it was the high drama of many people crying in the office due to pain, or the many people I have sent to the emergency room for evaluation. Regardless, I am feeling burned out and haven't been much up for blogging. So I couldn't pass up chocolate cake today when two pieces came my way. One of the nurses brought a chocolate cake made with sauerkraut, which was actually quite good. Then another nurse had me over for dinner and served a double layer chocolate cake. It was a nice treat.
Today I went searching for the results of a few studies I ordered. Unfortunately for me, but fortunately for the inmates, two of the ladies had been released to the community corrections program, where people are living in a half way house type setting. The medical file goes back to storage in Denver upon release so I may never see labs or studies I've ordered if the patient leaves before it can be reviewed. One particular patient had a complaint of a breast lump about a month before she left. I sent her for a mammogram and ultrasound, and she left prison two days later unbeknown to me. I requested the result today and it turns out she had a suspicious nodule that should be biopsied. I had to call her at her halfway house to break the news, and then send a certified letter with the results. They often have no insurance and very limited access to medical care once they are out of prison, so I have no idea how she will follow-up. It also frightens me to think what might have happened had I not remembered to check up on that result. I order a lot of studies here and can't be sure I always review the results before the patients disappear into the abyss of community corrections and the charts go back in to the ether. Sounds like a good way to get sued, which I am desperately trying to avoid. Yesterday a patient casually mentioned her ACLU medical malpractice lawyer during our visit. Not a good way to win over medical staff and impress others.
Today I went searching for the results of a few studies I ordered. Unfortunately for me, but fortunately for the inmates, two of the ladies had been released to the community corrections program, where people are living in a half way house type setting. The medical file goes back to storage in Denver upon release so I may never see labs or studies I've ordered if the patient leaves before it can be reviewed. One particular patient had a complaint of a breast lump about a month before she left. I sent her for a mammogram and ultrasound, and she left prison two days later unbeknown to me. I requested the result today and it turns out she had a suspicious nodule that should be biopsied. I had to call her at her halfway house to break the news, and then send a certified letter with the results. They often have no insurance and very limited access to medical care once they are out of prison, so I have no idea how she will follow-up. It also frightens me to think what might have happened had I not remembered to check up on that result. I order a lot of studies here and can't be sure I always review the results before the patients disappear into the abyss of community corrections and the charts go back in to the ether. Sounds like a good way to get sued, which I am desperately trying to avoid. Yesterday a patient casually mentioned her ACLU medical malpractice lawyer during our visit. Not a good way to win over medical staff and impress others.
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