It's the eve of my last day in prison and my emotions are mixed. I am happy that I will be "free" of the long Monday morning commute and being away from home all week, but I am also sad to leave the friends I've made (nurses, not inmates) and leave the patients without a doctor. Someone will come to fill my worn out Dansko clogs before too long I hope. And sooner or later, I know I will run into an inmate on the street or in my next office.
Overall, I feel really grateful to have been employed for the last 7 months and to have had this experience in prison. The correctional population has definitely experienced the health effects of poverty and being uninsured and I have enjoyed getting to take care of people who have no one else looking out for their medical needs (and often haven't been getting any primary care on the streets for years before they came to prison). I am constantly surprised and saddened by the number of women who attribute their long term health problems to physical abuse and drugs. I saw a 27 yr old today who had all of her teeth pulled and didn't qualify to get dentures in prison. I started talking to her about nutrition and eating fruits and vegetables, and she told me the kitchen doesn't given her any because she can't chew them. She broke my heart. It also seems like 90% of the women in prison are mothers, which I also find to be very disheartening. What choices and circumstances led the middle school school English teacher I saw today to end up in prison?
I had to laugh to myself yesterday when I walked through the prison yard and a diabetic inmate said to me "Bye, Doc!" and then, to her friends, "That's my doctor!" (Like there is any other doctor in our prison...) There have definitely been some satisfying moments, heart breaking stories, a few good laughs, and many patient tears, plus a few of my own. I leave with gratitude for my time in the slammer and excitement for my next adventure.
Hasta la vista, La Quinta!
Tuesday, May 17, 2011
Tuesday, May 10, 2011
The Mother Load
If you are unsatisfied with the medical attention you have received in prison, should you:
A) send excessive kites, each with more capital letters spelling URGENT and exclamation points that the last
B) write a "grievance" stating your complaint, which must be answered in a meeting with the nurse supervisor
C) have your mother call the warden and threaten that if the warden doesn't call back in 30 minutes, your mother will go to the media
All of the above have happened, and choice C (+/- media or lawyer contact) occurs to a surprising degree. I mean what business does the mother of a 38 year old former methamphetamine user with chronic leg pain have calling the prison medical clinic? I am totally appalled by the number of parent phone calls my boss fields for FULL GROWN INCARCERATED ADULTS. (It's not like the teenagers' parents are calling.) I mean, I know my mom has my back, but if I went to prison, I think I'd have to make my prison bed and lie in it.
A) send excessive kites, each with more capital letters spelling URGENT and exclamation points that the last
B) write a "grievance" stating your complaint, which must be answered in a meeting with the nurse supervisor
C) have your mother call the warden and threaten that if the warden doesn't call back in 30 minutes, your mother will go to the media
All of the above have happened, and choice C (+/- media or lawyer contact) occurs to a surprising degree. I mean what business does the mother of a 38 year old former methamphetamine user with chronic leg pain have calling the prison medical clinic? I am totally appalled by the number of parent phone calls my boss fields for FULL GROWN INCARCERATED ADULTS. (It's not like the teenagers' parents are calling.) I mean, I know my mom has my back, but if I went to prison, I think I'd have to make my prison bed and lie in it.
Monday, May 9, 2011
Welcome to Prison!
Recently I attended a provider training meeting at a department of corrections facility called the Denver Reception Diagnostic Center. While it may sound like a place where pepperidge farm cookies and lemonade greet you while you wait for a mammogram, the DRDC is actually the prison where all of the inmates get a physical exam before being sent to other prisons around the state. It is surrounded by a double fence with many, many rows of razor wire. Not so friendly. Initially, I was hoping to be placed at that prison since it's a short commute from my apartment, but it wasn't in the cards.
The provider meetings are a nice opportunity to chat with the other prison docs, NPs, and PAs and to compare experiences. The prisoners seem to get very good healthcare in prison, even for all the bureaucracy required for specialist visits and non-formulary medications. I do feel like I've won when a patient I've referred to a specialist has surgery (and I receive a legible consult note!), even though that's not supposed to be the most gratifying part of primary care. Seeing improvements in hemoglobin A1cs has also made me feel like I'm "doing something," which is also satisfying.
The guest speaker at the meeting was a retired infectious disease specialist who now works for a drug company. One might think that a drug company doesn't stand to benefit much from having a relationship with the department of corrections and its limited drug formulary. However, with oral Hepatitis C drugs on the market, there is a lot of money to be made, especially if a large organization like DOC starts incorporating oral anti-virals into its Hep C protocol.
Another interesting stat I learned at the meeting:
1/4 of HIV positive patients interact with the justice system in a given year. This represents an exceedingly high burden of disease for the corrections population. All prisoners get testing for HIV, syphilis, Hep C, and Hep B on arrival to the reception diagnostic center. I did get to tell a very relieved patient last week that her HIV test was a false positive (after an indeterminate Western Blot and an undetectable viral load x 2 over 6 agonizing months of not knowing for sure). My HIV patients are actually super stable and will be more like to die with HIV than from HIV. It's amazing how well HIV can be managed, especially when detected early. Hard to believe 20% of people in the U.S who are living with HIV don't know it. (Shout out to Aurelie and our grand rounds!)
The provider meetings are a nice opportunity to chat with the other prison docs, NPs, and PAs and to compare experiences. The prisoners seem to get very good healthcare in prison, even for all the bureaucracy required for specialist visits and non-formulary medications. I do feel like I've won when a patient I've referred to a specialist has surgery (and I receive a legible consult note!), even though that's not supposed to be the most gratifying part of primary care. Seeing improvements in hemoglobin A1cs has also made me feel like I'm "doing something," which is also satisfying.
The guest speaker at the meeting was a retired infectious disease specialist who now works for a drug company. One might think that a drug company doesn't stand to benefit much from having a relationship with the department of corrections and its limited drug formulary. However, with oral Hepatitis C drugs on the market, there is a lot of money to be made, especially if a large organization like DOC starts incorporating oral anti-virals into its Hep C protocol.
Another interesting stat I learned at the meeting:
1/4 of HIV positive patients interact with the justice system in a given year. This represents an exceedingly high burden of disease for the corrections population. All prisoners get testing for HIV, syphilis, Hep C, and Hep B on arrival to the reception diagnostic center. I did get to tell a very relieved patient last week that her HIV test was a false positive (after an indeterminate Western Blot and an undetectable viral load x 2 over 6 agonizing months of not knowing for sure). My HIV patients are actually super stable and will be more like to die with HIV than from HIV. It's amazing how well HIV can be managed, especially when detected early. Hard to believe 20% of people in the U.S who are living with HIV don't know it. (Shout out to Aurelie and our grand rounds!)
Wednesday, May 4, 2011
Know the Code
Hello from National Correctional Employee Appreciation Week!
This week, to thank us for our hard work, the prison is providing daily treats. Today was rootbeer float day...tomorrow nachos....Friday BBQ. Some of the other prison workers will be enjoying a steak dinner...others, a shoeshine. I think I would prefer the shoeshine to yesterday's "pop and popcorn," but the breakfast burritos on Monday were tasty!
And now, a fashion lesson from a recent prison email:
"With the warmer weather upon us it is a good time to revisit 4469-01, Appearance and Dress Code, particularly with respect to non-uniformed staff. The regulation does allow for wearing of "dress gauchos or capris" and provides the following definitions:
Capris/Crop Pants: A style of pants that is loose fitting and designed to end mid-calf or just below the calf with slightly flared legs.
Gauchos: A style of pants that is loose fitting and designed to end mid-calf or just below the calf with legs that are flared to resemble a skirt.
With both definitions, the key points to remember the fit (LOOSE), the length (MID-CALF) and that they are to be "dress" versions of these garments. To be allowed, the article of clothing must meet these definitions, regardless of how they are marketed."
For my remaining two weeks, I'm sticking to slacks.
This week, to thank us for our hard work, the prison is providing daily treats. Today was rootbeer float day...tomorrow nachos....Friday BBQ. Some of the other prison workers will be enjoying a steak dinner...others, a shoeshine. I think I would prefer the shoeshine to yesterday's "pop and popcorn," but the breakfast burritos on Monday were tasty!
And now, a fashion lesson from a recent prison email:
"With the warmer weather upon us it is a good time to revisit 4469-01, Appearance and Dress Code, particularly with respect to non-uniformed staff. The regulation does allow for wearing of "dress gauchos or capris" and provides the following definitions:
Capris/Crop Pants: A style of pants that is loose fitting and designed to end mid-calf or just below the calf with slightly flared legs.
Gauchos: A style of pants that is loose fitting and designed to end mid-calf or just below the calf with legs that are flared to resemble a skirt.
With both definitions, the key points to remember the fit (LOOSE), the length (MID-CALF) and that they are to be "dress" versions of these garments. To be allowed, the article of clothing must meet these definitions, regardless of how they are marketed."
For my remaining two weeks, I'm sticking to slacks.
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