Friday, 20 September 2019

Doctor in Jail

Two recent books give a vivid insight into 
what goes on in prison. It isn’t pretty 

It’s an afternoon at Bronzefield, a British women’s prison near Ashford in Surrey. Dr Amanda Brown hears a rumpus going on as she arrives to begin her shift. Prison officers are charging up the metal stairs. “Someone’s having a baby,” she’s told. She follows, noting the “deep stench of overcooked vegetables from lunch ...mixed with sweat and cheap soap.” She pushes her way past a bunch of officers and into a cell, where a tiny young woman is standing, her nightie soaked in blood below the waist. “Get it out of me! Get it out of me!” the woman screams. She is referring to the placenta, not the child; the latter, a tiny baby girl, is lying in a pool of blood on the floor. But the child is alive.

Meanwhile an American prison doctor, Karen Gedney MD, receives a prisoner in her office.

She is trying to give him support and help; he’s a Vietnam veteran who is serving life. He killed a cop and knows he isn’t going anywhere. Gedney has talked to him before but this time, things go wrong; he pins her to the wall using her desk and takes her hostage. He holds her hostage four 14 hours, during which he rapes her. Then the prison staff disable him with a stun grenade and kill him. A few days later Gedney goes to the gym, where another women says she’s glad she’s okay and nothing happened to her.

“No,” I said tightly. “Nothing happened to me, except that I was taken hostage by force, raped, exposed to a concussion grenade and saw someone blown away.” 
“Um – you need help,” she said, got off the machine, and walked to one further down the row. 

If you’re married to a prison doctor, I guess you don’t ask them if they had a good day at the office. 

Amanda Brown’s The Prison Doctor was published in June 2019, Karen Gedney’s 30 Years Behind Bars in early 2018. Brown’s book has had a significant impact and has sold very well, at least in the UK; Gedney’s has attracted less attention, but it is just as good a book. Both give a remarkable insight into what it’s like to be a prisoner in the UK or US today. It is not pretty.

Neither woman sought this line of work; it found them.

Karen Gedney qualified as a doctor in the mid-1980s. In the US, this has never been a cheap undertaking; today the average American medical student emerges with around $170,000-worth of debt, and some sources put the total cost of becoming a doctor much higher. But Gedney’s studies were financed by the National Health Service Corps, which provides scholarships for healthcare providers. The payoff is a period of public service in areas where there is a shortage of medical professionals.

Thus one day in 1987, Gedney finds that she’s been placed, unexpectedly, in a prison. Gedney does not name the prison, or even the region of the US, in the book, so I shall respect that and won’t do so here. But it is very easy to identify online if one wishes; suffice to say that it’s in a southwestern state. The upside is that it’s local, and she and her husband will not have to move. The downside is that the prison does not really want her. Gedney later hears that it had been forced to recruit a proper doctor because it faced being sued for inadequate healthcare provision. The medical staff do not give her a warm welcome. No-one seems friendly and one of the first things she sees is a prisoner being forcibly restrained and then bitten by a guard dog while having a seizure (she insists on treating him). Finally one of the staff, friendlier than the rest, offers to show her round. She is then told dismissively by a nursing assistant that the man is not staff but a prisoner and is a child-molester.

Amanda Brown has also arrived by accident. Up to 2004 she has worked as a GP, or general practitioner – that is, a family doctor, the equivalent of a primary care provider in the US. In The Prison Doctor, Brown says that the introduction of a new GP contract in 2004 caused friction between herself and at least one of her practice partners, so she left. The dispute sounds rather sudden. At any rate, Brown pens an angry article about the new contract for the GP’s magazine, Pulse. Another doctor sees it and recruits her for the prison service. It’s not a job that’s ever occurred to Brown but, aged about 50, she decides on a career change.

Brown has an easier introduction than Gedney to prison life, being welcomed by colleagues

at Huntercombe, a young offenders’ prison (at the time; it has since become an adult prison). But she too is taken aback by some of her new patients. Brown is shocked, at first, at the extent to which the inmates self-harm. They do it, she decides, to “displace pain they feel in their own minds – it can be anything from a scratch on the wrist to attempted suicide.” But what Brown finds at Huntercombe is nothing to what she’ll see at her next gig. Wanting a challenge, in 2009 she transfers to Wormwood Scrubs.

The Scrubs, as it is often called, is one of the UK’s oldest and most notorious prisons; as Brown recalls, it’s been “home” to some of the worst people on earth. Brown cites a few, including Charles Bronson and Ian Brady. Built in 1875, it currently houses around 1,200 prisoners. It is a hard place to work. Brown pulls few punches about what she has seen. Within a week or two she answers an alarm after an attempted suicide. She squeezes into the cell with the prison officers already there:

I pushed my way through them into what I can only describe as a bloodbath. There was blood everywhere – splattered across the walls, on the bed sheets. On the concrete floor, writhing in a pool of his own blood, was a young man with a massive slit across his throat

She wonders briefly whether the prisoner has smuggled a razor into the prison somehow to do this. Later she learns just how ingenious prisoners can be. Drugs can be brought in in the form of letters that have been impregnated with them and are then smoked. She’ll be ticked off herself for absent-mindedly bringing chewing gum into the grounds; it’s banned because it is used to take impressions of keys. Spiral-bound notebooks are also proscribed because wire binding can be used to pick a lock. Phones are forbidden as they can be used for criminal activity, and even an old one, if smuggled in, can command a price of £300-400 (about $360-480 at current rates).

One of Brown’s major duties, in the Scrubs as elsewhere, is to screen incoming prisoners and ensure that they do not need immediate medical attention, and that they have any medication they may need. They may be arriving from another prison, but in some cases they are on remand and have been walking the streets a day or so earlier; they are still in shock and are often very frightened. Gauging whether they can safely be left alone in a cell is a huge responsibility – one that eventually weighs heavily on Brown, especially after she gives evidence at an inquest on a prisoner who appeared normal on arrival but died in a cell from unknown causes a few hours after she saw him. It’s this strain, in part, that eventually persuades her to leave the Scrubs and go to HMP Bronzefield. But she has managed seven years at one of Britain’s most notorious prisons.

Over in the States, Gedney has even more problems. The management staff who do not want her there launch an “official” investigation into her conduct, something she only learns of by accident; shown the files, she is shocked by some of the comments. They include “She gives preferential treatment to blacks because she’s married to one” (which, as it happens, she is). Her Director is sympathetic, but says he can’t do anything because “they’ve got something on me”. Gedney has a four-year service obligation and cannot easily cut and run. She sweats it out. And in the end, she stays for good; it is not quite clear why she does so, but the work seems to have got under her skin. She finally retired from the prison as recently as 2016.

There are some differences between the two women’s working environments. Brown presents the prison staff as a mainly good bunch who would like to help the prisoners if they can. Gedney sees a more complicated picture. Early on, a prisoner arrives in severe pain; her nursing staff dismiss him, with contempt, as just having gas. Gedney finds he is having
The Scrubs
a heart attack. Meanwhile the director of medicine is the wife of the deputy warden and both are downright unhelpful. Gedney never really finds out why. Her husband thinks he can explain the hostile response from the prison staff. “You probably intimidate them. Think about it. You’re a doctor, and how many of them do you think have even gone to college?” Gedney also encounters racial tensions in the prison and hears of the way some of the prison officers talk about black people. In town, her own husband, a professional man, is pulled over and asked for his parole papers.

Gedney has two other big challenges that Brown need not confront. One is the death penalty. As a public servant, she regards it as the state’s decision as to whether a man will die; as an individual, however, she feels it is her decision as to whether she will participate. When a man is executed in 1989, she refuses. (Again, she chooses not identify the man so I won’t do so here, but it is not hard to find out who he was.) She doesn’t know him but he clearly knows who she is, and leaves her an extraordinary and moving letter. Later, she treats a cancer patient who is awaiting execution, and accedes to his wish not to prolong his life. She then finds that some people are angry that she did not keep him alive long enough to be killed.

The other horror that Gedney faces that Brown does not, is Vietnam. Today, the American survivors of the war are quite old. But when Gedney entered the prison service in 1987, the last American troops had been out of Vietnam for only 14 years are so; they were still around, and were a mess. To be sure, the country that was really traumatised by Vietnam was Vietnam, with – according to some estimates – three million dead. Nonetheless over 58,000 American troops were killed there, and according to the US Department of Veterans Affairs, a staggering 2.7 million served in-country. Today, according to Bureau of Justice stats, veterans in the US are no more likely to be in jail than anyone else; a bit less likely, in fact. But in 1978 they accounted for about 24% of all prisoners. These figures should be interpreted with care, as men serving in Vietnam were often draftees, and the ability or otherwise to avoid the draft must have been defined to some extent by one’s social class – in short, many of these men were more risk of jail anyway. Besides, there were more veterans; some of Korea and even World War II will still have been around, as well as those from Vietnam. Even so, it is a staggering statistic.

Gedney does not quote these figures, but is very aware of what the Vietnam veterans have been though. Her own husband is one; shot through the chest on Christmas Eve 1969, it took him a year to recover and his first wife, told that he wouldn’t, left him. Gedney encourages him to come into the prison and help found a veteran’s support group, and he does. The fact that she has earlier been raped by one of the veterans does not stop her from doing this.

Although some of the challenges the two doctors face are different, others are the same. Drugs are one; Gedney’s patients are on meth and more, and she encounters a prisoner with Hepatitis B who has been sharing his shooting-up gear with multiple people. Meanwhile Brown must deal with psychotic episodes brought on by prisoners’ use of spice, a synthetic cannabinoid that is being smuggled in in large quantities. Another phenomenon both must deal with is prisoner-on-prisoner violence. This is especially bad when it comes to those convicted of sexual offences against minors – the “cho-mos”, as they are called in the States; in Britain they are known as nonces. Arriving at the Scrubs, Brown is soon called to the first case she sees of violence against a nonce, a man in his seventies who is lying on the floor of his cell after a savage beating. Later she deals with something even worse:

A sickening indefinable smell hung in the airless room. I swallowed hard to stop myself retching. ...Severe burns covered the man’s naked body. His chest and both arms were blistered and bright red, with some areas oozing watery fluid, suggesting deep second-degree burns.

The man has been attacked in the shower. The other prisoners have flung boiling sugar water over him. This is used because it is more painful – the sugar glues itself to the victim’s skin, so that the boiling water is in contact with it for longer. Meanwhile in the States, Gedney treats a man who’s been subject to a “lock-in-a-sock party”, where a group of prisoners attack a cho-mo with sock that have padlocks stuffed down them. He needs 68 stitches on his head.

Brown describes these attacks but does not comment much on them. Gedney does. At one point she recounts a conversation with a sexual offender in which she clearly tries to understand how he got that way. She also tries to understand the savagery shown to them, and quotes a prisoner saying: “Every group needs someone to hate. Whether you’re white, black or Latino, it doesn’t matter. But what we all agree is hating the cho-mos.” A little later she treats a white supremacist leader dying of emphysema and again tries to get his story and listen to him. She comments: “Maybe I was naive, but it seemed to me that many people in both groups [the supremacists and the molesters] shared similar traits. They had been victims themselves, and then become victimizers. That was a cycle that needed to be broken.”

In general, Gedney is a lot more reflective than Brown – at least in print; the latter may have thoughts she doesn’t express. Brown mostly doesn’t know what her patients are inside for, and likes it that way. However, she does have more to say about them when she gets to Bronzefield, where she does give the story behind some of the prisoners, such as Andrea, whose life has fallen apart after being attacked with a claw hammer and raped; I found that
Bronzefield (Andreas Praefcke/Wikimedia Commons)
story quite hard to read. She also meets women whose substance abuse problems bring them back into prison again and again, but often not for long enough for them to be offered effective help. For many women offenders, this is a very long-running story. As Brown told the Daily Mail’s Claudia Connell (June 23 2019): “One girl, an addict, told me it was her own mother who’d first injected her with heroin when she was 14 years old. She wanted her to earn money as a prostitute and controlling her with drugs was the best way to do it. It’s a part of society I didn’t even realise existed before I started working in prisons.” She also notes in the book that some women actually feel safer inside, having been victims of lifelong domestic violence. This is not surprising. The charity Refuge quotes a 2016 Office for National Statistics report that two women die from domestic abuse in the UK every week.

Brown says little about the prison system she serves, or about the failings of the particular institutions she has worked in. But it is not hard to find the figures from other sources. The Scrubs is a case in point. An Independent Monitoring Board report in 2017 found that 57 prison officers had recently left but only 21 had been replaced. It found that the staff generally had a positive attitude towards the prisoners and wanted to help them, but that there were insufficient resources, resulting in maintenance problems and unsanitary conditions, delays in medical treatment, and poor access for legal professionals to their clients in the prison. There were 40 to 50 violent incidents a month. Bronzefield, too, has hit the headlines now and then, notably after the death of prisoner Natasha Chin in 2016; she had been recovering from major surgery when readmitted to the prison, and the inquest found that prompt medical attention would probably have saved her. (It should be made clear that Brown was not at Bronzefield at the time; she joined it later that year.) 

No-one seems to care about prisons much; they’re where you dump people no-one likes or wants, and nobody seems responsible for sorting them out. One of the few to make noises about doing so was the last Minister of State for Prisons, Rory Stewart, but he was in post for only 16 months; his predecessor, Sam Gyimah, held the post for just two months longer. Both have now not only left government, but been thrown out of the ruling Conservative party altogether for voting against it over Brexit. In the midst of the current mess, the Natasha Chins of this world don’t count for much in the halls of the powerful.

But perhaps Brown shouldn’t be expected to say much about this. Unlike Gedney, she hasn’t yet retired from the system, and like most of us, she can’t just say what she likes about the institutions she works for, and is expected to uphold. She seems frank about what she herself has witnessed, and she clearly cares about her patients. Reading The Prison Doctor, I thought that she probably had made quite a few lives a bit easier, and I suspect she’s saved a few as well. Even so, in the end, I found Karen Gedney’s book the more moving of the two. She is both deeply humane, and a good writer. 30 Years Behind Bars is an uneven book. It loses focus a bit towards the end, and is probably longer than it needs to be. But if you read it, you will not forget it.

These books left me with two impressions. One is anger that prisons are used as underfunded dumping-grounds for those who, for whatever reason, cannot cope. To be sure, there are also people in there who are just plain evil (and one can’t forget that Gedney was raped). But most of the people Brown and Gedney encounter seem as much vulnerable as anything else, often the product of lives that went wrong at the beginning.

The second impression, however, is more positive. These two women were public servants (and Brown still is). These books do remind you that some people want things to be better and will work to that end, even if there’s a cost to themselves. It’s a feeling strengthened by looking at pictures of the two women; so far as I know they’ve never met and are not likely to, but there’s an odd similarity – they both seem tall, confident and very vital, and both look a lot younger than their years. They also look as if they like to laugh.

In a grim time, I find them rather reassuring.

Mike Robbins is the author of a number of fiction and non-fiction books. They can be ordered from bookshops, or as paperbacks or e-books from Amazon and other on-line retailers.

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