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Thursday, August 03, 2006

I Could Use Some Time to Myself

I spent the past two days in AdSeg (ASU), where I go to the patients because they cannot come to me. In this particular unit, they cannot come to me because they have demonstrated violence - assaulting staff or another inmate - or are know gang members or violent felons. They are held in a single cell. This is what was traditionally referred to as "solitary confinement" or "the hole." Other prisons refer to such units as SHU, special or security housing units. When an entire facility is devoted to the most violent and dangerous, they are often referred to as "SuperMax," such as CA's Pelican Bay. In my case, the violent mentally ill are mixed in with the just violent.

I usually arrive when meds are being distributed, and vitals are being taken. One female CO sits to the side of the med-cart with a gadget that looks like a giant garlic press, and does nothing but crush pills - usually Wellbutrin & Seroquel - and stirs them into cups of water. Why? Both meds have major value in prison as Wellbutrin is "snorted" in the ridiculous belief that you can get a "high," and Seroquel to get a "low." I generally ask a patient the number of times they eat per day, and one man told me "twice, because I sell my lunch [a bagged lunch distributed at breakfast] for Wellbutrin." I'm waiting for drug reps to appear, giving patients pens or "sticky notes" to trade lunch for their particular medication.

The only sounds are the televisions which constitute most of the "group therapy," with up to 10 men in individual cages (about the size of an old phone booth, arranged in a semi-circle), animals noises, screaming, and from those cells close to you, muffled insults and comments: "I'm feeling suicidal, " or "my cellie just cut his wrists." This usually invokes great laughter from those cells in the area. It was pretty surreal to see a slightly-built psychologist, seated to the side of the cages, in a too-large stab-proof vest, and a clear plastic face shield.

These units are notorious for the fact that an inmate will spend all day, every day, segregated in his cell. Those with a "single escort" designation (meaning one officer brings you where you need to go within the unit) can go out to a very small yard for an hour, either alone or with a selected small group. This "yard time" is totally dependent on the availability of staff; if staff is busy, you'll stay in your cell. One patient with a "single escort" designation told me he had been in the yard 7x in a year. "Double-escort" inmates rarely get out. Neither TV's nor radios are permitted, only books are allowed. Obviously, this is of no distraction if you cannot read; unfortunately, this number is unusually significant.

I saw five AdSeg patients, and four of the five were "scrawny"; under 160 pounds and all of 5' 4" to 5' 7." What could they have done to end up here? I only asked one: "I was getting Prolixin shots at the state hospital, and the Dr. said, 'Remember, always ask for 100 mg.' When I got on Yard One and they wouldn't give it to me, I started yelling and protesting. They started [pepper] spraying me and I ended up here." Well, son, you were asking for 10x the maximum dosage, so right there you had a problem... But AdSeg?

How ironic that Social Security makes me inquire, as part of the "Daily Activity" aspect of applying for SSI, "Describe an average day." I feel quite stupid asking these men. One man said, "Well, first I get up and sharpen my knives, then I start to plot how I'll overthrow the government." But he could not stop himself from crying when he described living three continuous years on AdSeg: "You get so desperate for human discussion." What does he do? He's in the middle of reading 5 books at once; he can't read enough.

One 19 year-old patient arriving with a CO with bright, bushy red hair tied back in a ponytail. He was small and had a bit of a gait problem, and in contrast to the CO, he looked like a child. He said he was classified as developmentally disabled, but I'll bet if he was actually tested he would be Borderline Intellectual Functioning. He really didn't know anything was wrong "until two years ago when the prison gave me meds and the voices got very quiet." "Can you read and right more than your name?" "Yeah, but I don't read so good and I don't understand what I'm writing." When I asked about the average day, he just stared at me blankly for a few moments before saying, "nothing." He asked me, "But what do I do with these credits?" Credits? "Didn't you say I'd get between 850-950 credits?" "No, I said 'dollars'." He had been in a gang, only gone to school through the 8th grade. He softly cried as he said, "I really want to change my ways, sir."

The last patient was typical of the lunacy of this system. The sergeant told me ahead of time that he might have an "immigration" hold. This usually means that a Mexican National has been imprisoned, and when he paroles or completes his term, he is released to the INS for deportation. I addressed him by his last name, which he acknowledged, but immediately said, "That's not my real name." He explained that he was born at "Harbor." Harbor? Oh, Harbor-UCLA Medical Center. He is a citizen. He was in prison before and was absconding from parole when he crossed the border into Tijuana to buy drugs. He got high, and i
n an incident he says he vaguely recalls, came back across the border, was frightened by a "drug dog" and tried to run through the border entrance. The INS and the San Diego Police chased him, pepper sprayed him, and knocked him to the ground. "It burns your eyes, your nose, and your mouth, and I was spitting it out. They said I spit on them and told them I had AIDS."

He had originally been imprisoned under his illegal cousin's name, and that's whom he returned to prison as. He had a moderate tattoo of his real name on his left chest, and another that was
basically a half-circle from hip to hip over his navel. Who knows who he really is. To be released from the INS hold, he has to prove to Immigration that he does not have AIDS, because you cannot immigrate if you have AIDS. He too began crying when he talked about never receiving any communication from his family in LA; "No Christmas card, New Year's. My birthday was 2 weeks ago. Nothing." Sometimes he cuts his arms (and he showed at least a dozen long horizontal scars on his forearms) "just so I can go to the hospital and talk to the nurses. I get so depressed. I need to talk to somebody."

We sequester men with major mental illness in SuperMax-type units, with no natural light, no access to the outdoors, and no external stimulation but the shouts and screams of other inmates. Then from here, they will be paroled directly to the street. What are we thinking?


Blogger Sarebear said...

damn . . . . .

August 05, 2006 12:50 AM  
Blogger Dinah said...

What a depressing post.

Prolixin decanoate, I believe, is dosed as 25mg/cc, I've seen folks on 3cc q 2 weeks, so maybe this guy got 4? He sounds like he needed a lot.

You write well. If you need a break, I hear there's a nice Russian prison camp waiting for you. I prefer a warm island with all you can eat chocolate, but to each his own.

August 05, 2006 6:35 PM  
Blogger On the Same Page said...

You're right. I didn't consider the decanonate. But now that I think about it, I believe he said he was getting 200mg q 4 weeks, which would mean 100 mg q 2 weeks. He could be correct, but it's a bucket of Prolixin nontheless. Obviously, stranger things have happened. And the odd thing is that he prefers it over anything else. When I asked about side-effects, he said, "none." I haven't seen his chart yet; I requested 10 and received exactly none. Perhaps they are lost?

August 05, 2006 10:46 PM  
Blogger Dinah said...

I've refrained from offering any medical advise on blogs so far, but you've got me here: Don't give anyone 8cc of prolixin at once. I believe the max per site is 2cc (or maybe that's in the biceps and for larger doses it needs to go in the glut), but I don't think there's a muscle that can take that dose at once. I've seen plenty of people who want to take their neuroleptics...more since the the advent of zyprexa/seroquel/etc, but even back in the day the old stuff is calming and shuts up those not-so-happy-bunny voices. Please note that Shrink Rap has temporarily diverted from ducks to happy bunnies for reasons unclear to me, I just show up at the appointed time and place with the whatever animal they tell me to bring.

August 06, 2006 11:25 AM  
Blogger On the Same Page said...

Oh, so you come over here to give medical advice. Now I'm going to get hammered by the anti-phenothiazine contingency. I only gave him the time of day (he didn't know). The shot(s) came from CDC. I did, however, instruct him on the difference between advocating for your medication, and fighting for your medication. One will get you pepper-sprayed and placed in AdSeg.

August 06, 2006 6:23 PM  
Blogger mish said...

wow. so systems really do suck everywhere.

August 14, 2006 2:37 PM  

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