Shackles--up close and painful

Tuesday, October 04, 2011

When we were supporting our allies on the anti-shackling bill last year, we received this amazing piece of writing from a friend who is currently in medical school. K.S. asked us to use only her initials to identify her. Her powerful words remind us of the awful impacts of shackling anyone, pregnant or not. We shared this piece last year....and as AB568 sits on Governor Brown's desk, we decided to share it again.  Join us in encouraging Governor Brown to sign, and end the shackling of pregnant women in CA.

My patient is in shackles. I’ve never seen shackles this close before. I’ve never seen the chains up close. I’m stunned by how heavy it is. How big the loops of metal are. How tight the cuffs are. How little she can move her hands and feet. Despite what her prison guards may think or how the staff may treat her, she is not on a vacation from prison. It is not pleasant to lie in her shackles in a hospital unit. The swelling of her right hand from the tightness of her cuffs is real. The choice between the pain of her wrist or lying on her side to relieve the stabbing pain in her abdomen and back is real.

She does not enjoy the awful smell from the copious vaginal discharge she has or the wetness between her legs aggravated by the lack of underwear (I don’t know what weapon they expect her to make out of underwear). She does not look forward to the burning she feels every time she tries to urinate. She is not comforted by the auditory and visual hallucinations and slurring of her speech resulting from some poorly monitored Lithium dosing given to her in prison. She’s terrified. She’s in tears because she doesn’t know what’s wrong with her. She just knows that something isn’t right and hasn’t been right for weeks. But no one would listen.

She is not on a vacation from prison.

I don’t know why she was incarcerated. She told me she was stealing because she has four kids (aged 17, 13, 7 and 5). I don’t think it really matters if she’s lying to me. Every time I walk into the room, the prison guards stand up for me. I think they think they are showing me respect. I want to vomit. The action is vaguely reminiscent of court. As though I am a judge. As though this is a trial. As if my poking and prodding and asking her about symptoms and checking her vagina in front of an audience is a way to try and convict her and choose her sentence. The difference is I don’t have the power of a judge. I have to wait till the right guard comes on before I can get even one of her cuffs removed to do a semi-proper physical exam. I have to argue with the sergeant to remove one cuff so her wrist won’t swell up but end up settling with trying to get a sock under the cuff to relieve the chafing against her skin as the sergeant responds “it’s her fault for having her hand like that.”

I am angry at my inadequacy to advocate for her effectively enough. I am angry at the mockery of the guards in standing up for me. I am angry at how my profession has allowed for an illusion of power instead of taking into our own hands all of the responsibility associated with protecting and taking care of our patients. We have doled out our responsibility to everyone with just an illusory amount left for ourselves. We call ourselves scientists. We say that we will practice evidence-based medicine. Well, will someone please find me the evidence that shows that relinquishing the power of protocols to administration, prison guards, and insurance companies helps our patients do better? That our AMA’s political capital has been used wisely to protect the patients we serve instead of the pockets of our pants?

What is my patient’s sentence? Is what she’s going through enough? Is it enough that she is not treated like a person? That her medical rights, even as a prisoner, are sheared to pieces? That she is in severe pain? She thanks me and I feel a twinge of guilt. I want to ask her if she will forgive me for not knowing how to do more for her. For not knowing how to win back her rights as human being.

The guards don’t sit until I leave. If I could dictate her sentence, I would sentence her to repeat her childhood where she wouldn’t have to steal. Where she would have known the options and had the resources to not have her first child as a teen. Where she could have gone to school long enough to know how to verbalize her rights and advocate for herself and make a working wage to provide for her family. I would sentence her to live in a society where we don’t sentence her to repeated judgment and conviction for the position in society we created and then shoved her into.

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