Drunk in Public: the DIP

Each new booking at the jail answers a set of questions from a screening done by the officers. Nursing reviews the screening forms to see if the inmate takes meds, if they brought meds, and if they claim to have any health problems. As I sat in the small medial office in Intake reviewing the stack of twenty bookings from the day, a local cop brought in a DIP, a Drunk in Public. He was a short man of interderminate middle age with matted, deadleaf-yellow hair and jaundiced blue eyes. He limped and trembled. The intake officer bagged his property and gave him a black-and-white stripped jumpsuit. The DIP put on the jumpsuit in the changing room, but emerged without snapping up the front. "I need to be taken to medical," he said, looking at me.
"I am medical," I replied. "And I am going to evaluate you in the office over here and we'll make a decision about that." I opened the door to the little medical office behind the officer's station and indicated for him to have a seat as I propped open the door.

"I need to go to medical," he repeated, sitting down and trembling. "I've had two seizures and a stroke today."
"That sounds like a rough day," I replied and began to ask him a series of questions about how much he'd had to drink that day, learning that he estimated about 50 drinks and reported waking up in the ER with a blood alcohol of .205. "My liver doesn't work right, I have Hep C," he added. "I'm supposed to go the the Hope House tomorrow for detox, now that's all screwed up, cause I got arrested, and for what? I wasn't hurting anyone. I'm going to sue the city," he warned me. "I've already got four lawsuits against this city," he said, sitting up straighter in the chair and adopting an expression of dignity, as if rehearsing for his trial. "Yes, if I miss detox at Hope House tomorrow, then there is just going to have to be another one," he continued with exasperation, the way a parent would add punishment to an already grounded child. I could smell the alcohol pouring out of him filling the small room. My eyes started to water as I recorded my findings on a progress sheet. "I need to go to medical," he repeated, "At least in medical I can get a nice blanket,"he said, attempting a pitiful look through his yellowed eyes and arched mangy eyebrows.

His vital signs were fine. We do not start treating withdraw until an inmate is actually in withdraw, meaning they have to be sober or much closer to it. We usually did not start a Librium protocol until 12 to 24 hours after booking, if necessary. But still the DIP made me nervous, if someone reaches the point of DT's, Delirium Tremens, from alcohol withdraw, mortality is 40%. I knew the DIP was a candidate for the DT's, but with a BAC of .205, he wouldn't be at the jail long enough to reach them. "Go back out so the officers can finish booking you," I told him without looking up from my writing. "I need to go to medical, I'll have a seizure if I don't," he said again and he shuffled out of the office, his unsnapped jumpsuit baring his sunken, hairless chest down to the top of his underwear.

Security explained the DIP was just there overnight at most. "He stays here then," I told them. "If he has a seizure, we'll deal with it then, but I think he's got more than enough alcohol in his system to hold him till morning." The 350 pound bald officer missing the bottom three buttons on his uniform shirt nodded in agreement. "We'll give you a holler if something goes wrong."
"He says he's supposed to go to detox tomorrow, when he gets released from here, where does he go?" I asked.
"We just release them right out of the door of intake, they are on their own," he replied without looking up from the computer.
"So, I guess you don't, say, put them back where you found them," I said, envisioning a Night of the Living Dead sort of scene on Saturday mornings when all of the Friday night drunks were released to wander back across the interstate towards town, towards the bars.
"No," he replied. I could see the DIP in the early morning light of the next day, limping down the road, talking about the Hope House, threatening to sue the city.

My Comforting Advice

"I was raped, I haven't left the house since I got back from the hospital till the police came and got me," the young dark-skinned woman sitting in front of me explained in an irritated tone as if being forced to spell out something obvious beyond the need for explanation.
"So, you didn't get these prescriptions filled or take any of the medicine the ER told you to?" I asked, looking at the ER report and written prescriptions she had brought along on her arrest for bad checks.
"No," she answered, "I mean, I was just raped, after I was raped I went home. I didn't shower or anything for three days. then I went to the hospital and went home again. Now I'm here." I read over the carbon-copy ER report. The words "rape," "Trichomonas," and "possible Pelvic Inflammatory Disease," were written across the top. In the problem list the word "pregnant," was circled. Instructions were written to take two antibiotics for 14 days each.
"How long have you been pregnant?" I asked. She shrugged.
"I'm not too far along, but don't even get into that prenatal stuff, I'm going to get an abortion when I get out," she said, crossing her arms over her stomach, as if barring my access.
"OK," I said, "The sheet here says you have a vaginal infection, Trichomonas, did you notice any vaginal discharge or odor before you were raped?" I asked, holding the ER report in my left hand and flicking my right index finger into the center of the paper. I suspected she'd had Trich for awhile and not noticed. She shook her head "no."
"How about now?" I asked. She shook her head again. As I started to take her vitals I noticed she was missing her left index finger at the second knuckle.

"I didn't go to the hospital at first because I thought 'who would believe me?' because of where I work. But then I thought, 'what if he does this to someone else?' Then I knew I had to go in." she said as I started taking her blood pressure. I wasn't sure where she worked, but I was pretty sure it wasn't the Wal-Mart photo center. "How did the police treat you when they interviewed you?" I asked.
"The police were great," she replied. "The asked me lots of questions, they seemed very concerned, and they told me they'd look into it. They've been the only ones I've really been able to talk to about it."
"Well, that's good," I replied, "It's good that they listened to you," I added, not wanting to imply it was good she hadn't talked to anyone about it other than the cops as I started listening to her stomach and palpating her abdomen. "Anything hurt?" I asked. She shook her head again. "I am going to call the nurse practitioner for you, and we'll figure out what we need to do about your meds." I told her, making eye contact and smiling before writting some notes on the progress sheet.
"I'm only here for five days," she said.
"Don't worry, you'll start your meds here, then we will give you some to take home," I explained.
"So, I'm done?" she asked, getting up.
"Yes, I think they're going to house you down here because you are here for such a short period of time," I replied.

I called the nurse practitioner who told me to wait on meds till she could examine her the next day. When I arrived the next evening the woman with the missing index finger was housed in medical.
"I feel like I'm going crazy in here, I have nobody to talk to, you're the last person I was really able to talk to," she told me when I came around to get her vitals.
"What about your family?" I asked as I strapped the automatic blood-pressure cuff to her arm and pushed "start."
"They don't have collect calls on their phones. My mom, I called her from the hospital and said 'Mom, I'm at the hospital,' and all she said was 'I'm at work.' My sister has a newborn and a two-year-old, and she's starting back to work," she said.
"So she's pretty much out of commission," I said as I cut her off by pushing a thermometer towards her mouth.
"Those are the only people I really have," she continued after I removed the thermometer. "I feel like if I was in the housing unit I could talk to some people. Up here, I know you all are trying to help and all, but up here all I have to think about is the rape, I see it over and over again. I feel like I'm going crazy."
"It's here or Intake," I said, writting her vitals down on my index card. "You aren't here long enough to get classified into the housing unit."
"And I'm not here long enough to see Mental Health or a counselor or anything, right?" she asked.
"Well, I can try to refer you," I said. "What about reading?" I asked, nodding my head to some books on her cinderblock shelf.
"Normally I read all the time, but now, when I read, I feel like my head is going to explode," she said, looking up at me for a solution.
"Look, you're sort of in between," I said, "You aren't really here long enough to get classified and placed in the housing unit and get started with mental health, but you are here long enough for it to really suck." She nodded her head "yes." I had appraised her situation correctly.
"I just don't know if I can make it," she said. I could see tears accumulating along the lower edge of her eyelids.
"You are making it, you are doing it, minute to minute, right now." I told her. "That's all you have to do for the next two days is make it. Then you'll have more control over your life again. You can make choices again."
"I am going to do some things differently when I get out," she agreed.
"I know you have a lot going on," I said.
"A lot," she echoed me.
"All I can tell you for now is that sometimes life is really terrible and you just have to grind through it till you are in a better place. The one thing you can count on is that things will change, you will get out." I said, gathering up my equipment and preparing to secure her door. I realized I had just given her a stripped-down dharma lesson: sometimes life just sucks, the First Noble Truth, and things are going to change, the Law of Impermanence. Other nurses might have told her the Jesus loves her or that God had a plan for her. I had my own message. I thought about my own recent break-up and sleepless nights, my own anxieties about living alone, exiled from my previous life. I looked at her for a moment, to let her connect the sadness within me, stepping out from around the white labcoat for a second and allowing her to see I knew what the hell I was talking about.
"Thanks," she said, I could see gratitude in her eyes before I headed to the next cell.

The White Collar Offender

The next man the officers brought me from the holding cell looked like a business man wearing an inmate costume, the good-natured boss at the office party dressed up in a horizontal black-and-white jumpsuit to give everyone a laugh. He wore a gold wedding band and his slate grey hair was neatly combed. He wrote in his wife as his emergency contact person as I filled his name and number in on the dental paperwork. What was he here for? I wondered to myself, perhaps waiting bond on some white-collar offense? An accountant caught with his hand in the company cookie jar? I pictured his wife at their large five-bedroom home in a planned community built around a golf course. She would be blond, with a body well-toned from private tennis lessons. She probably didn't work I decided. I wondered if she felt guilty, if he had to steal to give her everything she wanted.

I moved through the dental portion of the examination quickly, no blackened, rotting, unsalvageable meth mouth teeth to document in detail. At the beginning of the physical, between asking about psych meds and how much an inmate drinks I am required to ask if an inmate is locked up for a violent crime or sexual assault. I asked the question quickly, as a formality. When I didn't hear him answer I had to look up to see him nod his head "yes." "This one," he said. I looked at him, confused. "Contributing to the delinquency of a minor," he said quietly, looking at me to make sure I understood. I realized he wasn't just caught buying beer for his teenagers to have a party in the basement, he meant contributing to the sexual delinquency of a minor. It struck me as strange that he still put his wife down as his emergency contact person. If my husband (a hypothetic individual at this point) was locked up for, well, I didn't know exactly what, but some sort of sexual act involving the underage, he sure as hell had better now put me as the emergency contact person. I wondered if the woman I saw on the edge of the gold course believed he was innocent, if she was in denial, or if she would stand by him regardless.

"So, this is a man who gets turned on by kids," I thought to myself as I continued the examination. He took no meds and had no special medical needs. Judging by the crimson undertone to the skin on his face and squiggles of burst capillaries sprayed across his nose and down the flanks of his cheeks I knew he was a drinker. I looked at him closely, searching his eyes, his face, his movements for some clue of his deviancy, something I could look for in others to tip me off, but found nothing. As I stood behind the business man in the jail jumpsuit I became aware of his small frame and wondered how jail life was treating him. I wrote a few more notes before looking up at the infirmary officer, "He's done, you can return him to his housing unit," I said, and wondered if his wife would drive down in her SUV bail him out.

My First Sociopath

I was nervous about working with violent men, sex offenders, and men who would flirt with me shamelessly. Yesterday, over the course of 14 physicals, I got to engage in all three situations. I submitted my list to the infirmary officer who coordinated with the floor officers to bring the inmates up to medical in small batches, stashing them in various rooms and holding tanks around the infirmary. A young white man with a bald head brought up in a group of four from the old part of the jail caught my attention as he entered the infirmary area with an attitude of ownership before taking his place in the holding cell with the most favorable view of the TV. Three young black men followed behind him, taking their seats after he had made himself comfortable. "I'll take him first," I told the officer, nodding to inmate Mr. Clean. In nursing school I learned the ABC's of priority of action, Airway, Breathing, and Circulation. First, maintain an airway, then focus on breathing, then check circulation. Working for three years in the women's prison I learned another prioritization decision tree: handle your potentially violent inmate first and get them out of your area, then asses the truly ill, and save the needy pain in the ass inmate for last.

"How are you doing today sir?" I asked, as he approached my desk. When I made eye contact with him the intense blue color of his irises reminded me of the "blue screen of death" my brain-dead Dell laptop radiated after an ant invasion. He didn't reply verbally, but instead curled half of his lip into a snarl and and shrugged his shoulders. I gestured for him to sit in the moss green plastic chair in front of me. "Do you have an emergency contact person?" I asked. Normally I give the inmates my pen to fill this information out themselves, but for him, I kept my pen to myself. "No," he replied, looking back to the television set hung over the officer's station. I began asking him a series of review-of-systems history questions. He shook his head "no" without taking his gaze from the talk show on TV. When I asked "Are you diabetic?" he turned to me suddenly, "yes, I was taking Glucaphage and one other, 5 milligrams I think," he replied.
"Glipize?" I asked.
"Yes! That's it, Glipizide," he replied, nodding his approval at my correct guess.
"But you didn't come in with those medicines?" I asked.
"No, I was taking that stuff at Jade Mountain, I just got out," he said. I paused, looking at him for a second. Jade Mountain (name changed) was the state supermax facility for the most disruptive offenders in the system. Inmates were maintained on 23-hour lockdown with no opportunities for education, vocational training, or even group religious services. An inmate's crime on the outside did not determine his placement in a supermax, but rather his behavior once he arrived inside. If he got into repeated fights, and particularly if he attacked staff, he would be shipped to Jade Mountain.
"Jade Mountain huh?" I replied, nodding my head to indicate I understood what that meant. "We'll get you set up here on fingersticks for a week to figure out where you are, then we'll get you set up with the nurse practitioner to figure out what meds you might need," I said, speaking in the medical royal we. "Do you know how long you will be here? Are you still on state paper?" I asked, trying to figure out if he had completed his state time and was in for a new offense, in which case he could be at the jail for awhile, or if he was still on probation, "on paper," and might be sucked back up into the DOC fairly quickly.
"I'm going back on paper for this," he replied, clasping his hands and hanging his head.


Mr. Clean also told me he had asthma but his inhalers were locked in his girlfriend's trunk and he hadn't been able to get in touch with her since he got arrested. I stood up and walked behind him to listen to his lungs with my stethoscope. On the back of his neck my initials were tattooed in three-inch letters of elaborately embellished calligraphy. "As if this whole thing couldn't get any creepier," I thought to myself as I started listening to his lungs. I heard a pronounced expiratory wheeze in all fields. "Well, sir, I can hear that you do need your meds, I am going to try to get you in to see the nurse practitioner pretty quickly about that," I told him, taking my seat again. He gave me a look, not of gratitude, but of a form of acknowledgement. I imagined that perhaps he would be a bit less likely to kill me for sport if he had the chance. "I through with this one," I looked past Mr. Clean and told the officer at the desk. "You'll start coming up tomorrow for fingersticks," I reminded him as he was escorted back down into the old part of the jail. As I entered him into the diabetic list on the computer I looked up his recent crime, Sexual Assault.

Journey to the Regional Jail

Prison and Jail are not the same. Everyone in a prison has been convicted and sentenced for a crime. In most cases an individual must be sentenced to over a year to even go to a state prison, otherwise he or she will pull the time at the local jail. The population of a prison is drawn from all over the state, I've worked at "my" prison for almost three years and I've never seen a former inmate on the street. There are several reasons for this, the first of which is that I do not get out much. Secondly, many of the inmates that were three three years ago are still there now, prison inmates do not return to the community as fast.

At a jail inmates may be housed anywhere from overnight to several years. Some are awaiting bond, some awaiting trial, some are drunks locked up to detox. A few have been sentenced and are awaiting a bed at a state facility. All of the inmates are drawn from the local community. If you work at a jail you are going to see former/future inmates on the street. the idea of working with men and knowing I would get to know all of the town drunks on some level made me drive past the jail on the way to work at the prison every day for close to three years without thinking about floating an application. But then things got bad at the prison and one of the nurses who had already made the transition from the prison to the jail encouraged me to come in for a tour.

When I went on the tour I could see the jail was for me. Only eleven beds in medical, so, a maximum of eleven patients. My primary duty as an RN would be to complete physicals, every new inmate booked into the jail needed a physical done by an RN within 14 days. Most of the nurses were LPN's, so the physicals tended to fall behind. I would also care for the inmates in medical, who were rarely total care. If someone was really sick they sent that person to the hospital. On my way out I picked up an application and spent my entire next day off filling in the blanks, writing essays, getting copies of college transcripts, and getting things notarized. It was like applying to Yale.

I knew I had to get out of the prison, every day was non-stop insanity. "Why can't you just go and work in a clinic, like a nice doctor's office?" my aunt asked me when I met my mom at my aunt's house in St. Louis. "Or in a hospital?" my mom asked. The three of us were sitting at the pool in my aunt's backyard watching my two cousins take turns on the diving board. I looked at them and thought about walking my rounds in Segregation back at the prison. The human zoo of sociopaths, female sociopaths. In my brief interactions with them to give their meds, draw their blood, or do their sick calls I peered into some of the most disordered manifestations of humanity. I thought about the infirmary and the variety of medical issues, cancer, HIV, high-risk pregnancy. I thought about the money I made, much, much more than the local university or private hospital. "I'm good at what I do," I told them. "I'm good at what I do and I get paid well for it."

My New View

Storm From My New View

The Break-Up

I've been back in the States for over a year, I tried to do the freelance journalism thing for 6 months, till my 2006 tax return ran out. Then I went back to work at the women's prison as a nurse, dayshift this time. Dayshift at the prison is unsafe at any speed, we don't have near enough staff to care for 1,200 angry women every day. The infirmary is overrun with one nurse to cover about 30 patients who require various levels of care. At least once every day I find myself thinking "I can't do this, I just can't do this," then I take a deep breath and remind myself that I am doing it, and just have to keep on forging ahead. At the end of each day I leave the facility amazed that nothing horrible happened.

Dan and I broke up in late May, after I'd been back at the penitentiary for a few months. I think he wanted to unload me for awhile, our fights were going to a new level this past spring and I felt like I had to talk him back into the relationship. One time, about a month before we broke up, I felt him pulling away and I told him to just break up with me, just do it, and not too worry, I wouldn't crumble. But this is how it ended: I was working a string of 5 12's, I came home the first night and we had some tension, I think he wanted to play video games and I wanted him to curl up in bed or spend some time with me. Next night, I think we both weren't looking forward to me coming home, he unleashed a stream of hurtful dialogue on me, things he resented me for that went back over a year. And I just knew the situation was all played out. I told him to stop, I didn't want to hear any more, that I would be gone in a week. The next night I came home from work he was at a hotel, so I gathered he was not interested in working it out.

I found an apartment in a day, used his truck to pick up all of my possessions and move them to my new place. Luckily I don't own much. In one week I was set up in my new little one bedroom. In the immediate aftermath I had a manic episode, I couldn't sleep, I'd be awake until midnight and woke up at 5 AM. I never felt tired. The mania helped me get through the move and get set up, plus, I saved money on food because I didn't eat much. I lost ten pounds in 2 weeks. I when I was wide awake at night I looked back at pictures from this past Christmas in Galveston with my mom and step-dad and thought "you know, we were really happy, what the hell happened?"

When we came back to the States and started going out with other American couples I realized something was missing between Dan and me, some form of closeness was gone. I mentioned it to him, and he acknowledged that he felt it too, we were removed form each other. We didn't spontaneously touch and check-in with each other like other couples. We were bored of each other. I set about trying to re-establish the connection, I was convinced that if we had some sort of activity we both enjoyed, that would help feed the energy of our relationship. I kept waiting to feel a certain way and he felt frustrated because he felt he could never please me. As his dissertation drew to a close he began a personal renaissance, planting a little victory garden in the backyard and delving into solitary activities I had no interest in. He felt that I resented the time he spent on solo hobbies, because, well, I did. I wished he would put that energy into something related to us. I felt starved and he felt hounded. He felt social anxiety and depression and I felt abandoned and rejected. I encouraged him to start therapy, I found him a personal trainer at the gym, and got a massage therapist to come to the house. He began to feel better, but that didn't bring us any closer.

I edited his dissertation, helped him clean out years of trash from his basement and backyard, and brought the household into a state of efficient organization. I managed his elderly parent's healthcare and legal affairs. The energy and power that allowed me to take control of these issues and improve his writing, health, and living conditions, turned out to be a force compelling his need to rebel against me, quietly resent me, and withdraw. I know he gave up on some level long before we broke up. I often wonder what it's like for him now, does he miss me? Is the house a wreck? Is he fat or thin? How did the last chapter of the dissertation turn out? Does he feel freed from an oppressive relationship? Does he have regrets? But I will never know. Dan and I no longer speak or have any form of communication at his request.

Dan did teach me to shoot, I am a member of the local rifle and pistol club now, he let me keep the .357 revolver I liked so much and I recently bought a used .22 Ruger Mark II target pistol. He was generous to me in the post-relationship distribution of possessions, letting me keep to hot water dispenser, the gun, and my favorite jade plant in the pretty porcelain pot. It seems crazy to me now, the idea that I will never go back to Sri Lanka, never see the Galle Face again. I know I will never go back because there is no reason to go back. If I get that kind of time and money together in the same place I am not going to waste it on Lanka.

Rainbow From the New View