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.