Haldol Boy

Each new inmate at the jail must get a test for tuberculosis done before he or she can be moved to the housing unit. The test is called a PPD, Purified Protein Derivative, or Mantoux test. A sterilized extract of tubercule bacilli is injected intradermally (just under the skin) and read 48 to 72 hours later. The reading is a check for an inflammatory reaction from the serum. If you have a reaction, then you've been exposed to TB. If the injection site welts up beyond 10mm in non-immunocompromised people and 5mm in immunocompromised people the test is considered positive. I have only seen a few positive reactions in the hundred of PPDs I've placed, and the best one was on my own arm when I was twenty-two years old. I completed a course of antibiotics and now have a chest X-ray every two years.

An entire family of Spanish speakers had been arrested and R&D called up to medical to get the PPDs done so they could be cleared out to the housing units. None of them spoke English, but we have the PPD and medical consent to treatment sheet translated into Spanish. The family consisted of a crying daughter, her gloomy husband, three of four other cavalier men who were perhaps brothers or brothers-in-law, and even the matriarch of the family. The matriarch couldn't read and I had to get her sobbing daughter to translate the consent form. The matriarch seemed oddly calm and smiling politely in her red jumpsuit, as though she had seem far worse than this before.

After I had dispatched the family, an R&D officer told me they had one more. They brought me a young white man with thin lips blinking his watery eyes at a rate I found distracting. I took down his information from this wristband and asked him if he was allergic to any medications. "Haldol," he told me and started to cry. He had a strange, exaggerated way of moving his mouth when he spoke, which made me suspect he had experienced a tardive reaction to Haldol at some point in his young institutional life. Tardive dyskinesia is a side effect of high-potency antipsychotics such as Haldol and is characterized by repetitive, involuntary, purposeless movements often including grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Often these symptoms do not go away once the medication is withdrawn. At age twenty the man already bore the mark of aggressive antipsychotic treatment in his body.

"I want to be dead, like my dad," he told me after I had gone down the list of Tuberculosis symptoms.
"Did your dad kill himself?" I asked. He nodded his head "yes." I decided I would deal with his suicidal ideation after I placed the PPD.
"OK, I need to give you a little shot in your arm to test for TB," I said, pulling a wrapped TB syringe out of my breast pocket. He smacked his lips and let out a shrill screech. "I don't like needles," he said staring at the needle in my hand and leaning away from me. The R&D officer came over to the door of my office and I gestured with my other hand for him to come in.
"Hey Buddy, what are you in for anyway?" the officer asked, coming into the room, filling half of the possible floor space with his bulk. The inmate turned to look at him and I stared to draw up the tuberculin serum.
"Stealing GPS's from cars," he answered.
"Well, did you at least steal anything good?" The officer asked. The inmate smiled and I walked over to his left side. He started to look at the needle again, smacking his lips. "Look at me," the officer said, "The nurse is going to give you a little shot, like a little bug bite, now, where're you from buddy?"
"I'm from Minnesota, I want to go home to my mom," he replied as I alcoholed off a spot injected the serum under his skin.
"All done," I said. "He mentioned he wanted to be dead like his dad, can you call the Psych Nurse Practioner while I finish up here?" I asked the officer. He nodded yes and returned to the R&D desk to place the call.
"You people are all the same," Haldol Boy said, pointing a finger at my chest, "Now you're just going to put me in a strip cell, my dad warned me about all you people."
"Well sir," I said, "Seeing as how your dad killed himself, I'm thinking that was really shitty advice. Maybe if he had told someone and toughed it out for a few hours in a strip cell he'd still be here with you and your mom and things would be better for you. We need to keep you alive down here so you can make it out and return home to your mom. How do you think it will be for her if you hurt yourself in some jail down here?" He was completely still and quiet. No tears, no movement in his mouth. His face was red and puffy from the exertion of crying. "Suicide is often an impulsive act, there is some research to suggest that if we can get someone through the intense, impulsive stage then they can make it pretty well after that," I continued as the R&D officer re-entered the office.
"We'll keep him here in R&D for the weekend, we'll keep a good eye on you buddy," he said and escorted the inmate out of the office. I felt satisfied with this solution. R&D contained several single cells where inmates could be easily continuously monitored by the R&D staff. A housing unit would be too much stress for him and not enough supervision. I finished up my paperwork on the PPD's, emailing the classification staff of the PPD's. On my way out I thanked the officer for backing me up in the office. "You did a great job or re-directing him for me," I told him. "Oh, that's just my job," the officer replied, folding his arms across his chest and resting them on his belly.