The Prison Doctor

by Dr Amanda Brown

  ‘Penis?’ I finished off his sentence to speed up the guessing game.

  It wasn’t really my job as a GP to deal with sexual health, that was left to the ‘Dick Doctor’ – as the boys called him – the doctor who ran the GUM, or genitourinary medicine clinic. But of course I would have a look if they needed me to.

  He looked bashful. ‘Yes, Miss.’

  ‘Okay, would you like me to have a look to check it for you?’ I said, trying to spare his embarrassment.

  He dropped his boxers. At first glance I couldn’t see the spot, and we had a good look for it, just to reassure him, but it wasn’t there.

  As he zipped up his jeans, Danny grinned, showing his crooked teeth. ‘I could of sworn I saw it. I thought I’d caught some disease or something.’

  ‘No, you’re fine, but you can put your name down for the GUM clinic if you find any more spots or blisters,’ I said as he disappeared out the door.

  Two minutes later I had Dave Samuel sitting in my consultation room, with surprisingly much the same complaint.

  ‘Got a lump on my balls and I’m scared I’ve got cancer,’ the teenager confessed.

  At that moment I heard an eruption of laughter from the waiting room, fading into the corridor. I thought I saw a smirk creep across Dave’s face, but if one had, it was gone seconds later.

  ‘Well, we’d better have a look then,’ I told him steadily.

  Dave stood up, towering over me. He had the same pasty, blotchy skin as most of the teenagers I’d seen, and a scruffy bit of stubble on his face.

  I asked him to lie on the couch so that I could examine him. Wendy was busy in the adjoining room so could not chaperone me in the clinic that day.

  I pulled the screen around the couch and with his consent I examined his scrotum, and found no lumps or anything abnormal.

  Another thunderclap of laughter exploded next door, sending Dave into a fit of giggles.

  ‘Sorry, Doc, I laugh when I get embarrassed.’ He stifled his sniggers with his fist.

  ‘You’re fine, you can get dressed.’

  ‘What a relief. Thanks, Miss,’ Dave said, then quickly scuttled out of my room.

  I sighed. What a morning.

  I took another sip, of my now lukewarm coffee. Wendy popped her head around the door for a quick moan about how noisy the boys were being.

  ‘I can’t think why they’re making such a racket,’ she hissed. ‘There’s a new PO on duty and he hasn’t taken them in hand. I’ll do it myself if he doesn’t.’

  Wendy was feisty, I didn’t doubt her for a second.

  ‘I’ll send in the next lad,’ she said.

  The next boy complained of exactly the same thing, a lump in his scrotum. I examined him and found nothing abnormal, and on it went. Every boy in my surgery that morning came in complaining of something wrong with his genitals.

  Of course I had twigged that something was up, so to speak, by the time the fifth lad walked into my surgery with an erection holding up his tracksuit bottoms like a tent pole.

  He was tall, well-built and oozing confidence. His tracksuit bottoms were hanging around his backside, and a wry smile curled across his mouth. He swaggered towards me and dropped his trousers and boxers and practically plonked his erection on my desk.

  ‘Is it big enough miss?’ he smirked.

  A rush of anger came over me. I was furious at his attempt to intimidate me. How dare they come into my office and try to abuse me? Wasn’t I doing everything I could to help them? I cared! I wanted to make things better, and all they could do was this? A male doctor wouldn’t have had this problem.

  I didn’t – couldn’t – show I was fazed by it, though, as that would have given him the satisfaction he was hoping for. I’d mastered a poker face over my years as a GP, perfecting an ability to hide shock – mostly so I could put people at ease, but in this case, to put someone in his place.

  I shrugged.

  ‘It seems pretty normal to me,’ I said dismissively, and then got rid of him pretty sharpish. He was just trying to wind me up and I had no time for it.

  There was another eruption of laughter as he walked back to the waiting room, no doubt getting a high five from all the boys. The clamour eventually died down as the prison officers took the teenagers back to their wings, while I sat there, raging.

  I couldn’t wait to vent my anger to Wendy.

  ‘What was that all about?’ I exploded. I told her about the boy with an erection and she was shocked and appalled.

  She shook her head in dismay. ‘That shouldn’t have happened, Amanda.’

  ‘Seeing their dicks isn’t a big deal to me, I’ve seen hundreds over the years, but I don’t like people trying to intimidate me,’ I said, still angry.

  It was horrible to think that boys the same age as my sons could act in such a threatening manner. But in a way I was glad; their behaviour had removed any illusions. These were not just any teenagers, these were not just any patients.

  ‘I totally agree. I’m going to report this to Dawn, don’t you worry about that,’ Wendy said, her hands on her hips. ‘I thought there was a lot of whispering and laughter going on in the waiting room. They must have hatched a plan when they arrived. That’s the problem with putting them all together. They’re bored, looking to make mischief.’

  ‘Testing me to see if I will break,’ I said. ‘Well, I won’t.’

  *

  I was glad to have David to offload on to that evening. As usual, he was his calm, rational self. He listened as I ranted about the boys, and then reminded me I didn’t have to carry on if I wasn’t enjoying the job.

  He turned the sports channel on mute as I kicked off my shoes and threw myself back into the sofa.

  ‘I can’t run away from a job because they try to wind me up one day. It’s a fact of life that sometimes you have to deal with things that are insulting and degrading.’

  ‘You don’t have to convince me,’ David said.

  ‘I mean, I’m incredibly privileged to see a world most people wouldn’t have a clue about,’ I continued.

  ‘As I said, you don’t have to convince me.’

  I sunk a bit further into the worn folds of the leather, lifting my feet onto the footstool. I closed my eyes. Maybe David had a point. I was trying to convince someone: myself.

  I was enjoying my new job. I was certain I was on the right career path, but something was niggling at me. I hadn’t found meaning in what I was doing. Was I making any difference to these boys’ lives, other than a quick patch-up job? Could anyone make a difference, or were they too guarded, their walls of self-defence as high and impenetrable as those of the prison?

  My limbs grew heavier, and before long I was dozing. Not even the cheers and chanting from the rugby fans on the television could wake me.

  Chapter Six

  Jared Keane wasn’t like all the other boys I’d seen at Hunt-ercombe.

  For a long time, I’d been hoping for something more rewarding from my work, and the breakthrough came with an 18-year-old who was months from being transferred to a prison for 18-to-21 year olds.

  As soon as he walked into my surgery, I knew there was more to his seemingly simple complaint of back pain.

  By now I’d treated countless cases of back problems. These were mostly caused by the paper-thin mattresses and rock-hard beds, or by overdoing weightlifting in the gym.

  Jared was shy, unassuming, and avoided eye contact, which was a shame because he had beautiful dark eyes and a very sweet smile. He had the typical buzz-cut hairstyle and bad skin. He had characters tattooed across his knuckles, and a dozen superficial lacerations sliced across both wrists. They were equally spaced, the product of time and precision. From his notes I could see he had used a plastic yoghurt pot as a tool to slice himself.

  Jared caught me looking at his self-harm wounds and pulled his grey jumper sleeves over his wrists, nervously tugging at the fabric.

  The cuts were fresh but not infected, and he was due to se
e the psychiatrist later on in the day to review his mental-health issues.

  Anyone who self-harmed in prison was on an ACCT book (Assessment Care in Custody and Teamwork). It’s a document that helps to ensure their safety, with repeated observations and entries by the members of staff who know them, commenting on their presentation and mood. If anyone was suspected of being at high risk of suicide, they were observed twenty-four hours a day in a gated cell.

  I tried to put Jared at ease by asking him about the history of his back pain, hoping it might open the door to learning a little more about him.

  I’ve always believed that in order to fully comprehend what’s going on with someone’s health, you have to try to understand them as a person. With Jared, there was clearly a lot going on underneath the surface.

  People self-harm for many reasons, but mostly it’s to displace the pain they feel in their minds. It can be anything from a scratch on a wrist to attempted suicide. When I had first arrived at Huntercombe, I’d been shocked by how common it was amongst the boys, but over time I’d come to understand why. The loneliness, the overwhelming sense of helplessness and hopelessness, the intense feeling of claustrophobia from being locked up.

  Guilt was also a big contributor. Some of these boys had committed terrible crimes, and were struggling to live with themselves. Others felt guilty for letting a loved one or a family member down.

  As with all the other boys I had seen, I had no idea what Jared was inside for, and I didn’t feel it was my place to ask. If he wanted to tell me, that was up to him.

  He rubbed the lower left side of his back. ‘I’ve been having these pains in my lower back ever since I’ve been here,’ he said.

  ‘How long is that, Jared?’

  ‘Too long, Miss.’ He sighed deeply, pushing the air out through his pursed lips. ‘Two and a half years. And I got another three to do yet.’

  ‘You’re moving?’

  ‘That’s right, Miss.’

  It must have been a relatively serious crime to warrant a five-and-half-year sentence. Perhaps armed robbery. It was hard to know.

  I wanted to look at his back with him standing up, so asked him to roll up his sweatshirt. He was reluctant, and I soon found out why.

  His lower back was riddled with old scars from cigarette burns. They looked like small craters dotted across his skin. It was hard to see how he could have done it to himself. I immediately suspected those cigarettes had been stubbed out by someone else.

  He was clearly uncomfortable with being so exposed, so I rolled his jumper back down and felt his back through the fabric.

  ‘Ow!’ he yelped, as I touched his left side.

  I apologised, pressing all over the area to make sure the pain was localised to that one spot. It was, and I was certain it was muscular pain, most likely caused by his mattress, or lack of a decent one.

  I then asked him to lie on the couch so that I could examine him further.

  ‘I’ve been trying to lie on my other side at night, but that hasn’t helped my sleep much. I can’t sleep as it is, and now I feel like I’m in some sort of straitjacket because I can’t move either.’

  ‘It can’t be nice sleeping on those beds,’ I said sympathetically.

  He caught me looking at his wrists and jumped in before I could ask.

  ‘I’m fine, you don’t need to look at them,’ he snapped. His voice hoarse with emotion.

  I softened my tone, my gaze.

  ‘Okay, I won’t do anything you don’t feel happy with, Jared. Why don’t you come and take a seat again?’

  As he slumped back into the chair opposite, I wrote a prescription for painkillers on his medication chart, avoiding anything too strong or with a potential for addiction.

  As I signed it off, I tried to delve a little deeper.

  ‘Do you have any family out there, Jared?’

  I had touched a raw nerve.

  He paused, toying with the idea of telling me, and then said, ‘No, Miss. I got no family.’

  I sat quietly, inviting him to say more.

  ‘I haven’t got any brothers or sisters, none that I know of.’

  He drew in another long breath.

  ‘I grew up in care.’

  His words lingered in our silence.

  Since arriving at Huntercombe, I’d treated a number of boys who had been brought up in care homes, and some of their stories broke my heart. Their stories of physical abuse – and sometimes worse – emotional abuse, and trauma were harrowing.

  How could poor Jared get to 18 and not have anyone on this earth who cared about him?

  I thought about my two sons, and how lucky they were to have a mum and a dad who loved them.

  I wondered if the reason why so many of the boys I saw in the prison were already young fathers themselves was because they longed for a family more than anything.

  It got me thinking about how Jared might have acquired those atrocious scars on his back. From his childhood? Coming from a disadvantaged background didn’t excuse Jared committing a crime, but I could understand how it might have taken away his self-worth enough that he didn’t care what he did with his life. If nobody loved him, he probably struggled to love himself.

  I wondered if there was something I could do to help him sleep. I couldn’t prescribe him pills, but I chatted through some alternatives.

  ‘Do you like reading?’ I asked. A lot of the lads in Huntercombe couldn’t even read or write, but I was confident that Jared was quite literate from the way he expressed himself.

  His eyes seemed to awaken at the mention of books. ‘Yeah, I like to read. But sometimes I get my letters the wrong way around. It takes me a long time, and it drives me mad.’

  ‘So not something that would be restful and send you to sleep, then,’ I said, trying to think up other calming activities.

  ‘I like to write though, Miss,’ Jared confessed.

  That wasn’t something I heard of a lot in Huntercombe – and it seemed like a passion I could encourage to try to help improve his confidence.

  He looked thoughtful. ‘When I can’t sleep I write down what I’m thinking.’

  I thought back to that sleepless night after the argument at my old practice. Writing away until the dawn broke, changing my life with every word.

  ‘Writing helps me get things off my chest,’ I said. ‘And I can feel much better when I put the pen down. So next time you’re feeling overwhelmed, and want to cut yourself, why don’t you try writing your feelings down first?’

  Jared’s voice trembled with emotion. ‘Yes, Miss.’

  I tried to catch his eye. ‘Are you okay, Jared?’

  ‘Yes, Miss.’ He looked at me briefly before dropping his gaze back to the floor.

  I told Jared that I had prescribed him painkillers for the next few days, and that he would need to collect them three times a day from the nurse. (Most prisoners were not allowed to keep drugs for self-administration, especially if they had a history of self-harm.) I suggested that he come and see me again if the backache continued.

  As he walked out of my little consultation room, his shoulders were hunched; his feet dragged with exhaustion, from lack of sleep and misery. It was a heartbreaking sight, and for the first time I felt the presence of my patient lingering on in the surgery long after he had left.

  *

  My walks through the fields behind our house had always been cathartic, a way to process and unload my thoughts, letting them drift away into the countryside air.

  I stepped over the stile in my Wellington boots, treading carefully so as not to skid on the wet slippery mud when I landed. I took a deep breath, filling my lungs with the crisp wintery air. I was walking through a paddock alongside two graceful horses that were tucking into a fresh pile of hay. They both looked up on hearing my squelching footsteps. One of them stared at me, intrigued, blowing hot, steamy air from its nostrils. It swished its tail a few times then returned to its munching.

  How lucky am I to be walki
ng freely through these fields? I thought. I’d trodden along that track dozens of times since I started working with the boys, but the contrast between their life, stripped of their freedom, and mine, had never been quite so obvious until then.

  Those boys were teenagers – they should be going out and having fun, bringing friends home, having girlfriends, or boyfriends, being looked after. Instead they were banged up behind bars and it seemed so sad and wrong.

  I felt unsettled by the thought of Jared, of what it must feel like to be locked away inside a tiny cell, knowing there was no one on the planet who cared about you. No one who would really miss you. No one to lean on when things got tough. He was one of many boys inside Huntercombe who had never known what it was like to have a family. He had left quite an impression on me.

  Hearing Jared’s story cast a shadow on the affluent world I’d known for so many years. The materialistic things I may once have thought were important suddenly seemed so trivial on hearing the 18-year-old’s struggles. I realized more than ever that all that really mattered in life was feeling loved and secure.

  A gust of wind hurled itself in my direction. I braced myself against its bite, hoping it would sweep away my mood so I could get a good night’s sleep.

  *

  It seemed I had made as much of an impression on Jared as he had on me. One week later, he was back in my surgery, but with a slight confession.

  ‘There’s nothing really wrong with me, Miss,’ he said.

  I looked up in surprise, wondering why he had come to see me. ‘Oh, well how can I help you then?’

  He reached his hand inside his tracksuit pocket. I heard a rustle as he pulled out a scruffy piece of white paper.

  I could see scribbles in all directions.

  ‘I did what you said: I wrote down my thoughts. I made an excuse to see you so I could show you what I’ve done.’

  Jared’s cheeks flushed with his confession.

  ‘Oh, that’s wonderful,’ I said. I was thrilled that he had taken my advice, and I felt touched that he felt compelled to show me what he’d done.

  ‘I’d love to read it.’

  Jared leant forward clutching the piece of paper with, if I wasn’t mistaken, pride.