The Prison Doctor

by Dr Amanda Brown

  It wasn’t Daniel’s first time in prison. One of the officers, Bill, recognised him. The two of them chatted away as if they were old mates, while I finished writing up my notes. I joined in the end of the conversation, remarking to Bill about the lovely jacket Daniel was wearing, which seemed to please him, as a big smile spread across his face and he proudly announced that he had bought it in a charity shop the previous week.

  He told me he didn’t have any illnesses that he knew of, he wasn’t a drug user, and he wasn’t on any medication. It was a little challenging at times to get a straight answer out of him, as he tended to go off on a tangent and talk about random things, but he certainly wasn’t acting in an unusual way, and gave no cause for concern.

  So you can imagine my surprise when at 9 a.m. the next morning, just as I was about to head off to the Seg to do the rounds, I heard alarm bells screeching and officers stampeding along the corridors shouting ‘Code Blue!’

  Daniel’s dead body had been discovered, curled up around the lavatory in his cell.

  Reports from staff working in the First Night Centre stated that he had grown increasingly agitated as the evening had worn on, so much so that they suspected he may have been smoking spice.

  But the toxicology report didn’t find a trace of any drug in his system. I wondered whether he may have had a stroke, a fit, a heart attack, but it was none of those either. It took months for the autopsy report to come back and, when it did, it stated that no cause of death had been identified.

  It was a total mystery, and the first time in all my years since qualifying in medicine that I had encountered a death in which the cause could not to be identified.

  *

  I sat on the wooden bench, my legs crossed, my hands planted on my knees, waiting for my name to be called. The room was high-ceilinged, wood-panelled and brightly lit. In front of me was the witness box where all the people involved in the inquiry would take it in turns to give their accounts of what had happened that night.

  Opposite the witness box was the jury, and to the left were rows of seats for the deceased’s family and friends. Behind them were seats for members of the public.

  The legal teams sat in the front two rows. Beyond the witness box, on a raised platform, was the coroner’s desk.

  Everyone stood up when he walked in. He was a short, bespectacled man, his black hair salted with grey. His face was crumpled, his expression frosty. His job was to investigate the circumstances surrounding the death, and to ensure there was no negligence or foul play. To make sure that if any fault was found, that everyone would learn from it. He would make recommendations after hearing the case, possibly suggesting certain prison procedures should change, to try to avoid another tragedy.

  I glanced across to the bench where the family would sit, but it was empty and my heart sank.

  I wondered if Daniel, like many of the prisoners I met, didn’t have any family, or had no one who cared enough to come to his inquest, and the thought made me feel so sad.

  ‘Doctor Brown.’ My name echoed off the high ceiling.

  I slowly rose to my feet, clutching my notes in my right hand, and made my way to the box. I looked to Karen and she gave me an encouraging smile. My heart was racing and my hands were shaking. My mouth was so dry I was worried I wouldn’t be able to speak.

  It started well. I was questioned by the barrister representing the Scrubs. He was there to defend me, not to try to trip me up. I told the court the little I knew about Daniel Craven.

  ‘There really isn’t anything more I can add,’ I eventually concluded.

  ‘Thank you, Doctor Brown,’ the lawyer said, nodding to the coroner that he had finished his questions.

  The lawyer for the Crown Prosecution Service then stood up. She was young, mid-thirties and immaculately dressed. Her blonde hair was tied back into a tight chignon bun. She stared back at me with cold, steely eyes.

  Clearing her throat, she said, ‘Doctor Brown, could you please tell us again your impressions of Mr Craven on the night you saw him.’

  I glanced down at the notes, balancing on the small wooden ledge inside the witness box.

  ‘Of course,’ I replied politely, although inside I was feeling increasingly frustrated that I had to keep running through a story that had very little to it. As far as I was concerned, I felt the focus should have been on the rest of the evening, on those hours Daniel was in the First Night Centre, reportedly growing increasingly agitated.

  I hadn’t fully understood the meaning of the word cross-examined until then. Ninety minutes later I was still in the witness box, repeatedly going over every minute detail of those fifteen minutes I had spent with him in Reception.

  In the end it all became a bit of blur. I felt under attack. I felt criticised. More than anything else I felt angry that I was made to feel guilty, as if I had done something wrong, in front of a whole room full of people. There was only one question that I remember clearly, one that cut deep.

  The coroner interrupted the CPS lawyer to ask me a question himself. Peering over his glasses, the frosty-faced man said, ‘Why would you have reason to go back into the notes, Doctor Brown?’

  He was referring to the fact that I had logged into Daniel’s medical records after I had finished seeing him. It was something I nearly always did after I had seen someone, to make sure I had typed the notes up correctly, that the sentences made sense and that there were no spelling mistakes. There was often a lot of pressure on the doctors, from the officers, to get the prisoners processed as quickly as possible, and so I usually checked the notes to make sure that I hadn’t made any errors in my rush.

  But I was taken aback by the coroner’s line of questioning. I felt as if he was implying that I had tried to cover something up. Maybe I was taking it too personally, and he just needed to understand my reasons for rechecking the notes, but with the tension I was feeling I was struggling to think clearly.

  A deathly silence hung in the air, awaiting my answer. I froze. The words caught in my throat and I couldn’t speak.

  With every second that ticked by I felt increasingly self-conscious, and as if everyone in the room was thinking that I had done something wrong.

  I felt so hurt, as I care passionately about doing the right thing, but at that moment I felt unworthy and useless.

  Thoughts tumbled through my head, but I still couldn’t speak. I knew in my heart that that there was nothing I could have done differently that night that would have made a difference.

  I felt as if I was going to pass out. Finally, I managed to answer his question, and I held myself together until the nightmare was over and there were no more questions.

  I clung on to my composure as I left the witness box. But with every step my legs turned more to jelly.

  Karen gestured that she would meet me outside the courtroom. I followed her in silence, feeling everyone’s eyes trailing after me, judging me. Although in reality they were probably fixed on the next witness being sworn in.

  I let out a little gasp of relief as soon as I reached the noisy corridor. I could breathe again.

  ‘Well done,’ Karen said, softly. ‘You did so well.’

  I smiled weakly and suddenly it hit me how utterly drained I felt.

  Karen gave me a hug and my composure cracked. I wrapped my arms around her and sobbed.

  ‘I can’t do this any more,’ I whispered, when I could eventually speak.

  She stroked my back soothingly. ‘It’s okay, it’s done, it’s over.’

  But the experience wasn’t over for me. I couldn’t just shrug it off as I had with so many of the prison dramas. It had knocked my confidence. But most of all, it had rocked that deep insecurity of mine to the core, and I had never felt so undervalued and useless in my life.

  Chapter Twenty-One

  In all my previous thirty years of practising medicine, before working in prisons, I had never had to attend a Coroner’s Court. But in the seven years I had been at the Scrubs, I had been requ
ired to attend on four occasions.

  Somehow, rather than becoming less daunting, each time I attended I found it more and more stressful.

  The shine had been taken off the Scrubs.

  I dreaded having to attend another Coroner’s Court, and became almost paranoid about writing even more meticulous notes on everybody that I saw.

  The fear of missing something was almost crippling.

  I worried that someone was going to find fault with me. I’d been told to walk with confidence when in prison. Now I felt like I was walking on eggshells all the time.

  The situation became worse not long after the court case, as a vicious batch of spice was doing the rounds.

  The effects were extreme, and the men that used it either became zombie-like or wild and very aggressive. Some were having fits and losing consciousness.

  I was terrified for the men’s safety, and I feared that sooner or later someone might die as a result of smoking spice.

  It was so bad that alarm bells were going off everywhere, and I spent my time going from one wing to another, seeing prisoners who were either recovering from the effects of it, or who were having to be restrained by officers.

  As doctors we were helpless to do anything. Sometimes we would send them to hospital, only for the doctors there to send them straight back to prison, saying they couldn’t help; the drug needed to work its way out of their system.

  The fear of further deaths took away the fun from a job I had once loved.

  The final straw came one afternoon when I was called to C Wing for an emergency.

  The nurses had helped one of the prisoners into the consultation room, after he had collapsed on the landing. They managed to get him onto the examination couch so that he could lie down.

  He was skinny and pale, his face covered in blemishes with a nasty weeping cold sore on his bottom lip. He looked undernourished and as if he hadn’t slept for weeks.

  Sylvie was already by his side, waiting to fill me in on what had happened.

  ‘Thank God you’re here,’ she said. ‘Today has been a nightmare. It’s one thing after another. What’s happening to this place?’ She shook her head, sagging with exhaustion.

  ‘We found Alex having a fit on the landing. His notes are on the screen for you.’ As I scanned the records, I could see Alex wasn’t a stranger to prison. He’d been in and out since he was 15 years of age, and had some complex medical issues.

  I initially suspected he might have suffered an epileptic fit, but he had no previous history of epilepsy.

  ‘I think he’s been on the old . . .’ Sylvie rolled her eyes to the ceiling, in frustration. I instinctively knew she was referring to spice.

  ‘I’ll never use it again, Doc,’ he murmured, then started retching violently. ‘I feel so sick.’

  He clutched his stomach, a thick string of saliva trailing between his mouth and the couch.

  His hair was bright ginger. His face was so white he looked like a corpse. Even his lips were drained of colour.

  In the ruthless world of prison drug dealing, it was usually the most vulnerable who suffered. Dealers sometimes wanted to test their merchandise, to see what effects it would have. They would often offer a ‘free’ sample to those with learning difficulties, or other vulnerabilities. Or they would simply force them to take the drug, to see what happened.

  I wondered if the young man had been cherry-picked to be a guinea pig.

  With anxiety in his voice, he explained. ‘I couldn’t sleep one night. Someone offered me a joint and it got me to sleep. The next night I thought it was a good idea, and that’s how I got hooked.’

  He stared at me with desperate eyes, looking for sympathy.

  ‘When you can’t sleep it’s like you’re doing double time.’

  I’d heard the term ‘double time’ on many occasions over the years, usually when the prisoners were desperately hoping that I would be able to prescribe them sleeping pills. I could imagine it must have been like having a double sentence, if the nights lasted as long as the days. Probably even more painful for those in the Seg.

  ‘When I do drugs, I don’t feel nothing. I don’t see nothing. That’s why I use; it makes me forget I’m here. It blocks everything out. I shut my eyes. I feel calm and relaxed. I can’t even move. It takes over, and the time flies, it absolutely flies,’ Alex said, before he started retching again. ‘But I’ve never used spice before, and I’m never going to use it again. Never!’

  There was nothing I could do for him. I didn’t know how the drug had reacted, and the last thing I wanted to do was give him another drug that could make things worse. He just had to let it work itself out of his system.

  I appreciated his honesty in admitting that he had used illicit drugs, as he knew that he could be punished for it. By telling me the truth he had spared me a lot of time considering alternative causes for his collapse, and possibly from sending him to hospital for further investigation and monitoring.

  That day I realised that the frighteningly rapid rise of the use of spice throughout the prison was out of control, and that I could no longer continue to work there.

  My time was up.

  *

  I had loved working in the Scrubs. I loved the banter, the noise, the excitement. I loved belonging somewhere. I loved the fact that the officers and a lot of the prisoners knew me. I was such a familiar sight around the prison that I felt like part of the fixtures and fittings. It was a really hard decision to make, but one that I knew was right. After seven years in the notorious Victorian prison, I decided it was time to leave.

  I don’t like big goodbyes because I get very emotional. So I didn’t let many people know I was going. Only my very closest friends at the Scrubs knew that the August bank holiday of 2016 was going to be my last day there.

  As always, David was fully supportive of my leaving, and of my decision to not give up working behind bars. Instead I had decided to face my biggest fear of all – working in a women’s prison.

  Many officers and medical staff had warned me not to do so, saying that female prisoners could be much more challenging, with a very high rate of self-harm. Governor Frake had given me some hard truths, having worked in the infamous Holloway for sixteen years. She said she much preferred dealing with men, and that I’d have my work cut out for me. But it was time to try something new.

  So I signed up for some shifts in HMP Bronzefield, a closed female prison in Ashford. It is now the largest high-security female prison in Europe, since the closure of HMP Holloway.

  Female prisons are not categorised in the same way as male prisons, and are referred to instead as either Closed or Open.

  Opened in 2004, the modern building is a huge contrast to the Scrubs. The prison is divided into four house blocks, each housing up to 135 women. It also has a twelve-bed Mother and Baby Unit, accommodating children up to eighteen months old. Unlike in the Scrubs, the Number One Governor is referred to as the Director, the prisoners as residents, and the Seg as Separation and Care.

  *

  As I took my last steps on my final shift in the Scrubs I felt incredibly sad. It was the end of an era, but I had made my decision and was looking forward to the next chapter in my life.

  I was walking down the grated metal steps to the ground floor of B Wing, my bag slung over my shoulder, my feet weary from another long day, when all of a sudden the place exploded with bangs and shouts from every direction. It sounded like a riot had broken out.

  ‘You fucking blinder!’ from my right.

  ‘Get in!’ from my left.

  ‘Eeeeengland!’ from above.

  It was the explosive sound that I had become so used to whenever there was a football match on TV. When a goal was scored the place erupted and the noise was deafening. It always made me smile. In that moment, there were a lot of happy people in the Scrubs.

  As I approached the exit gates, one of the prison officers was grinning.

  ‘England just scored!’ he said. ‘Worst
thing about being on duty is I don’t get to watch the game.’

  ‘Bad luck,’ I replied as I reached for my keys, but kindly he stepped forward.

  ‘Here, let me.’ The keys rattling in that old lock. It would be the last time I heard it.

  ‘Night, Doc,’ he said. ‘Safe journey home.’

  I smiled back, but the smile didn’t reach inside. ‘Goodnight.’

  I disappeared from the prison. Whether I had left a mark I didn’t know. But I hoped I had, in my own small way, helped some of those men.

  I was going to miss it. All of it.

  PART THREE

  HMP Bronzefield

  2016–present

  Chapter Twenty-Two

  It was New Year’s Day and, as I unlocked the final set of iron doors and gates that led to the Healthcare Centre, I had an unusual glimmer of hope.

  The hope that maybe, just maybe, some of the women that I had seen returning to prison time and time again might not be coming back. That some may manage to break the vicious circle of drugs, crime and homelessness that so many had been stuck in for years.

  My morning clinic was fully booked but my upbeat mood was soon squashed when I saw Jane’s name on my list.

  I had become very fond of Jane and felt deeply sorry for her.

  She was 21 years of age, tall, attractive, highly intelligent and articulate. Sadly, she had extremely complex mental-health issues and an extensive and varied history of self-harm, which included cutting her arms, burning herself with boiling water and swallowing cutlery and pens.

  In her young life she had swallowed so many foreign bodies that she had undergone twenty gastroscopies to retrieve them. On her last admission she was told that surgery was becoming increasingly hazardous, and that she somehow had to try to stop doing it. As soon as she came into my room, with her flat expression and empty stare, I knew she had self-harmed again. This time she had swallowed a plastic knife and fork. She said very little, but I had grown to understand her and didn’t need to ask her too much, which she appreciated. What a sad and tragic life, I thought, as I made arrangements for her to be admitted to hospital again.