The Prison Doctor

by Dr Amanda Brown

  After lunch I went to Reception to see the new arrivals from court and was greeted by Helen.

  ‘Happy New Year, Doc!’ she said with a cheery smile. She was soon to be released after serving two years for fraud, and was one of the prisoners who worked in Reception, earning from £2.40 to £3.20 per day depending on the job. Helen’s job was dispensing the ’welcome packs’ for the newcomers. Each pack contained: a plastic knife, fork, plate and mug; unbranded shampoo, toothpaste, toothbrush, soap, hair conditioner and hairbrush; six new pairs of knickers, six pairs of socks, two T-shirts, two tracksuits, two sweatshirts and a nightie; and a pack of tea and sugar. The prisoner’s worldly possessions could all be contained in one white fishnet sack.

  I had about ten minutes to get myself set up in the small windowless consultation room, before starting to see the stream of new prisoners who had arrived from court. Many of them were likely to be withdrawing from drugs and alcohol.

  I started along the familiar corridor, harshly lit by strip lights, my shoes squeaking against the mottled blue lino flooring. The tired white walls, smudged with black scuff marks. The slightly nauseating blend of microwaved meals and instant coffee wafted my way. The meals were offered to new arrivals because they would most likely get to the the house block too late to get a meal from the servery.

  To my left there was a notice board with picture illustrations of the prisoner payment system.

  Further down on the right was the room in which the new residents were waiting to be seen, and to my left was what looked like a shop counter where their possessions were checked and stored. Hajon and Jenny, two lovely officers, smiled and greeted me with a cheery ‘Hi, Doc.’

  ‘Busy today?’ I asked them. I was hoping that there would not be too many new arrivals on New Year’s Day.

  ‘It’s not looking too bad, Doc,’ Hajon replied. ‘Only ten due in.’

  On a Bank Holiday only the magistrates’ courts, not the Crown Courts, were open. On a normal day up to thirty new residents could arrive, so ten was an easy number to deal with.

  As I walked past the glass window of the waiting room, another voice cut across the din with a sense of urgency and a thick Essex accent.

  ‘’Ello, Doctor Brown . . .’

  The voice was so familiar I didn’t need to see her to know who it belonged to. My heart sank.

  It had only been five days since I had last seen Paula, to sign off her prescription on release from prison. Five days since she’d walked free. When we last met, she had been wearing make-up, her thick chestnut hair was washed and braided neatly into a plait, her eyes bright and full of hope. She was going to make it this time on the outside, she had said.

  She couldn’t have looked more different now, slumped in her uniform tracksuit. Her eyes were puffy and red, her long hair dirty and bedraggled, half covering her face. I couldn’t see her arms but I suspected they’d have new needle marks.

  Paula had already been screened by the nurse in Reception, so was the first to be seen. I called her in.

  ‘Good to see you, Doc,’ she said through her tears.

  I looked at her forehead and was pleased to see that she hadn’t cut herself this time, but I knew that she might if I didn’t give her the correct medication quickly. Paula usually self-harmed by cutting her forehead. The compulsion would descend whenever she was frustrated and overwhelmed by emotions, and, of course whenever she was feeling ill when withdrawing from drugs and alcohol.

  She’d left on a 50ml methadone script, but I guessed she probably hadn’t been to a chemist to collect it, either because she couldn’t be bothered or, more likely, because she had started using heroin again as she was still homeless.

  So many of the women that I treated for drug and alcohol addiction in prison were homeless, and early on I realised that homelessness was very often the underlying cause of the seemingly never-ending circle of drugs, crime and prison. One lady once told me that if she was homeless after being released from prison, she would almost certainly get back on drugs as the only shelter she would find would be in a crack house, and to get into a crack house she had to have drugs to give the person running the crack house and to use herself while in there.

  Many had also told me that they wanted to get back into prison so that they could sleep in a bed.

  Paula had an extensive medical history. By the age of 38 she had been addicted to alcohol, cocaine and heroin for over twenty years. She was diagnosed with hepatitis C in 2010, but had never had treatment, mainly due to her chaotic lifestyle.

  She had been in and out of prison from the age of 18. The longest sentence she’d received was six years at the age of 21, of which she served four years ten months. Most of her crimes had been theft to fund her drug habit. Thieving from shops, supermarkets – grabbing anything she could get her hands on in order to survive, and to trade for crack or heroin.

  Unlike most of the women I met, she had a good childhood and had attended an all-girls grammar school. She had always felt secure, but then her life went completely off the rails at the age of 15, when her father left home for another woman. This shock was the catalyst for her decline.

  She started to hang around with the wrong crowd, an older group of so-called friends, who introduced her to drugs. She started off using cannabis but soon was smoking and then injecting heroin and crack, and so the dependency began.

  She had broken down in tears when she recounted the horror of how she had been injected with drugs and then sexually abused, and then had fallen into despair when the drugs wore off and the reality of what had happened sunk in.

  ‘They left me for dead in a park,’ she sobbed, as she told me how she’d woken on a freezing cold day to find the buttons on her shirt had been torn off. Her bra was twisted, exposing her breasts to everyone who passed by.

  ‘I was falling in and out of consciousness, but I could feel the pain inside me from where they had raped me. It was burning, but I couldn’t move.’

  She had been helped by a random passer-by, who had taken her to hospital, but no amount of medication could heal the emotional wounds inflicted on her. Paula’s self-worth evaporated and her life had spiralled out of control.

  ‘My real demon is crack, Doc.’

  She told me how she had spent as much as £200 a day on the crystal form of cocaine. ‘It blocks out the memories. It takes away the pain. You understand, don’t you, Doc?’

  Sadly, I understood that kind of self-destructive behaviour all too well, as I had heard it from so many women.

  Paula was a warm, intelligent, articulate woman, with a lovely sense of humour, and on the many times I saw her she talked of wanting to sort her life out. She genuinely wanted to change her life, but she kept falling into her old ways on release as that was the only life she knew.

  I’d followed her through her highs and her lows, and grown to really like her. I wanted to see her get back on her feet, and every time she disappeared from my room, I was willing her to find the strength to change.

  I braced myself for the latest chapter in her tragic story.

  She looked exhausted. Strip lighting doesn’t flatter anyone but she looked particularly careworn, the pronounced lines under her eyes adding at least ten years to her age.

  ‘Doc, I don’t know how to cope when I get out of here any more.’

  Paula broke down again in tears, and I looked around the room for a box of tissues. To my frustration there wasn’t one. So I ripped a clean piece of blue paper towel from the examination couch and handed her a big wodge of it.

  ‘Here you go, lovely,’ I said.

  She blew her nose loudly, then managed to squeeze out a smile. I put my arm around her shoulders to try to comfort her.

  I needed to go through the routine questions on the computer template . . . why was she in prison? Sentenced or remand? If sentenced, how long for, etc. This was the ninth time I had seen Paula in Reception in the past eighteen months, and I could fill out almost every box without even asking her for
the details.

  Paula buried her head into her hands as she repeated:

  ‘I don’t know how to survive. I just don’t know how to do it.’

  It was clear that Paula wanted to turn her life around, but couldn’t see a way out. She was looking to me for answers, but I had none. I had learnt over the years that often the best and most helpful thing I could do was listen, and let people pour their problems out to me.

  ‘So what have you done this time?’ I asked gently.

  Paula’s eyes dropped to the floor. I could tell she felt ashamed as she withdrew into the back of the hard brown plastic chair. She tugged at one of her knotted strands of hair as she began to tell me how things had fallen apart after leaving the prison.

  ‘I planned to stay with my mum but that didn’t work out, so I was back on the streets and it was freezing. I was sleeping in a bin store in Ashford, not far from the prison.’

  It was terrible to think of her, two days after Christmas, alone and homeless. She’d become so institutionalised that she felt safer near the prison than in her own home town.

  As I had suspected, Paula hadn’t made it to a pharmacy to stay on methadone, and had gone back on heroin. She was back in prison for nicking booze and food from a local supermarket.

  ‘I thought I was having a nervous breakdown because I was imagining people following me, and then they weren’t there. I’m paranoid. Do you think I’m paranoid?’ she rattled on, breathlessly.

  She had no history of psychosis in her notes, but I’d seen before the erratic behaviour that accompanied withdrawal from drugs and alcohol. Paranoia was common enough.

  Her arms bore the scars of deep knife wounds, where she had cut herself out of frustration. Her skin was crisscrossed with lacerations. The wounds on her forehead were more superficial than on her arms, but sadly much more visible – a tattoo to her misery.

  Almost certainly, if she had not fallen out with her mum, and had somewhere to live, she would have stood a chance to get off drugs and stay out of prison. But, as she had confided in me some while ago, although she adored her mother she found it hard to spend time with her, because of her mum’s partner.

  ‘He tried it on with me when my mum was out at the shops. I told him to take his hands off me, that he was a dirty bastard for wanting me when he’s with my mum! He lost his temper and smacked me across the face. I fell and whacked my head on the corner of the couch. He grabbed a fistful of my hair and tried to push my head down as he climbed on my back but I wasn’t going to let him get me. I kicked him and I bit into his arm, and I managed to free myself and run for the door.’

  It was yet another story of a man taking advantage of her vulnerability. I sensed this encounter had hurt her more than some of the other abuse she had suffered – probably because she had been thrust into a situation that could potentially cause problems to her already fractured relationship with her mother.

  Paula had narrowly avoided being raped, but she couldn’t bring herself to tell her mum.

  ‘She wouldn’t believe me anyway, Doc – she’ll do anything to keep him.’

  But it was not just the boyfriend that made Paula wary of visiting her mum. A big part of what was keeping Paula from getting help was shame. She didn’t want her mum to see what a mess she was in, physically and mentally. She felt ashamed of the woman she had become, so she hid herself amongst the people who didn’t care about her, who fed her addictions.

  I didn’t go into too much depth about her crime this time around. Usually it was the same old thing with Paula – stealing alcohol. She drunk heavily to numb the pain of her past. She stole food because she was starving.

  She’d spent two nights in police custody, before appearing in front of the magistrates’ court, where they were familiar with her previous history and sentenced her to another six weeks in prison.

  I could tell she was embarrassed to be back in custody after insisting it was going to be different this time. Of course, she’d believed it would.

  Her eyes were still glued to the floor as I asked her questions about something she refused to address – her hepatitis C.

  She found it hard to look at me, because she knew she needed treatment and felt guilty that she was doing nothing to help herself.

  People can contract hep C if they share needles, so sadly it is not an uncommon problem with drug users. Fortunately, Paula’s liver was still functioning normally, as her bloods had been checked when she was last in prison and no abnormality was detected. Nor was she displaying any signs of liver failure, and although a small percentage of people with hep C recover with no treatment, she was scared that if she didn’t get help sooner or later it might kill her. Sadly, rather than tackling the problem, she stuck her head in the sand and did nothing about it.

  Instead she continued to drink very heavily when she wasn’t in prison, to try to keep warm and to block out her fears, thoughts and memories – which of course was terrible for her liver, so it was remarkable that it was still functioning normally.

  The only way for Paula to get treatment would be by being in one place for a few months, but she was never either in or out of prison for long enough to get help. Six weeks being locked up behind bars might feel like a lifetime for some, but it was not enough time for me to help Paula get treatment. By the end of her sentence in Bronzefield, the best I could hope for was to have her stable on methadone. Only she could decide when to change her life.

  I prescribed all her medication, and as she got up to leave she gave me a big, tearful hug.

  ‘God bless ya, Doc,’ she said.

  Relief washed across her face as she turned to me and said, ‘I feel at home here.’

  I realised the drugs weren’t her only addiction. She had become dependent on the safety that prison gave her. It was almost unbearably sad.

  Chapter Twenty-Three

  To begin with, my job in Bronzefield was based in the Healthcare department, running GP clinics and seeing new arrivals in Reception. Very rarely was I called to attend emergencies on the house blocks. In general those were dealt with by the nurses.

  The shifts were 9.30 a.m. to 4.30 p.m. in the week days (although I never completed the work in this time), or until 9 p.m. if the shift included a Reception session in the evening. The work was varied, exhausting, and often emotionally draining, but without doubt it was very rewarding.

  There were five other doctors sharing the work, and I worked on average three days a week.

  The first job of the day was to see the residents in Separation and Care, or those located in Healthcare, the rounds for each taking place on alternate days. After that I would start the clinic and see a range of different problems, including anyone who had arrived in custody too late the night before to have been seen by a GP in Reception. Those withdrawing from drugs or alcohol would be seen by the on-call doctor after 9 p.m. for their essential medication to be prescribed, but a full medical history would be postponed until the following day.

  In the afternoon there was another full clinic booked, with routine medical problems, path results to file and action, and prescriptions to be rewritten.

  The days were full on, but I was delighted by how many of the women wanted to open up to me. I found their stories fascinating, often tragic, and sometimes almost too shocking to comprehend. I became a shoulder to cry on for many of them, and I didn’t mind a bit. On the contrary I felt privileged to hear their stories and invariably humbled by them. At times we also shared some wonderful laughter, especially when they used expressions (often very rude!) that I had never heard before!

  My fears of working in a female prison had been completely unfounded. I felt accepted by the women from the very first day I worked there, and flattered that they felt they could relate to me. One of the nicest things they might say when the consultation was over would be, ‘Thank you for not judging me.’

  Some were lonely and frightened, but many of the regulars seemed happy to chat and often shared a joke. I was also amazed
by how many women told me that they felt safer in prison than outside.

  One lady told me that she had been in a violent controlling relationship for the past seven years, and that her first night in prison was the first time she had felt safe in bed for seven years!

  Another said that she felt more free in prison than outside, as she was free from the man who had controlled her for the past twelve years.

  Horrible and shocking.

  I soon realised that a high percentage of the women in prison were actually victims, and that was perhaps the most striking thing about female prisoners. Their stories of abuse, of being beaten, raped, and controlled both physically and mentally were deeply disturbing.

  Before I started working there I was concerned that the women might have perceived me to be from a privileged background, and therefore assumed that I would not be able to understand their struggles. The fact that they chose to confide in me was wonderful.

  The crimes they were being punished for committing were often a direct result of the abuse they’d suffered. I’d heard women explain how they’d killed their partner, after years of abuse, to protect themselves or safeguard their children. Countless women, like Paula, revealed how they were stuck in an endless cycle of drug addiction and crime which began after being abused. The memories of the abuse still haunted them, and they couldn’t stop turning to drugs to numb the pain, to blot out time, to stamp out the memories. It was either that or self-harming. Or worse: trying to take their own lives, which a lot of the women had attempted to do at some point.

  In April 2017 I was asked to run the Substance Misuse Clinic on House Block One. In a strange way I saw this as my final demon to face, as although I had the necessary qualifications to do it I genuinely did not want to.

  This stemmed from the fact that, up until then, my only contact with substance misusers was in Reception, when they were usually feeling extremely unwell due to withdrawal symptoms.