The Prison Doctor

by Dr Amanda Brown

  I sighed. ‘Who is it?’

  ‘It’s Rhianna. Rhianna James, Miss.’

  I glanced down my list of names and saw that she was on it.

  ‘Okay, come on in,’ I said.

  ‘There’s a riot out there, Miss.’ Rhianna closed the door warily.

  She was a big woman, her arms were meaty and looked like they could throw a punch. She limped her way towards me, her lifeless straggly hair falling in front of her eyes.

  She slowly lowered herself into the chair, keeping her right leg straight.

  She had come to discuss her methadone, but there was clearly something wrong with her leg.

  ‘How are you doing, Rhianna?’ I asked, tentatively.

  ‘Not good, Doc. 30mls of methadone is not holding me at all.’

  I could see from her notes that she had arrived at Bronzefield three days ago, and that she was in and out of prison like a yo-yo. She told me that prior to custody she had been on a 70ml script, and so obviously her dose needed to be increased.

  However, her main concern was a painful infected ulcer on her right lower leg, which emitted a very offensive odour that she was embarrassed about.

  She fanned her hand trying to disperse the smell, and her cheeks turned scarlet. I asked her to pull up her trouser leg.

  She was so embarrassed she could barely look at me. Slowly, Rhianna rolled up her grey tracksuit bottom, to reveal four sanitary towels stuck to her leg. The stench was beginning to engulf the airless room.

  ‘It’s all I could think of to dress it with,’ she said, ‘because I’m homeless and don’t have a GP. I used them to absorb the pus, to try and stop it smelling so bad.’

  A smell of rotting meat filled the room, forcing me to turn my head, catching myself from retching.

  ‘I’m sorry.’

  ‘No it’s fine, Rhianna.’ The nurse had arrived by then, and handed me some surgical gloves, and then managed to find some saline sachets and gauze. I started to gently peel off the sanitary towels, slowly, one by one. I held my breath as I did so. Lying underneath them was an extensive, deep infected ulcer just above the ankle, extending all the way up her lower leg.

  The raw flesh was oozing pus and watery yellow fluids. The smell was revolting.

  ‘Oh Rhianna, why haven’t you tried to get help?’ I asked.

  Tears brimmed in her eyes. ‘I was too embarrassed because of the smell.’

  Her shame had stopped her seeking help.

  The circulation in her leg had been compromised as a result of injecting in her groin, and so insufficient oxygen was getting to the skin, causing it to break down and allow the ulcer to form. She was already aware that she would have to stop injecting, as there was a risk in the longer term that she could end up losing her leg if she continued.

  Rhianna wasn’t alone in thinking she would be judged for the way she looked, the way she smelt, the fact she was homeless and took drugs. A lot of the women had told me that they felt ashamed of what they had become, and as a result didn’t want to draw attention to themselves. They would rather suffer in silence, and some would risk death rather than ask for help.

  I felt so desperately sorry for her, and for all the other homeless people out there.

  I smiled. ‘Don’t worry, we will get you sorted. How long have you been using for?’

  Rhianna looked to the ceiling as she searched for the answer.

  ‘About fifteen years now, I reckon.’

  We agreed a plan to get her stable on methadone, and I arranged for her to go straight over to Healthcare to get the ulcer cleaned and dressed in the wound clinic.

  ‘Thank you so much,’ she said, limping back out.

  The thought of Rhianna sleeping rough in some doorway somewhere with that huge festering ulcer stayed with me well after she had left.

  Unfortunately, so did the smell.

  The thought of being stuck with it for the next couple of hours was dreadful, so I kicked off my shoes, clambered onto the chair and reached for the fan that was collecting dust on the top shelf.

  I turned it on to full blast, in a desperate attempt to get the air circulating before the next patient arrived.

  I picked up my mug to take a swig of coffee but one whiff of the combination of aromas was enough to turn my stomach. I placed it back down immediately, just as someone began banging on my door.

  Chapter Twenty-Five

  A lot of people in prison think they don’t deserve to be there, but there are some who do. Amber was one such young woman.

  She had recently been given a job working in Reception, helping the new residents when they arrived from court. She was a bright, articulate, pretty young lady, who was serving a staggering seventeen years for a crime I would have never guessed she would have committed. She was so sweet, and looked so innocent, it was difficult to think she had been convicted of handling firearms and supplying class A drugs, after becoming tangled up with the mafia.

  But what surprised me most was how accepting she was of the harsh reality of spending the better part of the next two decades behind bars. That she would be in her mid-forties when she saw the world again.

  ‘I deserve to be here,’ she said, calmly, without a hint of self-pity.

  Her case had been splashed all over the newspapers because of the length of her sentence. That, and the fact that she was a primary-school teacher who hid a machine gun in her knicker drawer.

  She didn’t seem the slightest bit fazed if people knew what she had done. and seemed much more focused on what she could do for others while she was inside.

  Amber was training to be a trauma counsellor, so she could help support the residents in Bronzefield who had suffered physical and emotional abuse.

  She had popped into my room for a quick chat while I waited for the next patient to be escorted to my door. It was always good to see her, as she was unfailingly cheerful and positive, and never seemed to feel sorry for herself. It was lovely to be able to chat as friends, rather than to always be seeing people in a clinical role.

  She had thick, dark, glossy hair past her shoulders, beautiful big brown eyes, and a wonderful smile.

  ‘If anyone asks what I’ve done, I tell them to Google me. I don’t mind if they know.’ She shrugged, nonchalantly. ‘Acceptance is key. If you want to survive prison you have to come to terms with what you’ve done and the time you’ll be in here,’ she stated, matter-of-factly.

  I agreed. I found that those who could not accept their situation struggled a lot more. So many prisoners asked for medication to ease their anxiety, their stress, their insomnia, because they were struggling to cope with being in prison. Like Azar, in the Scrubs, they struggled to accept where they were and the situation they found themselves in.

  Those who had an ‘I did the crime, so I’ll do the time’ attitude appeared to cope a lot better.

  I also admired the fact that Amber was honest about knowing what she was getting into when she met her husband, who had been sentenced to eighteen years for his part in the crimes.

  She had grown up in a wealthy family on the outskirts of London, and she’d had everything she could ever have wanted as a child. Her life of luxury had continued when she’d married a man who was part of the mafia.

  Reflecting on the past ten years, she said, ‘I lived the mob-wife lifestyle in terms of the houses we lived in, the cars we drove.’

  I was very curious as to how someone like Amber could have become mixed up with a mob family.

  She smiled, her big brown eyes sparkling with the memory of meeting her man, who she was clearly still in love with.

  ‘I had just completed my PGCE teacher training, when I first met him. It was a blind date arranged by friends of friends I’d known from my course. It really was love at first sight.’ She blushed.

  I offered her a biscuit as I usually had some in my bag to share around.

  ‘Thank you,’ she said, biting into the chocolate-covered biscuit. ‘We were texting non-stop after that first nigh
t. A year and a half later, we moved in together.’

  ‘So did you know who your husband really was?’ I asked.

  ‘At that point I kind of knew what he did,’ she said, dabbing the crumbs from the corner of her mouth. ‘But I didn’t realise who he was. But when I met his family I was able to join up the dots, and his friends set me straight.’

  ‘And that didn’t bother you?’

  She shook her head. ‘No.’

  Assuming I might be shocked by such a statement, Amber went on to elaborate. ‘I was very independent and I wasn’t interested in his money. I fell in love with who he was when he was with me, not the mafia character he was portrayed to be.

  ‘What can I say? I just fell in love.’

  In a strange way, it was sort of heartwarming to hear. I asked if he was older than her.

  ‘He’s six years older,’ she replied.

  To some young girls, I supposed, a successful rich older man with a dangerous side could be attractive.

  ‘But,’ she argued, ‘I wasn’t some young naïve girl. I knew who I married.’

  ‘So you think you should be in prison?’

  Without hesitation, Amber said, ‘One hundred per cent I should be. Even though I wasn’t dealing or involved, I knew we had drugs in the house, I knew that we had guns in the house, I was aware of what was going on. I was complicit, and that’s why I’m here.’

  She looked young, but she came across as much older than her 28 years.

  Because of her lengthy sentence, she was located on House Block Four, where other prisoners with long-term sentences were also living, such as those serving time for murder, sex crimes, arson, manslaughter and terrorism.

  ‘Do you think you were given an unfairly long sentence though? Some murderers get less?’ I asked.

  ‘Firearms are very dangerous, and what with everything that’s going on in the world now . . .’ She paused for a moment to consider her answer. ‘Yes, I think my sentence was fair, we should have been made an example of.’

  It was an extraordinary thing to admit to. I wondered if that was why she was training to be a counsellor, as a way of trying to pay society back for her crimes. She talked more about the training she was undergoing, and her desire to help others, seeming to read my mind when she said, ‘I’m not doing it to make myself feel better. I do it because I want to make a difference and I know I can help these women.’

  I learned that Amber had also been working as a ‘listener’, which is similar to the wonderful work the Samaritans do. She was on standby twenty-four hours a day to lend an ear to anyone who was struggling. That might mean going to see a prisoner in their cell in the middle of the night. I could imagine that she would make an excellent listener, as she had such a calm, kind, pragmatic way about her.

  ‘Thank God I haven’t been a victim of domestic violence, like so many of the poor women in here,’ she said. ‘But I’ve seen with my own eyes how destructive it can be. I have a close friend who is trapped in a violent relationship. She’s always making excuses for him. It’s as if she has been brainwashed. I used to tell her to leave him, that she needed to put herself and her children first. What I should have done is just be there on the other end of the phone for her if she needed to talk. But I feel I let her down, and was not always as sympathetic as I could have been. I’m putting that right now, though, with the work I’m doing here. Being a listener, training to be a trauma counsellor, it’s an opportunity for me to give something back.’

  Just as Amber was one hundred per cent certain she deserved to be in prison, I was one hundred per cent certain she was being sincere about her desire to help others.

  I also admired her because she wasn’t complaining about her sentence, or about losing her lavish lifestyle.

  On the contrary, she told me that it had made her realise that most of the things she had owned, she hadn’t needed.

  ‘It was a shock to the system, I’m not going to lie. But you suddenly realise how little you need to get by.’

  She shrugged. ‘I adapted very quickly. I didn’t even cry. I still haven’t cried once, since I’ve been in here. It’s just not me. Crying won’t get me anywhere. I have to move on, I have to manage.’

  ‘What about your husband, will you stay together?’

  Amber cracked a smile. ‘It’s funny, everyone in here asks me that same question. I married him knowing what he was, so my feelings for him aren’t going to change now we’re in prison. I’m very loyal, I take marriage very seriously.

  ‘I’m also in jail,’ she added. ‘So I’m in the same situation as him.

  ‘I can visit him at his prison every six months. We’re allowed inter-prison phone calls – I can speak to him every month. And we can write letters, of course.

  ‘We’re good, everything is good between us,’ she smiled.

  It wasn’t a conventional relationship. But then, what did that matter if they loved each other?

  Suddenly, Amber rose to her feet. She’d done all the talking she’d needed to do, and I could see she felt better for having someone to chat with. So did I.

  I realised I was quite privileged to have her open up to me, and I wondered if locking things up inside was her way of staying in control of her life.

  She gave me one of her sweet smiles. ‘Do you mind if I have one more biscuit?’ she asked.

  ‘No, not at all!’

  I handed her the whole pack to share with the others.

  ‘You’ve got a good heart, Doctor Brown,’ she said, and then disappeared out of the door.

  Chapter Twenty-Six

  I found most of the women I was meeting in my regular Substance Misuse Clinic fascinating. Trudy was no exception.

  For years, Trudy had managed to hold down a full-time job as a housekeeper, alongside maintaining a serious heroin addiction. She’d looked after the luxurious homes of an immensely wealthy Middle Eastern family, and for decades she stayed out of trouble, working long hours and keeping up the pretence that all was okay when really she was crumbling inside.

  It was her first time in prison, and as she sat in the chair in my little room, I could see the relief on her face. Her tired, frail body almost melted into the seat with liberation, but her eyes were flat and emotionless, as if she had used up all her tears long, long ago.

  She was in her mid-forties, but looked older. Her skin was blotchy and flaky around her nose. Her hair was dark and straggly and going grey. Her voice was husky from cigarettes, and she coughed harshly.

  ‘I can relax now,’ she said, smiling wearily.

  It was still a strange thing to hear – that being in prison was better than being free, but it was something I had heard before so many times it no longer surprised me. I suppose being addicted to drugs had been a life sentence in itself for her.

  And then she said something that left an impression on me. There was no window in my room, but Trudy gazed ahead, wistfully, as if she was imagining the most beautiful of views.

  ‘I just want to live abroad, on a boat. I don’t want anything else.’

  Her words reminded me of the seascape that used to hang in my surgery, with a couple relaxing in the sunshine, looking out across a beautiful deep blue sea. When I felt like the world had got on top of me, I used to stare at that picture and wish I could just step into the frame, like Mary Poppins did in the film.

  ‘Don’t we all?’ I smiled back.

  She told me that she used drugs primarily to obliterate the memories of her abuse.

  ‘At first my partner would make sure he hit me where no one would see. He would smack me in the stomach. The ribs. I was working with three broken ribs at one point.’

  ‘He would hit me across my back with anything he could get his hands on, sometimes even the frying pan, or the saucepan.

  ‘But the longer I was with him the less he cared about what people thought, so he started punching me in the face.’

  ‘Oh goodness,’ I sighed.

  ‘I got good at using make-up.
Concealer around my eyes, lots of foundation.

  ‘It didn’t really cover the black eyes, but nobody said anything to me. You wouldn’t, would you? And a lot of the time my employers weren’t living in the houses; they were abroad while I looked after them.’

  She paused, suddenly considering what she’d just admitted. She frowned, crossing her arms defensively. ‘I never stole from them if that’s what you’re thinking. Never once. I wouldn’t do that. I was working all those hours so I could pay for myself.’

  I quickly intervened. ‘That’s not what I’m thinking, Trudy. And I want you to know, I’m not here to judge you.’

  She softened. ‘I know, Doc. You seem like a good sort. I just didn’t want you to think badly of me.’

  ‘Well, I don’t.’ I smiled. It was funny how many of the women in Bronzefield seemed much more concerned about how I viewed them than the men in the Scrubs had been. I wondered if that sometimes had something to do with them needing me more, emotionally.

  ‘So how did you end up with such a horrible partner? Did you try to leave him?’

  ‘So many times, so many I lost count!’ She spat the words out of her mouth.

  ‘But he threatened to kill me if I left, and I was scared. By the end I’d given up, it was easier not to fight him any more. There was also a part of me that thought I couldn’t do any better. He’d ground my confidence down so much, over the years. When I looked in the mirror I hated myself . . .’ Trudy’s voice started to wobble. Her face tensed.

  ‘I hated my hair, my face, my body. I looked old and tired and covered in bruises, and who would want to be with someone who looked like that?’

  She looked directly at me with sad, sad eyes. ‘Who would want me?’

  It was heartrending.

  She wouldn’t be the first woman afraid to be alone. Glancing back to Trudy’s notes, it looked as if she had grown up around abuse. But I didn’t need to ask. Trudy was a clever woman, and had already processed her reasons for putting up with the beatings.

  ‘I suppose I knew no better. My dad was an alcoholic. He used to do a right number on my mum, couldn’t even recognise her after he was done with her. He tried drowning her, he beat her with a poker, it was horrendous. And when he wasn’t beating her, he would rape her in front of me and my sisters. He tried to kill my mum four times before she left him.’