We kept the momentum going by devising a weekly schedule of group therapy that included the topics of community living, violence reduction, and substance abuse. During my daily rounds, I was delighted to see that our Mental Observation Unit was developing into a true therapeutic environment and that our patients were no longer lolling around on their cots and watching TV but were now participating in mandatory group sessions.
When it came to general population, my biggest challenge was ensuring that referred inmates were evaluated in a timely manner. The last thing I wanted was for someone to fall through the cracks, especially after the Ramirez suicide. The GP sessions took place in the clinic, where it irritated me that our quarters were crowded and cramped, especially since the medical staff was allotted roomy space. Our doctors and therapists were doubled up in booths that served as makeshift offices, so when an inmate arrived for his session, one person had to vacate the booth to maintain privacy. It rankled me that the treatment of intangible maladies such as depression—easily as agonizing and devastating as the worst physical pain—were always given such short shrift. But considering everything else I was faced with, now was not the time to challenge the existing arrangement.
It was the Bing, however, where I wasn’t feeling so confident. Almost every morning, I received a call from the punitive unit informing me that someone was threatening to kill himself. Thankfully, Pete and Dr. Diaz were accustomed to these situations, and I would dispatch them to investigate. Diaz would adjust the meds, and he and Pete would talk to the inmate, trying to cajole him into enduring the punishment. But it wasn’t long before Diaz called me from the Bing, asking that I come up to 4 South. This meant there was a tough decision to be made, and it was a nervous walk through the jail. When I reached the punitive unit, I stepped into an elevator car, and since I was going to the fourth floor, I held up four fingers to a corner camera, waiting to be spotted on a TV monitor. As the car lifted, the errant cries of the punished echoed throughout the cavernous tower, and I winced at the sound of a particularly piercing howl. When the door opened, a swarm of officers were hovering around a captain who was pressing a radio to his ear. From what I could glean, an inmate on the floor above had set fire to his mattress. The captain and COs disappeared into a stairwell and pounded upstairs to extinguish the fire. The inmate would be “extracted” from his cell and “arrested” for arson. Despite the heat, despite the additional legal charge—despite, even, the possibility of death—I was already learning that setting fires is a common ploy to gain relief from the torment of solitary. But I had also noticed one aspect of fire-setting that was never discussed: Who supplied the matches?
My arrival at 4 South was a far cry from my first quiet visit. The noise level was ferocious; the inmates were wide awake, railing violently against their confinement. Bodies thumped against the doors and faces were pressed into the small windows. As I walked past the cells, they cried out to me, “Miss! Help! Please, miss!! Please!” Fighting my natural urge to rush to their aid, I reminded myself that they’d done something to warrant this punishment—hurt another inmate, perhaps, maybe cut someone.
I kept my eyes trained on Diaz and Pete, who were standing in front of a cell with its door slightly ajar.
“Welcome,” Pete said wryly.
Diaz motioned me to the side of the cell. “His name’s Leonard Putansk. He’s been going downhill for a while. We’ve done the usual, upped his meds, talked to him, but we’ve got to make a decision here. I don’t think he’s ready to come out yet, but we’re getting close—there’s a lot of blood. I think you need to take a look and then we’ll decide. You ready?”
I steeled myself and nodded.
The officer pulled the door open to reveal a claustrophobic cell, the cement walls smeared with crimson stains. A burly young man in a sweat-soaked T-shirt sat on the cot and sobbed, his back to me. But he turned around quickly, his forearms slathered with blood.
“Please, miss! Please! Help me! My family, they’re in Kosovo—I don’t know if they’re dead or alive with all the fighting going on over there!”
“I’m sorry about your family,” I said softly. “That must be very hard.”
“It is—it is! I’ve already been in this cell for three months now. They’ve got me down for another six. They wouldn’t do this to a dog! I’m going to kill myself. You gotta get me out of here! I can’t take this anymore, I can’t. I’m telling you, I can’t.”
“Okay, just a minute now,” I managed, stepping back out.
Diaz motioned me out of Putansk’s earshot. “It looks worse than it is,” he said. “He’s picking at his skin. It’s superficial. He’s trying to make it as dramatic as he can so we’ll pull him out.”
“He’s doing a pretty good job,” I said. “So, why don’t we pull him out, send him over to MHAUII?”
“It’s not that simple,” said Pete. “He’s desperate, but they all are. We can’t pull them out just because they’re miserable; that’s the whole idea. We only intervene if we think his life is at stake, and at this point, I don’t think it is, although he’s going to up the ante.”
“Well, if we know he’s going to do something more drastic, why wait?”
“Because we can’t give in,” Diaz replied. “If we do, they’ll all start cutting themselves and threatening suicide. It’s a tug of war, Mary. Welcome to the Bing.”
As his words resonated, a sick, weak feeling washed over me. But I had to push it aside and stay focused. “But he’s already been in there for three months! With six more to go!”
“That’s nothing,” said Pete. “In these supermaxes they’re building all over the country, they throw people in a cell for the rest of their lives. ‘Here’s your life—a square box.’”
I shuddered at the thought. A human life—relegated to a box.
Since Diaz and Pete were disinclined to pull him out, I deferred to their experience and the three of us went back into the cell and informed Putansk of our decision. In response, he howled and beat the walls with his fists. “We’ll get someone from medical to take care of those cuts,” said Pete. Diaz nodded to the CO, who shut the door and locked it up. As we made our way out, Leonard Putansk’s agonized wails seemed to follow us.
As the day wore on, I tried to focus on other matters, but I kept thinking about Putansk. I just hoped he was doing a little better. When we didn’t hear anything more from the Bing, I relaxed a little. But the following afternoon, the call came: “They’re cutting someone down, a Leonard Putansk.”
My stomach knotted at the words—cutting someone down.
I pushed my paperwork aside and put my head in my hands. I was not cut out for this. The phone rang again, and this time it was Dr. Campbell, the new director of Mental Health. Somehow, the news had already reached him at Central Office. “Find out if he’s dead or alive and call me back,” Campbell snapped.
I forced myself out into the clinic where a swarm of officers, keys jangling at their sides, were running the gurney down the main aisle. In the examining room, Putansk was quickly surrounded by a sea of white lab coats. In the thick of things was Diaz, who waved me in from the doorway. As I reluctantly approached the table, Diaz put his big arm around my shoulders and ushered me up to the semiconscious inmate, pointing to the thick pink welt where the sheet had dug into his neck.
“He’s okay,” Diaz smiled. “Don’t worry, he’s going to be fine. I knew he was going to do something, but he timed it for when a CO would be walking by. We’ll send him to the hospital and when he comes back, he’ll go to MHAUII.”
“He’s going to be okay,” Diaz reiterated, in response to what must have been my ashen face. For him this was everyday stuff, but for me it was all new—and all horrifying. As Leonard Putansk was stabilized with a neck brace and wheeled out to a waiting ambulance, I wondered how I could ever come to terms with any of this.
34<
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Despite my apprehensions about the Bing, I plodded on, doing my best as OBCC’s sole Mental Health administrator, supervising every aspect of the operation—from monitoring referrals to figuring the payroll to compiling statistics.
There were also many, many meetings to attend: warden’s meetings, unit chief meetings, quality assurance meetings, staff and clinic meetings. I barely had a moment to breathe, and at one unit chiefs meeting, the pressure shot up. Dr. Campbell outlined the upcoming summer audit schedule, emphasizing its importance. “The audits are our report card,” he said solemnly, “and we expect them to be perfect.” I scribbled the date for OBCC’s audit, hoping Kelly would be back or that we’d at least have a clinical supervisor to spearhead the necessary chart reviews.
Next was the distribution of forms for staff to sign—everything from absentee policies, dress codes, and parking procedures to our relationship with DOC—plus countless forms on patient care. Taking a page from the Giuliani administration’s touted policy of accountability, St. Barnabas was churning out the paperwork. If the audits were less than successful, then we, the unit chiefs, would be accountable. In turn, we were to make our staff accountable. When staff deviated from policy, they would be confronted with their signed understanding of that policy. Management, even of such an inherently complex situation, was reduced to a simple maxim: everyone had a job to do, and if something went wrong, then the faulty link in the chain would be identified and corrective measures taken.
Although the accountability theory made sense in the abstract, its application was less than tidy. The premise that everyone had a job to do was turning a blind eye to the fact that many were doing more than one job. In my case, I was doing my job, Kelly’s job, and the job of the clinical supervisor. The staffing levels in most of the jails were inadequate, yet we were treated as if we had reasonable workloads. But as a fresh stack of forms was distributed, we silently accepted them.
Campbell finished up with a dreaded announcement: “We’re getting ready to fire all the limited license doctors. We’ve got enough fully licensed doctors, so we’re going to move ahead on this. We’ll let them go in waves. The transition should be completed by the end of summer.”
With this news, we all cringed. Most of us had worked side by side with our doctors for years and were rooting for them to pass their exams and stay. Besides, we suspected that all Central Office had in store was a fresh supply of moonlighters.
Defensively, the deputy director, Suzanne Harris (wearing civilian clothes), reminded us once again that this was a contractual obligation. “It’s not going to be any surprise to these doctors—they know. But just in case, you’re not to say anything about it. Not a word. We’ll handle it!”
I suspected that all four of OBCC’s doctors had limited licenses, but when Harris confirmed it, I felt sick. I tried to explain to the Central Office team that it would be no simple matter to place a new doctor in the Bing, but that was brushed off. They had no clue about the Bing, and my only hope was that Kelly would be back before any of this began.
But a week later, with no sign of Kelly, Hugh Kemper called. “Two new doctors are starting at OBCC next week. The first is Tarra Grant, and the second is Katherine Ketchum.”
“What about our own doctors?” I nervously asked.
“Well, just sit tight. We’re not going to let them go just yet.”
The following Monday, Drs. Grant and Ketchum arrived on schedule. If our doctors suspected what was up, they didn’t let on. They welcomed the women, perhaps assuming they were with us for training purposes. Despite my misgivings, on a personal level I found both new doctors quite likeable and was pleasantly surprised to learn that they weren’t moonlighters but dedicated, interested physicians. Ketchum, a petite blonde in her fifties, was an eager perfectionist. But after a tour of the Bing, she was horrified and refused to return. Fortunately, she took an immediate interest in the Mental Observation Unit, where she assumed the role of primary psychiatrist.
Grant, a feisty younger woman with a short Afro, was obligated to work in an undesirable setting like jail for two years to satisfy the terms of her student loan. Grant was warm, affable, and competent. Unlike Ketchum, she was game for the punitive unit and began accompanying our doctors to the Bing.
Both new psychiatrists, unaware that they’d been hired to replace the team that was training them, quickly assimilated, and I tried to blot out what would happen next.
* * *
As we approached the Fourth of July weekend, we were heading into one of the hottest summers on record, and in no time the jails were stifling. The scorched rec yard, usually teeming with inmates, sat empty under the blazing afternoon sun. The clinic was slightly cooler but by no means comfortable. The COs lugged through the halls in their polyester uniforms, drenched in sweat. But at least officers and civilians could look forward to going home and cooling off; for the inmates, there was no relief. Of particular concern were the mentally ill, whose medications interfered with the body’s ability to cool itself. Extreme heat could kill them. Each day the pharmacy cranked out lists of those on the questionable meds, and in the few cases where they could be replaced by something more benign, our doctors did so. Besides that, there was little else to do besides push them to drink plenty of water and to take cool showers. Considering the health hazard, air-conditioning on all Mental Observation Units should have been mandatory, but this was jail—there would be no such indulgence. Instead, two oscillating floor fans stood at either end of the dorm. Since DOC relaxed the rules prohibiting bare chests, mostly everyone was shirtless. The lucky ones had shorts; the others lay very still on their cots in dark jeans. Although I offered to have the heavy pants cut into shorts, no one took me up on it. Owning only one pair of pants, they had to look ahead to the fall and winter, when they’d be needed for warmth. When I realized my well-meaning offer was more of a taunt than a realistic option, I dropped it.
As hot as it was on the MO and in GP, nowhere was hotter than in the Bing. Trapped inside sweltering cells, the only salvation for the punished was that each had a small sink and access to cool water. One afternoon when the mercury skyrocketed past 100 degrees, Pete and Grant called and asked me to come up to 2 Southwest.
By now, going over to the Bing was a regular part of my day. There was no avoiding it. The Leonard Putansk encounter was my introduction to a daily onslaught of suicide threats and gestures. To cope with these cell-door visits and the gut-wrenching decisions that ultimately rested on my shoulders, I started bumming a cigarette here and there. I would steal away to the restroom for a quick smoke to brace myself for the walk over to the punitive unit. Solitary confinement was far worse than I’d imagined. Behind so many of these doors were blood-smeared cells, makeshift nooses, and the agonized, shell-shocked faces of people begging for a reprieve. As I walked through the halls that afternoon, I rehearsed the mental drill that I’d started relying on to help me keep walking: I reminded myself that solitary confinement was standard punishment in jails and prisons across the country. Thousands of mental health workers were doing exactly what I was doing. It was legally sanctioned and carried out in a nation that prohibits cruel and unusual punishment. Therefore, I told myself that none of this was really as bad as it seemed. Yet as I approached the big barred gate, my legs were wobbling anyway.
At the elevator, I bumped into Diaz. The sweat-drenched psychiatrist whipped his head to the side, throwing off a spray of droplets. “It’s brutal in there,” he said. “I’ve got to get water.”
When I stepped into 2 Southwest, it was as though I’d stuck my head in an oven to remove a roast—and kept it there! As I made my way toward Pete and Grant, sweaty palms were slapping and sliding down the windows. “We’re dying in here, miss—we’re dying!”
“Shut the fuck up!” the officers shouted. “Shut up, motherfuckers!”
I kept going, aware of a growing stench. Midway down
the floor, Pete and Grant were covering their mouths. The COs were darting away, pinching their noses. As I drew closer, I was also holding my hand to my mouth.
“Have a look,” said Pete, pointing to the open door.
I peered into the cell, where a young Black man was staring ahead blankly, all the while humming. Lathered in sweat, he was completely naked. With his cupped right palm, he raked his hand across his neck and chest, smearing himself with feces. The excrement was in his hair and slathered around his neck and ears.
“Send him out!” the officers yelled. “He’s lost it! You gotta send him out!”
The three of us retreated down the floor.
“Oh, my God!” I said.
“Pretty bad,” said Pete.
“What do you think?” asked Grant. “MHAUII?”
“Sure,” said Pete. “But we know what MHAUII’s going to say: that he’s malingering, that this is just a ruse to get out, that it isn’t life and death.”
Pete was right. This was not life and death, yet in accordance with anything decent and humane, we needed to provide this man with relief.
“Look,” I said, “as far as I’m concerned, a line’s been crossed. This could be calculated, but even so, if you’re willing to go to this length, then as far as I’m concerned, you win.”
“I’m with you,” said Pete.
“Me too,” said Grant. “Besides, the COs are going to lynch us if we don’t get him out of here.”
“All right then,” I said. “Let me go down and call MHAUII.”
Lockdown on Rikers Page 25