Man Down: Dreaming of Elephants

Editor’s Note: Last month, we began posting the work of Enceno Macy, an inmate in a US prison. I was contacted by the person who edits his work, who asked if I had any article suggestions. I said that I would love to see something on health care in the prison system, since we’re having such an interesting conversation about the health care prison among the supposedly free. He said he was already on the project when I asked; this is what he submitted earlier this week. One thing that’s clear is that we need prison reform; we need a lot less people ‘on the other side’, and we need to see how cruel of a system this is, where many people find themselves for petty offenses or for no good reason at all — draining the taxpayers and enriching private companies who provide prison ‘services’. Enceno’s articles are sent handwritten, then typed and edited by a trusted editor who I have known and loved for about 18 years. Comments typed into the response area will be sent directly to Enceno. Thanks for reading and for the warm response he received last time –efc

By Enceno Macy

Some people dream of freedom. I dream of elephants. One of the many amazing and wonderful things about elephants is how in their wisdom they truly care about each other. How could we kill something so majestic and intelligent and caring by commercializing it? Starting with P.T. Barnum the elephant was doomed, and I can’t even blame Barnum, who bought the world’s largest elephant for his Barnum and Bailey circus in 1882.

Phineas Taylor Barnum made millions on the philosophy that there’s a sucker born every minute. He was also a Republican who championed emancipation of slaves and founded one of the first hospitals in Connecticut. Barnum was no saint. He was a jail-bird himself, in fact, but at least he believed in giving good value for the money he conned out of suckers, and the hospital he founded was dedicated to quality medical care. What would he think of Republicans today who refuse to accept a black president and foam at the mouth over health care for all?

He would probably wonder if the care part of health care was as doomed as the elephant.

Without doubt, universal health care would be in the best interest of everyone in the U.S. A government’s priority is supposed to be the safety and well-being of society, and trillions of dollars are spent on military, police, firefighters, and other important agencies to ensure our safety and well-being. But what’s the point of the police or military saving us from murderers or terrorists if we can’t afford our cancer treatment or organ transplant or other life-saving care? Lack of health care kills and maims as surely as murder and terrorism. Yet insurers who profit from denying people medical care have convinced a nation of suckers that universal health care would be creeping socialism and destroy democracy.

The new suckers are born every second, ruled by fear. Do they even know what the word socialism means? Or democracy? I wonder. Do they know how much profit swells the pockets of CEOs and legislators while millions, unable to afford even minimum care, continue to live in pain or discomfort, or not at all? Do they have a clue how insane it is to force those millions to pay those same CEOs insurance premiums instead of buying into a universal medical account?

Given the prevailing insanity, whether or not society deserves universal health care is debatable. The quality of the health care itself is also debatable. In prison these issues are intensified a hundredfold. First off, you have to take the word care out of the equation, replace it with “minimum requirements” or “only because we have to” or “enough to beat a liability case.” Many states outsource to private medical provider companies, while others provide minimum requirements in-house. In either case, they are staffed by inadequate, barely competent or totally unqualified nurses and doctors, some of whom are unemployable anywhere else.

To get a bare idea of what this system means in practice, imagine yourself in an inmate’s shoes for a minute.

Here you are, on what would be a pleasant spring day, except for the pains in your stomach. Over the next 24 hours the pain grows. For a time, you keep telling yourself it’s the low-grade, out-dated and often rotted food the prison serves. Finally the pain is too severe for you even to focus. But you are in a cell in a huge block of tier upon tier of cells. Guards are rarely at their appointed posts, and there are no intercoms or call buttons in this 150-year old fortress of concrete and steel held together by layer upon layer of paint. In an emergency like this your only recourse is to ask your cellie to “man-down” you. This means one inmate begins the call of “Man Down,” and the call is picked up by others until every voice in the building is chanting it, “Man Down tier 3, Man down tier 3” or whatever tier it is.

There you are, half conscious, with a thousand or two voices chanting “Man Down” until a C.O. (corrections officer) manages to locate your cell. There are 45 cells on each side of each tier, so it takes him a while to find you. He calls for a wheelchair and takes you to the infirmary. Good, you think. A doctor will know what’s wrong and fix it. Ha. Instead you are seen by a nurse – or you assume he is a nurse. He pokes your stomach, takes your temperature, which is 104 degrees, and says you have a stomach flu. He gives you a sample packet of Maalox and sends you back to your cell. You manage to climb onto your bunk and for the next six or seven hours you drift in and out of a coma, waking only to purge violently.

More than 20 times you jump down from your bunk to vomit and dry heave. Finally you are unable to get back on your bunk, and the heaving has accentuated the pain unbearably. Your cellie man-downs you again.

This time they have to carry you down to infirmary; you are unable to move or even sit. They put you in an infirmary bed but give you no treatment and no doctor is there. The night nurse is not the same as the earlier one. This guy is new, only on his second day of work there. When you wake at some point after midnight he shows the first and only genuine concern you’ve gotten from any state employee. He says they had called the prison doctor at home, who refused to come examine you and would not clear an ambulance to come for you or authorize anyone to take you to the hospital.

By 7 a.m. you are too sick even to notice when they put you into “transfer gear” (a plain jump suit) and a car takes you to the hospital. You find out later, much later, that the night nurse had hovered over you all those hours and finally was concerned and alarmed enough to go over the doctor’s absent head and tell the security captain this was an emergency. Amazingly, the captain believed him and authorized immediate hospitalization.

n the hospital there is confusion because there is no record of care or doctor referral. Finally the E.R. surgeon makes the decision to “open you up” to find out what’s wrong. You come out of a long surgery with a couple feet of intestine removed and an open incision from your breastbone to your groin. Your surgeon explains that your appendix had burst and your entire body cavity filled with pus and infection. He says the infection was so bad and so spread out that another hour and he couldn’t have saved you. You are in intensive care and they will have to keep the incision open for at least a week to keep draining infection away. He is outraged that the guards insist on chaining you to the bed, stretching their filthy chain right across the open incision.

You are in hospital for more than ten days, among real human beings — doctors, nurses, and medical staff — who treat you like a real human being, with genuine concern and interest and care. Then you are returned to the prison infirmary where you promptly contract a virulent infection lying there in the same environment that almost let you die. It is nearly a year before your incision heals and you can walk normally again or even think of throwing a basketball.

You are one of the lucky ones: you are still alive. Others have lost a limb, or had an eye removed for lack of basic treatment or antibiotics. The current lack of any policy for containing MRSA (methycillin-resistant staphlococcus aureus, called “mercer” by inmates who haven’t any clue what it is) means that recurring, draining boils and pus-filled sores are simply bandaged and the inmate returned to general population, where the infection is transferred readily from anything he touches. Temporary, permanent, and ultimate (death) damage — avoidable, debilitating suffering – result from what even a sadist might consider to be criminal treatment of inmates around the country.

With time heavy on their hands and more often than not a desperate need to feel as though they matter to someone, inmates may seek access to medical treatment more than the outside public does. And some, just like some outside, are borderline hypochondriacs, requesting attention for insignificant reasons. Maybe because of these minor complaints, prison health workers quickly become desensitized to all inmate complaints or conditions, and simply assume that every inmate seeking medical help is faking it. A medic who genuinely cares – like the one who went over the doctor’s head to get care for a ruptured appendix – is rare indeed. His job hadn’t yet extinguished his natural inclination to treat you as if you are any human being anywhere in the world.

Paul Von Zeilbauer is a reporter for the New York Times who has written numerous articles on prison health care. In an interview with Amy Goodman for Democracy Now! he discusses some of the incidents he covered, all of which ended in death by indifference or neglect. His examples of the most shocking and ultimate endings call powerful attention to the issue. Many of his examples involve a company called Prison Health Services (P.H.S.), which has 86 contracts in 28 states, providing alleged health care to 237,000 inmates. In the last ten years, the company has been responsible for 23 inmate deaths. Those are just what we know about. One can only imagine the amount of permanent injury and disfigurement that also were caused by this for-profit company.

http://www.democracynow.org/2005/3/4/harsh_medicine_new_york_times_exposes

We are convicts, and most are guilty of criminal activity, from the most petty to the worst. It is easy for people (especially the general public, most of whom don’t know a prisoner) to let time fade the memory of — and dim any concern for — those hidden away from society. It’s easy not to care because prisoners have been generally villainized – for good reason sometimes, but not all the time. I don’t believe we deserve bleeding heart sympathy, but dehumanizing us or any sub-culture is counterproductive to civilized society. And no judge sentenced us to disfigurement, crippling, pain and death by slow, deliberate neglect.

Certainly no judge sentenced the woman I read about recently, an active 82-year-old who once climbed Mount Kilmanjaro. She had a hip replacement a few years ago, and something went wrong, becoming so painful she could barely walk. For over a year this American citizen – fully insured by one of those companies everyone will now be required to pay – went from one doctor to another, and not one of them even read her file or tried to diagnose what was wrong; the surgeon who had done the original hip replacement surgery actually refused to even see her or talk to her on the phone. The medical profession, it seems, cares more about protecting its profits than about curing illness and suffering.

Like elephants, the “care” part of health care is becoming as rare outside the wire as inside, I’m afraid. The sorry difference is that no thousand or two thousand voices call “Man Down” for that poor woman or countless others like her.