Last week while I was chatting with the sergeant in his office, I happened to notice a sheet of paper on his desk, printed with the black and white image of an inmate’s mug shot.  What struck me about the photo was that the guy had several tattoos on his face, including a large swastika.

“Why do you have this guy’s photo printed up?” I asked, because I’m always nosy like that.  “What did he do?”

“Oh, he’s a new arrival to the yard,” the sergeant said.  “I have to call him in.  I need to talk to him about a few things.”

I picked up the sheet of paper and looked at the name and ID number.  On our yard, clinicians are assigned their patients by the last two digits of the inmate’s ID numbers.  This particular inmate’s last two digits fell within my assigned caseload numbers.

“Oh, man,” I said.  “He’s going to be on my caseload.”

I’ve interacted with a wide spectrum of personalities among the incarcerated population, from the most polite and mild-mannered guy to the one who stared at me across my desk with such a look of intense hatred that I immediately terminated our interview.  I’ve been yelled at and assaulted (with no battery– thankfully, the correctional officer intervened when that particular inmate lunged at me).  So I wasn’t afraid to meet this inmate with the swastika on his face; I just wasn’t looking forward to it.

Today when I arrived at work, it was my Monday and I had to catch up on emails.  It was through one of those emails that I learned that the new arrival was no longer on my caseload.  (Later, I found out more details from custody:  The inmate had assaulted and severely battered another inmate on the yard, resulting in immediate transfer to Administrative Segregation, where he’d likely be put up for transfer.)

Sitting at my desk and looking at the email, I was happy with this turn of events for about a moment.  Because right after I found out that I had one less patient on my caseload, I opened the next email and learned that I’d just been assigned another new arrival.

I’d scheduled six patients for my morning line, and the first three came on time.  At 9:40, my fourth patient was ten minutes late.  At 9:45, I started to wonder if he had forgotten about his appointment.  At 9:50, he finally showed up.

This is a patient who has been on my caseload for a couple of years now and with whom I have a good rapport.  We have shared some laughs.  So when he walked into my office, I couldn’t help giving him a little grief and jokingly shook him down.  “What happened, Mr. F?  You’re twenty minutes late.  I was worried we would have to shut down the yard for emergency count and start looking for you.”

Mr. F did a double take and looked at me in surprise.  “What do you mean, Doc?  My appointment was for 10:00.”

He handed me his appointment ducat, and sure enough, the time printed on the slip of paper was 10 AM.

“Whoops, my bad!” I said, handing back the ducat.  “You’re ten minutes early!”

“Oh, don’t scare me like that,” he said, shaking his head.  He settled into the seat across my desk.  “These C.O.s already killing me softly.”

Today in IDTT (our Interdisciplinary Treatment Team meeting), I gave my case presentation on a new inmate, Mr. D, who recently transferred to our prison and had been assigned to my caseload.  He was a 68-year-old African-American man with a release date of 2027, when he would be 80.

After I presented the diagnosis, psychosocial history, and other relevant information to the rest of the team, Mr. D was brought in so that we could review with him the treatment plan and discuss any questions or concerns.  He didn’t have a lot that he wanted to say, so his portion of the meeting didn’t take very long.  After he left, my colleague Dr. Y turned to me and said, “He’s 68?!”  Dr. Y himself was 60 years old.  He said, “I wouldn’t have guessed he was 68.  He looks so much younger.”

He added, half jokingly, “It’s just not fair!  A lot of these guys look really good for their age.”  What he didn’t say and what we guessed was that he didn’t think he had aged as well in appearance as those guys.

“Aw, don’t feel bad,” Dr. E, who is Korean-American and around my age, said.  “It’s genetics.  And people of color just age better.  Especially Asians.  Look at Dr. V here.  She’s fifty-five.”