Today, one of my patients was complaining about a tier officer who he didn’t like.  “I just ignore him and keep to myself,” Mr. F said.  “If he say good morning to me, I just keep walking.”

“Hold up,” I said.  “I seem to remember a time when you told me that it hurt your feelings when you greet staff on the yard, and they act like they don’t know you.”

“Yeah, but that’s an inmate talking to free staff,” Mr. F reasoned.  “This is different.”

“Nuh uh,” I told him.  “Put all that ‘inmate-staff’ business aside.  We’re talking inmates and staff as people.  Human beings and common courtesy.  How would you feel if you saw me on the yard and you said, ‘Good morning,’ and I just ignored you and kept going?”

Mr. F thought it over.  He looked like he was about to say something and then changed his mind.  He heaved his shoulders with an exaggerated sigh.  “All right.  You’re right, Doc.  I hear you.”

A few hours later, I happened to be outside, walking across the yard, when I heard someone calling my name.  I glanced over at the line of inmates sitting along the bench and immediately spotted Mr. F.  The one with his hand raised in the air and waving at me.

I stopped walking and looked him in the eye to make sure that he knew that I knew he’d called out a greeting.  Then I turned, lifted my chin haughtily for a deliberate snub, and kept walking.  I glanced back.  He looked stunned for a moment before the light bulb turned on above his head and he started laughing.

I pointed a finger at him:  Bang!  Gotcha.

My first appointment of the morning was an intake interview with a new arrival.  Initial interviews take at least an hour, and they always involve a lot of paperwork, including the treatment plan.  One section of the treatment plan involves listing the patient’s current “strengths and needs.”  When we got to that part of the interview, I asked the patient to tell me what he considered his strengths.

“I’m not sure,” he said.  He sat there and I let him think about it for a minute.  He looked at me helplessly.  “I don’t know.”

“Okay,” I said.  “That’s okay.  We can come back to that part later.”

I moved on to the rest of the form and then got to the Suicide Risk Evaluation.  I went through the questions with Mr. M until I got to the part where I had to assess whether he had any current suicidal thoughts, intent, or plans.

“Basically,” I said, “are you having any thoughts or plans to end your life, right now, today?”  When conducting a suicide risk assessment, you don’t leave any room for vague answers.  You have to be blunt and direct.

I looked up from the form and saw that he was taken aback, almost affronted.

“No!” he said.  “I love me.  I wouldn’t hurt me.”

“Well, there you go,” I said.  “I think we found one of your strengths.”

One of the better things about my job is working with inmate-patients consistently for a couple of years and seeing them make progress and develop insight and change and grow emotionally.

Back in 2013, a young new arrival was assigned to my caseload.  He had been on parole and was back in prison on a new term.  He was twenty-four years old and struggling with a lot of emotional issues.  He had a lot of unresolved anger, and his primary coping skill was substance abuse.  The combination of being pissed off at his girlfriend while drunk led to his offense and arrest.

At first, he had a hard time sharing anything personal with me because he thought that would be a sign of weakness and vulnerability.  So when I saw him for his first few appointments, our conversations were short and superficial—nothing more than case management.  Eventually, he began to feel more comfortable talking to me and confessed that he felt nervous and scared about being released into the community.  He was constantly worried that he would mess up somehow and wind up back in prison, or that he would do something violent while still in prison so that he’d receive more time added to his existing sentence.

Once he was honest with his feelings, I was able to really start working with him on a deeper, more therapeutic level.  I referred him to treatment groups for additional opportunities for psychoeducation and guidance.  Gradually, he stopped being so anxious and started feeling more confident about himself and his ability to succeed.

Today was his last appointment with me.  His release date is Monday the 11^th, my day off.  When he came in to see me this afternoon, I asked him how he was doing.

“I’m feeling excited this time,” he said.  “I don’t have to come back unless I want to come back.”

At work, I carry a Personal Alarm Device (PAD) that will activate a loud alarm and flashing blue lights in our building, should I feel the need to push the button and alert officers that I need immediate assistance.  Once (in my first year of working at the prison) I accidentally pushed the button, and about eleven officers came running down the corridor to make sure I was okay.

Usually, I keep the PAD in my coat pocket and take it everywhere I go.  Today as I was crossing the plaza for my afternoon break, I put my hand in my pocket and accidentally bumped the PAD out, where it promptly fell to the ground.

Later, when I returned to the mental health building from my walk, I told the on-duty sergeant that I’d dropped my PAD in the plaza and I was afraid that I might have broken it.  “Can we test it?” I asked.  “To make sure it still works?”

This particular sergeant happened to be a buddy of mine who has spoken frankly with me on previous occasions regarding prison- and inmate-related issues.  Today was no exception.

“When you dropped your alarm,” he said, “and there were inmates in the plaza.  How did you pick it up?”

I knew what he was getting at.  “Don’t worry,” I said.  “Like this.”  I demonstrated by leaning over to the side with bent knees and carefully picking up an imaginary PAD.  After all, I’m not stupid.

There is an art to not flashing your rear end in prison.

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.”