Friday, October 18, 2013

Don't close that door ...

  I just can't imagine it.  Day after day after day, being in that cell with all of my day in the hands of someone else.  Never being able to open the door without someone popping it open for me.  Not being able to look out the window when I wanted to.  Not being able to shut out the noise of the hoodlums in the other cells.  No music.  No freedom.   
  I do live with a portion of that restriction every day however, as there are no doors in a jail that are not controlled by the man/woman sitting in Central Control with a computer that 'pops' the door.  I do have a key to my office, but it is also controlled by Central. Every door on every hall to every room is locked.  When I started working at the larger jail in the other county I was told from the beginning that you don't want to piss of the guys in Master Control (different places have different names - same thing though) because they have the power to 'forget' you; in the elevator, down a hallway...  you smile to the camera, which you are on everywhere you go throughout the jail and the man/woman in Central/Master are watching you as you travel the hallways, and you say please and thank you.  Most will not mess with you that way, but there is always that one that will have his/her juvenile pleasure for the day.  No one at the jail that I work at now would do that, unless its for a joke. 
  When you walk up to a door you call on your radio the number of the door (above each door) and Central will pop it.  If you are going down a hallway with other locked doors, they will watch you and pop them as you get to them. At the larger facility with elevators, you hold up the amount of fingers to indicate which floor you wish to go to.  Master sees you and sends the elevator up.  You don't push the button as it won't work, you wait for Master to send the elevator to your destination.   
  But that is the easy part of being in jail, working here.  Being an inmate here is a different matter of course.  Do an experiment ... go in your bedroom.  Close the door.  Darken the windows.  Have nothing in there except a book and some glasses if you need them.  You can touch nothing else because if you were in a cell you would have nothing else.  You cannot leave.  You can go to the bathroom when you want.  In the bathroom you can have one bar of soap, a washcloth, a towel, a toothbrush w/paste, and deodorant   That's it, nothing else, so don't touch your cosmetics, your fragrances, your Qtips, etc... In the cell the commode would be beside the bed, so you wouldn't be going to another room at all.  Now, back to the bedroom.  From 6 a.m. to 5 p.m. you must have your bed made, and you may not get under the covers during that time.  Oh, you're cold, too bad, still can't.  If you get caught being under, you get 'lockdown' for whatever amount of time the officer deems appropriate.  For different offenses that could mean 5, 10, or 30 days.  More on that later.  Ok, so, you are bored. You can have paper and pencil, so you could write a letter. You want to just reach out and grab that cell phone, computer, game, something, you just want something to do.  Sorry.  Can't do it.  You have none of that in your 'cell.' You want to go out.  Sorry.  Door is locked.  You are bored and the book isn't a good one so it's not holding your interest.  Too bad.  Take a nap, well, maybe not because if you sleep too much during the day you won't sleep at night, then your sleep cycle gets all messed up.  You want to sleep in in the morning.  Tough.  Meals are served and you will get up, be dressed, and be released out to go sit at a table after you get your tray off of the cart.  You have about 15 minutes to eat.  Not finished... too bad.  Back to your room/cell.  Now what do you do.  You wait till free time.  At least during 'free time' you can come out and talk with the other inmates, walk around the pod, even sit at the table and play cards.  But you can't go back in your cell once you are out.   You have an hour.  Back to room/cell.  
  And on it goes.  That's your day behind those locked doors.  Both the jails I work for don't have the bars anymore, they have the solid steel door with narrow long rectangular window looking into the pod.  If you are on lockdown, there is a cover that goes over that window, and you are then completely cut off.  There is one tv in the pod that hangs above the officers desk, controlled by the officer, and when you have the window covered you cannot stand at the door and watch tv even.  
  About lockdown ... well, you don't want that because that closed door will be staying closed for quite some time.  The inmates at my home jail get a good bit of free time - 1 hr, 1 hr, then 2 hr episodes a day.  Lockdown = 1 hour every Third day!!  and that will be by yourself, not with anyone else.  Imagine.  Closed up in that cell, covered window, for 3 days.  Your commissary food, supplies (ie: paper, pencil, etc.) are taken away until you are off of lockdown.  No phone privileges on your free time.  No communication with anyone.  Now, was whatever you did to get locked down Reeaally worth this isolation?!!  
  I try to imagine being in that cell, day after day, my freedom eliminated and I just can't shake the feeling that I would have one more humongous anxiety attack!  I cannot think of a single crime that can be committed that would make that worth it to me, and yet, we have some that are in and out of here all the time, longer stays each time in many cases.  And I ask myself...Why?!!
My only thought is ... Don't Close That Door!!!

Thursday, October 17, 2013

Liar, liar ... 

  One of the most difficult parts of my job as a correctional nurse is to look beyond the words and try to determine the truth.  It is a daily challenge as most inmates feel that if they tell the truth about their actions it will be held against them.  They mistakenly believe that if they acknowledge to me, their facility nurse, what drugs they have been doing then it will be as good as a confession.  In actuality, my part in their detention stay has little to do with their charges and I never 'turn them in' or reveal their answers.  However, there is always an officer in the room when I do my interview / assessment on the medical intake, which is where I obtain their medical history and attempt to discern what medical / psychological needs they might need attended to while incarcerated.  Once someone is charged with a crime and are under arrest and in jail, their comments while here are pretty much ignored.  What they fail to realize is that when those drugs or that alcohol that they denied taking / drinking start fading out of their system and the withdrawals start hitting, that's when they suddenly realize they need to be up front to me so that I can assist them through the worst of the delirium tremors and symptoms that will make them extremely uncomfortable for several days.  In some cases, it is a medical emergency if withdrawal is not treated / combated.  
  Then there are those that will say that they take More than they probably do simply because they have learned that I will start 'detox meds' which means that they will get some kind of drug to take, doesn't matter what it is, they have to be taking a pill to be satisfied.  Which leads me to the ones who have chronic complaints in hopes that I will continue giving them something that they can take just to be taking something.  These drug-seekers are sometimes hard to determine, but my answer is easy once I realize their complaints are continuous.  No more meds!  I only give the benefit of doubt for so long, through so many sick call complaints.  
  Bragging to other inmates is commonly heard.  Whether there is any truth to their stories is questionable.  They obviously feel they have to sound bigger and badder than the next guy to stay in the 'safe zone' while in the pods with other inmates.  
  Many learn the system, and learn how much power the facility nurse holds over their perceived level of comfort while incarcerated.  Therefore, I often hear sob stories about how bad a shape their back / knee / shoulder / etc... is in and how "terrible" it hurts.  I have the power to order them to be housed on the bottom bunk or bottom floor even.  Yes, many have had rough lives and most likely do have these ailments, but if I restricted top bunk because of complaints of chronic pain, well, we might as well get rid of the top bunks altogether.  It just can't happen.  There are only so many bottom bunks.  But many will still give it their best shot and tell me that they "have to" have whatever it is that they demand.  My best advice to these, stay out of jail.  
  Another common lie that I hear is the claims to having a history of seizures.  This one is more difficult for me, because often this cannot be verified by doctor reports and yet may or may not be true.  I have had some that answer "yes" and give elaborate stories, then on their next incarceration during intake they forget what they told me before and answer "no" even after I question repeatedly to see if they will change their answer.  If they do have a history of seizures, I then determine if the past seizures are in correlation to drug or alcohol withdrawal, or even head trauma.  This is another area they will lie in.  They want their past seizure to be from something other than a self-inflicted condition.  
  Some of the elaborate, well-thought out stories have blown my mind.  I had one woman who claimed to have colon cancer.  She was in her 40's, pale, and knew all the lingo that had me convinced that she was telling the truth.  Her story went bust however when I had her sign a "ROI" - Release Of Information form that I faxed to the clinic, Johns Hopkins no less, and got nada returned to me.  The note on the fax sheet that came in "patient unknown, not a client here, no history" which prompted me to call and make sure that there was no miscommunication.  Sure enough, after about 10 phone calls to all the places that she had claimed to be 'treated' either no one had ever seen her, or it had been years since and it was certainly not for cancer of any kind.  
  Another common lie told to me, because I can also control their 'special tray' diets; allergies.  This is also one that is not always the same answer on every intake.  I never lead them into an answer.  If I know that they said they had a fish allergy on prior incarcerations, and if they don't mention it when specifically questioned multiple times (I will keep coming back to the question) as whether or not they have food allergies, then I consider the previous admission of allergy a lie.  This also is another one that I have difficulty with determining truth, as few have actually had allergy testing or doctor proof.  Most just do not like fish, or consider nausea / vomiting an 'allergy' which is actually an intolerance instead.  I have learned that one of the best ways to get the truth of this is to ask the symptoms, then act like "yeah, right" towards their statements.  For some reason if they interpret that I do not believe it, they will start stumbling over explanations and often out themselves by not just saying yes and shutting up.  But, this is a tough area for me as real allergies can be life threatening; therefore, I have to order the special tray most times, for protection of the inmate and the jail and myself if it is true. 
  And so I spend my days trying to determine truths.  Sometimes easy, sometimes frustrating, sometimes fail.  But eventually the truth comes to light in most cases.  Most of the lies in here are predicable for cause / effect reasons.  My course of action normally will be the one that keeps them safe, beyond that ... eh.  Liars have become an epidemic, on the inside, and the outside...
  

Wednesday, October 16, 2013

Why Thugs ...

  When I entered nursing school, emergency medicine was my hearts destination.  I wanted to end up in the ER, working traumas, having adrenaline highs on a regular basis.  Well, as life would have it that just isn't how my life turned out for the long haul.  Yes, I did some stints in the ER, but mostly ended up in the step-down unit with some rotations through ICU and ER, but more ICU.  But that was okay, I loved every aspect of my job.  For 15 years I walked the halls of the hospital and felt quite content, even though I wasn't at my first choice in my profession, I learned all I could where I was at and believed that 'one day' I would end up there.  I had an EMT-Intermediate license, so I did get my hands in that pot now and then on the outside.
  Then I had an offer.  From the only doctor at the hospital that I had ever actually considered working for. He needed a nurse at his office, and he came to me.  He asked, I accepted, and life changed.  I had two small younguns at home, so it was a good change for me at the time.  And again, I loved my job.  I was older and wasn't so much in the need of all the adrenaline, so it was a good fit.  I learned more as doctor offices present different medical situations, and expanded that resume' job abilities in ways I never expected.  I got to assist with a lot of varied procedures.
  Then, 10 years later came the 6 back surgeries, lots of time out of work, and it was time for yet another change.
  After a short time home unemployed, I decided to take a medical transcription course.  That would be something I could do from home, no pulling/tugging on patients, no bending over patients doing procedures and drawing labs.  My last job wasn't that hard on my back, but it had it's days that challenged it.  This would be something I could stop and lay down and rest my back if I needed to.  So, the course done, and no job.  It would take just short of another year before I landed my first, and as it turned out, my only transcription job.  The plus was that the Family Nurse Practitioner that recommended me and worked there also made sure that they knew that I was a nurse.  They ended up hiring me also to work a few days in triage.  Yeah, not as exciting as it sounds.  I worked this part of my employment for a year, and was one of the few jobs I've ever had that I was really not thrilled with.  "Triage" turned out to be sitting in the office upstairs and answering the ever incessant phones!  The only part of nursing I have always disdained.  Calling test results, calling pharmacies, getting yelled at and cursed because for some reason the patient had the mistaken impression that their doctor was sitting in his office twiddling his thumbs Just Waiting for Them to call and see them immediately.  Anyway, I ended up letting that part of the job go and sticking with the keyboard that didn't talk back.  I worked another 3 years typing away happily at home.  I learned a lot of the GI part of nursing, an area I had very little experience in before.  And then, as so many things go these days, outsourcing struck.  The doctors office that I worked for decided that it would be cheaper in the long run to go to using one of the online transcription companies, and I once again found myself out of a job.
  I was out of a job, homeless for a span of 3 months as my marriage had finally breathed its final breath and I moved on, just before losing the job of course.  But, looking back, it was a good thing.  It worked out exactly as it should have, as I believe most things do.
  I decided that after a few months of trying to find transcription work that I would get my nursing license back and see what I could do with that.  An old friend of mine that I was friends with on Facebook saw that I was getting back into nursing, and suggested that I check into working for her, at a detention center.  I was very curious, but open to anything.  I had in the meantime gotten a job for Interim Healthcare and was being sent to 3 different facilities to work, only one of which I actually liked.  But I considered it a job, not the career choice I was looking for.  One of the places I did get to work was Schenck Job Corps.  That one, I loved.  If there had been an opening there for full time work I would have jumped on it.  It was a field of nursing that was strange and new to me, but in an atmosphere I felt at home with.  I learned more.  The other two facilities paid my bills, and killed my back.  I had to do something.  So I remembered my friend's offer and pushed for more information.  It wasn't up to her, but the company she worked for to hire me, so I started sending in messages, praying I would get chosen.  Eventually, that is exactly what happened.  One of the selling points I was told was my vast array of experiences.  In the job I would be entering, it would definitely come in handy.
  So the time came for me to begin a career again, and this time it was one I was very excited about, and once again found myself in love with my job.  I worked at that initial facility, a 600-bed detention facility for 3 months.  Then came another offer.  To change detention facilities.  The company that I work for is a contract company and has contracts for the medical departments of many jails, large and small.  The offer of the new facility would put me with half the traveling distance to work, 20 minutes versus the 40 minutes that I had been traveling daily.  It would take me off of 12-hr night shift to Monday-Friday 8:00-4:30.  It would put me by myself as the one-woman show of the medical department over a 120-bed jail.  I made the change, starting living in the daylight again, and found myself at home in jail.  I have been here now a year and a half, and boy, the stories I could tell you ... haha
  And so began THUGville ...