A man was put in prison in 2000 something, I don’t know why, didn’t ask.
He was transferred to my surgical service. It goes like this:
I get a page saying to call the transfer center at the hospital. It’s an ER 45 miles away. The doctor there has a patient who has a bowel obstruction – imagine a kink in a hose, an important hose – and no surgeon. He wants to transfer to the nearest surgeon, me. I say yes.
My patient is 55 year old, HIV positive,a prisoner with a hernia (a hole in the muscular wall of his abdomen, acquired through a previous medical disaster.) It has been that way for years, but he is in prison and the cantaloupe shaped mass protruding from him has not warranted…anything. Until now, because the bowel going into the hernia is now obstructed.
(Bowel obstruction: we are built like donuts with a long tube running through the middle of us. This tube starts at the mouth. You know where it ends. If the tube, which makes the “hole” of the donut, gets twisted, it is a mechanical problem and you will be looking for a human mechanic, like me. I know. It’s a weird job. Should probably be on “Dirty Jobs” sometime.)
Jim is my patient. He is rail thin starting at his nose and never ending. He looks like a rag that has been wrung out twice and thrown down. He is pleasant and kind to me. The pain of having the intestines twisted is unique. You can imagine it if you try.
When I examined him, besides the general issue of complete dehydration, institutionalized neglect and fear, it was clear that the cantaloupe-sized mass on his abdominal wall was the problem. It is not brain surgery, general surgery. He was in pain, so I gave him drugs, which helped. I imagined him bathing at the prison which is not a place one wants to look one’s best; but the shame of it fell down on me like the shower curtain they don’t have. Day in and out and in and out. I thought of my brother…
I took Jim to surgery shortly after meeting him. The liquid in his bowels had backed up to his mouth and when we put him under anesthesia, that liquid went straight in to his lungs. He immediately became very sick and the bacteria in that fluid caused his blood to stop clotting. This is not something surgeons like, uncooperative blood. It needs to clot, especially in a HIV positive patient. It is scary to work in that crimson, unclotting and living bath. I worked as fast as I could, removing the thinned out skin that barely stretched over the mass, freeing the bowel up, placing a patch over the hole in his abdominal and moving skin around to close him. My assistant got stuck with a needle. The risk for him to acquire the AIDS virus is less than 0.03%. It feels like a thousand percent. We will know for sure in six months. Six.
Jim was sick for days and then he slowly got better. Everyday I would come in to his room and even though he was incapacitated completely, a guard sat by his bedside not keeping vigil. She, or he, just watched, and kept her distance, and made sure the shackles were secure to the frame of the bed. No one was going anywhere, and again, I thought of my brother.
He may be, someday, in need of someone, something. He sits in a Texas prison, by his own doing, by the undoing of his damaged mind. I am, today, my brother’s doctor. I am his doctor through Jim. For my beloved and lost brother, I give, Jim. He is all sewn up and right as rain. He was proud of his new flat abdominal wall. I kept him an extra day beyond what he needed…for the TV and the window. I will make the prison bring him back to my office for appointments for as long as necessary and then some so he can look out the window of the driving car, so he can feel my hands on him without threat; so he can be touched.