Shot Her in the Mouth

I was standing with my cellmate as we were both asking for a job. The officer we would be working for asked our charges. My cellmate said, "murder". The officer laughed and said, "Really, what are you in for?" He replied, "My girlfriend got lippy so I shot her in the mouth." The officer pulled him up on her computer and indeed, he was arrested for murder and convicted of manslaughter.  She didn't hire him.
On our way back home, he confided in me that he found out his girlfriend had AIDS and probably gave it to him since they were having sex and she never disclosed. So during the angry confrontation he pulled out the gun he had brought and indeed shot her in the mouth.
This is the ignorance and fear that surrounds us.

Missed Meds/Proper Storage

On the streets its pounded into you, "treatment compliance, treatment compliance, treatment compliance"! You can forget about that when incarcerated. When you are first booked, you"ll miss 24-48 hours of meds. Every time you change institutions (move from jail to prison intake, intake to prison facility you'll spend your time at) there will be another 24-48 hours without meds.
I have yet to see meds refrigerated. My ritanovir is KOP and I don't have a fridge. The meds at pill call are in a rolling box in pre-printed bags. The same bags I would have in KOP but they hold them for watch swallow in in rolling cart, NOT refrigerated. In the summer months, I will bring up the issue...stay tuned.

Comments and Questions Welcome

The author hopes you all are enjoying the blog so far. He has found it very therapeutic to tell his story and hopefully help some others. He would like some feedback from you on topic suggestions, questions for him, comments on the blog, or anything else. They will be forwarded to him and he will reply in a future post. We will continue to post about twice per week so check back often, subscribe and tell your friends.

Thank you!

Death Stories

While in the hospital, two officers sat in my room with me the entire time, even though I was chained to the bed.  On one evening, a couple officers stopped by to have a chit chat with the ones in my room. My officer detail was fully aware of my terminal issues, as they were there the entire time, even when I had discussions with doctors and nurses. The idle chit chat eventually turned to their stories of hospital visits by inmates that resulted in death.  I don’t know it was that they are used to ignoring inmates in the bed, or if they just didn’t care, but they began a morbid competition of telling death stories about inmates: ones that died in their cells or died in a yard awaiting medical attention or in and ambulance that took too long to arrive.  They weren’t shy about stating that the deaths were frequently due to lack of quick medical response. They showed an aggressive indifference. Their stories and attitude brought me to tears in my hospital bed. My tears were as invisible to them as I was.

ER visit

  After being in prison only a week I got pneumonia, possibly from all the missed days of meds from county jail onward. When health issues can’t be handled in the prison health unit you are then taken to a hospital.  I was taken in shackles to a regular hospital with several inmates that also needed to go that day. This particular hospital had a prison entrance, but regular hospital nurses saw us. On the day I went to the ER, the four of us inmates were sat down on chairs next to each other and triaged openly in front of every body. That meant a review of medical history, chronic issues, medications and current issues. I quickly recognized what was happening, so I reached over with my finger and pointed to “HIV/AIDS” and said, “I have had chronic issues for 20 years” and again made eye contact. She got the hint and never said the words. You have to make your confidentiality requirements known.  Be smart and quick on your feet. Never assume they will protect your privacy.

Get it in writing and get there first

After not getting a pass or called for pill call for a couple days, I went to pill call on my own. I waited in line and when I got to the window I asked in front of everybody in line, “I’ve been here 2 days, do you have meds for me?” She responded, “What pills do you take?” I wasn’t going to call out my meds in front of everybody so I said, “I don’t have the names with me, i’ll come back.” I then sent a note requested that my meds be ready so I don’t need to name them publicly. The response came back, “I did not ask you to name your meds”. I knew then that prisons are very wary about what they put in writing. That made me cognizant of the fact that I need to get as much in writing and documented as possible.

In some living situations you have privacy like one man cells or a lockable foot locker. I was in one of these situations at one point so I decided to get KOP meds, that way I didn’t have to wait in the long pill call lines twice a day. One day we had a “shakedown”. This is where officers search living areas for weapons, drugs, stolen personal property, etc. During these searches your “house” is turned upside down. Your persona electronics (TV, radio, electric razor, etc.) are all yours and listen in your property file AND a nurse is there to verify that meds found are current and in your file. To make it easier for the nurses, the searching officers put all of the meds in plain view so they can easily go from bed to bed more quickly.

Inmates are not in the living area during the searches and in many cases, all inmates are places in the rec yard or day room.  When we were allowed to return to the bed areas, there were all the meds, laid out for all to see who pass your area before you get to it. NO concern for confidentiality. None. Wouldn’t it be easy place meds under pillow or mattress? So it’s a good idea to get back to the living area first.

Pill Call

When incarcerated ,medications are given out in 2 ways: “Watch Swallow” and “KOP: Keep on Person”. Watch swallow is where your medications are brought to you cell or housing unit and placed in your hand every time you are scheduled for a dose. In many cases you will be required to have water with you and take the pills in front of staff.  KOP is where you are given a monthly or weekly supply of your meds to keep with you in your living area. Recreational drug use is very popular in jails and prisons. Inmates are eager to see what pills you are getting, as they may want to buy them from you or steal them to get high. Keeping your meds confidential and safe is important and can be challenging. If you don’t want to keep bags of meds on your person, ask medical staff to change you to “watch swallow” and don’t be shy to tell them why. Confidentiality should be their issue too. You can also have some meds KOP and some watch swallow. Work with unit medical staff and always be humble and pleasant.

While in a crowded 12-man cell in the intake center, the pill call nurse came to the door and called my name. In front of everybody, she handed me six bags of pills and said, “here’s your week’s KOP meds”. Knowing that everyone in the cell was watching me, I purposely stared hard in her eyes and nicely said, “these may not be mine, mine are watch swallow, can you re-check and get me next pill call?” Then I gently forced the meds in her direction. I think she go the hint but immediately followed up with a note requesting my meds as “watch swallow” in order to maintain confidentiality. It worked out well. I thank that nurse. There are eyes everywhere in prison and everything you do, everything, will follow you.

Agressive Treatment Participation and Prepardness

Having HIV for over 20 years has allowed me to see the growth of patient knowledge and treatment participation, setting an example for others. Educating yourself about your disease, staying up to date and aggressively participating in your treatment plan is vital. Aggressive participation includes complete pill compliance, showing up for all appointments and labs and keeping copies of important records and results at home.

Being an active participant will serve you well in many situations. Medical emergencies can happen while away from home such as cruises, vacations and work travel. If you find yourself in the unfortunate situation of being incarcerated, knowing your medical information is vital.  When you are being interviewed by jail or prison medical staff, you will need to have exact medical names for meds, dosages, recent lab results, secondary illnesses, your primary care physician and specialists' contact information. Prison and jail staff will not make any effort to track down info for you. You need to make sure all of your chronic issues are listed from the get-go in your file. Jails and prisons avoid new diagnosis' because diagnosis requires treatment and treatment is expensive. They save dollars by avoiding or prolonging diagnoses.

If you have the luxury of knowing in advance you may be heading to a period of incarceration, take advantage of it.  Take care of your eyes by getting any prescription eyewear (transition lenses are a good idea), dental for sure and of course update and chronicle all your chronic issues. If you find yourself surprised by incarceration, hopefully you have been active and up to date with all your medical and dental needs. Providing medical treatment is very expensive for them so supplying them with your medical info from the start will help you a lot. Prisons and jails avoid diagnosing any new issues and are slow with treating chronic ones. Always be polite, humble, thankful and informed. Pick your battles. Understand the term, “community standard of care”. Know your grievance system. Document EVERYTHING. Save your copies of “Health Needs Requests” or whatever health care requests are called in you unit. Have the contact info for a “Med Mal” medical malpractice attorney. 
If needed, family, friends and attorneys can hold on to copies of your medical files at home and mail to facility.  If the mail room at the facility tries to block it from coming in, have your attorney send it in "Legal Mail". Legal mail is protected and cant be read or reviewed by jail or prison staff.  The legal mail system is invaluable. Legal Mail is an envelope addressed to you with your attorney's return address on the outside AND when opened and casually flipped through does not contain contraband (i.e. inappropriate photos). Medical files are legal mail allowable.Keep family and friends involved as outside pressure helps. Remember, HIV/AIDS treatment often involves newest cutting edge treatments but that is NOT community standard of care, which is often 1-2 years behind and sometimes never catches up. Get ready for bare bones medical response. I say “response” because often, prison and jails do little prevention and mostly response…slow response.