Twelve Patients: Life and Death at Bellevue Hospital (3 page)

The technician would fasten the plastic gridded molded mask over his face and screw it into the table. His throat was burned raw by the radiation treatments. Two circles of hair loss on the back of his head marked the radiation fields. To relax him during the procedure, a nurse injected him with Ativan, a sedative to take the edge off the anxiety and discomfort of being locked down on a metal table with stomach acid lapping up his esophagus, the nausea from the chemotherapy
threatening spontaneous spasmodic vomiting. His stomach tube dangled down the table, almost touching the floor.

Very few people in the United States know that the largest penitentiary system in the country is in New York City. For most, Rikers Island exists simply as a TV set. Only the guards who go there and the prisoners and their families have a clue about the scale and operational routines of the place. There are eleven prisons on Rikers, an island about the size of Central Park, a short distance from the takeoff corridors of LaGuardia Airport. The only access is by a bridge from Queens that is heavily controlled by the Corrections Department. Family members, lawyers, guards, and prisoners are ferried back and forth in vans and buses to the eleven prisons, infirmaries, and miscellaneous outposts on the island where thousands of people are warehoused out of society’s view. There is a supermax prison for the extremely predatory and violent prisoners, a prison for women with room for their infants (if the women have the capacity to care for them), and a prison boat when the census gets extremely high. A smattering of high-value prisoners, such as the corrupt cops and Madoffs of the world, are kept segregated—otherwise, imagine.

The general population of Rikers consists of short-stay prisoners awaiting trial or sentencing, or prisoners sentenced for under a year. Longer terms are served in more than sixty upstate prisons holding more than fifty thousand prisoners, most of them from New York City. The state legislature in Albany has lobbied hard to bring prisons to the poorer rural communities in the northern reaches of the state, providing economic benefits to dying industrial communities. The fact that prisoners are separated from their loved ones and the fragile human ecosystem that sustains them when they finish their time is an “externality,” an unfortunate side effect. It’s an economic and social cost that is not factored into the “benefits” of rural development and keeping society safe thanks to the mass incarceration model. The rotating prison door of re-incarceration is good for certain businesses.

After I reach 19 South, our med-surgery prison unit, it takes me
about ten minutes to make it through the elaborate security apparatus run by the Department of Corrections. Metal detectors, sequential electronic gates, and a Plexiglas-enclosed lookout monitored by several officers dressed in blue uniforms review all incoming and outgoing activity in this hospital prison. I call Patty to tell her that I will now be incommunicado, and then place my cell phone in a mailbox-size locker and pocket the key, supervised by a seated, attentive corrections officer.

“Gate,” I shout. A very large guard approaches slowly and without affect, dangling a huge key in his hand. He lets me into the unit without looking at me—his eyes floating to some invisible place right over my head. When I finally enter, I am really in Corrections’ space. This is not a civilian universe, though we have made an effort to bridge the cultures of medicine and corrections, to achieve a balance of security and a health-supporting environment. As I enter the conference room, Juan Guerra looks up and smiles. He and his twenty-two-year-old son are in deep conversation. His wife, a lively, strong woman, looks worried.

This dingy “conference” room at least offers a modicum of privacy and, most important, some freedom from the constant barrage of noise, the shouting, the bright fluorescent lights, and the call for “gate” that punctuate the air like a slap in the face as nurses, aides, doctors, corrections officers, pharmacy techs, dietitians, therapists, administrators, supervisors, regulators, and wardens make their way in and out of the unit. Still, the windowless room is depressing with its dead color, the echo of metal on metal, the scratched Plexiglas, and the omnipresent guard in the corridor outside.

I am glad to see Guerra looking relatively strong. He is about to get up when he sees me. I urge the family to go on. I pretend to look for something in the chart to give them time to speak.

“The
pandillas
[gangs] are death for you,
m’hijo
. You have to make a choice soon, or it will be made for you.” Guerra waves me into the room, but I step outside the door and signal that he should take his time.

“My friends are who protect me,” his son says.

“That type of protection is a death trap.”

“Without them I am dead.”

“Then you will go to the DR this week and stay with Tio Juanito,” Guerra’s wife interjects. “We used to leave Santo Domingo to avoid Trujillo and his butchers, now I have to send my son home to avoid the gangs here.”

“Tio Juan’s is bullshit. I am too old for horseback riding and cleaning the stables and driving a tractor.”

“When I was your age it was the Lords or the army,” Guerra says.

“So what are you saying?”

“I am saying, Javie, that for you it is the same choice.”

Javie laughs. “The army will save me? Look at you!”

“Learn from me. You go in, you enlist and choose carefully who you hang with, and you stay away from drugs—nothing in the vein, up the nose, nothing. You do that and the odds shift right away.”

I sense a pause and lean my head back in the room. Javie looks at me straight in the eyes without anger or hostility. He knows I am on his father’s side. After decades of being in and out of the system, Guerra has learned to use his smarts and humor to get people to help him. He is not completely powerless, even though he has cancer and is in prison. He is trying to teach his son to survive in what suddenly strikes me as a nearly hopeless situation.

Guerra stands up, a bit shaky, and introduces me to his family as the “
mero mero
” or
the
man who would help explain his treatments. We shake hands and trade the
bachata
CDs we’ve both brought, the rhythmically contagious music from the Dominican Republic. In fact, Juan Guerra and I like to joke about his
tocayo
or namesake, Juan Luis Guerra, one of the most popular
bachateros
in the world, who sells out Madison Square Garden in an hour.

Juan Guerra’s family has visited him in jails and prisons from New York City to the upper reaches of New York State near the Canadian border. They have sustained him and, in a way that is not immediately obvious, he has sustained them. I lay it out slowly and carefully, what to expect from the chemo, the radiation, the fatigue, the pain medications, and so on, taking a lot of time for questions, drawing diagrams
and a time frame on pages ripped out of my black-flecked notebook. The treatment will take another two months, and the recuperation another four months after that. To return to a sense of well-being takes at least a year—really two years. During that time, quarterly surveillance in the form of PET scans will determine his future (or if he will have one). The disease and the treatment will test the whole family’s limits—they will need as much backup from family and friends as they can muster.

Guerra blocks me when he thinks I am saying too much. It’s interesting because I thought he hadn’t been paying too much attention, but he has taken in everything and has been weighing it against what his wife and son can handle. I am struck by his subtle calibration of his family’s ability to handle stress in its protean forms.

For years, I had been at the tail end of discussions about compassionate release for terminal prisoners, those who were so ravaged by disease that they posed no threat to society regardless of their crime. Guerra, who had never committed a violent felony and was struggling against a life-threatening disease, was a good candidate for release.

Humanity dictated that people like him could and should spend their last days with their families. The hard-line punitive thirty-year-plus political environment demanded time served without mercy. Many patients, unfortunately, had no family left and many families were dysfunctional remnants, incarceration’s other silent victims. For others, this basic social unit proved remarkably durable. Most patients released under the compassion rubric could not walk. Others had progressive neurological diseases and couldn’t breathe without oxygen being forced into their lungs. Most had only a few weeks or a month to go. Still many critics of the humanitarian program clamored for revenge—“Let them rot in prison and die alone!”

But I can’t help but think of the old expression: If one is intent on revenge, one should dig two graves. One for one’s victim and one for oneself.

Why was Guerra still in limbo regarding compassionate release? Yes, he was a recidivist and still addicted to heroin. He had a possible terminal disease with a generous 30-plus percent chance of a cure. It
was all numbers, statistics, and probabilities. The treatment was protracted; if he could complete it, he had a chance. If he could not, then he had no chance and the inexorable growth and expansion of the cancer would kill him in a year max.

We’d filed the papers for compassionate release with the prosecuting attorney, a recent Harvard Law School grad (as she let me know in the first three minutes of our conversation), and we attempted to call her office a dozen times without a response. Finally, I called on connections. The husband of one of my attending physicians was a prosecuting attorney with a bright political future. He was eventually successful in getting his colleague to return my call.

She was tired, grouchy, and clearly did not know much about the case in question. This was not a highlight of her day. The scorecard for her life after the DA’s office was about putting prisoners behind bars, not letting them out. That was her ticket to partnership and a lifetime in elite legal circles. I got that, so I put my argument in terms of not compassion, which would have netted zero results, but rather cost efficiency. Juan Guerra’s care in jail would cost $350,000-plus; he had a wife and son and a stable home situation. I also reassured her that the Guerra case would not come back to haunt her as she moved up professionally. Guerra’s Vietnam War record and the fact that he had no felonies for weapons possession or violent acts of any kind were predictors in his favor.

We still heard nothing for well over a month. During that period I would pop in to talk to Guerra from time to time, to check his neck and mumble reassuring nothings. He was losing weight, losing hair, and, indomitable as he was, beginning to lose hope. He was not angry talking about prison or his life. He did it half laughing and with a partial smile. It was life as he knew it. The prison routines, the judicial system, the court-appointed lawyers, the shitty food, indignities, risks and violence, gangs, protection were all kept in a part of his brain he shared only occasionally. The trick was appearing confident and not vulnerable when he spoke of his life behind bars. This was survival strategy number one. Knowing how to wait. But now, of course, waiting was not a survival strategy. Hope was not a plan.

As I leave the conference room to go back to my office, Budd finds me. “There’s been a glitch,” he says.

“No!” I say, surprising even myself by the tone of surprise in my voice.

“Yes.” Budd’s matter-of-fact tone does not hide his frustration. “Apparently the clerk faxed in the wrong form and the lock-them-all-up-for-life guy in Albany got wind of the release so it’s all touch and go now. We can’t release him without the right document. We’ll have to get the right one signed ASAP if he’s going home.”

“Guerra doesn’t know. Can you stall a bit?”

“Yes, we’ll have to. Let me figure something out.”

“Okay. I’ll be back up later. Call me if you know anything.”

“ ’Kay. Later.”

Getting out of the prison unit is a lot easier and faster than getting in—if you’re a doctor and not a prisoner, of course.

I check in with Patty to learn that the Mexican minister of health has been delayed. I climb the two flights of stairs to the male psychiatric ward to take a look. Some patients sit at the round tables in a large room chatting with the aides, nurses, and doctors or sit quietly by themselves or pace. Coffee and cartons of apple juice and packages of cookies have been handed out, like a break at summer camp. Uniformed guards stand at both entrances. There are about thirty patients, mostly black men, a few whites, and some Hispanics. They are schizophrenic, bipolar, depressed, anxious, suicidal, schizo-affective, and have personality disorders. Many have been abused, many are ex-felons, many have drug problems, some have AIDS, and many have all of the above.

The psych ward brings up a memory of my medical school training years in Brooklyn.

A twelve-year-old had been found in the psychiatry emergency intake room by a clerk, who noted that he had been there for several days sitting in the same chair. The boy was wearing a pull-down gray winter hat and sunglasses. He was brought into the triage area for questioning. When the nurse removed his hat and sunglasses, the bruises around his head—black eyes and a swollen-shut right eye—made it
clear in a microsecond what the issue was. His story emerged in stages over weeks. His mother and her boyfriend would tie him to the steam heating fixture in their apartment. He was fed from two dog bowls on the floor, one for water and one for dog food. He was beaten if he cried and if he didn’t cry. He was whipped and watched this couple smoke crack. His mother would bring up other men for ten dollars. He would whimper and they would beat him. One day they dropped him in front of the hospital. After he was admitted, we fed him ice cream, candy bars, McDonald’s hamburgers, Rice Krispies, and anything else he wanted. Then he was sent to the ACS, Administration for Children’s Services, for disposition to a family that would look after him. That was it.

Today he would be forty-six years old. I was twenty-four when I met him. I have never gotten the image of his baby face out of my mind. Every time I see a bruise, I see his face. Was he in the prison ward? Was he in a unit like this somewhere, having orange juice? Was he alive?