Quick! Name a book that describes the experience of being a medical professional in a jail or prison! . . . Can’t do it, can you? There are lots of books that talk about the life of a lawyer or a doctor in general. There are books about prison inmates and even correctional officers. But, to my knowledge, no one has ever written a book describing the experience of working as a physician in a jail or prison. Maximum Insecurity: A Doctor in the Supermax fills that void. This is a wonderful book, written by Dr. William Wright, about his experiences providing medical care to inmates in the Colorado State Penitentiary maximum-security prison. And not only is this the first memoir I am aware of written about correctional medicine, Maximum Insecurity is also a gem–funny, informative and engrossing.
As most of us have, Dr. Wright came to correctional medicine from another career. He had retired after working for 30 years as an ENT surgeon, but then, like many newly retired doctors (I know a few like this, myself), he got bored. He stumbled across an ad looking for a doctor to work in Colorado’s maximum-security prison. Dr. Wright thought this might be an interesting challenge. His wife thought he was nuts. But nine years later, he is still in corrections and has written this fine memoir of his experiences.
Maximum Insecurity begins with an account of the “culture shock” that all of us in corrections have experienced when we first become acquainted with the strange world of a prison. There are clanging doors, blaring speakers, and the rules of security. There is also the introduction to dangerous inmates as when Dr. Wright heard this from a five-time murderer: “You scared, ain’t you doc? You should be. I be the baddest man you ever see.” And there is the dawning realization that correctional medicine is different . . . and the same.
“I figured that my background as a surgical specialist would come in handy with prison medicine. I’d seen the shows. Knifings. Shootings. Beatings on every hand. A wonderland for a trauma surgeon. What I found was a kind of third-world general practice. High cholesterol. Stomach aches. Back pain. Asthma. High blood pressure. It hadn’t occurred to me that these tough, battle-hardened criminals might also have regular human diseases.”
Dr. Wright discusses the unique nature of working with incarcerated inmates that the rest of us understand so well, such as trying to examine the nether regions of an inmate who must remain shackled for safety under the watchful gaze of the accompanying correctional officer–who happens to be female. He has a section discussing the pros and cons of free medical care versus having a $3.00 inmate co-pay—including the strategies that inmates use to avoid the co-pay. Dr. Wright hits other correctional high points as well, like dealing with requests (and demands) for extra mattresses and special shoes, inmate legal scholars, cheeking and the surprising medications that can be abused behind bars: “I had to look at a sudden outbreak of urinary retention in twenty-year olds with some skepticism.” There are sections on the various manifestations of hunger strikes as well as the “swallower” phenomenon—those inmates who will swallow anything, like pencils and sporks, and how hard it is to stop them.
Dr. Wright is a surprisingly good writer. I laughed out loud several times, such as when he describes a particular patient as “a murderer and sometime preacher of the gospel” and when he describes the grievance process thus: “if a kite is a derringer of annoyance, a grievance is a howitzer of outrage.” Or when he talks about this universal correctional truth: “If there’s one thing that’s endemic at the supermax, it’s constipation.” This is good enough stuff that I read several of the more entertaining stories to my wife after she asked me what in the heck I was laughing about.
Besides this, Maximum Insecurity also has several chapters devoted to non-medical aspects of prison life. These include an interesting discussion of various prison gangs, contraband smuggling techniques, a history of executions in Colorado, and the hard life of a Correctional Officer. Dr. Wright has not missed much, from suicides to the epidemic of hepatitis C to successful prison escapes. I thought I knew correctional medicine pretty well, but I learned quite a lot.
Unfortunately, Maximum Insecurity may be unlikely to attract medical students to work for the Colorado penal system because Dr. Wright wonderfully conveys the frustrations of working in a mind-numbing bureaucracy. This includes being second-guessed and critiqued by non-medically trained supervisors, barely functioning computer systems and scratch-your-head illogical rules, like the one banning the reading of books during down-time between patients. No wonder the Colorado prisons are, as Dr. Wright says, “chronically short-staffed,” especially with physicians.
I recommend Maximum Insecurity highly. I hope that it will encourage others of us to write our own memoirs about our experiences working in corrections. I would like to read a similar book about prison psychiatry, something Dr. Wright does not mention. Jails are an entirely different environment, who’s going to write the first jail medicine memoir? What about correctional nursing? Juvenile facilities? Maximum Insecurity is a great start.
Maximum Insecurity: A Doctor in the Supermax will soon be available for purchase on Amazon.com. However, Dr. Wright is offering a free advance copy of his book in PDF format to readers of Jail Medicine! Just write in comments that you would like to read Maximum Insecurity, and we will send you a link to the book via email!