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The head of Healthcare arrived, greeting me with a friendly smile and a handshake. I hadn’t seen Dawn Kendall since my interview, six months previously – the process of getting security clearance and having contracts drawn up for the job had taken that long.
She had a clipboard in one hand and a large set of keys in the other, which clinked as she rolled them between her fingers. She looked like she meant business, with her black trouser suit and white blouse.
I was given a locker in which to store my phone, bag and coat, then she unlocked another large solid metal door, and I followed her through. That was locked behind us, the sound heavy and horribly final. A large metal gate followed; again keys jangled, locks turned. Then – finally – we were in the prison grounds.
‘Once you have your key training you’ll be able to do this yourself.’
She turned around and grinned at me. ‘But for now, you’re stuck with me escorting you.’
I’d liked Dawn from the moment I met her. She was a large lady with a big personality to match. I got the sense she wanted to mother the boys because, somewhere, deep down, I’m sure she felt sorry for them.
I believed that most of the staff genuinely wanted to make a difference, and I hoped I was also going to be able to.
We walked across the courtyard, then through another metal door and another gate, and finally we were in the Healthcare department of the prison.
The walls were brightly coloured and there were a variety of drawings and paintings stuck on them. ‘All done by the boys,’ Dawn proudly announced.
She walked briskly ahead, filling me in on some facts that belied the innocent-looking appearance of the place.
‘Huntercombe is home to 360 of the country’s most troubled teenagers. Sadly, many of the kids inside here have come from troubled families. Violence is all they’ve known.’
We turned a corner and I skipped to keep up.
‘The UK has the most juveniles locked up behind bars in Europe. This age group, 15–18-year-olds, has the worst reoffending rate of all: 82 percent are likely to commit another crime within two years of being released.
‘You’re not shocked easily are you, Amanda?’ she asked as she unlocked the door to the clinical room.
I shook my head.
‘Good, because these boys can be rude, they can be aggressive, particularly when they don’t get the medication they want.
‘Some of them will have had drug addictions, and will want you to prescribe them strong painkillers and sleeping pills. These need to be avoided at all costs; they’re highly addictive and can sometimes be used as currency, to trade for cigarettes or items of clothing. Some of the boys can also be bullied, attacked for them. Drugs are a commodity here; we need to be careful.’
In the twenty years I’d worked as a GP I’d only looked after one patient who was addicted to any medication. My experience wasn’t going to be much use to me. I had so much to learn.
The Healthcare department was where the prison GPs ran their clinics, alongside other healthcare professionals, including the dentist, psychiatrist, optician and GUM consultant – a doctor specialising in sexual health.
Dawn informed me that there were a lot of self-harmers in Huntercombe, and to prepare myself for seeing some horrific scars and shocking wounds.
She sighed. ‘It’s very sad, but often it’s an outlet for these boys. They are lonely, depressed, some just want to die. They turn to self-harming as a way of offsetting the pain and stress they’re feeling inside their heads.
‘A lot of these lads don’t want anyone to see their wounds, or the scars from cigarette burns, the scalds made with boiling water.’
I felt a huge pang of pity. It was awful to think boys the same age as my sons felt so desperate and helpless that they needed to self-harm in such a way. No one should suffer like that.
Again, I hadn’t seen many patients who self-harmed while I worked at my surgery. More to learn.
I wouldn’t be dealing directly with mental-health issues; they would be handled by the psychiatrist. However, I might have to tend to their wounds, particularly if they had become infected and needed antibiotics. I might also have to represcribe antidepressants if the psychiatrist wasn’t in.
I had been expecting to deal with the common complaints that teenagers usually present with, such as acne, asthma, skin infections and rashes, etc – conditions I’d seen hundreds of times over the years in my old practice. But now the type of patient would be very different.
A couple of nurses were popping in and out of rooms along the corridor, and Dawn called them over to introduce me. I was given a lovely warm welcome by both.
‘The turnover rate of doctors is high in prisons,’ Dawn explained, ‘so everyone is hoping you’ll stay with us. We need some consistency here.
‘Apparently, working with the 18-to-21 age group can be the most challenging of all. They’re the most notoriously difficult. Too much testosterone in too confined an area. They’re always fighting, with each other mostly, but sometimes with the prison officers as well.
‘That’s why I like working here.’ She stopped outside a pale green painted door. ‘Despite the government statistics on reoffenders, I feel like we still have a chance with boys this age, to help put them on the right path in life.’
Dawn unlocked the door and pushed it open.
‘And this is where you will be working.’ She stood back to let me pass.
It was a far cry from what I was used to, but it wasn’t as bad as I had expected. It was small, clean, and had the essentials. There was a desk and shelves, all compact and well designed, as if it had come straight out of IKEA. There was also an examination couch on the other side of the room, with blue tissue paper placed on top, ready for my first patient.
The lovely thing about the little room though, was that there was a window – even if there were big metal bars in front of it! I wasn’t expecting to have natural sunlight, so although the view wasn’t up to much I was grateful. I peered out on to the tarmac yard outside.
‘Can get a bit noisy when the boys are walking across the yard,’ said Dawn. ‘Silence is a luxury in this place!’
She was standing on the opposite side of the room, stroking her top lip with her forefinger as she tried to remember any details she may have forgotten. I had so many questions but I decided it was better to just get on with the job and save them for later. It seemed to me that this was the kind of place that you learn as you go along; sink or swim.
‘A nurse will run the clinic with you, she will let the boys in and out and tend to all the minor things through there.’ Dawn pointed to an adjoining room.
‘Ah speak of the devil.’ Dawn took a step backwards to make way for a petite, pretty lady, in her early sixties, wearing blue trousers and a long blue tunic top. A biro was peeping out of the top of her breast pocket.
She may have been five foot nothing, but I could tell I wouldn’t want to get on her wrong side. Nobody would. She had an authoritative air about her.
Dawn introduced her.
‘Amanda, this is Wendy – or Matron, as the boys like to call her.’
Wendy stared up at me through her thick dark fringe. She had a blunt bob cut which was striped with grey hairs. Her face was stern, but she had kind eyes.
‘Wendy must be one of our longest-serving staff. Thirty years now.’
‘Thirty-two next May,’ Wendy corrected her, as she busied about doing her things, darting in and out of the room.
‘If you have any questions, she’ll be able to help you.’
Just as Dawn was leaving, she spun around and looked me straight in the eye. Her voice was hard now.
‘One last thing. Make sure you do not reveal anything personal about yourself to the boys. Keep where you live, any details of your family, private.’
The words were chilling.
I nodded obediently.
‘It’s not permitted for any prison or medical staff to have any sort of communication with inmates after their release.’
I nodded again. Things suddenly seemed to get a lot more serious. I’d been so used to being entwined in my patients’ lives at the surgery. I had followed their journeys over the years, visited them at their homes, watched their lives evolve. This was a completely different way of approaching medicine. I would be seeing prisoners in my clinic who I might never see again.
Dawn softened as she saw my flash of concern. ‘You’ll be fine. It’ll be a challenge.’
With that, she disappeared along the corridor.
*
My thoughts were interrupted by a thud on my desk. I looked up to see Wendy had given me a large plastic box of files. Inside were orange A4 folders, of varying thickness, each marked with a number – the prison number of the boys I would be seeing that morning. It was wrong to make the assumption that the thicker files would be the more demanding patients, but from everything I’d heard that morning, I couldn’t help but jump to that conclusion.
‘Doesn’t make for light reading,’ Wendy grimaced. ‘And here’s the list of boys you will be seeing.’ She placed a sheet of paper on the desk.
‘Thank you,’ I smiled, grateful for her help. I knew I could do with having Wendy on my side.
She carried on whizzing back and forth between rooms, making the final preparations. I glanced at my watch.
‘What happens now?’ I asked, as she reappeared.
Wendy explained that the officers from the various wings were collecting the boys, who had either put in a request to see me, or who one of the nurses had decided needed to be seen.
‘They then wait in the communal area until I call them in,’ she explained.
I peered out of the door to look at the waiting area, which had approximately twenty plastic chairs set out in neat rows.
‘Everything is plastic here,’ Wendy explained. ‘From the chairs to the cutlery.’
‘Oh?’
‘To try to prevent them from self-harming,’ she said.
And again, I was forced to face the reality that some of these young people felt so desperate that harming themselves seemed the only escape.
‘You’d better get set up, they’ll be arriving any minute.’ Wendy nodded, and left the office again.
I returned to my desk and glanced over the names of the boys I was about to see. What had they done? I couldn’t know about their crimes, that was a detail not recorded on their medical notes. Besides, I would have hoped that knowing about the severity of their crimes wouldn’t have affected my ability to help them. Yes, I would hope that . . . but it was a relief not to have to prove as much. Who were they? What were they coming to see me for? Of course, it was no different to any new patient, not really . . .
By the time I’d read to the end of the list, the noise from the waiting room had swelled into loud chatter and raucous laughter.
An authoritative voice bellowed, ‘Oi, keep it down in here!’ That must have been the prison officer in the waiting room.
Which only led to more sniggers.
And to the prison officer becoming even more irate.
‘Keep it down in here, I said!’ he shouted, banging his fist on the door.
‘Ah, you can fuck off an’ all!’ came the reply.
Then, in a flash, chairs were screeching across the floor, more shouting, more swearing, scuffling, threats, then silence.
I nearly jumped out of my skin when Wendy knocked on my door.
‘That’s what happens if you put a bunch of rowdy teenagers in a small room together,’ she said, poking her head inside and rolling her eyes. ‘I’ve got Jerome Scott here.’
I pulled Jerome’s file from the plastic box. It was as thick as a book.
‘Come in!’ I called out.
I prepared myself to meet my first patient in prison.
Chapter Five (#ulink_21f8374a-ca55-5295-bd93-6773b27c30ac)
Jerome was tall, skinny, and wore his grey prison tracksuit bottoms low enough to show off his boxer shorts. He was pale, spotty and had a diamanté stud in both ears. His hair was shaved along the sides and spiked with gel on top. He looked like every other teenager who had spent too many hours indoors playing video games.
It was only his eyes that told a different story. They were bloodshot, puffy, hollowed out by the shadowy purple circles underneath. He looked as if he hadn’t slept in months, and I prepared myself for his request for sleeping tablets.
‘Come on in, take a seat.’ I welcomed the teenager in the usual friendly manner I’d always greeted my patients with, in my old surgery.
Jerome swaggered across the room and slumped into the chair opposite. He automatically slipped into a slouch with his left leg outstretched and his right elbow hooked over the top of the chair.
‘How can I help you?’ I asked, leafing through his most recent medical notes to familiarise myself. Antidepressants, medication for anxiety. Bruising to ribs and left cheek and cuts to forehead, following a fight with his cellmate. I looked up to check how well the wounds on his face had healed.
‘It’s my feet, Miss.’
I was taken aback a little. After such a build-up, and a complex history, I wasn’t expecting such a seemingly minor complaint.
‘Oh dear. What’s wrong with your feet?’
‘They hurt when I walk. It’s these shoes, innit.’
Jerome lifted one of his black trainers into the air, which I assumed must be part of the prison uniform. He then returned to his slouch and started biting his nails, or the little bits of nail he had left. I noticed a tattoo of a snake wrapped around a sword on his left wrist, the tip of the blade peeping out from under the cuff of his jumper.
‘What sort of pain are you feeling, and whereabouts on your feet?’ I could believe those shoes weren’t the most comfortable.
‘I’ve got blisters everywhere, Miss. I can barely walk, it’s so painful. I can’t be doing with these trainers.’
It was strange to be called Miss, but I suppose Jerome saw me as an authoritative figure, like a teacher – unlike my previous patients who, on the whole, had viewed me as a friend. Did I want that responsibility? Could I take it?
I moved around to the other side of the desk to take a closer look, asking Jerome to remove his socks and shoes. He waved his slightly smelly bare foot in the air to reveal the tiniest of blisters on his right heel.
His eyes looked sheepishly to the ground.
‘It’s killing me. I can barely walk!’
He didn’t seem to have any problems swaggering into my office a moment ago, I thought. I started to wonder if there was a bit more to his complaint.
‘Why don’t you pop next door, and the nurse can give you some plasters for your blisters.’
The words had barely left my mouth when Jerome fired back with his own diagnosis and cure.
