It was just another day practicing medicine in a maximum-security prison. Not all that different from private practice, but my patients are, on the average, more polite. I was perusing my schedule for the day, and seeing the same old same old: Follow-up hepatitis C; follow-up diabetes; follow-up heart disease; follow-up Hep C, diabetes, & heart disease and wants stronger pain medicine; assaulted another inmate in the fist with his teeth; wants a sports bra (really, it was a guy).
When I got to the one that said “wants to discuss asthma” I figured it was a no-brainer. Then I read the note in the chart. The young man (18, I think) wanted to be pronounced free of asthma so he could go to boot camp. Boot camp is an intensive military-style training and rehab regimen reserved for those young offenders deemed “potentially more salvageable” and whom perhaps shouldn’t be exposed to some of the senior criminal element. It shortens the sentence time, and is generally considered desirable. It is also not permitted for anyone with a history of the disease of asthma.
I won’t try to defend the policy of excluding anyone who ever was diagnosed with asthma. The bureaucracy put it in place after someone who had a history of mild intermittent asthma died in boot camp, from an attack. The guy hadn’t had an attack in years, and didn’t keep an inhaler with him anymore. He died, and they made the policy. No more asthmatics in boot camp, no matter how mild their disease.
So I look at the chart. Two and a half years earlier, the kid had been in juvie hall, for some unspecified crime (I generally don’t bother looking into their crimes). His very first visit to the Corrections health system during that incarceration had been for complaints of cough and shortness of breath, and he gave a history at the time as having had asthma. Wheezes in the lungs and reduced lung peak flows were duly noted by the doc, who prescribed anti-asthma inhalation treatments, which promptly cleared his symptoms, his wheezes, and improved his peak flows. He’s treated for asthma appropriately for the next 6 months, with notes being made that he’s under good control. Then he stops using his inhaler, and does ok for his remaining year in juvie hall.
Now he’s all growed up, and admitted to Adult Prison. For a new offense. And he’s just found out he can’t go to Boot camp with asthma. He starts the discussion by saying that his asthma hasn’t bothered him in years and years! I say sorry, but it’s documented you have it. Noone with a history of asthma goes to camp. Even if it’s gone now. Then he backpedals a bit, and says that he never had asthma at all, someone just put it in his record! When I point out that he himself checked “asthma history” on his admission health screen years ago, he changes his story and says he just put that down because he thought if he said he had asthma, they’d feel sorry for him and let him out sooner, but he never really had asthma.
So I ask about the documentation in the chart of treating him for it, and he gets really pissed! “That’s just what they said about me! I’m telling the truth! Why do I always get disbelieved? They could have been lying too, you know!” I pointed out that his past and current circumstances tended to undermine his credibility, so he shifted tactics again, and told about the death of his father, and his dying mother, and how he’d seen the light, and how he deserved this chance to do this and make changes!
Well, I asked some pertinent questions, and examined him and did all that doctorly stuff, and told him that it appeared his asthma was not active at present, but it was well documented that he’d had it in the past, and that was something I couldn’t change.
Then he began to allude to how good his lawyer was, at least as good as Johnnie Cochran, and did I want that kind of lawyer after me? If I didn’t play ball and send him to boot camp, he’d sic him on me! I pointed out that the state had lots of lawyers to take care of that end of the business, and he could point his lawyer anywhere he felt the lawyer needed pointing. Besides, if his lawyer was as good as Johnnie Cochran, what was he doing in prison? And furthermore, what I said didn’t matter, his diagnosis was clearly spelled out in his medical record, and that was what any decision would be based on.
At that point I saw his slick nature take over completely. He’d been 80% con man, 20% sincerity before, but now it was 100% criminal mind at work. “You mean that’s the only place where it says anything about my asthma, in my record? You could change that for me!” “What do you mean?” “Change my record! Take out all that stuff about my asthma! Do that for me!” “Why would I do that?” “So’s I can go to boot camp and get out of this fucking prison! Just do it!”
This was the first time an inmate tried to make me overtly complicit in unethical behavior. In the past they’ve tried to wheedle stuff out of me, making stuff up and faking symptoms, and playing on sympathy, etc. Never before had one come right out and told me they wanted me to violate rules and laws for their benefit, however. I was pissed.
“Get out. Leave now!” “What?” “leave this office.” “why?” “Don’t say another word, or I’ll do my best to see that you spend the next month in solitary confinement. Go. Go now. Goodbye!”
So he left, and I wrote it up in his chart, but not in a conduct report. I may yet regret that, I may not. We’ll see. But as I’ve pondered the whole thing, running it over in my mind, I realize just how big a narcissist the kid is, and also what pissed me off the most: He’d tried to get me to pity him, he’d tried to intimidate and threaten me with his lawyer, but he never did try to bribe me!!! Turkey. Of course I frankly can’t conceive of him having anything I’d want, much less be willing to compromise myself for, but good grief, kid! And he thinks he’s a player.