A prisoner's tale: bad medicine.

A large prison complex, like the one in which I was incarcerated until recently in Arizona, has several units, each with its own set of facilities and interior fences. As some inmates are moved from maximum- to medium- and eventually to minimum-security units, they are seen by different doctors for a variety of minor ailments. Those like myself who develop more serious problems are seen by specialists outside the prison after being referred to them by the prison unit doctors. In this way prison health care works like HMOs and other health-care systems that require patients to be seen by a primary caregiver before the system will pay for a visit to the specialist. The cost of the extended care must be approved by the nonmedical staff.

For the most part I have found that the doctors and nurses in the prison units are just as capable and compassionate as those on the outside. But there the comparison ends. My recent experiences with the health care provided by the prison system may well serve as an example of what can be expected from a health-care bureaucracy that treats everyone as just another computer entry.

I spent two-and-a-half years in a maximum-security unit and another year and a half in a medium-security unit before earning my way to a minimum-security unit. When I arrived I had no indication of the cancer developing in my prostate. Prostate cancer rarely shows early symptoms. If I had known, I might have objected to being moved into an old army tent erected in an area originally intended for water run-off.

Shortly after my arrival, a routine blood test and then a biopsy showed up positive for cancer. I quickly learned that a degree in engineering and thirty years of programming computers had not produced an understanding of male anatomy. I was much more familiar with how the internal parts of my computers worked than with the functions of my own body.

Had I declined, or tried to delay the surgery, I would most probably not have had the option later. That's a fact of prison life. So after five years in prison and at the age of fifty-three, I had my prostate removed. When I came back from the hospital I was moved into a dormitory. I thought myself lucky and my problems at an end. Then I came down with the flu, which moved from my head to my chest and then into my abdomen. I developed a whole new set of problems, which I first suspected to be the lingering complications of a staph infection I had acquired in the hospital. What I subsequently went through should not happen to anyone, whether in or out of prison.

My treatment began when the prison doctor, aware that I had been suffering for several weeks, gave me two rounds of antibiotics as well as medication to control the spasms in my bladder. He promised to recommend that I be taken back to see the specialist who performed the surgery. But he could only recommend. Someone at the prison's administrative center must decide when, or even if, an appointment will be made.

Unlike the maximum-security units where the toilet is in the cell you share with another inmate, or the open stalls in some medium-security units where the guards can watch, the stalls in a minimum-security dormitory have ceiling-high partitions. The stalls were the one place you could have any privacy, and I often retreated there to be alone with my medical problems. Unfortunately, the floor of the stalls was usually awash in liquid, making me wonder if some men were afraid to touch their own penises, even to aim. Frequently, the toilets were also full and toilet paper was unavailable. At moments and in surroundings like these, as I squeezed my muscles in a useless effort to urinate normally, I realized once again that I had no more control over my situation than I had over my bladder.

After three weeks, I was moved from the dorm into a room where my bladder problems were not so public. My visits to the bathroom, however, were no more successful. I was hurting enough that I asked for an emergency appointment with the unit doctor. This request was denied twice before I was finally allowed to see him. All he could do was apologize for the delays. A guard then called my name. "Hurry up. You're wanted at the admin center." That was where the specialists came to see inmates referred to them by prison doctors.

After I had waited for two hours, the urologist finally called me into the examination room. He tried to insert a Folly catheter with no success. He then considered what to do next while the nurse waited patiently for instructions. I just lay there half naked - and fully worried. The doctor, still holding the catheter, then said to the nurse, "This man is wearing boxer shorts. Didn't I request that he be given briefs and panty liners?"

The nurse consulted my chart. "His unit doctor ordered them last month." She put the chart down. "But the person at Central Supply who fills their orders has quit."

The doctor shook his head in what I interpreted to be resolute understanding of the prison system. He said, "It's eleven o'clock, can you have him in my uptown office by noon?"

The nurse suppressed a laugh. "No, it will take longer than that to do the paper work. I can get him to the hospital emergency room tonight."

The doctor held up the catheter, which was beginning to look like a garden hose. "Get dressed and go back to your unit," he said. "I'll have you out of here and in my office sometime in the next twenty-four hours. You'll be okay. Drink lots of water and try to urinate as much as you can."

I wished it were that simple.

Back at the unit, I sat in my favorite stall wondering what was going to happen next. Eventually an officer came in looking for me. He said I was going to the hospital for emergency surgery. He sounded concerned. Did he know something I didn't?

I was strip-searched and locked into leg shackles and belly-chain handcuffs for the trip to the hospital. At four that afternoon, a nurse pushed an eight-drawer mechanic's tool chest into my room in the hospital's prison wing. The doctor came in and quickly began selecting philiforms, followers, and catheters of various sizes with which he managed to drain my bladder. He then told me that I'd have to stay in the hospital that night. He would do a TransUrethral-Resection-of-the-Bladder-Neck the next day. The procedure is defined as noninvasive because it does not require cutting the skin. But I wasn't so sure that having what looked like a network TV camera and a plumber's Roto-Rooter shoved up my penis was really noninvasive.

Two days after the procedure I was back in prison. A lot had happened in just over seventy-two hours. I was still feeling a little discomfort, but my urination problems were gone - at least for the moment. The doctor told me that I would have to go back to his office every few weeks for "aggressive dilation."

I had spent an extra night in the hospital learning how to clean myself, and the area around me, so that I could perform a self-catherization. I left the hospital confident that I could do this without any problems. But when I got back to the minimum unit, I found that it had been raining and there were now standing pools of water around the tents. The water stank. I was told that the sewer line under the housing unit on the hill above the tents had broken and the rain had washed the effluent down to our area.

There was no privacy in the tents, so I went into the bathroom trailer. The sergeant suggested that I use one of the stalls. But even if I could have cleaned off the toilet tank-top sufficiently, the walls were only waist high. The lieutenant's suggestion that I use the shower wasn't practical either. There was nowhere to lay out the lubricating jelly, or cleaning supplies, except maybe on the floor. The bathroom trailer was used by two hundred men, and no matter how well I cleaned an area there was still the probability that I would pick up some kind of an infection on the catheter and pass it into my bladder. I decided to wait until I could get moved back into a room. Maybe the scar tissue in my urethra would not constrict too much in the next few days.

Two weeks after I got back from the hospital, I was again stripped and thoroughly searched before being put into leg shackles and belly-chain handcuffs to be brought to the urologist. I was about to find out the meaning of "aggressive dilation."

We went in the back door to avoid the other patients. The doctor did not keep us waiting. He entered and addressed the officer accompanying me. "You've never been in here before. You can wait out in the hall if you don't want to watch."

"I'll stay," he replied, hooking his thumbs into his gun belt.

The doctor nodded. "Okay, have him drop his pants and shorts and lie back on the examination table."

I managed the maneuver without help or release from my chains. The doctor raised a platform under my legs. A female nurse handed him a syringe. As he squeezed its contents into my penis he said, "This may burn a little." It felt cold.

The nurse laid out a series of silvery stainless-steel instruments that looked like giant barbless fishhooks. The guard was curious. "What are those for? I thought you were just going to catheter him?" He then looked at the door as if he were reconsidering waiting in the hall.

The doctor selected an instrument and held it up to allow the sterilizing solution to drain off. "We use these to stretch the constricting scar tissue. I've filled his urinary tract with K-Y that has been infused with Zylocane. I'll be quick and he will feel only a little pressure."

I felt his hands on me; they were cold. The instrument was slender and the curve at the end gentle. I began to think he might be right. The second instrument was slightly larger and the feeling of pressure greater. The fourth dilator was the biggest. As the pressure increased, I tried to stretch the leg-shackles while pressing the belly-chain handcuffs into the examination table. My only distraction was watching the transportation officer, whose pallor alternated between a bright pink and a dull shade of olive green. The pressure was eventually released and I was able to relax, unhurt.

The doctor then handed a box of tissues to my guard. "He can get dressed now. There may be some leakage. Give him some of these to stuff into his shorts." He left the room to prepare the paperwork that would go back to the prison unit with me.

On my way out the doctor stopped me. "We'll do this again in a few weeks. Keep on cathetering yourself every evening. If you see any change in your urine stream, have the unit doctor call me. If we wait too long we might have to go back and make more cuts in the scar tissue. So make sure they call me. Good luck."

The doctor obviously did not understand how the system works. An inmate just does not have that kind of control.

Two more trips to the urologist's office for aggressive dilations were followed by delay after delay. I finally made an emergency medical request. Prison policy required a response within twenty-four hours. After eight days the nurse called me back in to ask, "Has your problem resolved itself?"

I answered, "No."

The next day I was taken to the urologist. He was upset about the unnecessary delays and talked about another visit to the hospital. He then told me that the scar tissue was only one millimeter from the bladder sphincter and one mistake, one slip, and the damage would be irreparable. He decided to wait before taking the risk of cutting the scar tissue again. I was relieved.

I have subsequently been moved to a prison unit for sex offenders in another part of the state. But my medical problems are not at an end. Like many others who must deal with an unresponsive health-care system, I cannot be sure I will continue to receive the treatment I need.

There are some who believe that prisoners like myself get better medical care than we deserve. I can only hope that none of them ever has to deal with a system which dehumanizes both the patient and the doctor in favor of the bottom line.

Raymond E. Williams says this about himself: "My first computer had vacuum tubes. I was once a respected member of the computer world, looked up to by my customers and associates. Today I am serving seven-and-a-half to fifteen years for attempted child molesting. I do not excuse my actions. What I did was wrong. I hope that my writing will present a view of my life in prison on several levels."