Notes from the Texas Gulag

  

Chapter 1

 

You may ask, like, how did you first know you were in an alternate universe of health care? The answer is one word. Actually two words—an acute medical condition. Jaw fracture. 

Having worked adult trauma at the county hospital in Austin back in the day and having seen a couple of jaw fractures in my time, not to sound all cocky—but that’s guys in nursing, isn’t it? We call it the way we see it and don’t sugarcoat like the chicks do. A lot of boy-nurses like to lean in with our testicles, instead of pushing nuts aside, you know? It’s like that working in a prison hospital too. This is a pretty tough crowd on both sides of the nurses station glass. 

At Hospital Galveston the number of prisoners with broken jaws seemed, well, extraordinarily high. According to my calculation as a nurse who has done trauma before. Inordinate, isn’t that the word? As in IFH—inordinately fucking high. Like really fucking way high, bro, as one might say to a colleague while waiting for a turn at the narcotics cabinet, but not like you would write in a learned article in a nursing journal. Or while taking report from the ER nurse or from the day nurse on my own unit—at change of shift, at Hospital Galveston, on Galveston Island, home to Texas prison health care? To set the scene. The cause of the broken jaws always seems to be the same thing, that the prisoner “slipped and fell in his cell” and hit his face on the metal sink. 

The report from the ER nurse is on the telephone but report from the prior shift nurse about the patient who will be my responsibility for the next twelve hours is in person face to face at the nurse’s station or, even better, standing next to the bed and looking at the patient. Night shift starts at 7 p.m. So, like, “jaw fracture,” the day shift nurse described the cause of the prisoner’s injury as “hit the sink,” while raising the index and middle fingers of both hands in the air—and saying it, you know, while wiggling those fingers. Like, making quotation marks with his wiggling fingers, “slipped and fell,” sure. Moving his fingers in the air like that in order to emphasize doubt because the guy had almost certainly broken his jaw while getting the shit kicked out of him in prison. Hello! Not to sound all cynical or anything. 

Later, doing a physical assessment of the same guy—the prisoner with the broken jaw? He looked me right in the eye and mumbled very convincingly that he had indeed slipped or fell. That was “the mechanism of injury” like the ED doc would call it. Hard surface instead of blunt force or whatever when three guys get you alone in the prison shower and administer a beating. 

A good nurse doesn’t always need to know what caused an injury in order to know how to take care of the patient afterward. An Officer explained to me, btw, that the only thing worse than getting the shit kicked out of you in prison is being labelled a snitch, which can be fatal. Whereas a broken jaw is only painful. Until you come to Galveston Island to have the fracture set. 

Another nurse who used to be a guard gave me a critical insight regarding prison health care and all these broken jaws. The real mechanism of injury is machismo. Testosterone is another drug that flows freely in Lone Star prisons, in addition to weed and meth. In this dangerous environment the risk is not a small cell with a metal sink but a lot of young guys who are trying to establish their ranks in a hierarchy. Or who may have big mouths and say the wrong thing to the wrong peeps, you know? Most of these broken jaw guys are young—young to me, in the twilight of my career. In my experience, some of them do indeed have a big mouth, or have “a mouth on him,” which we all do, but meaning something else behind bars. The question is how is the black male caregiver—culturally humble and conscious of his own biases—to react? Is it my place to judge, as Florence Nightingale might ask. What should one think of the way my brown brother from Laredo or from Eagle Pass on the Texas-Mexico border, so many of the broken jaws belong to Latinos, who got caught robbing a supermarket and is doing a dime, ten years, in the Texas Department of Criminal Justice, is it my place to judge how he expresses his pain? Is that really my concern? To determine if he’s a little crybaby bitch or not? Is that really the RN’s call? A lot of Hospital Galveston patients, btw, just want to take a painkiller and watch TV. 

The broken jaw guys are mostly Latinos, not to repeat myself and not to stereotype. A nurse from Galveston County Jail which is on the other end of the island told me that at her lockup it’s more black eyes. “I’ll ask them,” she said, “how’d you get a black eye and they’ll say that they fell. It’s always the young guys.” 

On a 1 to 10 scale the pain is always 10, that’s been my experience too, civilian broken jaws and the prison variety too. Until the swelling goes down. When they’re first out of surgery the broken jaw guys kind of look like squirrels with their cheeks full of nuts and they can only mumble, usually to ask for more meds. So, like, that’s an introduction to Hospital Galveston. It’s a shithole, basically, the Texas Gulag—like the Black Hole of Calcutta without the hole. It’s a job to me. 

Outside the prison hospital, this island’s main moneymakers are tourism and health care/research at University of Texas Medical Branch, which is the name of the academic medical center that has the contract to care for the state’s prisoners, not to repeat myself, who get shipped in from across the Lone Star State. By ambulance and by bus. That’s the system. Medical Branch is my employer but the Texas Department of Criminal Justice—aka the state prison system, TDCJ as it is fondly known—did my pre-employment security check and had to okay the hire. In the past, Galveston’s employers were not so picky about using black labor. The city’s original business was cotton—not corrections. 

The textile was produced by slaves up in the Brazos River Valley where my daddy’s family is from actually, and was exported from the Port of Galveston, behind what is now the campus, where my maternal great grandfather worked on the docks. To set the scene. This is where Juneteenth was declared, also up the street from campus, you probably know that already if you’ve heard of Galveston before. At the end of the Civil War. That Act of Liberation freed Daddy’s family from life on an East Texas plantation, while Mother’s people arrived from the Caribbean as what she called “monkey-chasers from Jamaica” after the war. Her language, not mine. The Jamaicans came to Galveston after Emancipation as free men to work on the docks. Or so we were told. To set the scene again. Galveston is my ancestral home. Here or Brenham in Texas's Brazos Valley where Father’s family was from. My belief is that my mother was born in the same hospital that now employs me, but Mother was birthed on the maternity department’s black side. 

The local history center says there was an African American hospital built on the island just after the Great Hurricane of 1900, but pushback from white residents shut it down. Again, Galveston Island is Old South and some aspects of plantation life and the cotton economy continued to exist many years later and remain still. There’s supposed to be a photograph in the Galveston County archives from the days immediately after the 1900 hurricane, which killed 6,000 people, showing white men holding guns on Black People and forcing them to clean up the debris and pick up bodies after the storm. Not having seen the photo myself. Medical Branch is also my alma mater, btw, where my Highest Honors graduation in the Science of Nursing took place two decades ago, not to brag. My nursing job back then, back in the day, was nights in the Children’s Hospital, now it’s nights on the prison side of campus taking care of old men and old women who may be on their last ride in Texas, off into the sunset like cowboys. The similarities between pediatric nursing and prison nursing are that both begin with the letter p and both involve substances that begin with p. Like pee. And poop. To set the scene yet again. 

This may be too much information but did you know that a newborn’s pee can be odorless? And a baby’s poop can be almost sweet-smelling up to, oh, about a couple of weeks or so after birth? That’s my experience working in a hospital nursery and having cleaned more than the average black man’s share of baby bottoms. Not like you would want to dab a little baby poop behind your ear before going out on a date or anything but relatively speaking, as seen thru the caregiving lens. 

A few months into a baby’s life the stink starts to attach, for whatever reason, while the poop of a 60-year-old—like some of these old prisoners at Hospital Galveston, in the custody of the Texas Department of Criminal Justice, the aforementioned TDCJ? Some of the shit here emits an aroma that is positively fucking deadly all the time. 

Not to get all graphic, but opening the diaper of an old inmate—like many of Hospital Galveston’s patients, not to repeat myself—can be like taking a whiff of poison gas in the trenches of World War I. You know, back back back in the day in France? Not having been there personally but having read the history. 

My old job at Medical Branch included changing diapers on a lot of babies and lately it’s been changing diapers on a lot of old men who the Texas prison system will not release even if the inmate is too weak to use the urinal or to turn himself in bed. Prisoners like these remain dangerous, officially. The State of Texas and Governor Abbott are making a big policy mistake regarding these ill inmates, it seems to me as someone on the front lines of health care, which is a phrase that nurses started using during the COVID pandemic and that some people would say applies here. “The front lines of health care.” The bureaucratic error by the State of Texas does not involve keeping a lot of apparently harmless old men behind bars, long after they are no longer a danger to society. There may actually be a good reason to do that, they may not have anywhere else to go. Bad care might be better than none at all. Some of these folks on Unit 7C of Hospital Galveston, which is my home unit, btw, have nowhere else to receive care. 

Like the cancer patients who want oncology treatment and will commit a crime to get it? Instead, this time it’s a different dynamic entirely and is driven by land, actually, like everything else in Texas. The sheer fucking size of the state. The size of the Lone Star State has to be figured into every public policy decision and that didn’t happen here, with TDCJ, and the results have been murderous. Someone just forgot—most likely a Democrat, back in the day when the D’s were still in power. 

So, like, Texas is a big place and that’s a big problem for prison health care because inmates have to be transported to a hospital to receive care. From dozens of lost pisspot locales across the state, where the last generation of prisons was built. (Pisspot is a synonym for shithole, btw.) Which was a Texas-sized bad policy decision by state government, mostly the fault of Democrats, who are liberal by allegiance, but sometimes lack much common sense. Not so much the evil Republicans like you would normally expect, you know? 

Evil is also present today at Medical Branch and at the Texas Department of Criminal Justice, which are the euphemistic titles of the collective Gulag that employs me. This diary of working nights on 7C—this healthcare confession—is Hospital Galveston Confidential. It chronicles my last patient care job, nights in correctional health care, looking out from a prison tower on the sunny Gulf Coast. The Island is a major vacation spot too but my patients never see the beach. 

Galveston is known for humid days, balmy nights, mosquitos the size of sparrows—with global warming the little fuckers never die off during winter. The beach water is cloudy all the time because the Mississippi River mixes with the Atlantic here. That’s all the geography you need to know. The history is that Galveston used to be the richest and most important city in Texas but isn’t anymore. It's still kinda Old South—in good and bad ways. There used to be a slave market downtown actually, not to sound all medieval and scary. The island has kind of a New Orleans corrupt/sinful feel but the music and the food aren’t as good as in N.O. and the corruption is not as palpable. Galveston is where hurricanes hit directly, climate science isn’t my best subject, while New Orleans is inland and doesn’t get as much flooding? So, like, every decade or so a big storm hits Galveston Island and washes away the sin, you could say. The TDCJ prison bus brings it back again. 

You probably want to know the most depressing aspect of prison health care, people generally want to know the worst first. Who was my scariest patient and what were the most freaky or macabre crimes? 

If you’re a sentimentalist like me, you would probably agree about a really heartbreaking young guy during my time working here. He was a black stick-up artist from South Texas—maybe 22 or 23 years old. He was a good-looking kid who probably got more than his share of pussy in the Free World, not that that’s important here. So, like, he had breast cancer. Yes, men do get breast cancer but it’s rarer obviously than in women. There was an opportunistic infection spread everywhere across his chest too, can’t be more specific because oncology is not my area of expertise either, but it was like an alien microbe? Like something escaped from the National Lab, which is just down the street on campus, actually, Biosecurity Level 4 or whatever—Wuhan-on-the Gulf, you might call it. 

That is Galveston Island. That’s the Medical Branch campus. To set the scene finally. The far end of the island includes the freaks and ghouls who live on the water along the causeway leading to Houston. The near end is Medical Branch and all these doctors and scientists. The prison hospital in an undisclosed location on campus. So, like, this black kid with breast cancer was in a lot of pain but he was always polite and reasonable about any delay with his meds. He knew he was dying and he died with dignity. 

Another nurse told me that this particular Black Gunslinger—Texas produces too many, although their storylines can be surprisingly uplifting. The South Texas Kid, like Billy the Kid, he was waiting for his grandmother to visit him before letting go, seen through the lens of the lone Black Cowboy narrative. Before setting off on his last lonely ride? That’s what happened, actually. His grandmother came to see him and he died down in ICU. Mostly there doesn’t seem to be a lot of tearjerking drama, or none that anyone is talking about at the nurses station, where it’s my practice to listen in. This is a busy med-surg unit, you feel me, the difference from a civilian hospital being that there are guards on the doors. Some of these patients are precisely the mean motherfuckers that the State of Texas says they are but others are probably entirely innocent, that’s my view, as seen through an injustice lens. And that includes the women, there are some super scary ladies on the unit, call me not-a-gentleman if you will. 

There were two old ladies in a room a little while ago, for example, one was my patient and one not—one black and one white. The black prisoner had whacked her mother back in the day and the white lady distributed parts of her significant other over a number of West Texas counties. Not that there’s anything wrong with that. She wanted to spread the love. Some people might call it romantic. 

The two of them got along like peas in a pod! 

At night they didn’t seem to sleep, you’d go into the room at 2 a.m. to give meds or on rounds or whatever, it’s the middle of the fucking night and they’re lying there in bed in the dark giggling like teenagers after lights out. Just a couple of old ladies who had a shared history of homicide of loved ones. Or it was like they’re chatting on the porch back of the nursing home, back home in Pisspot, in the pineywoods of Texas just this side of the Louisiana state line? 

Hospital beds are supposed to be kept low to the ground, to avoid falls, but the black murderess—the lady who whacked her mom? She asked me to raise her all the way up and leave her high, against the rules. The risk being me getting a write-up—discipline, which the prudent nurse tries to avoid. 

Until she explained to me that being high gave her a view out the security window looking out on the Port of Galveston, ships coming and going and all that. And my heart melted. It was the kind of scene she probably hadn’t seen in 20 years and would never see again. She was very sweet and she had good veins which is unusually important to nurses. Because this prison is part of a major research institution—Medical Branch, my employer and alma mater.  There are a lot of labs to be collected. A lot of blood taken and given. So, like, any R.N.—me or any of my co-workers, we might say about one of the patients, the two old ladies in the room or anyone else, “Oh yeah, he killed a family of five. But he has good veins if you need to stick him.” We say good veins like it’s a positive personality trait. 

Killing a family of five is actually pertinent to any discussion of Hospital Galveston, btw, which is what this healthcare facility is officially called—Texas prison healthcare central, run by the University of Texas Medical Branch. Aka, the Lone Star Gulag. Where sick inmates of the Texas Department of Criminal Justice are cared for or come to die. So, like, you may recall from the news last year that a convicted murderer—a man named Lopez? He escaped from TDCJ medical transport. Offender Lopez—those people, what can you say? Not to sound all racist or anything but black people have tried to show our Latino brothers and sisters that crime is not the way! The Latino community has been so slow to take our advice and good counsel. But we digress. 

So, like, Offender Lopez escaped from a TDCJ bus on his way to the TDCJ hospital in Huntsville and while on the run he killed a grandfather and four kids at a white family's vacation home somewhere up near Waco? Does that sound familiar? It was all over the news last year, for a while at least, until the next Lone Star bloodbath happened. You never have to wait long. Texas produces more than its share of mass killers and sometimes it’s hard to sort them out. Late last year? Before being killed himself in a gunfight with police, down near San Antonio, isn’t that right? Wasn’t that the chain of events? So, like, the escape of the inmate-patient, named Gustavo Artemio Lopez, has produced a lot of nervousness and handwringing by officials at the Texas Capitol and for good reason, the barbarity of the crime was shocking. A family on an isolated ranch slaughtered like cattle. But it’s actually just the latest TDCJ-related bloodletting. Because at all hours of the day and night, sick and allegedly-sick prisoners—the maimed and the dying—guys with broken jaws—are traveling on Texas highways going to and from Hospital Galveston or Texas Tech University Medical Center, on the West Texas prairie in Lubbock, which also takes care of Lone Star State prisoners. So, like, this guy who killed the family was on his way from his prison unit to a non-emergency medical appointment in Huntsville when he escaped. That’s what the Texas Tribune reported right away. Let’s start there. 

This chain of events was confirmed when the State of Texas issued a much-anticipated public report. It was a white paper full of alleged facts about Offender Lopez‘s slaughter of the innocents and what may have been his unleashed anger at his unlawful detainment, depending on the lens used. There was just a single word redacted from the state report in the very first paragraph—regarding what kind of appointment the killer was on his way to, when he escaped and started to whack people. A big hint is that the word that was blacked-out has seven letters and begins with m, like “medical.” Or six letters and begins with h, like “health.” And we know that because the rest of the 20-odd pages explains in great detail about the difficulties and risks of transporting patients from prison units across the state to hospitals in Lubbock and in Huntsville and on Galveston Island, on our sunny Gulf Coast. 

TDCJ, the state prison system, is a keep-the-lid-on-a-problem kind of state agency, not a get-ahead-of-the-problem kind which is less common in Lone Star government. Conservative means liking things the way they are both in Huntsville, where the prisons historically have been headquartered, and at the State Capitol in Austin. We’re going to do some of the heavy lifting for TDCJ here and explain what the risks are for keeping state prison inmates healthy in Texas. It’s an important subject—and don’t forget why. The Big Picture is appalling, courtesy of Big Data. The U.S. imprisons more people than any other country in the world. And Texas really loves to lock people up and follows only the federal government and the State of California in number of people behind bars. At TDCJ’s 100 or so so-called “units” or prisons. 

An oncology nurse at Hospital Galveston told me the other day about sitting down beside an inmate with cancer, in order to start an IV to give the guy chemotherapy. The inmate said to her, as casual conversation with his caregiver, “I could grab that needle and stick it in your eye before you could do anything about it.” 

Naturally the oncology lady was surprised by the direction of the conversation and distracted from completing her task and she called her supervisor to come and try to start the line instead, to give the guy his chemo. This is not as chickenshit as it sounds. Because sometimes, for whatever reason, there needs to be a different nurse. 

But the supervisor came and was also frightened and declined to treat and the prisoner was returned to his home unit, in Shitville, Texas, which is just a little past Ft. Worth. Without receiving the care that he had come to Medical Branch to receive. There’s not much patience for bad behavior by patients, btw, that’s my impression working here only a short time, the hospital is run by the University of Texas, btw, as mentioned above. Any prisoner who refuses care or who threatens/commits violence will almost certainly be sent back to serve out the sentence without treatment, because there’s always another prisoner who does want care and who will cooperate and not endanger healthcare workers. That’s the theory and it appears fair in practice, no? Something else that the oncology nurse said is also pertinent.

Some of TDCJ’s inmates with cancer diagnoses who have served their sentences, and been released, will commit another crime on the outside—in the so-called Free World. Can you guess why? Because TDCJ is one of only two sources of free cancer care in the Lone Star State. Yessir or ma’am. The inmate wants to come back to prison for free chemo, so he does another crime and gets caught—or whatever—is that how it works? Or do you call Capitol Hill in D.C. and threaten your congressman because prosecution will be federal and health care is better in federal prison? How is that for fucked-up incentives? Hospital Galveston is kind of a weird environment, yeah, for a couple of reasons, not just related to its exceptional patient population.

There may be questionable incentives in prison health care too, just like in the Free World. Especially if your prior experience is in the Free World where health care is also fucked up but fucked up in a different way. 

 

        

 

Chapter 2

 

TDCJ buses are all white, you can’t miss them on the causeway to the island. This is Texas’s Devils Island, just like French Guiana off the damn coast of South America. The prisoners’ uniforms are all white too. 

The buses are going to and from the Gulag, not to repeat myself, on the way to medical appointments, prisoners riding hundreds of miles to see a provider at a hospital in Galveston or in Lubbock or Huntsville. It’s a logistics nightmare and dangerous as can be. To set the scene. So, like, the kid with breast cancer who was waiting for his grandmother to visit so that he could die? You wouldn’t believe it coming from Hollywood but it’s Hospital Galveston on a micro level. 

There’s also the macro view, during the pandemic the number of state prisoners dropped because courthouses were closed and there were few new arrivals on the bus from the county jail. Now the courts are in business again and people are being locked up, which is the way we like our jurisprudence in the Lone Star State. There’s no better remedy for wrongdoing than twenty years in TDCJ, that’s what a lot of Texas juries believe. Or you get the ultimate treatment—the injection that cures all ills, like riding Old Lightning, which is what the electric chair was called, back in the day. 

Hospital Galveston which is what the prison hospital at Medical Branch is officially called—my employer—serves inmates in state prisons in about eighty percent of the state, an area roughly the size of France. Patients from units like Rosharon, Coffield, and Gatesville, where the ladies stay, all east of the Pecos River, all come to Medical Branch. While sick inmates west of the Pecos, like Montford, Mechler, or Clements are seen by providers in Lubbock, at Texas Tech. Where my graduate study in nursing is now taking place, at the Health Sciences Center. 

My graduate advisor was actually working in Tech’s ED in Lubbock back in the day, that day—like early 2000s. A TDCJ prisoner who had been brought in for treatment tricked a guard and escaped and raped two Tech nurses. That’s the considerable downside of the job. After being hired at UTMB for 7a to 7p, the dreaded night shift—my orientation included a lecture on safety for new employees, given by an Officer, which is how the TDCJ guards are called, not guard.

So, like, this Officer—she was kind of hot, actually, not that that’s important here. 

She told us in the security orientation about the wily ways of prisoners who will want to seduce us or trick us. You feel me? And that got my attention big time, especially when she said, “TDCJ does not negotiate.”

 In case of hostage-taking, she meant, like what happened to the two nurses in Texas Tech’s ED, who were held hostage and assaulted? The hot Officer said that prisoners have been known to trap the nurse or nurse’s aide in a room and push the bed in front of the door, to bar entry and exit and—presumably—then start issuing demands. That TDCJ, headquartered in Huntsville, in the pineywoods of East Texas, will ignore. Just so you know. Not so sound all brave or anything because that is oh-so-not me. 

In fact there’s a bloody history of hostage taking at TDCJ, at a unit in Huntsville actually, amongst the drooping moss and concertina wire of East Texas, that did not end well for the hostages. You have to understand and approve of TDCJ’s non-negotiation policy theoretically—on a macro level, on a macho level if you will. That is completely commendable and fits neatly into the overall Texas narrative which often involves a lot of gunfire and blood. But on a micro level it’s my ass, as mentioned above. It got my attention big time, you know, when the Officer told us that. 

The other thing the TDCJ lady said was to treat all the prisoners the same. She meant in the sense of considering all of these folks to be potentially dangerous, without wondering why a particular individual is in custody of the State of Texas. This was probably good advice but if you’re curious—and like to know details—TDCJ assigns a risk level to each inmate that has as much or more to do with their behavior in prison than whatever evil or alleged evil that got the person behind bars in the first place. Assuming that the inmate really is a villain and not merely a political prisoner of the Lone Star State. Who do exist, in great number, most of whom having two things in common, they are black and locked up. 

A Black Man or even one of my Latino Brothers who has refused to bow down to The White Man and shot it out with the pigs instead? 

Couldn’t that be the real backstory on the guy under my care right now in Bed 3? 

So like, anyway, the TDCJ lady at our new hire in-service said not to worry why the inmate was sentenced to prison, unless he or she is completely a mad fiend, my words not hers. In that case you may want to know. Like, again my words not hers. If the patient has a free-world history of strangling people you may not want to expose your neck when leaning over to listen to the heart, right? That would be my belief about proper patient assessment, forget what they told you in nursing school. But what’s most important is behavior behind bars not what he or she allegedly did before the prison gate closed, so to speak, that’s what the Officers all say. That advice actually fits with Nursing’s Prime Directive that everyone should be treated equally. Be reasonably fearful of everyone. And as a practical matter you’re too busy on a busy medical-surgical hospital unit to look up a patient’s alleged crimes and misdemeanors because, as the Officer said, it doesn’t really matter anyway. 

Cellulitis on a guy who hacked up and barbecued Aunt Lucy looks just like cellulitis on a bank robber or a member of the Mexican Mafia. Hello! Or a member of the Black Liberation Army who has been wrongfully accused, you know? The guilty and the innocent are indistinguishable in the nursing context, and everyone deserves to be pitied in the custody of the Texas Department of Criminal Justice, whoever the patient is and whatever they’ve done, for the love of God. Not to sound all noble but as an experienced RN. Having said that, TDCJ is a shithole. If you’re asking my professional opinion. 

So, like, that’s been my preliminary impression during my brief time at Hospital Galveston, having been quickly involved in the care of a lot of people. Not to bitch or anything but they said at the hiring fair that the ratio of patients on med-surg was 5 to 1 for nurses on nights but really it’s always six to one. Not to be all disappointed or anything because all hospitals lie about nurse staffing levels, in my modest opinion. It’s six on days too, btw, at 7C, which is especially hard to do on day shift with all the doctors getting in the way and asking for shit to be done and the procedures and studies, or whatever. The night charge nurse also gets six, which makes me sad, to tell you the truth. Not to bitch about work or patient ratios or anything, but Hospital Galveston is a busy place. 

Still, there are times after a patient interaction when you may just want to know, you know, whether it’s useful knowledge or not to the primary mission of caregiving.

“What is this guy in for?” 

Because the patient is really strange or a pain or threatening or whatever. 

So, like, my curiosity about a patient has only been raised a few times—and luckily, TDCJ offers a way to satisfy my interest. With its “Inmate Search” app that tells you what unit a prisoner is on—across the hundred TDCJ units in the great expanse of the Lone Star State. What crime he or she was sentenced for. Length of sentence and in what county the trial took place. Google is the next step from there and you’ve got your guy or girl and can read up. 

Sometimes it does help to learn what you can on what may turn out to be a challenging patient. To cut to the chase, of those patients who got me wondering, probably eighty percent were men and about half of those were convicted of sex offenses, often involving kids. Of the other half, half of the half (25% for those who are math-challenged like me) were your average murderers and armed robbery-types, gunslingers of some kind or another, and the rest were drug offenses, trafficking not so much possession, like you might expect. Surprisingly few drug crimes overall actually, which is good, although another nurse told me of a recent admission to our ICU for a drug overdose, this guy coming from one of the units in deep East Texas where he had obviously taken some bad shit or taken too much of the good shit and almost killed himself? 

White collar criminals have been, like, totally missing among my patients. Too bad!

My preference would be at least one or two fraudsters, because they’re always white guys or Asians and will help even out the racial disparities in incarceration. Not to sound all racist or anything. As a black person who does not entirely believe that the Texas criminal justice system is colorblind, thru that lens, you know? My impression of Hospital Galveston is that the races are pretty evenly distributed, with blacks, whites and Hispanics in more or less equal proportion, a one-third, one-third, one-third kind of ratio. Which is of interest only because blacks make up only about 13% of the population of the state. Is that a law enforcement outcome discrepancy or a healthcare discrepancy? You tell me. It might make a good Social Determinants of Health (SDOH) paper for a nursing journal. 

Regarding black inmates specifically, speaking as an advocate, speaking as part of a long tradition of nursing advocacy actually? 

My natural inclination—looking across the wards of Hospital Galveston—is to follow the one-third, one-third, one-third view of guilt. 1/3 of the African Americans prisoners in Hospital Galveston did exactly what they were charged with. That’s my best guess. Another 1/3 are in prison because they got caught in a law enforcement net even though they were not technically guilty of whatever they were sentenced for. Call it karma, call it a civil rights violation, call it what you will. Which actually has an analog in my own childhood because in black family life the belief in crime and punishment is also pretty fucking absolute, just like in the Texas courts. Or at least that was the case with my own family. My mother, may she rest in peace, had a beautiful backhand that she didn’t use for tennis. You were being slapped not just for what you did this time but also for what she never had a chance to slap you for before. Does that make sense? That’s TDCJ too. 

Something like that logic is at work in the state’s prisons. He or she the prisoner may not have done the exact same illegal and/or violent shit that got him or her locked up in the first place but did do a lot of other similarly illegal shit, without getting popped by the pigs. It’s a kind of guilt by association but only involves one person and that person is usually black/Latino and ends up behind bars. 

So, like, 1/3 of these brothers and sisters who are my patients—this is said even though we, the patient and me, bond as black people in a white racist world? 1/3 of these brothers and sisters are guilty as a motherfucker. Case closed. To quote President Trump, “Lock ‘em up.”

So, like, finally and most crucially, the last third 1/3 of black patients in Hospital Galveston were just the closest African-Americans at hand when white police decided to make an arrest. That scenario is especially likely if the arrest was made anywhere among the pineywoods of East Texas, near Pisspot where there’s a prison conveniently located, usually called the Pisspot Unit. The white bus doesn’t have far to go from the courthouse to prison in a county where Jim Crow still lives. For example, there was a sister among my patients recently, completely smoking hot and oh, maybe 35 years old? This is tragic, bro.

So, like, she was locked up for repeated drunk driving. Like she was “going to kill somebody,” isn’t that what the judge always says and maybe sometimes it’s true. But certainly not with this woman. She was too fine, you feel me?

Anyone could tell just looking at her in her prison whites that she was an angel, sent down by God to test men, and completely innocent of the charge of felony Deriving While Intoxicated. She was too fine to do the crime, as we say in the black community. Like, there are some chicks who are too hot to be held responsible for their actions even if they did exactly what was charged. This black chick was one of those. 

Or she already had wasted somebody—she was on her third or fourth drunk-driving offense? That’s what the TDCJ app said! And somehow the knowledge of what she was in for made taking care of her so much easier, despite the injustice of her sentence. She was not a hardened felon. She was just a beautiful woman who had come to a bad end. Courtesy of Jack Daniels and the State of Texas? No way, bro! Obviously she was sentenced on false charges, that would be my whole point. She was probably set up by a white female cop who was, like, jealous? It’s totally possible. Probable, even.

With Latinos my guess is that there’s about a 3-to-1 split, 75% in prison based upon some kind of genuine illegal activity, you know what those people are like! And a quarter completely innocent like the aforementioned one-third of black guys and black girls and the especially fine sister who got the felony DWI. This is a kind of back-of-the-envelope calculation based upon my time on Galveston Island. Wrongdoing here is always a relative thing because there’s always been so much sin thru the years, it’s an island tradition. 

The white prisoners are all presumed guilty or mostly guilty, by definition, not to sound racist. Test my logic: In a criminal justice system that favors white people and that whites control it seems less likely that white inmates got swept up innocently when mostly white cops were arresting people without real evidence. Does that make sense? 

The point is that on the wards, doing your rounds, you have to treat everyone well because that’s what nurses do and because you don’t know if the patient really is a felon. Most of the time you don’t know what they’re behind bars for at all, unless you consult TDCJ’s handy “Inmate Search.” That is part of the moral burden of a prison nurse. To check the app or not? Mostly not. Btw, among my patients at Hospital Galveston so far have been only two Asians—both Vietnamese guys. This is said with utmost respect and affection for the noble Vietnamese people. And in recognition of their struggle and ultimate victory over the White Man in the jungles of Southeast Asia. 

And no attempt to stereotype. 

All apologies in advance, but Vietnamese guys have just as short a fuse as black people! How cool is that? 

The Viets are almost as hotheaded as Latinos—who kind of take the cake. According to my calculations. How much cooler is that? We’re all the same, after all, under the skin, because race is just a societal construct, in other words something that somebody made up. At least that’s what they teach in nursing school. So, like, this is a true story. There’s a historical document somewhere in the Texas Archives to back it up. Immediately after the Civil War a Union officer arrived by horse from New Orleans, after the Rebels in Texas had surrendered. To set the scene. 

He visited a Texas prison, apparently in Huntsville, and reported to D.C. that he believed the Lone Star government was using the prisons as a means of controlling the black population. 

You think? Is that even possible? 

Twenty years later, after the report to D.C., my great-grandfather was sentenced to life in Huntsville, for a murder committed in Washington County actually, which is not far from Huntsville, so he didn’t have far to go to get to his cell. To set the scene again. 

Because instead of waiting for nightfall like anybody else, like anyone with any common sense would do, he shot somebody in the middle of the afternoon on a busy street with plenty of witnesses! If you were wondering—you know—what 1/3 of prisoners he fit into?

Geographically TDCJ is a system of units, originally around Huntsville and in East Texas, and now spread across the state, about, what 100 prisons total? Housing over one hundred thousand men and women. Personally, having set foot in an actual unit only twice in my life—long before Florence Nightingale entered my life—both times back in the day in Huntsville, which is still the administrative home of TDCJ and where Daddy’s Daddy’s Daddy did his time. So, like, there was a connection for me personally. Both my visits were to the Ellis Unit which still exists today and is where condemned men used to wait to get whacked back in the day, if my memory is correct. Or was where they were held just prior to getting whacked? My first visit to Huntsville back in the day was late ‘70s or maybe the spring of 1980. The prisoner was a white guy who was condemned to die and he looked at me through the glass partition the way tigers look at little kids through the glass at a zoo. 

Have you ever noticed that hungry look?

This white guy seemed to be completely predatory and sociopathic. Those people, what can you say? Not to sound all racist about the Caucasian race but those people, what can you say? There’s no respect for the law among certain demographic groups, we’ll leave it at that.

You knew what Caucasians were like back then, the 1970s, that was a time before there were any black or Latino serial killers. Like nine times out of ten, the picture in the newspaper of the Mad Fiend was a thin, pasty-looking white guy, or a fat white guy with glasses. Not to generalize. And this predatory-looking white guy in the Ellis Unit visitation room was the one they decided to let out! He was released on a technicality, the proverbial technicality that conservative lawmakers like to talk about, he killed again and was killed himself—if memory serves true. He was shot in a gunfight with pigs somewhere in the Hill Country. The other guy who brought me to Huntsville was a black inmate who was the Lone Star State’s most prominent political prisoner back in the day. For however long he was locked up. Lee Otis Johnson was his name. 

Lee Otis was a Righteous Brother who was sentenced to 17 years by a Houston judge for a single joint, in a less cannabis-friendly America than we live in today. 

The point is that Democrats complain that the Republican conquest of Texas was somehow unfairly accomplished—nefarious. But the Texas Democratic Party was running on fumes when the change came, like a car with an empty gas tank. The D’s had made some pretty bad decisions—including harsher sentences, like the imprisonment of Lee Otis Johnson—and prison locations, which was maybe numero uno on a long list of bad policy decisions by the last Democrats to be governor. The D’s rolled the dice and the State of Texas lost. Where to lock people up? That was the question and state leadership didn’t get it right. Where to place the next generation of prisons? The decisionmakers did not consider an aging prisoner population or mandatory sentences or availability of healthcare facilities in Pisspot, Texas, next to Shithole, in Shithole County. Which is where the new prison was built. 

It was a bad decision made in Austin, for example, to provide economic stimulation to a dying ranch town somewhere in the Panhandle, in a county with a total population of 12. In order to keep the county in the Democratic Party. 

The D’s failed to predict the effect of mandatory sentences, which means elderly inmates staying in prison longer, and new prisons holding a lot of old men—and old women. Like some of these guys lying in beds now in Hospital Galveston with no hope for release. Who can’t even toilet themselves. Mixed with rising healthcare costs and the lack of healthcare facilities in the far corners of the state where the new prisons were built. 

The consequence of which has been a lot of white buses and ambulances on the road to Galveston, which is Texas’s original Sin City, on the sunny Gulf Coast. It would make a good paper for Texas Tech’s Health Sciences Center actually, where my studies are coming to a felicitous end. How has the distribution of prisons in the state guaranteed bad care for its prisoners? No one really listens to nurses though. Until it’s too late. So, like, early one morning when the routine labs were being drawn, the patients are stuck like every fucking morning, to set the scene again.

 Usually at 4 a.m., in time for the results to be ready when the residents arrive on daily rounds or the attending MDs is at home eating croissants and looking in the computer. At midnight the nurses can start drawing blood, actually. That way, doing it early, the physicians already know what they want to order when they arrive, not to repeat myself, because they have access to results on their phones when their driving in or eating breakfast. That morning with my needle already in this inmate’s arm, he looked up at me and spoke. 

“You know, to be honest,” he told me, “I don ‘t really like black guys.” 

My reply, “You know, to be honest, black guys don’t really like you, motherfucker,” began to form on my lips. 

You have to be able to talk a little shit to do this job and sometimes you may need to be direct. Profanity is never called for unless it’s called for, that’s my rule in other domains of my life too. It hadn’t happened to me yet, getting ugly with somebody at work, my interactions with the prisoners were all cordial up to that point. But you like to keep your options open with this patient population, even the grannies. She could have whacked somebody back in the day, you know. She may have a mouth on her too. Only utmost professionalism and the spirit of Florence Nightingale—the Lady with the Lamp whose caregiving ethos infuses my black soul—kept me from going off on this Latino guy. 

Only Florence, whispering in my ear, stopped me from telling this patient where to go and what to do when he got there. 

The prisoner was a little used-up looking dude, probably mid-50s and probably looked the same way since he was 35. A lot of the inmates look surprisingly okay, their skin for example, if you look past the tattoos. Because they’ve been in prison so long and there are theoretically no drugs or alcohol or pussy/dick in TDCJ—or whatever may have afflicted them in the Free World that is missing behind bars. Theoretically. The quantity of white bread alone that the prisoners eat could be fatal, that’s a sure cause of ill health—starch. But the guys and girls do get plenty of time to sleep. It’s an almost monastic experience, what they describe, if a monastery had bad food and gun towers and was noisy like a screaming bitch. It’s a no smoking environment, fyi, again in theory, for both guards and inmates. But not this guy—the Latino who didn’t like black guys. 

He didn’t look particularly healthy, no. This guy was not like he was going to the great beyond anytime soon, however. Pasty, which was a concern but not acute. His feet looked okay which is my quick way of assessing someone’s overall health. Their feet. He just looked kind of old and vulnerable and used up, not to repeat myself. By way of explanation of his rude comment about black men, he said that he went to a mostly-black high school where some of the brothers apparently made him feel like a punk. 

Is that right? 

That was my question to him.

Because as long as he was talking about his insecurities, even vis-à-vis the Black Race, he wasn’t complaining about the needle. He had absolutely no veins, btw, not to cry like a punk myself. He wasn’t pulling his arm away, nothing like that, you know, which was cool. As a patient he had a right to refuse labs but he did not. He could say whatever he wanted to say within reason, that was my attitude, you have to keep an open mind in correctional health care because everyone has a lot of issues, including the staff. 

Everybody has a story to tell too, you have to be cool and accepting of whatever it may be. It’s their story, not yours. 

But in prison there are also overriding dynamics, like safety. And Hospital Galveston is a particularly chaotic environment, because it’s where two super-chaotic forces meet, health care and incarceration. On this little island. Three chaotic systems if you include the Texas highway system, that also affects which patients come to the Island of Sin and when. To set the scene.

 

 

Chapter 3

 

Had “the talk” with the night nurses, who are mostly female. If anything security-related happens on the unit, my message was that they cannot rely on me. Because Lucius is out of here. Like, gone. Don’t expect heroics, in other words. Expect disappearance instead.

If a colleague needs my assistance passing meds or an extra pair of hands picking up a patient who has fallen, sure thing. But help subduing a violent and/or crazy patient? That’s not part of my job description. If things get really ugly, and getting out of the building entirely becomes necessary, in my saving-Lucius’s-ass judgment, you know those bedsheets that everyone likes to tie together to escape with in the movies?  It’ll work for me as well as a prisoner. That’s my feeling, you know?

So, like, you probably think that working this job the nurses will be rude or dismissive of the inmates under care. That is oh-so not the case on 7C. Not in my experience. Getting people wound up is not just unprofessional, it’s counterproductive. Even in the glassed-in privacy of the nurses station, on my home unit—even as we refer to the senior surgical resident as an asshole and wonder how an especially clueless intern got into or out of medical school? The patients are still shown respect. No shit, yeah, not to sound all noble but it’s true. It’s weird and wonderful and maybe a beautiful thing that you can find respect and dignity in the oddest places, including the Texas Gulag, TDCJ for short. In Hospital Galveston it’s Mr. So-and-So, or bed number so-and-so if we don’t remember the name. Even if the guy whacked his grandmother.

Respect for the patient is beat into you in nursing school and anyone who has worked practically any amount of time in a hospital knows that patients—whoever they are—are vulnerable and they rely on the RNs and mostly trust us and we mostly reciprocate the trust. Mostly. Without knowing or caring who the inmate killed or raped or ripped off or even if he or she actually did any of those things or is merely an innocent pawn of the evil State of Texas. Aka the White Man, speaking as an African American. Which is my view most of the time, frankly, that life in the Lone Star State is mostly just another aspect of racial perfidy in the American South. This view is that, actually—specifically—the heart and soul of institutional evil in Texas is TDCJ, not to sound all judgmental of the prison system. And besides, the real enemy in the hospital—every nurse soon realizes—is the doctor. Even if you have to watch your ass with patients sometimes too. 

During that post-hiring in-service with TDCJ when the guard lady talked about what not to do? She especially warned us about not getting too close to these guys or girls—the hospitalized inmates. Or believing their shit. Like, he’s really going to marry you or whatever when he gets out of prison if you just smuggle a phone or some weed to him now? Please! That’s what the lady from TDCJ asked us in the security in-service before we went to work in our individual departments. She asked us that question and we all shook our heads. No! That was the rhetorical question from the Officer. You don’t want to reciprocate to that level, no, that was her message. My nursing unit manager when she hired me said the same thing, she warned me, you know? 

She said that my job was to render care but not get involved. Don’t get too close. Which was kind of an unnecessary warning, me being at Hospital Galveston mostly for the paycheck, UTMB pays nurses pretty well. Not being here on the Island of Sin looking for friends or potential soul mates, you know? Although some of the guards are hot and are technically fair game. But any closeness with a patient means jail time and is a sure 100% nursing license-killer.

My co-workers warned me specifically that the female inmates are especially dangerous, with their mouths, because they will make up shit about nurses, especially guys. When there are a lot of female patients—ours is a coed facility, you’ll be happy to know, just no mixing in the rooms. When there are a lot of female patients the drama level is PFH, pretty fucking high to use the non-technical term. Women are a growth trend in American prisons, btw, and they need to behave better or not get caught, the same rules as for guys, that’s my feeling. It’s only fair, right? We won’t get into that here. The point is that you have to treat people like people and leave at home any bad attitude or prejudices you may have. Rudeness is not called for in Hospital Galveston until it’s called for. The only exceptions to this rule in health care overall are paramedics and ER nurses, some people say corrections healthcare workers too, because they have to deal with crazy people or the highly intoxicated or dangerous or all three. To say nothing of the crazy and dangerous. 

On the wards at Hospital Galveston it’s not necessary to go off on anybody, usually. In my experience so far. The patients are there because they are sick, that call has already been made. If the prisoner gives you too much shit you just call the Officers, you feel me, who are always there. And even the TDCJ guards—the “Officers” as they prefer to be called—are mostly cool. Especially the older black women. They’re like my mother, may she R.I.P. Who had a terrible backhand but would usually listen first? Before letting fly with that hand. The guards have pepper spray instead. 

One thing about the pepper spray, or so the Officers tell me, don’t let it impress you too much. The guards say that most of the guys who they’re even thinking of using pepper spray on have already been sprayed so much at their home units they think it’s perfume. Not to disappoint. If there’s really going to be trouble you’ll hear a call overhead for guards to go to a particular location. They swarm the inmate in question, just like cops swarm a nigger out on the street, prior to shooting him? Whereas in TDCJ a beat down would be more likely than a shooting. A guy might end up with a broken jaw for instance.

 So, like, TDCJ guards are overwhelmingly minority and predominately black. A lot of women. Sometimes the Officers call the inmate “Mister” or “Miss,” just like the nurses do. “Now Mr. Johnson,” you’ll hear an older black woman’s voice ask a patient somewhere down the hall, she’s standing at the entrance to a room and addressing someone thru the doorway who you can’t see, “do you really want to do that?” 

And Mr. Johnson really does want to do that, whatever that is, because that’s why he was trying to do it in the first place, when he got caught. 

But hearing the lady Officer’s question he lays back down on the bed without anyone having to wrestle him to the ground or whatever. Because the black lady was cool. Courtesy really helps with this patient population, if you’re thinking that you may one day do this kind of work. Precisely because these guys and girls have been treated like shit on their individual units or in jail or by the police or whoever. Or by life, that’s my feeling, not to go all psychosocial on you. But an apology at Hospital Galveston is golden. 

Unless the guy has already lost it, you know, which is when you may want to shout “Help” instead and run for a secure door. Don’t ever lie. That’s what they warned us in pediatrics back in the day, not to lie because “the kids lose all trust in adults.” So, like, taking care of kids, it seems to me, you had to make up shit, by telling what they used to call summer camp lies? Like when adults tell the children to get on the bus we’re going to the beach when really they’re going to the library? That kind of thing. Like, dude, you would tell some little fuckhead kid who is going to throw a tantrum or spit the med back at you, this isn’t medicine—it’s a special candy syrup! At Hospital Galveston they won’t believe you the way kids do. Even if you’re telling the truth. So, like, these guys and girls are super suspicious.

With prisoners you really are sorry about their conditions or circumstances, locked up like damn animals, cooking in the damn cells back on the units. But you can’t get into that on a 12-hour shift. There’s too much other shit to do or to talk about. At least the black prisoners should be pitied, as mentioned before, empathy and sympathy both—according to my calculations. A surprisingly high percentage of black prisoners are innocent of the crime. Or of this particular crime, the one they got locked up for. A third of these brothers and sisters are not even guilty at all, unlike white guys who are almost certainly genuine perps. An example is illustrative. 

So, like, there was this brother doing time for something sex-related, statutory rape, like, he was a 16-will-get-you-20 guy, as the inmates say. To set the scene. The girl was too young. 

So, like, this inmate was giving me shit during a medication run one night with him and two other guys in a room on acute—7C—my home unit. The patient room had three electric hospital beds, used to be only two, and a metal sink mounted on the wall. An open bathroom with a toilet and a partially-closed shower. Privacy is none or very very little. 

There’s a TV up on the wall. Can you picture that? 

If you’re a patient in the Free World or anywhere else you don’t want to fuck with a nurse on med pass because we have to pay attention in order to get it right. In the modern American hospital the patients are taking something for fucking everything including the time of day. There are a lot of pills, a lot of shots and lot of IV sticks, to say nothing of a lot of IV meds. In Hospital Galveston it’s not that it’s so many meds, really, it’s that there are so many patients, a lot of surprisingly heavy patients, people who need shit done. They have come to the island for a reason and probably should have been there sooner.

So, like, this 16-will-get-you-20 brother was showing off in front of the two other guys in the room by hassling me. Which the patients don’t normally do because they like being in the prison hospital more than they like being in their prison unit, wherever it is, in the scrubland of South Texas, or the Oil Country of the southeast coastal plain, or the pineywoods of East Texas, and they don’t want to get sent back right away. And everybody likes nurses, right? We’re considered angels, not me personally, but the profession, you know? Hospital Galveston also has better food than wherever they’re coming from and there’s air conditioning they don’t have on their home unit. What’s not to like? With the TV overhead these guys control their own channel selection, that’s a form of empowerment, right? Just like in the Free World. 

There are painkillers too. Who could ask for anything more? So, like, it turned out this guy who was ragging me at bedside had something contagious and he got moved to a room by himself, that’s not important here. But in addition to whatever illness placed him in isolation, he had an ugly leg wound that had gotten even nastier. 

A lot of prisoners have leg wounds because the Texas prisons in addition to being very hot are very dirty, by all accounts. Not to be judgmental of Governor Abbott and the Republican wrecking crew at the State Legislature. But to set the scene.

You see a lot of leg and foot-related conditions that should not be there, except the prisons are shitholes. Which is what the public wants, shitty conditions for shitty people, or so we are told. And it’s probably true, the Texas public is bloodthirsty and wants its pound of flesh or a maximum sentence for what are often very bloody crimes. Even if you didn’t really do it, somebody has to pay, you know, as seen thru an Amnesty Project lens. But heat and filth and lack of circulation are a potent combination to promote infection. 

So, like, one night after changing this guy’s foot dressing, we got into an argument, me and the 16-will-get-you-20 guy who was black and from a semi-rural county near San Antonio. To set the scene again. He wanted me to bring him some ice cream. No shit. Which wasn’t going to happen in this lifetime or at this point in his lifetime. You know those little institutional cups of ice cream you get when you’re a hospital patient in the Free World? Hospital Galveston has those too but they are reserved for cancer patients who need extra calories. There are protocols to follow on 7C. And my preference is not to start breaking rules at work until my probationary period as a new nurse is over, you feel me? So, like, we kind of got into it—me and this black guy, the 16-will-get-you-20 guy. Talking shit to each other. 

He said he had a “right” to ice cream. Those people, what can you say? 

What was that word that Caucasians used to use about niggers, back, back in the day? When Ronald Reagan was President and somebody invented “Welfare Queen”? “Entitled,” that’s it. Close neighbor to entitlements, which is not a bad word in Black English, btw. African Americans feel we’re owed something, yeah, entitled. Like we think we deserve something without working for it? Well, yeah, except we did work for it, back in the day, during slavery, we built the country, we just didn’t get paid. But we won’t get into that here. The issue this time was not unpaid wages, it was ice cream. 

Those people, really! 

So, like, it was me telling him he didn’t have a right to shit without saying the shit part. 

So, like, a lot of the prisoners at Hospital Galveston really get into asking for snacks and drinks, crackers and chocolate pudding and all that, orange juice in little containers at 3 a.m., you know? It’s their right as patients to get snacks. Which the guards say that these guys/girls would have to buy on their home units in the prison store but are given free of charge to patients. Not to generalize but sometimes the inmate asks the nurse or the nurse’s aide for shit and then doesn’t consume it. It’s like that in the Free World too. 

There may come a point of privilege and expectation on the part of a patient in a hospital—prison or Free World—that makes him or her pretty fucking insufferable, actually. The nurses reach a consensus in conference at the nurses station at 2 a.m. In a Free World hospital it’s the middle of the night and everybody is talking about Miss Jones in Room 109 who “needs to go home now,” whether she’s cured or not. Because she thinks this is a hotel. After a few days some of the inmates start to think that too, like they’re at Hotel Galveston, which is down the beach about a mile towards Houston, not Hospital Galveston which is where you really are, bro. You may have to explain it to the guy.

Sometimes you have to explain the facts of life too. Some of these guys and girls are testing boundaries, just like kids, what-can-I-get-away-with-here-with-this-here-motherfucker? And they will ask for stuff they aren’t even going to consume, just because they saw another prisoner get it. Or they start hoarding shit like they’re back in their cell, in Pisspot, on the Pisspot Unit, or wherever, in the semi-damned indignity of the Texas Department of Criminal Justice. This particular brother’s bedside table was already full of shit he hadn’t eaten. But he was fixated on ice cream and my fixation was on telling him no. There we were, two strong black men going at it—about ice cream. Voices raised at two a.m. 

Then it struck me like a lightning bolt—straight to my heart. 

Maybe he didn’t do the crime and instead of being his caregiver that made me part of his oppression. 

Which was an awful feeling, really, really, really bad, a feeling deep in the pit of the stomach which is where my moral pain localizes. No lie. Suppose someone was like that to my great-grandfather back in the day after he whacked the guy who cheated him at cards, back in Brenham? Except that Great Grandfather, who was also named Lucius, really was guilty as sin. Nelson Mandela who did a lot of time in a cell before becoming Liberator of South Africa, and all, before becoming our collective consciousness—Mandela liked to say that you can judge a society by how it cares for prisoners. You can judge a nurse that way too. 

“You’re shouting at me just because I asked for something!” this brother told me. Words to that effect. Which was right, actually. 

He got an injured vibe going, it was pretty persuasive actually. Like he was Mother Teresa and someone just pinched his ass? This prisoner was pretty convincing, actually, never underestimate an inmate’s mouth, that’s the message here. It can be a pretty formidable thing. 

These guys and girls have nothing to do all day but talk, for years on end—guilty or not. Some of them develop potent verbal skills and that’s coming from somebody who has talked a little shit in his time. Most of these guys are way over my head in terms of self-righteous rap. And they can go on for hours—just talking shit—like those famous Negro men of old who said they could stay in the pussy for a full hour without busting the nut? Like the legendary Sixty Minute Men—but talking, not fucking? These guys are found in abundance in TDCJ. They have nothing else to occupy themselves, for years at a time, not to repeat myself, so they talk shit. And suddenly, my caring, nurturing side as a RN came forward and filled my hair-covered masculine breast with compassion. My inner Florence Nightingale spoke up, even though Florence was a white chick. 

“The ice cream is a non-starter. You’re just not going to get it. But I shouldn’t have raised my voice. I apologize if I offended you.” Hearing myself say it and not quite believing it either, but it was a start! And it was said with zero sarcasm because he really had made me feel like a bad nurse.

Having apologized maybe ten times total in my entire time working with adult patients, not to sound all macho or obtuse or anything, and eight of those times were, like, totally insincere. But this was coming from my heart and soul, corazon y alma and all that, like Mexicans say. Like a fine Spanish chick will tell you and you believe it, because she’s fine, even though she’s also mentirosa? 

And this 16-will-get-you-20 guy looked at me and he blinked. 

In a confrontation the first one to blink is the loser, you know that’s what President Kennedy said after he went toe to toe with the Soviets over nuclear missiles in Cuba, back in the day. If you know world history. When you’re in a standoff with somebody the first person to break the gaze is the loser. Here the issue was vanilla or chocolate. The patient made it sound just as important as those Russian missiles off the coast of Florida. 

16-will-get-you-20 kept talking about what he wanted but by now you could tell that the wind was out of his sails. And instead of me being only kind of sincere like in my last apology to a patient, a few years prior at another facility, my apology this time was almost wholly sincere! Like, that’s progress, right, in my moral development? And it’s like, so not the first impression people have of me, sincerity. 

So, like, looking back over my shoulder, feeling like there was someone else present, besides me and the 16-will-get-you-20 guy? It was the Lieutenant, the supervisor of the guards, standing behind me in the room. She was a hot black chick, actually, maybe half my age, not that there’s anything wrong with that. There’s just something about women in uniform, wouldn’t you agree? Especially when they carry handcuffs? Someone must have called her because of the raised voices and now she stepped forward to the bedside. The prisoner was still bitching, but you could tell his heart wasn’t in it. 

“The nurse already apologized,” the Lieutenant said. “What more do you want?” 

“I want ice cream. I feel I have a right to it.” Those people! And instead of me saying, “No, you don’t, mofo,” there was just a noble silence on my part. Like Denzel Washington after he has shot all the white people in the room? 

Me gathering up my wound dressing shit—gauze and saline, bandage scissors and all—and leaving, with the Lieutenant still standing there and listening but planning to do absolutely nothing because that’s what supervisors do, absolutely fuck all. That’s how you get promoted in the first place in Huntsville, where TDCJ is headquartered, the less you do the higher you go. The Lieutenants listen well but do fuck all. Not to generalize. They just appear from nowhere when things start to get hot. Anyway, a couple of days later, the same thing—another black guy—this time behind bars for murder and he wouldn’t let me draw blood and me threatening to tell the doctors, it’s around 4 a.m. and my whole plan is to get out on time and start drinking at like 7:30 in the morning because it was my Friday? To set the scene. 

“What they goina do,” the prisoner asked, “send me to prison? I been locked up for 33 years.” 

Actually he had been locked up for 37 years, not to be stickler for detail, but according to the TDCJ app. Some of these guys who are never-going-to-get-out lose track of time. It’s like all the heavy lighting overhead in the ICU, a patient gets disoriented about time because there may be no cues to night and day. There’s so much light all the time, it’s always daytime in ICU. In prison it’s like that too, the time just passes in a continuous blur. Not to sound all transcendental. 

So, like, the pressure had been building between me and this guy over a couple of days, there was a little machismo in the room, my balls can be pretty big too. He had a real attitude. Probably based upon the fact he would never get out. Except in a coffin. 

So, like, he was talking shit to me now at, like, four o’clock when my patience is at its lowest because there are so many labs to draw and you can’t get distracted. 

So, like, we got into it pretty good, once again two proud black men going mano a mano with our mouths—when we should have been fucking with white people instead, right? That’s one way to see it.  Thru a Black Revolutionary lens. 

And then, suddenly, a noble spirit came over me standing at this guy’s bedside, just like before with the ice cream guy. Like Florence Nightingale but with a penis, you could call it. “Listen dude, let’s start over,” me basically saying to him, “I’m sorry if I was rude to you.” There was at least a one-third chance that he never committed the crime, after all. 

And me turning to look behind me, once again there was a hot black Lieutenant, just standing there, listening therapeutically or getting ready for a take-down. She had long, painted nails, like what good was she going to be if it got physical? How did she intend to save my ass with those fingers? Sometimes even sisters act dumb like white chicks—and it’s usually what they do in the name of fashion. That’s why guys make better nurses. We’re ruthlessly practical and don’t care how we look. 

So, like, the Lieutenant stepped forward to the alleged murderer’s bedside to do some therapeutic listening but the inmate was adult enough to have already moved on. Jesus, he had beautiful veins too, not to get all sentimental, black men usually have the best veins, that’s been my observation through the years. Unless they’re drug users and they’ve used up all their intravenous access, which is a big bummer at four o’clock in the morning with a needle in your hand. If you’re just learning about it for the first time because it’s been busy and you haven’t had a chance to do a full assessment yet? Hello! 

He was a beautiful guy too actually, like a model or athlete—tall and built like a NBA guard. Not a big guy but big enough to hit some three-pointers. He probably got more than his share of pussy when he was back in the Free World, too, it was amazing that he could look so good after all these years behind lock and key. He was The Beautiful Prisoner, not to go all literary on you, and being totally heterosexual myself.

His hair was in graying corn rolls, he had a big, healthy smile, and he was slim overall but well-muscled without being showy like the guys who hang out in the prison gym. He had just had a hip replacement so not everything was going well but he still looked good for his age which was our age actually, he was maybe five years younger than me. He liked to try to flirt with the Officers too, he was exactly the kind of guy they had warned us about in security orientation, really. When the TDCJ lady talked about manipulators, remember? He was in for life, he had nothing to lose.

The female Officers rolled their eyes at him like he was full of shit, him telling her that he had missed her since the last lockdown, or since last time she pepper-sprayed him. Or whatever, what can you say?

 You could tell that the Officer liked what she heard. The weaker sex and all that. 

Women are vulnerable in a way that a noble Black Man can never allow himself to be. Based upon my experience at nurses stations, listening to the chatter, women do have a weakness for good bullshit that is almost as strong as men’s attraction to tits and asses. A lot of chicks like a guy who has a rap even when she knows it’s b.s., she still wants to hear it, that’s pathological, right? 

Even when women know it’s complete bullshit they still want to know what it sounds like, in order to judge a guy’s game and compare notes with other chicks later, not to repeat myself but having had the discussion multiple times on nightshift at hospital nurses stations across this great country, at 3 a.m. when women give up their secrets. But we digress. So, like, the guy who got my second apology was the lady killer or presumed lady-killer. In fact that may have been why he was in prison in the first place, he killed a lady. My policy is never to ask anybody why they’re doing time because it’s not like you’re going to get the truth, right? And life is too short. These guys live to talk. It’s how they pass time, not to repeat myself, an anecdote that one of these guys is telling may never end. You ask a guy at Hospital Galveston how his arrest for bank robbery in Midland went down back in 2013 and he starts with his father losing his job in the Oklahoma oil patch back in ‘83. An hour later he’s still talking and he hasn’t gotten to Texas yet. Please.

Overhearing is always an option though, and if things are slow—Sunday night for example. Listening at a prisoner’s door can help pass time. Catching parts of the conversation, especially if you’re doing a task that takes a little while, like a wound dressing change. Or fucking with an IV, and you can ask directed questions like they told us in nursing school is so important for success in patient assessment? Human assessment, too.

And if his rap is not entertaining you just tell him you have to go and do something else. Which is always true, there’s always something else to do. If it’s not interesting you can break off the interlude and say you have to chart. Or just walk away like you weren’t listening in the first place. That’s kind of why the wards attract me, life on the infamous med-surg unit. It can be entirely cool if you aren’t taken hostage and if you use a filter. Used the apology strategy a little while later to a white guy who was in for burglary but it didn’t work. He continued to be an asshole with me. What can you say? Those people!

Anyway, what you hear from patients can be very unit-specific. If you’re working in the ER, for example, you’re only seeing people for a short time and the explanation of what happened to bring them to the hospital has to be really succinct. If you work in the ICU—the patients are out of it. Or they’re in too much pain to talk. Or they can’t talk even if they want to, because there’s a tube down their throat. But on the Med Surg wards the patients can effectively narrate their condition in life and if it’s not interesting or it’s obvious bullshit—you just say you have to go do something else and walk away. My weakness is not wanting to walk away, frankly. Being interested in the Human Condition and all that. Even when you have another patient to see. Once back in the day, working trauma for the county hospital in Austin, going into a room to do a dressing on a patient who was hit by a shotgun blast to his stomach? To set the scene. 

His lower belly was a mess. There was a bag to collect poop, his wound was covered by soiled gauze and blood and drainage. He talked me through the dressing change, it was my first time with this particular patient and he knew how to change the dressing better than the nurses did. Because he’d seen it done so many times. So, like, we’re talking about other shit too and he told me how he got shot. 

His wife did it. His old lady, actually. How wrong is that?

She found out he was cheating and she met him coming home—getting out of his car in their own driveway. She was apparently aiming for the offending anatomy but missed a tad high. 

You know what he said were the last words he heard, after being shot but before passing out? “Children, go inside,” his wife said to their kids. “I’ve shot your father.” Isn’t that touching? 

That’s what kind of got me started listening in hospitals. Moments of truth in the continuing drama of health care, not to go all transcendental on you or sound like Dalai Lama. That guy’s wife who pulled the trigger? She may be one of my patients right now at Hospital Galveston, if she hasn’t finished her sentence yet. How special is that? 

Another time on adult trauma, also in Austin, it was a black guy who was a player—he liked the married ladies. Like the white guy who got shot by his wife? But this black guy got shot by the husband who was being cheated on. The cuckold, you know? Just to mix it up. The husband came home while this guy was sweating up the sheets with the man’s wife.

And the brother who was shot with his dick out was paralyzed. In Austin people always say that your downfall is karma and that’s my belief too, here on the Island of Sin. Austin is a very karma-heavy town, while Galveston is more Biblical, as in original sin, you know? 

So, like, that black guy was literally climbing out a bedroom window when the bullet hit him in the lower back, hit the spinal cord or whatever and he was suddenly a paraplegic. Here’s the zinger. He was unable to use his bone after that, is that karma or what? Was God looking down and pronouncing judgment or what? Black people are a people of faith, let me tell you. 

And this partially-paralyzed patient—even though he could not back it up—was still talking some pretty smooth shit to the female nurses! He would have been getting all kinds of pussy with a rap like that if he had a bone that worked. That’s what is meant by the indomitable human spirit. The hospital in Austin was my first job as a nurse and adult trauma prepared me for aspects of care at Hospital Galveston, which is likely to be my last patient care job, btw, not to repeat myself. The first concern at Hospital Galveston frankly is not illness, btw, it’s escape. 

We also had a couple of escapes in Austin, back in the day, which should be mentioned in the corrections health care context. Escape—elopement, whatever you want to call it, doing a runner as the Brits say is a danger at any hospital, even if it’s in the Free World. So, like, during my early training in Austin, back back in the day, there were two escapes which guide my views today at Medical Branch regarding the escaping patient population. A big issue in prison medicine is who is trying to get out the window and how? Not why, which we already know, he’s a prisoner of TDCJ, but how. The first two times for me at the hospital in downtown Austin also apply as background to escape from the Texas Alcatraz, Medical Branch’s campus on Galveston Island. 

So, like, one patient on trauma was a head injury who somehow got away from supervision at our nurses station, where we had him sitting in his wheelchair so that we could watch him. He ended up rolling down Congress Avenue, in front of the State Capitol, still in his wheelchair. The cops called the hospital and said he was wearing our hospital gown, that’s how they knew who to call. That is technically an elopement, not an escape, because only prisoners escape, right? The second guy was a real prisoner, also on adult trauma, don’t know what he was in County Jail for but he came over with a deputy and was handcuffed to the bed in a room for a few days, on the end of the floor, nearest the Capitol? To set the scene. His window kind of looked out on a little hillside that leads up to the Senate side of the building from Red River Street, in the middle of the Live Music Capital of the World. To set the scene again. 

The deputies on watch in the hospital room got bored with that duty pretty damn quick and were prone to fall asleep in a chair in the corner of the room. But this inmate made a lot of noise, groaning and all, from the time of his arrival, which probably made it hard for the deputy to take a nap. The prisoner moaning about pain and how bad he felt, you know? It was an act! It was totally an act. He was trying to put the guard off his guard. How cool is that? Those people! 

He was Latino, yeah, makes you wish he was black. 

So, like, it happened on my day off which is disappointing to report because it would’ve been cool to be there and get his autograph before he went out the window. Anyway, the moaning inmate somehow managed to get out of his handcuffs and jumped down onto the roof of a lower building next door and was, like, gone. He was lucky because that was an era when hospital windows still opened, unlike now you’re sealed in and breathing recycled air all shift. At Hospital Galveston the escapees somehow go through the wall, that’s my understanding, at least that’s what people tell me, not having been here long enough to see an escape yet but kind of hoping, you know, just for the experience?

A former Lieutenant who is now retired said he walked into a bathroom in Hospital Galveston back in the day, and there was just a hole in the wall and a rope of bedsheets. He ran and got his pistol, he said, but that guy was gone too, just like my guy back in the capital city. Which was somehow reassuring because one likes to think bedsheets are still used for escapees. Even in the high tech world in which we live, there are some ways of doing things that never change. And the TDCJ security response to an escape was still the Lieutenant running to get his pistol, just like in a movie? 

The more things change the more they stay the same, no? Prison health care is not primarily about health. The biggest priority is preventing escape. Once you accept that reality, giving care gets easier. 

The ex-Lieutenant couldn’t remember if the escaped guy when he had to grab his pistol was the same inmate who later whacked someone up near Dallas. A nurse who helped orient me said he was doing patient care one day and went home and on the eleven o’clock news they were talking about an inmate who had just escaped and the nurse recognized the guy’s name because he had been taking care of the guy earlier that day. What a coincide, that’s Hospital Galveston too. Like, how cool is that? Escapees can be dangerous and all, but the social worker in me likes to see people at least making an effort to change their life’s circumstances. Even if that means going out a window when no one is looking. Especially because approximately one-third of the black inmates aren’t guilty in the first place, again according to my calculations. And escape is an important consideration because TDCJ doesn’t negotiate. 

In TDCJ’s hierarchy of crime, in the prison corridors, high up are bank robbers and murders, low as you can go are sexual predators, but above all other felons are inmates who have escaped prison, even if they were caught later. Just the act of successfully escaping from a major prison can heap kudos on an inmate’s criminal career. An Officer was talking to me the other day about a prisoner on another unit of Hospital Galveston who escaped twice. Even the Officer talked about the guy like he was a rock star. That guy who escaped at Texas Tech E.R. and raped those two nurses? He was a brother, sad to say, and he must have been part of that one-third of Negro inmates who actually did the deed, whatever crime they were charged with in the first place. He was a mean nigger and all that. Some do exist, but a lesser percentage than the White Man claims, as seen thru a psychosocial nursing lens, and less than guilty white inmates, that’s my whole point really. 

So, like, the Texas Tech black guy was already serving a 140-year sentence for rape and other shit when he was taken to the emergency room in Lubbock. Prison Legal News takes up the account from there. This short news item tells you everything you need to know about escaping prisoners in the health care context, at Hospital Galveston and anywhere else, actually. “A Texas prisoner used a fake gun to back down an armed guard and hold an entire SWAT team at bay for over an hour. Dekenya Nelson used a hairbrush, soap, a deodorant bottle, and pages from the Bible to make a convincingly real-looking weapon,” Prison Legal News reported. 

“For almost 90 minutes Nelson also held two University Medical Center nurses hostage. During that time he is alleged to have sexually assaulted both women. Nelson was a prisoner at the Smith Unit in Lamesa TX when he was transported to University Medical Center for treatment of internal bleeding caused by swallowing a can opener. He was placed in a room with a prison guard and an armed guard was stationed outside the door. When Nelson complained of the cold, he was given a blanket.” To set the scene. Under cover of the blanket Nelson used a hidden key to remove his handcuffs. “Once freed, he produced the fake gun he had hidden in his jump suit. The guard in the room swung his nightstick at Nelson and missed.” It gets worse, kind of like a comedy skit, but this was real. 

The State of Texas added another 175 years to Nelson’s sentence, if you consult the TDCJ app it doesn’t even bother saying when he's eligible for release or whatever because the guy will never see the Free World again. Inmate Nelson is in Huntsville, btw, at the venerable Ellis Unit, and has become quite an accomplished writ writer. He even sued Medical Branch over care at Hospital Galveston once. How cool is that? 

There is compassion at TDCJ, to give the Gulag the credit it deserves, but it’s rare, except from the nurses. 

 

 

Chapter 4

 

As a newbie nurse, you get to see most of Hospital Galveston pretty quickly but there’s a lot to take in. So, like, you can come to work at your home unit, mine is 7C, and the charge nurse tells you that you’re being “floated” to somewhere they need a nurse more. My assignment for one whole shift was the Infirmary which is a kind of a shithole basically, the Infirmary at Hospital Galveston is. Not to be judgmental. 

It’s a large room in a basement somewhere—that’s what it felt like, being underground. Only been there one time and needed the help of my preceptor to find it. There were a couple of Officers circulating continuously across the room, about 30 beds in rows, all filled the day of my visit. To set the scene. And an apparently secure glass-paneled nurses station. 

There was a TV “lounge” for the inmates who could walk or had wheelchairs. This area was supposed to be off limits to the nurses actually, nobody told me and the whole first half of my shift was spent going in and out of the lounge, getting the guys watching TV to take their meds or whatever. 

These prisoners had been brought to Sin Island for specialist appointments or for procedures or surgeries or because they were sick but were better now, or reasonably well staying in the Infirmary and didn’t need to be in the main hospital anymore. Awaiting transport back to their home unit, in other words. Waiting for their ride, to use slang, that big white TDCJ bus to take them back to the Pissville Unit, in Piss County, which is next to Shithole where the Shithole Unit is, in deep East Texas? These patients in the Infirmary were stable, the medicine practiced at Medical Branch is pretty high level. The practitioners know how to do the right thing even if it’s not always done? That’s true of a lot of healthcare environments sooner or later. Nobody can give 100% all the time. But at Hospital Galveston the limits are placed by the State of Texas, like, how much care to give? What the Legislature will pay for, in other words.

So, like, the nurses get maybe ten patients each in the Infirmary which sounds like a whole lot and in an ordinary hospital would be too fucking much, TFM is the nursing acronym. Once you accept the assignment it's too late, if you're going to walk out you have to do it before beginning patient care. In ordinary circumstances the Board of Nursing would probably take your license anyway, just for being dumb enough to accept that kind of patient load, whatever the circumstances and however the shift turned out. Once the nurse accepts the patient assignment it’s his or her ass. You can practically hear the investigator from the Board asking, a hint of irony in her voice, “And you thought ten to one was a safe assignment?” So, like, you’re kind of fucked either way. To say nothing of bad care for the patients. 

But at the Infirmary a heavy patient load seems okay because all you have to do is pass the guys their meds and do a quick physical exam and write a note on the patient’s condition. Or maybe do a dressing change, which is how my time was passing, about midway through that shift in the basement. To set the scene again. Still on my new nurse orientation which was 6 weeks and began on day shift, God forbid, this place is busy during the day. So, like, changing a dressing on a diabetic inmate who had just had a leg amputation? 

He was a brother which is important to me, younger than me—in his black prime so to speak, maybe mid-forties. A man that age, there’s still a lot of booty to hit, you feel me? But having lost his leg now and being locked up didn’t help his chances in the pussy domain. He seemed to be adjusting okay though or as well as can be expected, what can you say? He was already in TDCJ, what’s losing a limb after the loss of a Black Man’s freedom, that is the philosophical question, to quote Shakespeare. You may never give up The Struggle but—believe me, Brother—eventually we all give up The Ghost. To set the scene in the Infirmary finally. 

This guy who had the amputation was learning to use a wheelchair but he said that he hadn’t showered in 10 days. Which is, like, a long fucking time, LFT to use the healthcare acronym. 

Me and the nurse’s aide got him under the water, we offered to lift him onto the shower bench but he wanted to do it himself. He did super, btw, he had already taken ownership of his new life, which is what you want to see. Soap and water on the wound itself, that was healing well. A lady from Physical Therapy came by and worked with him and she gave me a few tips too. Got him back to his bed to put on a fresh dressing, and you know, like, my thing is to listen? Not to talk unduly about myself. Not to act like a Black Savior or anything. But helping this Brother taught me something special. How to steal, actually. Which was interesting in itself, worth the trip to the Infirmary, being totally honest myself and not knowing about the activities that may have led some of my patients to be incarcerated in the first place. 

So, like, me working on this dude’s missing leg, and sitting across the aisle from me on another bed was a prisoner who was explaining to another inmate, on the bed next to him, how to be a successful thief. So, like, wrapping a stump is straightforward, you just got to make sure the dressing won’t fall off when gravity goes to work. When the patient stands up on crutches or hobbles around or goes to the pisser or whatever, is that too much information? This black guy could maneuver whatever was left of his leg, there was just nothing on the end. Except, now, a bandage.

So, like, me taping the gauze and listening at the same time to the guy across the aisle explain how to steal. Being a scrupulously honest person myself, this was, well, an education. 

The guy doing the explaining was white, maybe fifty, he looked kind of like a small-town bank president or a successful insurance salesman, actually. Pillar of the community and all that? 

He looked like a guy working for the Chamber of Commerce in Pisspot, Texas, back in 19 and 58. He had a full head of conservative cut hair, greying at the temples, prosperous-looking in a small-town I-like-to-screw-other-guy’s-wives kind of way. Does that make sense? Not that there’s anything wrong with that. The guy who the bank president was talking to on the other bed was also white, younger but scrawny looking, also in a small-town Texas way. Hardscrabble, that’s the word you hear out west, a Hardscrabble Texas white boy or maybe an Okie in the original meaning of the word, like he really did come from Oklahoma? A cracker in today’s Negro street vernacular, if one wished to be rude, which is not my intent here. 

As crude as the word may sound, cracker is nonetheless descriptive of the pallor and dry skin of a certain kind of cigarette-smoking poorly-hydrated Southern white guy or white girl, and is like half the adult population of the Panhandle, Oklahoma and Texas varieties both. Not to generalize or anything. Not to sound racist. Some of these folks call themselves crackers, actually, and who are we as POC to dispute The White Man or The White Woman about their preferred pronouns? So, like, it was just two guys talking. The scrawny white guy was hanging on the prosperous white guy’s every word.

 “What you do, see,” began the bank president as he explained how he had ripped off his boss back in his Free World days. He didn’t work in a bank, it turned out, he was a truck driver and he said that the key to stealing at work was not delivering all the merchandise that he was carrying. And that made a certain sense. 

There was always a missing last crate of merchandise, this former truck driver said, and he knew because he took it. It was that simple. 

What he did with what he stole was a little surprising. “If you’re hauling eggs, see,” he told the younger guy, “then you hold onto that last crate. And when you’re done with your route you go to the Truck Stop and you meet up with the other drivers that have something to trade. See?” The younger guy smiled and nodded. Oh wow, so that’s how you do it! The Okie was clearly impressed. 

A crate of eggs must be a lot of eggs and you can find other drivers at the Truck Stop who have ripped off cargo from their own deliveries to exchange with. A kind of a flea market for thieves. Oh wow, how cool is that? 

“Another driver might have shampoo for example, but it’s too much shampoo for him to use. So he’ll trade for some eggs. See? That’s how you do it.” Now we know. This guy talking was my patient too and he was in Hospital Galveston with a diabetic wound not yet as bad as whatever had caused the black guy to lose his leg. 

This white guy’s dressing needed to be changed too and his blood sugar needed to be checked and his sugar was, like, in the ozone. He was heading along the same path as the one-legged black man, maybe towards an amputation if he didn’t watch out. That would happen in a few months or a few years, after he returned to his cell in the Gulag. At Hospital Galveston on the in-patient acute unit we check diabetic’s blood sugars before all meals and at bedtime, btw, four times a day just like in a Free World hospital. While in the prisons where these guys live for years at a time they’re routinely checked only twice a day. Or so the prisoners say. That may be the problem, not to sound like a SME, a subject matter expert. Twice is not enough to maintain good blood sugar control? That's the way they taught us to apply our healthcare informatics training at Texas Tech.

What would that look like? A lot of neuropathy, a lot of diabetic ulcers and a lot of amputations, is that right, Professor? Hmmm. With a little research, it might make a good paper for a nursing journal. Or it’s all the starch they’re eating—all the white bread. That’ll kill you too. That would also make a great paper—nutrition in the prisons of the Texas Department of Criminal Justice, aka TDCJ. Except nobody in the Free World wants to know. And you have to be careful. Putting on my Statistical Hat—that the instructors taught us to use in grad school—would mean judging the rate of diabetic amputations among TDCJ prisoners against the number in the Free World, where it’s not great either. Anyway, the State of Texas defends itself by saying that you can’t judge TDCJ healthcare outcomes too harshly. Many of these patients are folks who may not have been going to doctors even before they got locked up. 

Their health was already compromised in the Free World, that’s the State of Texas’s argument and it has a certain inherent truth. But when you take someone’s liberty you also take responsibility for their health, right? The U.S. Supreme Court ruled that, in 1976, based upon a TDCJ case. Hello! The ruling presumably involved one of the shithole prisons in or around Huntsville, back in the day. 

My best professional opinion—if you asked me as an almost master’s-prepared nurse-scientist, diploma already in the U.S. Mail? Health care in the Texas Gulag is bad but not as bad as it could be. Like, not as bad as in the Soviet Gulag, for example, the difference being that it’s hot in Pisspot, and in Siberia it’s cold? Or not like being a Roman galley slave or anything like that, back back back in the day. Not like row or die and somebody is whipping your bare back to make you go faster. Not that bad. Or not like burning for eternity in the sulfurous flames and fires of Hell. Although it's just as hot, out there on the units, in Shithole and in Pisspot both. 

The quality of TDCJ health care is probably at a level exactly where the majority of people in the Lone Star State want it to be, bad but not fatal. Or slowly fatal, not so fast as to draw attention of the courts. Unless it comes time for the Big Needle, that works within minutes, the TDCJ-administered medicine that cures all ills. One thing is certain. Hospital Galveston is the fastest-changing patient population during my time in the saddle as a bedside nurse. To set the scene. You can be taking care of some guy when the shift begins, at 7 pm, and you look up and suddenly it’s 2 a.m. and standing there is a guard with a wheelchair and handcuffs or who has brought a stretcher, and the Officer says, “He’s going back to his unit,” and of course it’s the first you’ve heard about the transfer. 

TDCJ’s primary mission is to prevent escape not to provide health care. 

The primary concern is the logistics of the transfer, not necessarily the prisoner getting his or her next round of meds. Once or twice it’s been a tragedy to me personally—a middle-of-the-night transfer. Not to sound all self-centered, this is only mentioned in order to show how a night shift can roll, here on Texas’s Island of the Damned. Not to bitch about my work assignment or anything.

So, like, instead of me having a quiet night—which is the only kind of night to have, actually, in health care, both for you and the patient. Instead of me keeping the six patients they gave me at the beginning of the fucking shift—not to sound unprofessional. Instead of me keeping the patients who are known quantities to me by two in the morning, oh no, we can’t do that. Instead, a quick discharge and the next admission will be mine. To get me back up to six patients like everyone else. 

Which is a pisser and means a lot of extra effort with admission paperwork and labs and all that. Start an IV and send blood, you know what you have to do even before the doctor writes the orders. Which upsets my qi because boy-nurses are all about rhythm and being in tune with the energy of the nursing unit. That would be my argument to the charge nurse, suggesting that she give the admission to some other more deserving nurse. Btw, the guards don’t want the inmates to know when or how they will be transferred because TDCJ doesn’t want the guys or girls to have a chance to make a plan. Which these guys and girls in leg chains do far better than the State of Texas does, make a plan that is. You know? Not to be rude or condescending about leadership in Huntsville or in Austin. 

You can be talking to a patient and even in those rare cases when you know exactly at what time the Officers will come for him—or her—for the ride back to his or her unit, and he or she asks you, when are they coming for me? You still don’t tell. 

There may be a bunch of guys going back to the same unit, for example in Pisspot—the guard is telling you this in the middle of the night. The White Bus is waiting, headed to some unit somewhere in the vast and lonely expanse of the Lone Star State, not to sound all dramatic. On the boundless prairie of West Texas or more likely among the pine trees of the eastern part of the state. Maybe on the coastal plain around Sugar Land. And you just looked up while charting in the hallway and there was an Officer standing there, or two Officers if it’s a bad dude they've come to collect. TDCJ is transferring your guy or girl in the middle of the fucking night, back to the fires of Hell, because it’s more convenient to do that right now. Or safer. Who is a mere nurse to judge? 

My boss warned me once—in interactions between security and nursing—everybody who works here, meaning guards and nurses, needs to stay in his or her “own lane.” Which sounded like good advice. 

But my lane is still kind of a mystery to me. The comings and goings from Hospital Galveston, by ambulance or by prison bus, are complicated by security—and by the roads of the Lone Star State. And by medical condition. There are actually prison cells somewhere on Medical Branch’s campus too, no shit, even though this is a university. These holding cells, someone told me about them one night. My colleague said they’re just like regular prison cells, for guys and girls who have been discharged from the hospital and don’t need to tie up a bed anymore, and who are waiting to go back to the Shitville Unit by bus. Maybe after an appointment with a specialist. To set the scene. So, like, the jockeying for beds is intense, so many people coming and going, particularly interesting is the lot of the writ-writers, who may have longer stays on Sin Island than other prisoners do. Maybe they end up in the university cells because there’s air-conditioning.

Writ-writers are the guys and girls who sue the State of Texas over the abominable conditions. Who complain to the courts about the heat in the cells? And the filth? Or the violence? To say nothing of the damn food. Bitching may actually serve a purpose, as it turns out. The squeaky wheel gets the fan, you know? 

A few of these writ-writers get kept at Hospital Galveston past their scheduled discharge, including a couple of my recent patients, because the lawyers or the judges or whoever is in power in Huntsville has decided that these particular guys or girls can only be housed in well-ventilated cells. Which are extremely rare in the Texas Department of Criminal Justice, at the units in Pisspot and in Shitville both. So, like, in the inmate’s absence from the ventilated cell on his home unit, the fan was taken by someone else, maybe while the writ-writer was on the white bus to Sin Island. There’s nowhere cool available on his unit right now for him to return to. 

Still, all in all, the care at Hospital Galveston seems almost nearly—kinda—okay. From my viewpoint, given the circumstances and given that it’s industrial health care intentionally stripped of the humane element. And given that it’s all that the public will pay for. And given that this is Texas where empathy is a scarce commodity. “Bad” with an asterisk, you might say. Based upon my prior experience which is considerable but not in correctional heath. Take this opinion, therefore, for what it’s worth. 

This is my first and will be my last experience taking care of prisoners. Still, there are certainly some very good people at Hospital Galveston. No doubt. Don’t underestimate the skill of the providers. Dr. Ojo the medical director is a Nigerian-American cat and is totally cool. He’s like one of only two black men of my acquaintance in the role of physician anywhere on the whole fucking campus, back in the day or today. And there have been, like, only two sisters. This island is still the Old South, literally. 

One of the two black women docs was an internal medicine resident who came to 7C at dawn a couple of weeks ago. She ordered every test known to modern medicine? And was super-hot, like an easy 9 or 9-and-a-half? Think she was from the Caribbean, actually, and she had more ice on her ring finger than the Titanic had on its bow. Not to sound jealous of the brother hitting that particular booty. Not that that’s important here. So, like, this cat Dr. Ojo, who is the Big Dog at Hospital Galveston? He is super-competent. 

He actually rounds on the units and asks the nurses what’s going on? What a pleasant change from my prior hospital experience where you only saw the bigwigs at the Christmas party or maybe during Nurses Week, when they came by to bring you some little shitty giftbag that cost like $3. Not to go all radical union member, only because this is Texas and at Medical Branch there’s no nurse’s union.

The first time Dr. Ojo saw me—new to in-patient acute—he walked over to me at the nurses station and took my badge in his hand in order to pronounce the name. He asked me what my last hospital was, seemed to approve the answer, then let me go. This wasn’t mere courtesy, he was vetting me. This is said with complete love and respect for the Nigerian peeps. They are awesome. But in Nigeria, people run so many games that Nigerians who come here to the Land of the Free—and Home of the Brave—are still always worried that someone is running a game on them? Not to sound all racist or nationalist or whatever. 

But speaking as a noble slave-descended Black Man, who is a natural-born straight-shooter like John Wayne, we slave-descended Negroes don’t run games. At least not on other black people, although it’s always open season lo lay a little trickery on whites. For me personally, the most important quality of the Nigerians living in the United States—to me, personally? A lot of African women are hot and will give it up to an American Brother, as a show of Black Unity, so to speak. Not that that’s important here. Let’s see, you may want to know, in my new career at Hospital Galveston, what is my approach to correctional nursing? That’s a fair question, bro. 

It’s pretty much like any other kind of in-patient care except you’re more rushed in a prison hospital than in the Free World because of the demands of security. At Hospital Galveston you have less total time to complete tasks than a civilian RN does. Doors to patient rooms and the doors to the nurses station are locked and you have to ask someone to buzz you in or get the guard to bring the key. Literally. All of that takes time because there’s not always someone around to open the door. We’re supposed to have two Officers on 7C at all times but quite a few of my shifts this spring there’s only been one. That adds time to tasks too, because maybe a dozen times each night you have to find the lone Officer and disengage him or her from doing something for another nurse and get him or her to do something for you. You have to cultivate the Officers btw, and respect them, they hold a nurse’s balls/ovaries in their hands. Depending on how fast they move. So, like, weaknesses in my nursing practice? That’s a fair question too. 

Being super-organized during the shift is not my strong point, to be honest. Even after all these years. If you asked about my work style, my mantra is to be proactive in order to avoid trouble or in order to have the most time to deal with it.

It’s always appropriate to take another set of vital signs, for example. Turn patients who have surgical wounds because you may find a bed full of blood underneath. That’s what our instructors warned us back in the day and it's true. And make sure you get a look at people’s skin, it’s one of my few hard and fast rules during a shift when shit is happening and you have to remain flexible. The ultimate goal is that in the morning the patient is in at least as good health as he/she began the shift. That means you have to prioritize. A lot of these ladies and gentlemen are really sick. My thing, my idiosyncrasy of practice is always to look at the patient’s feet as the best outward sign of chronic disease. Especially in TDCJ because it’s a shithole and feet are the point of contact with the institution. The worst luck at bedside is to catch a problem late, it seems to me, after it’s had time to fester. If you catch it early you don’t have to do the paperwork later or you don’t have to call the docs and start taking orders, which is more shit to do in an already shit-to-do filled environment. The nurse’s interest and the patient’s interest are the same 99% of the time. We both want a quiet night. My primary overall professional goals can be summarized by only two rules. Not to hurt anybody and to get home on time. Not to repeat myself.

 So, like, you may ask, what about shortcuts? It’s hard not to use them when you’re super busy, with a nursing shortage and all, but bad practice can have bad results. Our instructors back in the day talked to us about that too. 

Once at Hospital Galveston—it’s embarrassing to admit, as a seasoned RN. This happened not long after my arrival on 7C. So, like, once—due to rush, although that’s really no excuse. We were passing meds, you know? And, like, not that this would be my usual practice, because the nursing instructors taught us better. But leaving some medications unattended on a computer in the hallway? In order to go into a room to talk to a patient? Does that sound reasonable? It’s actually bad practice. To set the scene.

And returning to my computer, my preceptor who was this uber-competent African chick? 

She was standing there, waiting to chew a little proud Black Man ass. To set the scene again.

My preceptor was from French-speaking Africa and she was hot—and a very good nurse. In fact, she was far better than me. She was actually a newly-minted nurse practitioner, still looking for a first job in advanced practice. This chick was my principal preceptor on days, for three weeks, and a Filipino guy picked me up after that for orientation on nights. The foreign nurses have saved American health care, actually. Filipinos and Filipinas who studied at home in the Philippines are some of the best nurses that it has been my honor to meet. There was a PICU nurse at Medical Branch back in the day, during my time on the unit, who was an anesthesiologist in her home country. Anyway, this African chick was always right, the Cameroonian lady, you know the way black women are always right? Like sisters here at home but the accent is different when they are lecturing somebody? Skilled in nursing and skilled in chewing a Brother’s ass. 

Because black chicks literally are right most of the time. 

This one, my preceptor, could put this proud black boy-nurse to shame on his skills. At that moment she was standing there with my abandoned meds in her hand. She was having a coronary event. 

“Do you know,” she asked me, holding up my medications to make sure every pill was visible, turning her head to the side like a German shepherd trying to understand human speech, “what would happen if Dr. Ojo found these sitting here?” 

One of the other nurses had already told me what would happen, actually. Not to sound like a smartass. But speaking of Dr. Ojo, the other nurses said, basically, “He’s very nice. Just don’t screw up.” Which is fair, right? Because medication safety can mean people’s lives. And leaving meds out is bad practice, especially in this environment. Medical Branch as an institution though—that’s another story. This place is a totally sketchy spot in the healthcare ecostream. Just like Galveston Island is a totally sketchy spot on the Gulf Coast. Completely dodgy, bro, actually. Some people come here in order to do the wrong thing. 

Not to sound petty but for Nurse’s Week, you know what the fucking nursing administration did? The Chief Nursing Officer, or whoever? They gave all of us a giftbag with skin moisturizer and lip balm. Hello! What about the guys? That was my question when the charge nurse gave me mine. Fucking hell. What is this shit? That was my question to myself at the time. Not to sound like a Neanderthal but the black male—descended from noble African warrior stock—does not use moisturizer or lip balm, bro. Again, not to sound like a cave-dweller.

Besides, boy-nurses know old African wisdom—how to moisturize your skin. It’s best done from the inside, bro, with water, not outside with creams and potions. But that’s the way chicks like to do it, by putting stuff on. They like to get all tarted up, you know? Don't get me started.

Or a pink bow in her hair, if it’s pediatrics. 

Like, coming to work on a hospital nursing unit and you’re wearing makeup? Don't get me started. You ought to be able to suspend a RN’s license for that alone! Especially if it’s a guy. Not to sound like a Neanderthal again. Does the Medical Branch Nursing Office even understand that there are men in the profession now? How about giving the guys something really useful for Nurse’s Week, like condoms, or a few of those little blue pills? 

Like for E.D.? 

Which doesn’t mean Emergency Department, although it can be an emergency when it happens, you know? So, like, anyway, something just began to worry me about Hospital Galveston. Out of the blue. Call me paranoid if you will. Maybe call me a good nurse. So, like, this is exactly what it’s like to worry in a health care environment, btw.

 Sometimes it’s a question of good care vs bad care, you see that everywhere from time to time, in many healthcare settings. Good practice versus bad practice, too. But it can also be about someone taking advantage of a vulnerable patient population. 

Worry in a hospital takes the form of intuition as much as lab results, experience telling you that something bad is going to happen or already did happen and you’re fucked. Or the patient is in trouble. That’s nurse’s intuition which may be backed up by a look of panic on the patient’s face because the first person to know the patient is going bad is usually the patient. And my experience working with children, where emergencies are usually respiratory. If you wait until the patient’s airway is already closing, you’re fucked. Not to sound all dramatic. But that’s nursing intuition too. It’s what led me to worry on Sin Island or Island of the Texas Damned if you’re being formal. Our part of the Lone Star State’s sunny Gulf Coast. 

Like Devil’s Island but closer to shore and there aren’t as many sharks in the sea. But there may be more sharks on land. To set the scene again.

 

 

 Chapter 5

 

You’ve heard of the Nazi medical experiments on concentration camp prisoners? After the war the Allies hanged a few nurses too. Who absolutely deserved it—not to be critical of another RN’s practice, you don’t really know if you didn’t work the shift, isn’t that what we say? 

The Japanese also experimented on prisoners and the US military seized the data in order to bring it to American scientists, because of its supposed value. That’s a very incomplete history of gross medical malpractice as seen thru a correctional care lens. Domestically maybe the second best documented example of healthcare evil in this country are the famous “Tuskegee Experiments” of the U.S. Public Health Service, circa the 1960s. You’ve probably already heard about that. Letting black patients suffer the effects of illness in order for doctors to watch the progression of the disease. Which in the Tuskegee case was syphilis. You couldn’t make this up. 

And of course the most famous victim of American medical exploitation, in a very crowded field, was Ms. Henrietta Lacks of Baltimore, Maryland, who had samples of her cancer cells grown, through years, across biological sciences, after doctors at Johns Hopkins took them from her. In order to commercialize her immortal genes, hence Oprah’s movie and the book by Rebecca Skloot. So, like, of my eight hospitals in the last two decades or so—working as a staff nurse in each—a low-level grunt in the Big Picture of American Medicine? UC San Francisco was my first step into this pitiless white abyss of unethical patient care and/or unethical research. Which may also be the template for operations of the University of Texas Medical Branch on Sin Island. 

My first whiff of evil, if you will, was at the University of California in Baghdad by the Bay—as S.F. is called by those who know the city. The City of San Francisco is kind of in a class of corruption by itself. In fact an unethical series of experiments has just come to light at UC’s S.F. campus, which is called Mount Parnassus, located in S.F.'s Sunset District on a big hill. Which may be a template for what is going on at Hospital Galveston too. Looking through a West Coast lens actually, Medical Branch becomes totally sus too and for the same reason. “Sus” being short for “suspect,” as young people like to say. UCSF is a medical corporation with an academic façade, in fact that’s all the campus does, all health care all the time, just like UTMB. 

UCSF—also like UTMB—conducts well-funded healthcare research and has a big patient population, and wants it bigger. The San Francisco campus just took over two hospitals in Hawaii and is famous for attention to its business side. UTMB on the other hand has a lesser academic reputation but has bragging rights with a Level Four Biosecurity National Lab. Don’t you wish you had one? Where presumably scary shit grows, about four blocks from my crib actually. And a short walk across campus from the prison hospital. Not that there’s anything wrong with that. 

Like UTMB, there’s a long and cherished history of racism at the University of California San Francisco that continues today. If Mount Parnassus is not the belly of the beast, it is the beast. thru a business-of-healthcare lens. UCSF has historically been a white and Asian institution, like UTMB is still, but for the longest time UCSF was almost solely white even with the large Asian population in town, to say nothing of all the Negroes and Latinos in California. Black people were the patients and research subjects. Which is also a pretty good description of UTMB today, white faculty with some Asians. Black and Latino patients.

So, like, the Mission District where my UCSF clinic was, during my employment there, was located in an almost exclusively Latino neighborhood, at the time of my arrival, but was becoming not just white like the rest of the city but super-white. Silicon Valley white people, techies all, with high brows and high incomes. Not to stir racial animus. You’d see buses full of Google people coming and going, a few Asians but no blacks and definitely no Latinos. During my time in Baghdad, people knew what was going to happen to the old San Francisco but it hadn’t happened yet. Gentrification. But because UCSF is an academic research institution and still needed research subjects to test medicines and procedures and similar shit, for new protocols, or whatever, or new products, the University of California was fucked. Like, completely bent over—no Vaseline—no kiss—no nothing. These new-to-town high-tech parents from Google or Apple or wherever wanted nothing to do with research on their perfect little white kids. A lot of the wealthy white San Francisco moms wouldn’t even allow their children to be vaccinated—because of mercury in the vaccines, or so the moms thought, don’t you know? 

Like, there was no way a Silicon Valley mom’s little Ms. Perfect was going to be taking any untested med, thank you very much, something that was not federal government-fucking-approved? And even a lot of approved meds weren’t going in little Kendall’s or Courtney's mouth either, not in Baghdad by the Bay. And in my capacity as the nurse, advocating for Mom, not that she needed it, my feeling was, “Good for her. She’s got sense.” Because you can’t trust academic medicine in the U.S. They’re always up to something, that would be my first point really. Some other moms didn’t have that option though. That’s my second point. This is part of UC’s history of exploitation of vulnerable populations. The University of California is the same group of people who brought us the Atom Bomb, what do you expect? 

So, like, UCSF recruited black children from across the bay—in Oakland—a heavily African American town, where the patient families wanted health care and got it in exchange for cooperation with research. Isn’t that how it works? UCSF has been on a buying spree recently, as mentioned, gobbling up a number of smaller hospitals in and around San Francisco and monopolizing health care—not to be judgmental of the famed hill in Outer Sunset, home of the medical gods. Which was also my neighborhood during my time there, you know, between the UCSF campus and Ocean Beach? The bottom line is that San Francisco is another dodgy town, just like Galveston! How cool is that? But it’s a different ocean and a different vibe, if one is speaking in terms of the cosmic dimension, which masters-trained nurses may be called upon to do. Blacks are especially important in Baghdad because black DNA is more varied and better suited for research. So, like, no one in San Francisco has blinked an eye about UCSF’s research protocols if they get the DNA. And on Galveston Island they used to sell niggers—not to sound judgmental of practices in the Old South. Except it’s still like that today. 

There’s not a whole lot of free-floating ethical concern in Galveston, any more than there is in S.F., let’s be brutally honest here. Not at Johns Hopkins on the East Coast either, witness Henrietta Lacks. Johns Hopkins eventually apologized. UCSF eventually solved its research supply problem by buying Oakland Children’s Hospital, in order to get to the kids, renaming it “UCSF Benioff Children’s Hospital Oakland.” After the Tech Guy—What’s-his-Name Benioff, of the company Salesforce—like it’s a royal title. So, like, those affluent and well-educated parents in San Francisco who didn’t want their kids in research studies really were right, that would be another point. Charles Blow of New York Times just reported that two black children died during testing of a RSV vaccine, back in the day. Without the families being told the kids were research subjects? The RSV case was not at UCSF but it’s not for lack of trying by the white gods of Mount Parnassus. And now it turns out there’s a totally different research scandal at UCSF, actually. It's more unearthed history involving vulnerable patients at UTMB’s research cousin on the Pacific. 

This abuse involved state prisoners. That would be my ultimate point, actually 

The medical exploitation which has been documented and confirmed was uncovered by a black lady doc at UCSF. You may wonder why be suspicious about your own alma mater, bro? It’s a hospital and a university, they’re probably doing the best they can. They help people. But, for example, my antennae are raised all the time here, on the Cancer Coast. Where there are not many black doctors to speak up. Just like in Baghdad by the Bay. So, like, this was the report on UCSF’s racist research on National Public Radio. It was what the black lady doc or whoever discovered and has since been proven true in Baghdad and may be the template for Galveston aka Sin Island too. 

UC was called out that—back in the day—there were experiments on dark-skinned California prison inmates, that consisted of injecting them with pesticides. To determine the effect of the poison and to see if the results were based upon skin color. Kind of like the Tuskegee Experiments previously, intentionally injuring a patient of color, who in this case was a prisoner of the State of California, in order to study the results. To set the scene. It was like something the Nazis would have thought of, the difference being that this American version of medical experimentation on prisoners of color was performed by Jewish physicians who were UCSF faculty, like similar other experiments on prisoners at the University of Pennsylvania about the same time. Which has its own academic medical research operation, the University of Pennsylvania does, just like UTMB and UCSF, the difference being that in Pennsylvania the docs used asbestos injections instead of pesticide. In San Francisco the experiments were on dark-skinned prisoners to see the effects of darker skin, literally, in case you missed that the first time. Which sounds totally sketchy and is almost perfectly racist. 

The University of California conducted its own investigation, confirmed that the report was correct—and then started shoveling high and deep. But there was just too much shit and too much stink, you know? So, like, one of the original UCSF researchers from the pesticide experiments on prisoners was still on faculty when the radio report aired a few months ago and his counter argument, delivered by his son, was that his medical department—dermatology—was being unfairly singled out, because other medical departments of UC were doing unethical work on patients too, for over two decades. Hello! All further explanation has been buried by UC President Michael Drake who, by trade, is a UCSF physician, not that there’s anything wrong with that. He’s a Brother, btw, although you wouldn’t know it from his actions. 

Dr. Drake was faculty at Mount Parnassus for years before he began his rise in University of California administration. So, like, one of President Drake’s mouthpieces, a lawyer/spokesman named Scannell, said it was “harassment” to push for more details of UCSF’s racial experimentation on black prisoners. The most obvious other possibility—the most likely next shoe that could drop in California—is that the university was also involved in sterilizations of vulnerable populations, which have already been documented on California prisoners during the 1960s. But we digress, because this is about Texas. The point is only that UCSF has gone to extraordinary lengths to obtain a vulnerable patient population, for whatever reason, for whatever use. UTMB already has one.

TDCJ prisoners. 

The medicine is good but there’s always risk of exploitation at academic medical institutions, of which there are six in UC System, and six at UT, depending on how you count. It makes you worry as a staff nurse at Medical Branch, actually, especially working in Hospital Galveston. Prisoners are particularly vulnerable. Speaking up for and advocating for them, as a masters-trained nurse and all that? It doesn’t look good for Team Longhorn, bro, let me tell you that right now. 

But that can’t discourage a Red Raider because in Lubbock we have been taught at Tech’s Health Sciences Center that the truth must be told. The 150,000 prisoners of the Texas Department of Criminal Justice, spread across a hundred units, are at risk big time of exploitation. Because UTMB has the same business model as UCSF, it’s in the same “endeavor,” as Chancellor Hawgood on Mount Parnassus likes to say. Like the Cosa Nostra, actually, or Mexican cartels. An administrator in the UCSF School of Nursing was just sentenced to federal prison for stealing $1.5 million, btw, by having the nursing students make out their tuition checks directly to her. That’s abuse of another vulnerable population, students, and is what the University of California does best. 

There are a lot of unconventional and bright minds working in academic medicine but what they’re actually working on can be scary and exploitative shit. Specifically the whole “endeavor” thing that the UCSF chancellor Dr. Hawgood talks about is just Big Business—Big Money—and Big Medicine. In Baghdad by the Bay just like at Medical Branch, here on the Cancer Coast. So, like, the announcement about UCSF’s experiments on prisoners only heightened my sense that something was stinky on Sin Island. All these prisoners—it gives you pause, being a prudent nurse. You have to assume the University of Texas is up to something because, historically, UT always is. Speaking as an alum of the institution. Frankly, it seems now, not to lecture, it seems that only Red Raiders have the required high level of ethical purpose that promotes trust in Lone Star public health care. It’s because of Tech’s close-to-the-land West Texas roots, that’s my personal belief. The “West Texas ethic,” yeah. That’s my feeling, approaching graduation from the School of Nursing in Lubbock. 

So, like, the history of unethical behavior in academic medicine is long and varied and it’s hard to know what exactly to fear, especially when there are so many possibilities for UT to do wrong on the 66 square miles of the Island of Texas Damned. Or how about Texas’ Island of the Damned, which is my own preferred name for my workplace? With so much evil that is so totally fucking do-able on prisoners, for example, as we’ve learned from the University of California. The prudent nurse has to worry because our professional responsibility is to the patient, not to the hospital. 

Not to the docs—God forbid. Nor to our supervisors. You can lose your license by forgetting that a RN’s responsibility, what the Board of Nursing is looking at when it hands out discipline, is acting responsibly to the patients under care. Putting the patient first. And because nursing discipline—like the Texas criminal justice system—falls hardest on black men. Male RNs of color have to be especially careful. When the Board punishes, it’s not Kimberley with a pink bow in her hair who gets suspended, it’s Jamal with eight inches in his pocket. Who is a natural Black Man and the white chicks feel threatened by his uber-masculinity and report him on bullshit violations of practice? But we digress again.

Still, sorting out cause and effect in a chaotic environment is difficult, you feel me, when you’re busy wiping booties and passing meds. For example, this was remarkable, a couple of transgender patients were admitted to 7C recently and it was my first time to work with this patient population and that put me on high alert. How did you know they were transgender, you may ask? Seriously. A patient with a big penis and big breasts is a big sign. One of these ladies kept letting her hospital gown slip down to reveal boob. Please.

Also, this was another clue—never having had a trans patient before—while passing these prisoners their meds there was a lot of drama. You know what chicks are like, drama queens and all that? Not to sound completely Neanderthal or anything, just being honest. Boy-nurses call it the way it is. But the patients were falling right in with gender expectations already, not to sound totally cave-dweller myself.

Both patients were getting the same testosterone-blocking pills, estradiol and medroxy-progesterone, have you heard of that particular cocktail? This was my first time to pass these two meds together for this purpose. In the old days in nursing school the instructors taught us, “Don’t give any med that you don’t know what it's for.” Fuck that. Nowadays it’s an impossible standard to meet because there are so many new treatments, health care is advancing more quickly now even than at the beginning of my time in the saddle, a couple of decades more or less. And everything is much much more costly. It can be hard to keep up with all the new meds alone. The prices will blow your mind too. A lot of expensive shit keeps appearing because health care is a big business, not to stress the obvious. Anyway, regarding these two patients TDCJ’s rule is that transgender prisoners must be alone in a room, presumably to prevent assaults. A dive into their charts also produced “TRANSGENDER,” like a stamp, which was another big clue. 

An Officer said later—this was her explanation—that some prisoners are already transitioning before they are condemned to prison and TDCJ is obliged to continue the treatment. Which makes perfect sense. But the second of my two patients—doing time for an alleged kidnapping of a kid—had already been behind bars for 15 years. This is so totally not meant to sound racist but the prisoner was Caucasian, you know what those people are like! There’s a demonstrably far greater chance that she really was guilty than the average black TDCJ guy, according to my calculations. So, like, anyway, obviously the transition must have begun while in the custody of the State of Texas. Even though Governor Abbott would have a heart attack, and although Lieutenant Governor Patrick’s head would turn a full 360 degrees and he would begin to speak in long-extinct Biblical tongues. If he knew. But there may not actually be much that the Governors can do.

According to my online research there was another TDCJ inmate a few years ago—a guy from Brenham, actually? Which is my other hometown, what a small world in which we live! That’s where Great Grandfather got sentenced from, not to repeat myself.

This prisoner from Brenham, also home of Blue Bell ice cream, btw, wanted to transition and sued TDCJ and won in federal court. To set the scene. This is my understanding from looking on the Web. His win was overturned on a technicality by the legendarily conservative 5^th Circuit Court in New Orleans. But even the appeals judges made clear that they were not ruling on the merits of his claim that he has a right to change genders while in custody of the State of Texas. So, like, this was my understanding, not being a lawyer myself, just being a RN, tell me how much blood to send to the lab, you know? So, like, the appeals court only made its ruling based on the procedural error this Brenham-born writ-writer made. 

Some of the writ-writers are wonderful writers, btw, you can only admire their descriptions of the horrors of drowning in the Texas Gulag, not to sound all literary. My bet is that they write so well precisely because they are not lawyers—although TDCJ also houses no small number of members of the State Bar, rest assured. 

The point is not that there’s something wrong with being transgender, which there most definitely is not. The point is that a lot of shit happens that you never hear about in Huntsville, which is now synonymous with Medical Branch, my employer and alma mater. No light escapes. Because society doesn’t want to know what’s really happening in our prisons, and especially not in prison health care. 

That would be my whole point, really.

 

 

Chapter 6

 

My bedside career that is now ending has included eight hospitals and two nursing homes. One of the hospitals was tiny, in West Texas, a so-called “critical access” facility with a few beds and sketchy care. In the High Chihuahuan Desert, actually. Sometimes we had federal prisoners, illegal immigrants who were picked up by Border Patrol on foot out on a rancho somewhere, dehydrated and blistered and all that. They were lucky to be alive and needed IV fluids, you know? There was always a Border Patrol guy or girl at bedside because the patient was technically in custody but was at, like, zero risk of trying to escape, because they didn’t want to go out in the sun again.

From the hospital their next stop was Marfa—not to see the famous Marfa Lights. Instead to see the inside of the Presidio County Jail where the feds keep/kept their peeps in the Trans Pecos. To set the scene. 

A couple of my former employers were old-fashioned county hospitals—in Minneapolis and in Austin. Another was part of a huge private corporation, HCA, where the care was pretty good and super expensive. My lone nonprofit gig was in Seattle where one of my patients almost bought the ranch one night—the Big Ranch, not in West Texas but, you know, up in the sky? 

Seattle was my only brush with unexpected death during my entire nursing career, thank you very much, over a quarter-century. Not to brag. Included in my healthcare tally however, through the years, is breaking an old lady’s hip during a bad lift, back back in the day, working as a nurse’s aide while still in school. The patient was a stroke victim with one side much weaker than the other and getting her out of bed, into her wheelchair, we went to her weak side and her leg buckled and she went down like a sack of potatoes. To set the scene again. The hospital paid all her bills and gave the victim $50,000. But luckily, all my patients have gotten out alive over a quarter century, thank you very much again, except one, in Seattle, who was already “actively dying,” an odd phrase really, when the shift began. 

Another guy in Seattle on that same neurosurgical unit where the guy almost bought the ranch and the actively-dying patient died? This other guy had just whacked his wife and was spending the night on neuro, to await an early morning mental evaluation. 

A sheriff’s deputy was with the guy non-stop. Like within reach, unlike the Border Patrol guy or girl in the hospital in West Texas who could be down the hall talking on the phone and the prisoner wasn’t even handcuffed to the bed. The guy who whacked his woman was handcuffed to the bed, or ankle-cuffed actually. So, like, the hospital kitchen in Seattle insisted on sending the wife-whacker his meal trays with metal cutlery, including a steel knife? Questioning the use of metal cutlery with in-custody patients might make a good paper for a nursing journal, actually, what do you think? 

Two of my employers have been academic medical centers—UTMB and UCSF, the later being the venerable University of California San Francisco. Which is said to be the most prominent public medical campus in the world. To set the scene. UTMB and UCSF are examples of academic medical centers like the University of Pennsylvania in Philly. Or Johns Hopkins in Baltimore. At institutions like these the care is almost always statistically better than in private hospitals or “at the county.” But these university hospitals are also the most dangerous—big time—for the patients, ethically. Because there’s a culture in medical research of exploitation of vulnerable populations, previously for medical advancement and now for financial ends. There’s obscene amounts of money at stake. Not to sound cynical. 

Just a few decades ago, back in the day, patients were exploited for the prestige of the researcher and now they’re exploited for the money, or the prize that may lead to money. Not to sound jaded as a staff nurse. Btw, we have a genuine German scientist leading health care on Sin Island now. Not that there’s anything wrong with that because the Europeans can’t be any worse than American docs in terms of greed. The physician who replaced Dr. Raimer a few months ago as President is a cat named Jochen Reiser. The good doctor might as will have “Big Pharma” stamped on his forehead. He’s a Big Medicine/Big Money kind of guy in the tradition of Dr. Hawgood in Baghdad by the Bay who is all about the business of health care. 

That’s because Medical Branch is gearing up for commercialization— bigtime—which isn’t in conflict with its research mission, because they’re the same thing. There’s not much transparency, either. The only thing we know for certain is that on any given day as many as 1500 TDCJ inmates are traveling the roads of the state, going to or from healthcare appointments, on Sin Island or at Tech in Lubbock on the noble dust-blown West Texas prairie. That’s what TDCJ said in the report on the murder of that family up near Buttfuck, in Buttfuck County, by the prisoner going to see a doctor in Huntsville? The most-discussed unit in TDCJ may actually not be in Huntsville, btw, it’s probably Dalhart, located up at the very top of the Panhandle. The Dalhart Unit is famous because it was built as an economic boon to two counties, a wider target than Texas’s traditional porkbelly legislative politics in which only one local community feeds from the state’s trough at a time. 

Dalhart is near the old home of the great cattle spread XIT Ranch, in an area that is now known for large-scale dairy operations. To set the scene. There’s a community hospital nearby, which is a good thing, but serious cases at the Dalhart Unit have to be shipped to Texas Tech’s university hospital in Lubbock. What there mostly isn’t locally—near Dalhart—is housing. For that reason this prison is famous within the Department of Criminal Justice for being chronically understaffed by Officers and under-populated by inmates. Which may be good because the prisoners are not overcrowded in the cells, is that a felicitous possibility? 

Dalhart is a perfect example of how not to build a prison, actually, in Texas or anywhere else. It was the result of a serious planning fuck up by the Texas Democratic Party, btw, that last generation of D’s in power, in Austin and in Huntsville, including the late great Governor Ann Richards. Richards was actually leaving the Governor’s Mansion and George W. Bush was moving in the same year that Dalhart opened. The Democratic idea was tougher penalties—longer sentences—in order to please conservatives. Which also presented the opportunity to build more prisons in order to meet the increased need for incarceration and to offer employment to folks across the state, especially in rural communities, jobs in construction and as Officers. All meant to save the Democrats at the next election and when that didn’t happen, the Republicans took over and liked what they saw because Republican voters like long prison sentences too. What a small world in which we live!

Some of the guards who work in Dalhart today actually live in Oklahoma and commute to Texas to do their shifts. If you asked what is the worst TDCJ unit—well, there’s a lot of competition for the title of worst prison in Texas, isn’t there? Let’s be honest here. For many of the units there’s a kind of race to the bottom.

The two you hear about most frequently from Officers as the closest to resembling Hell on earth are Coffield Unit, up near Palestine in northeast Texas, where bad boys go, and the Stiles Unit just down the road from Hospital Galveston actually, in Beaumont, in the southeast part of the state. To set the scene. Stiles actually has a satellite healthcare facility operated by Medical Branch. Again, according to the Officers and inmates both, the level of terror at these two units—TDCJ prisons are invariably called units, btw, like the guards are called Officers not guards. The level of degradation at these units is reportedly pretty fucking unreal, PFU, to use the non-technical acronym, in Beaumont and especially in Palestine. But it’s hard to know exact details because everything in the Department of Criminal Justice is highly non-transparent and meant to be that way. Especially the violence and dehumanization. A white prisoner from Coffield, a guy with lightning bolt tattoos who had a neo-Nazi thing going on told me something interesting. To set the scene in Palestine.

We kind of bonded during his time on 7C, me and this Nazi, don’t ask how. It’s still unclear how we even got started talking. Anyway, he told me that Coffield is a scary place even for him. He hinted that the only reason he’s a white supremacist at all is because racial allegiance offers a level of protection in certain lock-ups, especially it seems, the units around Palestine which is in the armpit of the Lone Star State. In my opinion. Never having been there, personally, and refusing to go. Basically, all the units around Huntsville are known for old-fashioned white racism. Although there’s a lot of competition for that honor too, just like the most talked-about prison, Dalhart. 

If you’re looking at a map to find the Coffield Unit, the nearby town is pronounced “Pales-teen,” btw, like the Texas shithole it is, not “Pales-tyne,” like the beautiful country that one day will be free of Zionist imperialism. This Lightning Bolt guy said he has done federal time and Texas time and federal prison is definitely the way to go if you have to be locked up. But we all know that already, right? So, like, a Black Muslim patient who did time in Beaumont’s infamous Stiles Unit said that there isn’t much difference between the Officers and prisoners at Stiles. “TDCJ recruits in the projects,” this Muslim brother explained. 

He was speaking of the poor areas of the three oilfield towns down the road from Galveston, shitholes all, that make up Texas’ “Golden Triangle” leading to the Louisiana state line. Again, if you’re looking at a map: Beaumont, Port Arthur & Orange, respectively, each worse than the other. Meaning that some young brothers and sisters who grow up in or around Beaumont for example, and who are poor—despite the city’s wealth and fame as home of the Spindletop oil gusher that made Texas rich? Despite plenty of white people with money, there aren’t many ways to escape your birth if you are Negro. Which is the kind of thing that you might even hear from an Officer who has dropped off a patient at Hospital Galveston or is picking one up and has time to chat. A lot of the Officers are black and are aware of systemic inequities in Texas even though they work for the system. Some of the folks who grow up in Beaumont for example go to work as Officers and others clock in as prisoners. Luckily for “public safety,” and to satisfy the demand for prison cells in Texas, there’s also a federal prison in Beaumont that is nicknamed “Bloody Beaumont” for its level of violence. 

If you accept the premise that conditions in federal lock-ups are better than in state prisons, like Lightning Bolt said, imagine how bad Stiles must be if it’s worse than Bloody Beaumont? That might actually make a good paper for a nursing journal, looking at the number of jaw fractures, for example, at Stiles as compared to the federal prison during any given year? Let’s see. To smuggle a phone into Stiles can cost $2000, paid to an Officer, which seems like a lot of money. But that’s my information and the source is good. 

Prison corruption cuts out the middleman and has the Officer receiving the payoff directly from prisoners’ family members. No money changes hands at Stiles itself. If you’re a nurse interested in psychosocial aspects of incarceration, a reliable TDCJ-related source said that phones are bought by syndicates of prisoners, each inmate chipping in a certain amount of money, a dozen guys let’s say, at $150 each. The phone is hard for the warden to find during a search of the cells because it only stays in any prisoner’s hand for one day and then moves to the next member of the syndicate. Not that it’s important here but the phone is always moving. The prisoners say that their odds of not having it confiscated are better that way. 

Other than how to smuggle a phone though, of which my knowledge is detailed, my understanding of TDCJ’s inner workings was slim to none when hired at Hospital Galveston. It’s hard to judge an organization that you’re part of, especially if you’re low-level and can’t see the Big Picture around you. And never having done time, state or federal, thank you very much. Just a few months ago, starting work at Medical Branch, my knowledge of TDCJ as an organization was nada. To set the scene. The public hears a lot about Texas prisons in the media, of course, even people living outside the state know the horrific acronym TDCJ. Like Dachau—without the ovens—although it’s still pretty damn hot.

 In my circle of Black Men for example, not me personally but Brothers of my acquaintance who have gotten on the wrong side of the judicial system in Texas for whatever reason? Like some of the black guys in Hospital Galveston no doubt. Knowing more than a few men of color who are political prisoners of the State of Texas, and all, but as an outsider to TDCJ you usually only hear about the gory details of an “incident” on one of the units long after the fact, of civilians who get whacked or raped by an escapee, like that family in Buttfuck that got slaughtered last year. Or the insufferable heat in the cells—you hear a lot about that. Conditions that are cruel and inhumane which is the way the State of Texas likes it. You don’t hear more because it’s a closed system. TDCJ is a closed complex social environment, like Sin Island itself actually—and is an economy of its own. That now includes Medical Branch. To know what “they” were up to at Hospital Galveston, speaking as someone who sees conspiracy everywhere and was at the same time concerned about his patients? You needed to find out what was really going on in TDCJ as an institution. 

That meant knowing the town of Huntsville and the proto-plantation life that still exists in Lone Star prisons, originally in East Texas but now spread across the whole damn state. Not to sound paranoid. 

Happily, there was a way to do just that! 

By talking to the Officers who came and went on 7C, delivering patients and guarding them at night. And of course by talking to the patients themselves, most of whom were longtime observers of TDCJ, you could say. As in years, if not decades. And, frankly, listening to shit that didn’t concern me, which some people might call eavesdropping, but is my thing anyway, not to sound like a freak. Trust me, you can bust a nut listening to TDCJ’s greatest hits, Huntsville’s worst episodes of violence alone, across the years, will take your damn breath away. 

And then—by contrast—you’re completely blown away by an occasional breath of institutional humanity in the Texas Gulag. No lie.

 What follows is coming from a very smart young black female Officer. She was/is smoking hot actually and liked/likes to listen to rap. Music is always playing low in the background at her work station. To set the scene. So, like, she told me early one morning, both of us tired as shit and waiting for the morning peeps to show the fuck up. Even though it was still two hours before they were due to come to work? To set the scene again. 

So, like, she was talking about TDCJ the institution and she said that during her training to be an Officer she was taught that if she’s working on a unit somewhere—in Shithole, let’s say, which is next to Pisspot, in Piss County? It’s up in North Texas but before you hit the High Plains. 

So, like, if she’s guarding the fence line from the tower and she has a rifle. Can you picture that? Let’s say someone is trying to escape through the fence, or over the wall, or whatever, trying to get away from the unit, wherever. Prisoners are trying to get away. The instruction she received in her TDCJ training was that if she has her rifle, “Shoot to wound.” She said that was what she was told. 

“But if you accidentally kill,” she said,  “you won’t get in trouble.”

How cool is that? Doesn’t that make you totally proud to live in the Lone Star State? Governor Abbott and Lieutenant Governor Patrick may be cool guys after all. Don’t bet on it, but it’s a possibility?

And that totally surprised me actually, not to sound all jaded again. But expecting to hear the exact opposite from TDCJ, really. Knowing a little more by that point about the Department of Criminal Justice, and all. But sometimes even as a liberal in Texas you can be wrong. Even as a Black Liberation Warrior who is critical of everything the White Man and White Woman do? Even as a radical African American whose ancestors have done time you can still be pleased by an act or policy of the State of Texas, rare though it may be, and almost certainly accidental in nature. 

So, like, instead TDCJ could have said, “Shoot to kill but if you accidentally wound, you won’t get in trouble.” Right? That sounds more like State of Texas, don’t you think? Medical Branch goes to great lengths about security, btw, to avoid escape. There’s not a fence line to electrify or guard tower to shoot people from but there are certain safety practices that involve secrecy. What follows is just between you and me. So, like, there are no signs pointing to the prison hospital on campus. 

Hello!

You either know where you’re going or you don’t, in which case you’re totally shit out of luck, SOL is the correct nursing acronym, in health care as in life. Like when you get a terrible assignment, six total-care patients who are pissing and pooping non-stop, that’s the definition of SOL but getting lost on campus is up there too. Good luck finding my patient care area, btw—med-surg—aka the in-patient acute unit. If you don’t have detailed instructions you’re fucked, doomed to wander the endless halls of the University of Texas Medical Branch forever, like the damn Flying Dutchman out on the Gulf. What good does that do actually, having no signs pointing the way? Because frankly the lack of geographical clues on campus has confused me up the ass on a couple of occasions already. This may be partially due to advanced age but just as likely it’s due to the campus layout. 

So, like, you probably haven’t heard about a political incident—you could call it—back in the day in Washington, during the Eisenhower Administration? About the CIA? It’s germane when discussing the lack of signage at Medical Branch.

So, like, what happened back then in D.C. illustrates the Hospital Galveston conundrum, in the context of subterfuge for security reasons. To stop prisoners from escaping. So, like, it was the mid-1950s—must have been, when General Eisenhower was President Eisenhower. This applies to finding the prison hospital at UTMB too. So, like, it’s about President Eisenhower and his driver and the President’s brother who needed to get to the CIA headquarters. Have you heard that one before? 

So, like, the President was in a White House car with his brother who was also some kind of public official and the President’s brother needed to be dropped off at the CIA, wherever it was, before the move to Langley, Virginia. And the Secret Service driver couldn’t find the CIA offices because signs had been intentionally put up that were misleading or that didn’t name the CIA or Office of Strategic Services or whatever name the spy agency used, back in the day, during the 1950s when Eisenhower was prez. Have you heard that one before? The camouflaging of the spook headquarters was intended to confuse foreign spies or Soviet paratroopers or whoever.

And President Eisenhower made a command decision, that not being able to find CIA headquarters was probably not helping to keep the nation safe. He ordered that the correct signage be posted. Which is why today there is a CIA turnoff on the Virginia highway.

That’s kind of my whole point about working in Hospital Galveston, actually. Does not being able to find the front gate really help to stop prisoners from escaping? 

It’s a very practical question, actually. Because Hospital Galveston is in a big building that contains a lot of other shit and getting to work at night requires going up these elevators and down this hallway and turn here, turn there—go up these stairs, whatever, and swipe. And swipe again. There are at least three Officers in glassed-in posts to get past, maybe a pat-down too. Getting to work is just do-able at my age if you’re highly caffeinated and the buzz hasn’t worn off. And if you still have good blood levels of testosterone or estrogen or whatever and you’re ready to begin night shift in a correctional healthcare environment, where some guy who the press dubbed the Mad Fiend or the Butcher of Brownsville can roll thru the door at any moment. An oral surgery resident told me the other day about a patient who had part of his face bitten away by another prisoner. Not that that’s important here but it is illustrative. So, like, if you’re a new employee like me, getting off work in the morning and trying to get out of the building at 7 a.m.? That can be a mofo too.

 Going from all that artificial light and stumbling outside into the glow of morning on the Gulf Coast. It’s disorienting. So, like, it can be hard to master—even for an almost masters-trained nurse, you know? It was two whole months before finding the exit of this motherfucker became totally routine and unconsciously do-able for me, despite my high level of healthcare training. Not to sound all special needs or anything. You may say, well, you still sound pretty fucking dumb, but it’s not me, it’s working nights. It’s a killer. There was a study a few years ago that night nurses lose five years off their lives. From metabolic disorder or whatever, and a few of us probably clock out and leave the building in the morning and walk into traffic. Like, by accident? Or even on purpose if it was an especially bad shift. 

Fatigue dumbs you down. Your reaction times are slower too. Speaking of mistakes—speaking of dumb—any discussion of TDCJ safety practices has to include the biggest security errors, right? So, like, right now we’re actually marking the 50^th anniversary of the Huntsville Massacre, aka the Huntsville Prison Siege. Have you heard of the killings at the Walls Unit, back in the day? 

It was a particularly bloody example of Texas’s Great Age of Carnage—the 1970s, when so many peeps were getting whacked over drugs. More even than today, actually. The drug of choice then was cocaine, not weed or Fentanyl like today. And a lot of other peeps were being sent for prolonged stays in prison for killing them. Does any of that sound familiar? 

That’s how it’s known, the Huntsville Massacre. It was a bloody day in East Texas, at Walls Unit. To set the scene. That bloodshed led to TDCJ’s non-negotiation policy that the lady Officer told us about during safety orientation, remember her? Huntsville negotiated that time—a half century ago—before the Rangers or whoever started shooting. Unlike the policy today which is that the Rangers shoot first and negotiate after. Unless it’s Uvalde, where they never shot at all. 

That time 50 years ago at Walls, the Governor actually agreed to a lot of the prisoners’ demands, really, just not guns obviously. But the escaping inmates didn’t need guns because guns had already been smuggled in. You can read all about it yourself but the important part, noted by Wikipedia, “The convicts made a number of demands, such as tailored suits, dress shoes, toothpaste, cologne, walkie-talkies and bulletproof helmets, all of which were provided promptly. With the approval of Texas Governor Dolph Briscoe,” who was from Uvalde actually, and was member of that dying breed, a Democrat at the Governor’s Mansion, and dying out for good reason. The D leadership, just like the hostages, were Dead Men Walking but didn’t know it yet. TDCJ’s culture was a big part of the reason. 

At the Walls Unit everybody got whacked except one inmate who was executed later for his part in la matanza. The dead hostages were both prison librarians—not nurses—but my point is exactly the same, bro, you feel me? Anyway, that’s some of the history of TDCJ, known as the Texas Gulag. "Security" makes the Gulag impenetrable but it is possible to describe its shape. 

Originally the prisons were arranged like a crescent or an arc in East Texas. A former warden said that if you’re looking at a map of the state and look down from Huntsville, to the south towards the coast, there have always been prisons in Brazoria County for example, and just north of Brazoria in Sugar Land too which is the Sugar Land of The Sugar Land Express—an early Spielberg movie, with Goldie Hawn. To set the scene. The film was about an escape from TDCJ. 

That movie—spoiler alert—ends with a Ranger’s bullet and the storyline is taken from actual events. 

If you look up from Huntsville on the map, which means looking north there’s a pisspot called “Tennessee Colony,” which sounds very antebellum, pre-Emancipation—pre even Jim Crow—moss on the trees and all that. It’s part of the larger East Texas shithole surrounding Palestine. Again, don’t be a tourist, it’s “Pales-teen” if you’re talking about the town. “Pales-tyne,” if you’re talking about the land of milk and honey where the Palestinian peeps will one day be free. East Texas is corrections country, the same way it used to be cotton country, not to repeat myself. This arc of area from Brazoria in Southeast Texas up to Palestine in the northeast part of the state—with Huntsville in the middle—has always included the state’s lockups, now known collectively as TDCJ. The cells were segregated until the 1960s, the towns and prisons both, actually. 

That arc is part of the Lone Star State’s old plantation economy which extends into the cotton-rich Brazos River valley, where my daddy’s people swung a scythe back in the day. Where there were once slaves doing the work that the prisoners would do later. 

For the longest time actually prisoners were required to work and were rented out as farm laborers or road crews, for construction, or whatever, by wardens. The prison system has also always owned its own land for growing food, and raising animals, prison farms where inmates worked and work still. That’s what the Officers tell me. TDCJ was self-supporting in food production at one time and provided good food to the inmates, or reasonably good, but that changed as the prison system turned to selling its best products. Maybe not exactly that scenario—but close enough when you’re talking to somebody in the middle of the night, as they’re putting cuffs on your patient and you’re trying to get the last meds down the guy or girl’s throat before the White Bus leaves. 

That’s what you hear from the experienced guards who rotate in and out, coming from the units or wherever, spread across the Lone Star State. This information may actually be a few years old but that doesn’t mean it’s not still good! That’s the beauty of TDCJ. Change comes very slowly to Huntsville. It’s still Jim Crow.

 “The pigs and chickens eat better than the inmates do,” said an Officer who works on a unit that has a big agricultural operation. 

A lot of people complain, btw, about China and Xinjiang cotton—or whatever—produced by prisoners? Our own Texas Gulag also has some fine products for display. For example all the highway signs in Texas are produced by prison labor, an Officer told me that. You didn’t know, did you? Me neither. This Officer who was a black guy working at a prison in Shithole, East Texas, said that TDCJ owns a lot of acreage across the state and he said there’s a big plot of prison land being sold right now to developers. A fact that was confirmed by my Internet search. To set the scene.

So, like, exact details of the sale have been ruled confidential by Ken Paxton, our esteemed Attorney General, whose office has been kind of Corruption Central in Austin for a few years now? Not that there’s anything wrong with that. Like, even if he is the chief law enforcement officer of the state. General Paxton has decided that TDCJ does not have to reveal who the buyer is, where the land is or how much it’s selling for. Oh wow. So much for Republican demands for transparency in governmental operations, huh? So much for draining the swamp. 

Hearing about this land deal is actually when my paranoia first got going, but it's probably an unrealistic fear. Like an earlier theory of mine about the vast number of mood meds used by TDCJ? Not because General Paxton is honest but because what he's doing with real estate doesn’t really affect the health of my patients. Not for that reason but instead just to dish dirt on TDCJ, let's get into the real estate deal anyway. The transaction is being handled by Texas Land Commissioner Dawn Buckingham who is a plastic surgeon by training and is also a graduate of Medical Branch. What a small world in which we live! 

Medical Branch is a very connected campus in the halls of power of both the Lone Star State and in D.C. too. UTMB actually produces quite a few docs whose specialty is politics, like other docs are renal experts or pulmonary specialists. For example there’s a black Republican UTMB doc who is an elected Galveston County commissioner. So, like, before we get all paranoid about Medical Branch alums—let me assure you, there will be time for that later, to get all paranoid about the medical practitioners on Sin Island. So, like, this is the oldest medical school west of the Mississippi River. It’s also a very political campus and bigtime conservative too. The quality of the medicine comes and goes, UTMB was very good for a long time and may be on the rise again. One time back in the day, me working in the Children’s Hospital on the island almost exactly 20 years ago, which was also the time of the American invasion of Iraq? To set the scene. 

On a break one afternoon, you know, going to the Medical Branch campus cafeteria—and guess what? The French fries had officially been replaced on the menu by “Freedom Fries.” The horror! The horror! They’re French fries, is nothing sacred? Definitely left a bad taste in my mouth, bro. This whole fucking campus is beaucoup conservative and totally sketchy on top of that. Not to sound all suspicious, but as a prudently paranoid R.N. who wants to keep his nursing license. For example not to carry tales—not to gossip, which boy nurses don’t do. Men in nursing don't gossip, btw, we only share information. It’s the chicks who gossip.

But a very good RN who worked with me in Children’s back in the day, at the time of the Freedom Fries incident, you could call it, during the Iraq War, this chick was totally pro-Bush and pro-invasion and we got into it a few times, let me tell you. It’s not just the whackjob conservative docs who you have to worry about at UTMB, there are plenty of whackjob conservative nurses too. Anyway, this white woman who worked in the pediatric ICU with me had to be schooled by a male RN of color about oppression, you know? She needed a good talking to, let me tell you, about black nationalism and Malcolm X and the proud African American warrior, but that could wait, actually, until she was no longer helping me to do my job.

Her re-education was critically important only up to a point, because she was a very good nurse, a lot better than me, and she did a lot of useful shit for me, not to sound all mercenary. When she helped me, that made up for some of her political failings, you know? She wasn’t even smoking hot and we still became friends, call me noble if you will. Anyway, Medical Branch is a Republican campus, not that there’s anything wrong with that. Unlike UCSF on the Left Coast where everyone claims to be ultra-liberal and they do even worse shit to people of color than in Texas. 

So, like, Dr. Buckingham who is the incumbent elected Texas Land Commissioner may not have been the one who sold the prison property to the developer in the first place. If we’re talking corruption in Texas government. She’s not the first person to suspect, actually. And she’s a good person even if she is rightwing nutjob like practically everybody else in the Texas Republican Party, not to generalize or anything. She would only be, like, number 3 or 4 on my list of suspects about the prison land deal. Dr. Buckingham is not a boob-job kind of plastic surgeon, btw, she’s the real thing, her specialty is reconstruction. If memory serves, our paths even crossed once morning back in the day. 

Not that this is important but it was the last hour of my shift, one morning, which had been spent doing a beautiful dressing change on a kid with bad burns and, suddenly, this young blonde chick walked in at 6 a.m. and took the dressing completely down, destroying my noble work, my edifice of patient care? Which pissed me off big time, because she could have called ahead and said that she was coming at s0-and-so time and the dressing could have been changed after she finished. That's called coordinating with the nursing staff and is much appreciated, bro. 

My idea at the time, after she destroyed my work, was to ask her, “Who is your attending?” Like that, kind of tapping my foot in exasperation, like you would say if you were schooling an intern not to fuck with the nurses? But it turned out that this young white chick was the attending physician. Which limited my avenues of response. She was the Big Dog. She was kind of hot, actually. That was Land Commissioner Buckingham, if memory serves. She’s kind of a hottie. And she has a heart.

She would be for example the doc to help those indigent burn victims from Latin America who are staying around the corner from my crib. They are charity patients of UTMB. One hesitates to criticize someone who really helps others, unlike the liberals who just talk, even though, not to repeat myself, Dr. Buckingham is apparently a total whackjob conservative. Not that there’s anything wrong with that because Galveston Island is full of them.

The land deal which for a time was my favorite TDCJ conspiracy may actually be more about her predecessor—another one of the Bushes, nephew to the former President W. You can blame the Bush Family for all kinds of shit, in Texas and abroad, that would be my point actually, including over a hundreds executions at TDCJ. But you can’t find out the exact facts about the land sale because General Paxton has sealed the file, not to repeat myself. And Dr. Buckingham is responsible for asking him to make the deal confidential. The land is probably in East Texas, btw, which is the fastest growing part of the state, did you know that? Not Austin or even the Big D. All we know for sure is that the uncle of the Land Commissioner Bush who might have sold the land was responsible for the Freedom Fries in the UTMB cafeteria and the deaths of tens of thousands of innocents in Iraq. Which is bad enough. But anything else would be speculation on my part. And being a Registered Nurse does not permit for much speculation, as you’ve probably noticed. We’re all about facts.

The land being secretly sold may include old plantation fields which have historical value but don’t really affect the health of the prisoners who are my patients today, right? Which has to be a concerned RN’s primary concern. Not to worry about corruption in Texas government, which is pretty fucking overwhelming, Democrats as well as Republicans, but instead a more pertinent question is how might patients be at risk? So, like, you have to look somewhere else. In order to discover what TDCJ was really up to at Hospital Galveston. 

You had to look at the institution itself, in order to find out what was really going on. As it turned out the key to the prisoner’s health care at TDCJ was Medical Branch itself. 

 

 

Chapter 7

 

There may be some evil shit going on here, that would be my masters-level opinion, something being done to the prisoners, not by them, that would be my preliminary diagnosis as a budding nurse-scientist, no longer a booty-wipe at all. American university medical centers like UCSF and UTMB are Ground Zero for sketchy shit, really. You have to measure that against the good they do. 

Speaking of which—the good that UTMB does—around the corner from my crib is an apartment building full of poor families from Latin America whose kids are burn victims. You have to weigh the kind of service to patients like these against Medical Branch’s sins. We pass each other—me and these indigent families—walking to and from the Seawall. The kids are in wheelchairs or some of them on foot and bandaged like mummies. Or missing limbs. So, like, no one denies Medical Branch’s history of service, but in addition to the good, UTMB also likes more sketchy endeavors. 

Previously, as a Longhorn, it would never occur to me to say something like that. But now—speaking as a turncoat Red Raider? The truth about UT must be told. Let the stats fall where they may. For example. So, like, what follows is an example of data theft by UTMB. It’s NFD, no fucking doubt in my opinion, again as a masters-level nurse. Call it what you will. In fact, you be the judge and jury.

So, like, all prisoners who are admitted to Hospital Galveston sign three pieces of paper when they arrive. Just after they roll through the doors in fact. To set the scene. It’s all part of the admission process that goes along with a doctor’s exam and blood tests or CAT scan or whatever, to settle him or her in. If the patient is cognitively with it and can participate. Each signature is witnessed by the nurse. Indeed, nursing provides the paperwork, together with a clipboard and a pen, these two items being religiously removed from the room afterwards. We don’t want idle hands trying to make something dangerous or useful for escape, do we? So, like, the admission process is where prisoners get their shit stolen by the State of Texas, in the persons of the faculty of the University of Texas Medical Branch, my alma matter and present employer. 

The first form the prisoner must sign is a consent to be treated, that is standard in any hospital. The second form is a promise by the patient not to do anything stupid that might lead to a fall, like getting out of bed without using the call light or without talking to the nurse. The third form is actually the one that is problematic. So, like, it’s a blanket consent allowing Medical Branch to use the prisoner’s healthcare information for any purpose whatsoever. Hello! You have to read the fine print, which nobody does, but it’s there. Not to get all paranoid, but what do you think about that? It’s totally sketchy, that would be my view. It’s exploitation of a vulnerable patient population too, in my almost-done grad-student opinion. They taught us about shit like this in class actually, not to sound all uppity educated Negro or anything. Not this specific bullshit but the possibility that researchers will exploit vulnerable patient populations for data, yeah. Most students in the healing professions are probably being taught the same thing today. To watch out for data theft. 

What’s interesting is that at Hospital Galveston it's the State of Texas you have to worry about as thief. The prisoner is signing away his or her information when he or she arrives and agrees to care. At a vulnerable time, btw, when he/she is sick and wants to be treated. To set the scene. Having assisted in this process myself without recognizing the dubious ethics, it makes me guilty of a certain complicity, not like the nurses in Dachau or wherever, but bad enough, you know? The inmate-patients don’t know because the nurses don’t know and wouldn’t have time to talk about it even if we did. The only reason this is even vaguely on my radar is because we just learned about it in class, not to repeat myself but we’re Red Raider nurses now, in my case not a mere Longhorn anymore. And God help me, not a fucking Aggie. 

Healthcare data is a big business in the United States, worth a lot of money to a lot of people. Big medical data sets like TDCJ’s can be golden. To train A.I. or whatever. Not to sound like a s.m.e. (Subject matter expert, we like to use that acronym in class. It sounds kind of cool.) And the prisoners at Medical Branch are being asked to sign away their privacy and/or commercial rights, that’s my whole point, really. The accent is supposed to be on “informed” in “informed consent” but instead, on Sin Island, it’s on consent for commercialization.

 Some of these guys and girls have been locked up for a long long time, you know, or their education levels were not that high to begin with. Which is what a lot of inmates have in common, poor formal schooling. Hello! The only thing that they may know about DNA is that it’s what got them busted in the first place. No disrespect intended. You know what you call that? A vulnerable patient population, bro. And then there’s the matter of hate. Some of these guys and girls don’t like TDCJ very much and they don’t like how the State of Texas treats them and when it’s 4 in the morning—time to draw labs—they refuse because it’s their only act of defiance in the Lone Star Gulag, LSG being the acronym. Maybe they’ll give up their data for research, that’s possible if the prisoner really did the deed, that’s my theory. If he or she really is guilty and feels guilty? It’s possible, not to go all Freudian on you. They’re penitent, like he or she wants to make it up to society for drunk-driving and killing Little Susie skipping down the sidewalk on her way to the library? Don’t hold your breath but it’s possible. 

Do you know, btw, what the Old School social pecking order is in the prisons? The guy who rolled over Little Susie is probably considered a middle class offender in TDCJ. Higher up are murderers and bank robbers, sure, but the top of the heap are the prisoners who have successfully escaped, even if they got arrested again later. If it’s black peeps behind bars of course—remember that only a third of us got locked up for something we really did? The rest is just damn racism. According to my calculation. Most of my brothers and sisters in custody of the State of Texas today are actually political prisoners, in other words, that would be my professional view, if you asked me as an experienced RN with considerable psychosocial training. Anyway, the hijacking of prisoner data is exploitation of a vulnerable population, a practice that has a long and ugly history in health care and appears highly likely here. 

So, like, if you were concerned by the karma on Sin Island and asked me, what’s Galveston really like? What’s the real deal at Medical Branch? My answer would be that there used to be a market just down the street for selling people. What does that tell you, bro? So, like, there are clues in the past, like that alleged picture of those black residents being forced at gunpoint to clean up dead bodies after the monster 1900 storm. A big hint actually came from my student days at Medical Branch, back in the day, working weekends in Children’s. So, like, it was the appearance in my life of Dr. Raimer, when purely by chance we met on campus. 

Dr. Raimer is a white guy, not that there’s anything wrong with that, especially since that’s what there mostly is at Medical Branch, white guys. So, like, at the time we met—it’s not important how we met but my memory is that we just started talking one day at a meeting or something and he offered me a job in the prison hospital and my response was, like, no thank you. Being happy at Children’s, liking that patient population and the care. My response was kind of, like, not in this fucking lifetime, bro, thank you very much, although you don't want to call a physician “bro.” Or NFW, as in no fucking way? Which you don't want to say, either, to anyone in power. That level of negativity but expressed politely? Anyway, that chance meeting turned out to be an augur of my future at HG, Hospital Galveston as it is known even then. President Raimer, he became later, because this was a politically astute doctor. In fact UTMB is very often more about politics than medicine. The political profile of Medical Branch is prominent for such a small school. This campus was for a time considered a dying institution, that has been re-born with the help of prison patients and powerful friends in D.C. and in Austin. To set the scene. So, like, Galveston was Texas’s most important port until Houston began to grow—and the same is true of Galveston’s healthcare infrastructure. Medical Branch used to be the most important medical institution in the state. 

A research university like UTMB is judged not just by its doctors and facilities, however, but also by the patient base, by seeing many different kinds of patients and a lot of them. A lot of people coming for care or coming for procedures or for research, or for all three. That was Johns Hopkins’s road to fame and success in Baltimore, btw, where there were a lot of black charity patients who traded being studied or being used to teach procedures, whatever Hopkins needed them for, in exchange for receiving medical attention. Healthcare exploitation, isn't that how it worked? Which was also the origin of UCSF’s interest in black kids in Oakland. Health care is a cynical trade everywhere in the United States, and at the best of times medical research can be a dirty business indeed, especially in S.F. and in Baltimore. Maybe now on Sin Island too.

 Gradually however, back in the day, coming to Galveston Island was no longer worth the trip for many patients in Texas, not worth the extra mileage past Houston which eventually had more hospitals and more providers to choose from. At one time the majority of surgeons practicing in Texas were educated on this island—a lot of white guys basically, not that there’s anything wrong with that. These Galveston-trained docs were still in senior positions, for example in the county hospital in Austin at the beginning of my career in healthcare at the turn of the century. They were dying out but not dead yet. Then the number dropped precipitously as medical schools in Dallas and San Antonio grew and claimed patients and healthcare glory. The only reason UTMB was not closed entirely after any one of the bad hurricanes that have hit the island—we’re due one now, btw. The only reason why Medical Branch survived the storm is that UTMB survived the storm structurally, or so we are told, and politically. UTMB’s former graduates are older now and in positions of influence in the State of Texas and want their alma mater open. Which is my alma mater too and, you know, you can’t help feeling sentimental about where you went to class, old school ties and all that.

It’s an exceptional campus, inbred like the island itself. While UCSF is international—like the city of San Francisco. Both places are sketchy as hell. Not to get all metaphysical, but UTMB is closed and incestuous, like East Texas? The brother of the last Speaker of the Texas House of Representatives graduated from Medical Branch, btw, neurosurgery or something hands-on like that, and is now the state representative in a district that includes part of Galveston County. Congressman Ronny Jackson of Shithole, West Texas, is a Medical Branch guy and was Physician to the President for both Bush and Obama. Representative Jackson became a Navy admiral but he just got demoted after revelations of sketchy shit that he allegedly did in the White House. Still, anyway, historically there was the matter of not enough patients coming to Galveston as Houston’s healthcare complex grew, until—thirty years ago exactly—UT got the contract to provide medical services to most of Texas’s prisoners, ensuring a constant flow of patients for practice and study, the tab going to the State Legislature. To set the scene again. Any money that Medical Branch saves from the contract the university gets to keep. What’s not to like?

After the TDCJ contract was signed, Texas’s powerful Congressional delegation chipped in—during the Presidency of former Texas Governor Bush? What a small world in which we live! The Texas delegation in Congress and the Bush White House succeeded in getting a National Lab placed on the island, Wuhan-on-the-Gulf you could call it. Even though common sense might question building a laboratory with dangerous organisms a few hundred yards from a prison hospital with locked-in patients? Not that there’s anything wrong with that. Of course prisoners do try to get away. Let’s see, what else bad can you say about TDCJ? Which now includes Medical Branch. Let’s put the question a different way: How much time is there in your day? 

In a spirit of transparency, and as part of the same critical appraisal that we apply to Chinese prison labor? Western ethicists and journalists like to make disparaging comments regarding prisoners in the People’s Republic, right? Regarding inmate-produced goods and exploitation of prison labor. And taking prisoner’s organs for transplant. Shouldn’t the same standard be used in judging TDCJ? Clear labelling, bro. Our prison system also profits from human bondage, after all, in the cotton fields or onion fields, or whatever, of the Lone Star State. In East Texas where the plantations used to be.

The Officers say for example that a percentage of meat sold in Texas supermarkets, including big chains, comes from prison farms. To set the scene. Shouldn’t that beef or chicken or whatever have a “Inmate Labor” label like everyone wants from Xinjiang? Wouldn’t that be fair? What’s sauce for the goose is sauce for the gander and all that. My revolutionary idea could be a great marking tool, actually. Or not. How about TDCJ having its own food label, “Prison’s Best”? Or how about “Prison’s Pride”? What do you think? It would combine product promotion and public disclosure. The trademark image would be a sweating bare-chested black guy in leg chains. Or better yet he’s attached to a ball and chain, like the kind Great-Granddaddy wore when he was in Huntsville. But this prisoner is smiling and holding up an organic tomato in manacled hands? What do you think? Prison’s Pride. 

Or, hold it, hold on, this is even better: TDCJ could have its own microwavable Condemned Cuisine. 

They’re recipes of plates that soon-to-be-executed inmates have asked for in the past, through the years, the kind of last meals that—if the pentobarbital used in the execution chamber doesn’t kill you—the indigestion will. Like two dozen fried shrimp and a quart of Rocky Road ice cream. 

These plates would be sold under TDCJ’s Last Meals brand, with the motto emblazoned across the top of the package, “It’s to Die For.” What do you think?

Also, on the subject of the exchange economy inside TDCJ’s walls? A black woman who was an unwilling guest of the State of Texas for a few years near Waco told me that in her lock-up the currency of exchange was blowjobs. Giving hummers to the Officers was how you got what you needed. “I wouldn’t suck,” she told me proudly, although her quality of life behind bars was rougher for that reason, she said, because she wouldn’t go down. 

Huntsville, home to TDCJ, is a cesspool although it’s a pretty little town just like before, back in the day in the post-bellum/Jim Crow era when the wardens rented out chain gangs and they still lynched niggers in the town square. Up the road aways from Huntsville is Anderson County—county seat Palestine—smack in the middle of East Texas where the good people especially liked to see Negroes swinging from a rope. Texas’s great early 20^th century Golden Age of Lynching peaked in and around Anderson County, where the prisons are an evolution of the plantation and are wholly designed to keep POC down, that’s my hypothesis, as seen through a nursing equity lens. Everything affects health care, including imprisonment. 

A particularly well-informed Officer and a poor toothless Brother who had experience doing time in East Texas, both these black guys told me the same thing, actually. This is just so fucking scandalous. They said that unless a TDCJ unit produces watermelon for example, which is a fruit near and dear to the black peeps—and to our Pali brothers and sisters in the Occupied Territories? Or it’s peaches or whatever, and it’s harvest time, and there’s a superabundance of produce so to speak, the inmates don’t get much, even though they’re the farmers who raised the shit in the first place. Is there no justice in the Lone Star State?

This Officer who has several years in TDCJ was a middle-aged black guy like me which means totally trustworthy, at least to me. He was working on 7C a couple of nights, you know, and he was speaking to me brother-to-brother in the context of The Evil that White Men do? And White Women. He told me a couple of things actually. To set the scene. 

He was maybe 15 years younger than me, not that it’s important here. He said that of the 21 meals served to an inmate during a week on his unit, five are real food and the rest is just slop. Nutrition and health care are weaponized at TDCJ, actually. If you have a bunch of guys and girls who are in good shape, in good health, they have a better chance of jumping the fence when the chance comes, or kicking the guard’s ass in a fight. You feel me? Bad nutrition and bad health care can be part of the State of Texas game plan, a second line of defense after the steel bars and fence. Because state leadership says that’s what the public wants and it probably is. The Texas public is a bloodthirsty crew and tight with its pesos too. Not to be negative or disparaging because TDCJ is not all bad. Only like 75% bad, or like two-thirds hprrific, in my opinion, which may be a biased opinion. 

Speaking of which, if you asked people who know me, what’s that cat like? Somebody might say, “He likes to listen. The same way other niggers like to talk.” Not to sound cool or above the fray or anything. But mostly impartial? Yeah. Mostly.

Because you soon realize at Hospital Galveston that everybody has a story, even if it’s not true. And what you hear sometimes is totally bizarro and depraved. Not to sound all in danger in the frontlines of health care or anything. Or if that kind of shit is your thing, you know, weirdness and criminality, and you look at the TDCJ app even if you don't need to? That’s not me, to get all curious like a chick, that’s not the way the strong Black Male rolls, not to sound better than everybody else but my interest in other people’s personal lives is zero, after a quarter-century doing this job. There’s absolutely no prurient interest left, speaking as someone who wipes shit for a living. 

It's just that there’s just some kind of odd smell here, at Medical Branch, and it’s not poop or pee, although there’s that too. Around this place—Hospital Galveston—there’s some other odor, like when you know a patient has taken a dump and you haven’t even opened the diaper yet? 

Once back during my time working in Seattle, this might make a good paper for the annals of bedside care, actually. An infectious disease doc appeared at the foot of my patient’s bed on neurosurgery and told me just from the smell as he entered the room what bacteria the patient’s wound was infected with. Pseudomonas. We cultured the wound and the infectious disease guy was right. It gives you a bad feeling because something stinks here on Sin Island too. And you can tell right away what it is, public corruption. That’s like an infectious organism too.

The problem with having a bad feeling in a hospital is that you may not know what the feeling is about. It may be unfocused or generalized? Or there are just too many possibilities about what is wrong. And frankly—having made a mistake previously in this regard—having previously had a completely unfounded suspicion about health care in the prisons of Texas. To be totally honest. And that first time being totally wrong. Because God knows that you don’t have to make up bad shit about TDCJ, Jesus, it’s happening all the time. 

My mistake that prior time was a false interpretation of data about medications being purchased by the prisons. To set the scene. That time turned out not to be really bad shit in health care, despite my suspicion. TDCJ was actually innocent of wrongdoing, for a change, that was the way things worked out. Me blaming Huntsville for something bad that really didn’t happen, finding conspiracy where there was none. As a budding nurse-scientist, with a shiny new master’s degree almost ready to hang on the wall, you have to report that too. Because sometimes it’s not what you think. 

So, like, the same data can have a lot of different meanings. My big mistake, you could call it, was believing the worst interpretation of something happening at TDCJ because it’s such a shitty place, you know, Huntsville and the prison farms and executions and all that? Believing something that upon closer inspection turned out not to be true. And clarification came from working at Hospital Galveston actually, how cool is that?

So, like, to start at the beginning, some records came into my hands a few years ago showing massive purchases of mood stabilizers for the prisoners that Texas Tech cares for, in Lubbock. This was long before my studies there. To set the scene. So, like, maybe six or eight years ago? And out west, basically, west of the Pecos River. That’s not geographically accurate but cosmically is correct, West Texas, where Tech handles health care for prisoners, not UTMB. In one of the areas where TDCJ expanded beyond its historic East Texas roots. Again that’s not exactly geographically accurate, again, but it’s close enough. Comanche territory basically, if one is making one’s Indigenous Land Acknowledgement like many institutions that have ripped off Naïve Americans try to do. 

My first impression of the medication purchases was, oh wow, that’s how TDCJ controls the prisoners! That’s why we don’t hear about riots or Officers getting dismembered in the penal hellholes of the Lone Star State! Again, how cool is that? The inmates are all on mood meds, bro! Paxil or Prozac or whatever, that was my inexpert analysis of the data on the purchases. By keeping everybody artificially mellow the State of Texas avoids mayhem. That was my premise as a wannabe nurse-scientist, before going to graduate school, not to sound superior to my ordinary fellow and sister asswipe RNs. It would make a good paper in a nursing journal, that was my thinking at the time. The only problem was it wasn’t true. 

There’s a big caveat, it turns out, when drawing conclusions about stats generally. This is something our instructors hammered into us as Red Raider nurses, graduates of the Health Sciences Center in Lubbock. You have to be careful about what inference you draw. The numbers may be right but that doesn’t guarantee that the numbers mean what you think they mean. TDCJ actually has a unit for inmates with psychiatric problems near Lubbock—somewhere in West Texas—and it might make sense that there are large purchases of that class of meds in that part of the state. On Sin Island, on the other hand, at the hospital that covers prisoners across the rest of Texas, the average medication profile appears to be quite different. At least based upon my experience on 7C, passing a lot of meds pretty quickly to a lot of people. A cross section of prisoners you could almost say, again maybe not exactly but close enough. 

Only one of my patients has been on a mood stabilizer actually, so far. He was a young white guy with tats who looked kind of edgy like he needed something for his nerves. In fact a couple more of my patients probably need to be taking something too, but that’s above my pay grade, prescribing meds is not part of my job description, and it’s apparently not really the way things roll at TDCJ anyway. That’s not the institutional culture of the prison system. You’re there to do the time and feel every minute of it, basically. So, like, call me a worrier or call me a good nurse, there’s still just been this nagging feeling that something is wrong on Sin Island, besides the gambling and the whores. And not to mention the historical slavery, here on the sunny Gulf Coast, home of the first medical school west of the Mississippi and all that that. That’s my whole point really, Medical Branch is up to something, evil and corruption running amok on the beach at night. 

There’s always evil in big academic medical centers and there’s been a lot of historical evil on Galveston Island and Medical Branch is where two bad influences meet, you could say, not to sound all puritanical or anything. But what it is—what’s been bothering me—is lost in the fog on Galveston Bay. How does that sound? Be honest, is that too dramatic-sounding? Just out of sight in the mist, as one might say if one was of a literary nature.

So, like, for example, back in the day during my studies in Galveston this doc named Raimer, who was a jefe in TDCJ health care actually? Twenty years ago he told me about a Death Row patient who had tried to kill himself. The means of suicide was the patient saving up his pills and taking all of them at once, alone in his cell? If my memory serves. The circumstances were a little unclear even at the time but poisoning oneself is popular in prison, kind of like suicide by hanging used to be in county jails or being hanged with the help of the jail deputies, which happened/happens too. Anyway, the attempted self-poisoning earned the condemned guy an ambulance ride from Huntsville to Hospital Galveston and a stay in the ICU. To set the scene again. 

Dr. Raimer telling me this as we talked about correctional health care long before it became my work area at Medical Branch. So, like, the ICU fixed up the Death Row guy and returned him to Huntsville and then TDCJ whacked him. That’s the bottom line. That’s what this cat Raimer said. In the prison health context, poisoning is an especially popular way to pull the plug on Death Row, btw. A couple of the last guys sentenced to death from Austin—a Negro who killed his girlfriend’s mother? He was in the news quite a lot if you were in River City at the time. And an Asian guy who capped a cop in a Wal-Mart? You don’t hear of Asians running amok that often, not to sound all racist or anything. They're generally wrapped too tight for that kind of thing and their culture keeps them from snapping, so they paint watercolors instead? Not like black people! We like to reach for a nine mil, the same way Mexicans like something sharp. Not to sound all racist or anything.

Anyway, both these condemned guys from Austin cheated the hangman. At least one of them is known to have used a practice called “cheeking,” when a patient pretends to swallow scheduled medication but actually hides the pill in the inner cheek. In order to do the deed later—after collecting multiple doses—he or she takes everything all at once, maybe a week’s worth of heart meds, or whatever, and it’s good night, nurse. And goodbye, too. 

What else is there to say of morbid interest? 

Medical Branch had the dubious distinction last year of being sued twice in 12 months by young black female doctors, who are extremely rare on this campus, not to repeat myself, and who were dismissed from their residencies for “professionalism.” In other words after a subjective view of them by white faculty, one renal lady and one something else, as opposed to their objective skills as physicians. Dixie never died on Sin Island, you could say. Their attending physicians, the Big Dogs, just decided they should not progress in their residencies, a decision not based upon their skill as physicians. You’ve heard of driving-while-black? This is also practicing-medicine-while-black and nursing-while-Negro.

Speaking from my personal experience, mostly dealing with the on-call residents at night, very few trainees of color have passed my way unless they’re Asian. This campus can be a brutal place and a good hospital. And at least those black female MDs who worked with me at night were on campus, as short a time as it was. Because other than Dr. Ojo, no black male doctors have physically crossed my path at Medical Branch. Asian or white is mostly what you see. There are not even many Tejanos or Tejanas, speaking of diversity, in a state that is half-Latino. Just like UCSF, Medical Branch was built upon a caste system. 

UCSF also has a history of showing minority trainees the door and Mount Parnassus has actually been studied and in the literature on UC there is said to be a “black tax” for studying there. No shit, it’s been identified and studied. The tax is psychological and means everything is made more difficult for minority students at UC San Francisco. There’s a racial hierarchy on both campuses, in other words, if one looks thru a social justice lens. 

In Galveston’s case this funky little island is where the Old South still lives, just like in the plantation lands around Huntsville. So, like, being especially curious about the two dismissed young black female doctors, you know, and me sending an email to a reporter who wrote about the first woman? This reporter replied that she didn’t actually come to Medical Branch for her story. But she said that she was told something special about Galveston Island, to prepare her if she did have to come. This comment was made to her by a source who gave her a description of the character of our very own place in the sun, here on our very own Texas Gulf Coast. 

“Galveston is like something out of the 1960s.”

That’s what the reporter said she was told. But the island is actually more like something out of the 1950s. 

In the 1950s Galveston was like Las Vegas before there was a Las Vegas. What follows is an absolutely true anecdote and more telling even than President Eisenhower looking for CIA headquarters to drop off his little bro. So, like, the Texas attorney general back in the day, in 1956 actually—unlike the guy who holds the office now—was serious about law enforcement and not a thug, again, unlike the guy now. To set the scene. 

Attorney General Will Wilson came to Sin Island with a squad of Texas Rangers—in 1956—and shut down the gambling and the brothels. Before that, Galveston was Sinatra country, a playground for high rollers and the Mob, including Frank Sinatra himself and his presumed Rat Pack. Until then, the authorities had always turned a blind eye to what happened on the island. Seen thru a morality lens, if you asked my opinion? The real problem at Medical Branch right now is that there hasn’t been a good hurricane in 15 years and a lot of moral detritus has built up, just like plaque on your damn arteries. It’s like what happens when you don’t clear your gutters, too. Or you don’t floss your teeth. In academic health care it’s often about exploitation of vulnerable people and the doctors at Medical Branch must have a degree in that, too. 

So, like, Dr. Raimer who told me about the Death Penalty patient who tried to overdose? He eventually became President of UTMB and he lasted until a short while after my hire on 7C, actually. Just a few weeks ago Dr. Raimer was removed by the University of Texas Regents for something weird, involving a vulnerable population, in this case male students. His crime was inviting them to his home in order for the good doctor to style their hair? Details are scant, although no other touching was said to be involved. Just the hair. What would you call that, freaky deaky or not? It’s certainly something new in the annals of academic misadventure. 

Dr. Raimer told the Galveston Daily News that the real reason he was removed was for clashing with the campus diversity guy, who happens to be married to a high-ranking official at UT System offices in Austin. That sounds more likely but both could be true. There’s always a lot of drama at UT, like at UC. On Sin Island there are a lot of storms and high seas, it’s not just the location in the Gulf, it’s the institution. Medical Branch is an academic medical center—a research school. The patients are sicker, the outcomes are supposedly better, although that’s been challenged recently, but the ethics are almost always worse. Usually bigtime bad, actually.

 

 

Chapter 8

 

So, like, my feeling of suspicion at work began to focus one morning while emptying a bag of pee, actually. It had nothing to do with TDCJ’s bad food or medicine purchases, as it turned out, or even the land sales. You may ask, well, what happened? What did you see? And there’s no real answer. It’s just nurse’s instinct. 

So, like, one of my patients was a white guy in prison for child molestation. To set the scene. Something caused me to look him up on the app. Not that he was difficult, or threatening, just that he was strange? 

With some patients it seems prudent to find out something about them in order to know if there’s a history of violence, for example. So, like, this guy was in the hospital for a kidney resection because of cancer, which means the surgeons had cut out the bad part of one kidney. A partial resection like this guy’s surgery is theoretically still cool because you can live with only one kidney or maybe even a part of one. He would be okay if the surgeons got all of the malignancy, isn’t that right, me not being an oncologist personally? So, like, it’s six one morning, kneeling on the ground beside this Kidney Guy’s bed in order to drain the urine at end of shift. 

His pee looked like pink Kool-Aid which can be normal because kidneys contain a lot of blood. Again, not being a renal specialist or anything—a nephrologist—but having taken care of a few of these patients over the years, child and adult both. Kidneys can bleed like a mofo, to use the nontechnical term, BLM is the nursing acronym, bleed like a mofo. That’s pretty much the limit of my expertise. That and the fact that passing a kidney stone out your pecker is said to be the closest pain to childbirth that a man will ever know. But we digress.

So, like, me on my knees filling a urinal in order to chart the amount at the end of the shift when a couple of medical residents came to bedside. To set the scene again. They were doing morning rounds. And they were happy to see me measuring the output because the overnight urine flow is important and the nurse sometimes forgets, including me. And my question to them, since they were standing there, me holding up the urinal full of the guy’s Kool-Aid in my hand, “Is that the color you expected?” In order to give report to the next nurse who may not know normal for a kidney resection. That’s called collegiality which is not exactly my middle name but does happen. Especially if the RN who is going to follow me in the morning is hot or nice or whatever. Or is a sister. Or has been collegial with me. Or it’s particularly important to the case, like here. 

“That’s exactly the color we expected,” one of the young docs said.  

That patient raised my suspicion subliminally. His stay was completely unextraordinary and would have passed out of my memory like most of the hundreds/thousands others over the years. Except, a couple of days later, there was another kidney resection patient who was extraordinary. An extraordinary pain in the ass, actually. To call a spade a spade, just between you and me.

So, like, this patient was already in a room upon my arrival for work at 7 p.m. and she had given the day nurse a little trouble but not much. Only because the patient barely just arrived. She was still groggy from the surgery and was not yet alert enough to be a pain.

This Kidney Lady and me would be spending the whole night together which turned out to be highly emo, you know, a lot of drama. Not to be critical of women. But it was all her fault. 

This lady had already lost one kidney to cancer and just had the second one partially resected. Theoretically she still had enough working kidney tissue to survive without dialysis. Hopefully. Or so the doctor’s notes said. It was a long night. Let me say that at the start, the Black Male RN always perseveres, you know? Not to sound all noble. But to call a spade a spade again. This particular patient the Kidney Lady complained about everything, btw, madre bloody mia. From pain to nausea to the nurse. 

Just to prove it wasn’t me, let me tell you what happened about a week after the Kidney Lady came to 7C. So, like, one night we had three women in a room, including her, and we almost had to break up a fistfight. 

When the nurses entered, after hearing a commotion thru the impenetrable soundproof security glass of the nurses station, you know? The three ladies in the patient room were being just a tad loud. 

Kidney Lady was sitting on the side of Bed 3, at the far end of the room, gathering her strength to get up and go after the patient in Bed 1. The background to the dispute was never revealed. And it was odd that the Kidney Lady was going to kick a little ass because she claimed to be on death’s door every moment from the time she arrived on 7C the week before. 

Even that first night, the week before, her medical condition in my judgment was cool and the gang, actually, she was progressing. In a bedside job you need to be honest about your own skills and mine are not perfect but are competent, that’s me. Knowing when not to worry is a skill just like being able to start an IV and my judgment was that she had a good first night. The Kidney Lady was getting an opioid for pain, although it was never enough. Except there was no physical indication that she was in discomfort. She just bitched all night long. Although that was her right. Pain levels are the patient’s call but when they tell you it’s 10 out of 10 and they’re having a normal conversation with their roommate until you walk into the room—and then they’re suddenly dying—the experienced RN has doubts, you know? What you’re hearing from the patient may not be grounds enough to call the on-call physician to increase the dose. 

She complained of a lot of nausea that first night and said that she had vomited and—this may be considered gross by some readers. But she puked into a cup and showed it to me and there was barely anything there. After a quarter century working in hospitals—having seen more than my share of puke, not to sound cocky like a guy? But considering myself pretty spew-competent, my experience ranging from a newborn baby’s dribble to a medicine-induced launch of stomach contents that can stain your scrubs from across the room? Again, not to get all cocky. But if you’re not even going to hit the wall with vomitus from your bed, don’t bother to use the call light, you know?

Just joking! 

She had retched, okay, but ma’am—this was my explanation to the Kidney Lady that first night. Ma’am, you just had surgery and consumed a lot of medication. Sometimes the best way to deal with nausea after surgery is to get everything out of your system, you know, does that make sense? And a good spew—aka a Technicolor yawn, like we used to say as kids? It can be a good thing.

This Kidney Lady was getting Zofran by mouth for nausea, that's routine, and the docs also ordered a med called Phenergan to be given IV, at the nurse’s discretion. This nurse chose not to give it. 

So, like, Phenergan was the first med that my clinical instructor warned me about back in the day, third semester nursing school after learning how to wipe booty, when things started to get serious in our raining. In class we started with pee and poop and moved on from there. The instructor said Phenergan can have a lot of unpleasant side effects, although it is effective for nausea. To set the scene. The head of trauma surgery at the county hospital in Austin, who was another Medical Branch-trained guy, btw, told me once that he gave Phenergan to the cattle on his ranch because it was cheap—a dollar a dose. Which was not the best recommendation in a hospital treating two-legged patients, you know? But Phenergan was already on my radar as a new nurse, entering the profession at the turn of the 21^st Century, as a measure of medication price inflation and as a not-to-subtle indication of the changes about to take place in health care. As hospitals and doctors became more profit-centric, not that there’s anything wrong with that.

We were just exiting the era of cheap drugs, like Phenergan, effective but with drawbacks. Appearing suddenly were meds like Zofran, that the doc ordered for the Kidney Lady actually, and was originally intended for the mind boggling nausea of chemo patients? But was suddenly at the turn of the century being more widely used and was much more expensive—$120 a dose for Zofran, in the county hospital, as opposed to a buck for Phenergan out on the ranch. Zofran was better at targeting symptoms, or doing whatever, and Phenergan became a second line drug because of its side effect profile. A lot of Old School nurses have views about using it and mine is not to give Phenergan IV unless absolutely fucking necessary. AFN is the nursing abbreviation if you’re interested. 

Which did not describe the Kidney Lady’s condition that first night. Phenergan wasn’t AFN. That was the patient outcome during the night, actually, she did okay, everything went well for her in my opinion. But the Kidney Lady was on the rag in the morning, at the end of shift, which was her right again, whether she was a prisoner or not. It was that first morning after her arrival when everything kind of turned to shit for me actually, not to sound all self-obsessed as a member of this selfless profession. 

So, like, bright and early the next morning four residents showed up outside the Kidney Lady’s room. To set the scene.

Morning is usually a good time for me personally. Night shift is going home for one thing, which means me. And two—not to sound totally superficial! But number two, sometimes the docs on morning rounds are hotties? 

A little end-of-shift eye-candy helps to raise a Black Man’s blood sugar and can give him that final burst of energy needed to reach the door, you know? 

The four residents broke up and one of the women went into the Kidney Lady’s room. Looking through the glass, the patient was clearly giving the medical resident an earful about the Nursing Service’s shortcomings. The doc stepped back out of the room. 

“How was her night?” she asked. 

The doc was kind of hot actually, Asian chick or part Asian, an easy 8 on my personal scale. Asian chicks and Latinas are kind of my thing, btw, not that it’s important here. 

“She did okay,” was my answer.

“That’s not the story in the room.” 

Giving the attitude right back to her. “There’s a lot of drama in there.” The Black RN admits mistakes but will stand up for good care. Clearly, nonetheless, the resident believed the patient. That's cool, it's all cool, you feel me? Black people are used to being undervalued for our contributions to society, not to pull a guilt trip on anyone.

Then all four of the doctors kind of confronted me. 

They wanted to know why the Phenergan hadn’t been given? 

Because it was my call whether it was necessary. Which was true. Being nice about it but that’s the way it is sometimes in a hospital. It falls on the shoulders of experienced nurse leaders like myself—many of us masters-trained or soon-to-be masters-trained—to teach young doctors which way is arriba. Especially boy-nurses like me who have huevos grandes like mine. Not to sound all cocky or anything.

 If you use a med that the doctor says may be used, and it has bad side effects, the Board of Nursing can question your judgment later. “Didn’t you know,” the Board investigator might ask, for example, “that Phenergan has a lot of side effects?” It's a valid question. You can’t win. But you can lose. The Kidney Lady was getting Zofran and, for all intents and purposes, the vomiting had stopped. The patient still felt nausea that first night but is that reason enough to use a big IV dose of an iffy med? My decision was no.

My judgment was that her anxiety was making her feel worse and that was communicated to her civilly and as the advice of her nurse. So, like, one of the four residents who were grilling me was European, he sounded Eastern European actually. You could tell that he was still pissed off. Part of the problem for doctors from other countries who have come to the U.S. for further training is that nurses in the United States exercise judgment. We’re not merely the physician’s assistant—although we do assist him or her. But we have our own practice and make our own decisions when they are our decisions to make. It’s not like that in most countries where the nurse is basically the doc’s bitch to order around, and the physician tells you what you need to do on a micro level.

But seeing that these guys and girls, the four residents, were not happy—it was time for an apology to the rounding physicians. They have hard jobs. And in health care you need to move the ball forward for the patient, without tripping over your own ego. Especially in nursing, ego comes second to what’s best for the patient. And having apologized to a resident maybe five times in my entire career and four of those were insincere? That did not dissuade me from making amends this time too. Again, call me noble if you will.

My words of contrition weren’t about me, the conversation that morning was about the Kidney Lady’s needs and getting the team on the same page. Like, in the past, one of my apologies to a resident, maybe even the senior resident, might have been something like, “Yeah, I’m sorry that didn’t get done. Can I get an order for an enema for Bed 3?” That had mostly been the nature of my expressions of sorrow in the past. This would be my sixth insincere apology to a medical or surgical resident, over more or less a quarter century. But it was completely called for, in part because these docs were standing between me and the door at 7 a.m. 

“Maybe I didn’t handle this very well.” 

That seemed to smooth the waters. 

And what’s interesting is that any one of these guys and girls—the unhappy trainees? They could have changed the order to require use of Phenergan but did not. They could have gone to a computer and ordered Phenergan be used instead of leaving the decision to the nurse’s judgment. In my report to the morning nurse, the same African chick who oriented me to 7C actually? And who was a better nurse than me, remember her, the lady who chewed my ass for leaving my meds out? 

Telling her in change of shift report, “The docs want the Phenergan used.” 

And coming back that night and checking the Medication Administration Record she didn’t give Phenergan either. And soon it became clear why this patient, the Kidney Lady, was a train wreck. Complaining half the time and on death’s doorstep the other half. She was with us a couple of weeks, full of drama. Someone looked her up on the app and googled her and the backstory was passed from nurse to nurse during report. 

“She killed her child.” 

Because it was pertinent, not merely gossip. She was in prison for killing her own kid. 

She had a lot of emotional issues—psychosocial issues we say, especially those of us in advanced nursing study. That view was eventually shared even by the doctors actually, the more they dealt with her. Although the docs did not address it. 

Can you imagine being a mom in prison for killing her own child? Locked up with thousands of other mothers, many of whom would give anything just to see their kids? Child molesters probably have a better life in prison, by comparison to child killers. The Kidney Lady was going mad and no one cared because she was an inmate. 

Crazy, btw, can be the least of your problems in TDCJ. 

Or being crazy is a way to escape, as seen once again thru a psychosocial lens. Crazy as an escape for those prisoners who will never make it over the wall. There are a lot of crazy people in prison, btw, if you aren’t fucked up mentally when you arrive in Huntsville, TDCJ sees to it that you will be when you leave. If you leave. So, like, my original observation that there was a lot of drama with this patient turned out to be correct. 

One night a doctor came out of the room after seeing the Kidney Lady and mentioned that the patient was odd. “She killed her own child,” was my explanation. Boy-nurses are direct and call it the way it is, unlike the chicks who like to sugarcoat. 

And this doc, who was kind of hot, actually? 

She stopped and looked up at me and nodded. Like that explained it. Which it did. “We never hear about that, you know,” she said. She meant what the patient is in prison for, like it was not a consideration in the deliberations of the medical team. 

But maybe it should be? 

Because maybe cellulitis is not the same on a member of the Mexican Mafia as on the guy who barbecued his mother-in-law and served her to worshippers at a church picnic. Maybe healing is influenced by who the person is and what their life story was before they got sick? That’s my soon-to-be masters-trained professional opinion. This lady doc was saying that the doctors already have a lot on their plates curing physical illness, without bothering with what the patient is locked up for. Where the prisoners’ heads are at is something different altogether, apparently, unless they’re stark raving mad and they get sent to a psych unit out west of the Pecos River, where they’ll be prescribed mood meds.

So, like, a couple of weeks later, you know what happened? One night when my patients happily did not include the Kidney Lady, by luck of the draw? 

Standing at my computer in the hallway, doing my charting, like 3 a.m. To set the scene. 

The Kidney Lady walked by in handcuffs, accompanied by an Officer. She was being taken back to her unit, in Pissville, which is near Shithole in Shithole County. The White Bus had come for her. 

She stopped and turned and looked at me when she reached the electric gate. “Bye, Lucius,” she said. 

Like we were BFF. When in reality she had driven me crazy, from 7p to 7a, on any number of occasions. And because her farewell was so sudden, and so unexpected, she left me speechless and my sincere regret now, unlike any false apology to the physician, is not having said goodbye to Kidney Lady or wished her good luck or in some way recognized her humanity. 

It made me sad especially because she was such a young woman. My headstone will be covered by moss and the inscription faded long before the Kidney Lady sees the Free World again. If she ever does. Anyway, as it turned out she was why my nursing intuition was worrying me, here at Hospital Galveston. My intuition focused on kidneys, actually. Don’t ask me why. 

My nursing diagnosis was healthcare corruption, something festering and putrid, like an infected wound. And that stinks just like damn pee. It was the same whiff of corruption you smelled at UC’s campus in San Francisco. 

Kidneys made the most sense for any number of reasons. 

They’re worth about $50,000 each and the trafficking in body parts that we blame on the Chinese is just as likely in this country with our burgeoning transplant industry. Because there’s beaucoup unfilled demand. 

With a lot of the surgeries being done at academic research institutions, there’s big money that appears to be nonprofit, rather than straight up Wall Street thuggery which it really is. Like at UCSF where Chancellor Hawgood is trafficking in Negroes. Not to be critical but these people are capable of anything. The American transplant pipeline is already described as hopelessly corrupt and there was just a move by the President to change it completely. 

To set the scene. 

 

 

Chapter 9

 

The largest number of transplants in the United States are kidneys but you also got your livers, lungs, corneas and hearts. The family of an inmate who died in state prison in Alabama just announced a lawsuit against the State of Alabama because his body was delivered from state prison to his family for burial without a heart. Literally.

There’s probably a lot of harvesting of organs going on, actually, not just in Asia but closer to home. Which is totally cool with me, to tell the truth. My feeling as a HCW is that when you give up the ghost, you give up the body too, but a lot of people don’t feel that way. Especially in a conservative Biblebelt southern state like Tejas. What American medical centers call using cadavers for “research,” may be more like using them for spare parts. Major research schools, like UCSF, ask for bodies to be willed to the university, supposedly to teach anatomy thru dissection, or for other kinds of study, but just as likely now for transplantation. That’s my masters-educated opinion too.

UCSF for example has an aggressive body donation program for “research” purposes. But where do the body parts, for those 800 transplants that Mount Parnassus does in a year, come from? California law prohibits using state prisoners for research, actually. Donated corpses as a source of organs is highly fucking likely, bro, HFL is the nursing acronym. The biggest difference between UCSF and UTMB is that UTMB has a better source of cadavers. All those inmates who were given exorbitant sentences and died in custody and there’s no one left to claim the body when they die? Kidney transplants can be done with live donors, btw, which have the best outcomes, but the vast majority of transplanted kidneys come from deceased donors. Hello!

The waitlists are being gamed, we already know that from the White House. Some Free World patients for example break the implicit rules and go on the transplant list in multiple states, like Apple’s Steve Jobs did back in the day, to get his new liver. To set the scene. That’s the transplant pipeline in a nutshell. It’s corrupt, like academic medicine itself. 

The Kidney Lady piqued my interest not because she didn’t really have cancer and her kidney was not really diseased, but because of the possibility of a kink in the transplant line. UT is involved in a lot of shady shit, actually, let’s be honest here. We’re in Texas, it goes with the territory. And academic medicine is particularly problematic, as we know from Tuskegee and from San Francisco. To say nothing of Baltimore and Johns Hopkins. Practices that may or may not lead to “better” medical science, not just related to transplants, are acceptable in academic medical centers where big money has become the biggest player. It’s a commercialized environment and there’s good reason to think ill, that there’s a hidden market for kidneys on Sin Island too, for instance. Cargo ships still arrive at the dock in Galveston, from Latin America, with bananas and sugar. Are kidneys going out? They used to import niggers here, and sell them, kidneys ain’t no big thing as seen thru the lens of Sin Island’s ethical history. This might even be a step up from selling the whole individual.

A former TDCJ warden told me that there’s a cemetery in Huntsville where they bury prisoners who have died in custody and whose bodies are not claimed by family, and that every year as many as one hundred prisoners are interred there. What’s that, like, 200 kidneys, 200 lungs, 100 livers, 100 hearts and 200 hundred corneas? The beautiful thing about kidney transplantation is that recipients and donors both can be well into middle age. Transplantation is not always about exact matches either, there are degrees of matching, that we won’t get into here. But it’s a fairly-straightforward and much-in-demand surgery. You just need a supply of kidneys. The hot young black female Officer who liked rap and told me about how to handle a rifle if you’re standing guard for the State of Texas on a prison wall? She told me something else too. 

She said that earlier this year, during the spring, there were a total of 13 suicides and homicides on one TDCJ unit alone. The supply pipeline is assured. All that testosterone, hundreds of deaths in units across the state, Medical Branch running a chop shop for prisoner parts, no sweat, not that there would be anything wrong with that. There used to be a market for whole human beings down the street from Hospital Galveston, what are a few especially in-demand human organs? That’s the fear that taking care of the Kidney Lady provoked in me. Not that she didn’t have cancer, Medical Branch didn’t harvest hers, most kidney transplant donors are already dead, or so it is said. But just think how easy it would be to take someone’s organs if the bodies are headed to a pauper’s grave in Huntsville? Parts poached from a vulnerable patient, literally, in a population of the most vulnerable in society, like that inmate who got carved up in Alabama. You may say, well, that’s not proof, but there’s proof too. It’s circumstantial but still pretty damning. Let’s dish some dirt on TDCJ.

So, like, doing an open records request to Medical Branch, the university’s lawyers didn’t know me from Denzel Washington, right? 

UTMB Legal didn’t know that this guy asking for records as a citizen is actually an employee who works across campus, you know? My request was for the total number of kidney transplants done at Medical Branch in the last couple of years. And UTMB refused to say, which was a tad odd. 

So, like, the university appealed to the Texas Attorney General—the venerable Ken Paxton, chief law enforcement officer of the State of Texas. The university wanted General Paxton to allow Medical Branch to refuse to release the information. Which he did. Just like with that TDCJ land purchase, the A.G. decided that everything was confidential. Transparency is apparently not high on General Paxton’s to-do list. Nor on the list of the University of Texas. And which was, like, odd because universities usually like to brag about their accomplishments, how many transplants they’ve done and all that, but not Medical Branch. 

The answer from the university lawyer, a cat named Taylor, quoted the head of the UTMB renal transplant team saying that the number of live kidney transplants—that is from living donors—had not increased from a handful in the last couple of years. But UTMB’s lawdogs also gave me a link to an academic source. If the university is up to no good, it would be from cadaver donors, all those guys and girls who die in custody and TDCJ disposes of the bodies. This is where it gets interesting. 

So, like, the stats reported by Medical Branch were for a couple of years “post” pandemic and showed like 90 or so one year and 100 the next, kidney transplants that is, with cadaver donors. About 40% of the kidneys were sourced from willed bodies, including presumably TDCJ inmates who left their bodies to science. A small number came from the national transplant network. But over 50 came from “other” sources. And you can’t know exactly what that means because Attorney General Paxton has declared the info is confidential. What do you want to bet that some of those “other” donors were wearing white uniforms and were shackled at the ankle when they died? But transparency in high-demand transplants is up to the most corrupt official in the state. Not that there’s anything wrong with that. Some information also came from UC San Francisco, which is totally sus in its operations too, enough said. The University of California is as bad as the damn CIA but the CIA has better ethics, that's my dicho. To set the scene. 

So, like, recently there was a pro-Palestinian disruption on a bridge leading to San Francisco and UCSF issued a press release saying that the bridge closure was endangering the 800 transplants that Mount Parnassus does every year. Which is a huge number, almost 1% of all the transplants done in the country every year done by UC San Francisco alone. Obviously if Mount Parnassus, which is the head of the dragon that is UC, says it’s doing that many, there is no reason to doubt that UCSF has the surgical suites and the surgeons to do the work. The real question is where is the university getting the body parts? 

Both UCSF and UTMB have willed body programs, in which people leave themselves to medical science for research, yada yada. But not explicitly as spare parts, you know? And it's easy to see how this would play out on Sin Island, with access to prisoners. Take for example Attorney General Paxton himself, who is already under indictment for securities fraud, trial to begin “shortly,” and who has admitted the facts leading to a multi-million dollar judgment against the State of Texas for his malfeasance in office and who was just acquitted but not absolved in an impeachment trial? That Ken Paxton. Not that there’s anything wrong with that. Not to be a Ken-Paxton-basher, because it's too easy. 

But there's a lot of drama with this Attorney General, what can you say, and a lot of gossip, and none of it is about him doing the right thing.

So, like, suppose for example one of his mistresses has end stage kidney disease. Like the one who refused to testify at his impeachment? 

Does she get on the transplant list and take her chances like everybody else, undergoing the pain and indignity of dialysis three times a week? And maybe take the risk of death like the dozen to two dozen members of the American public with end stage renal disease, mostly minorities, who die every day waiting for a kidney transplant? Or does she call Sex Pax, as General Paxton is said to be known to his women? Does she call him and say, “Pax Daddy,” another diminutive that the state’s chief law enforcement officer is said to like, “I need to find a kidney, or I’m fucked”?

Or General Paxton himself needs the transplant. Or one of his big money donors, like a rightwing nutjob oil guy who lives just up the coast from Sin Island, in Houston? What a small world in which we live.

Or it’s a University of Texas Regent, or ex-Regent. Or someone high up in UT System Administration? Or a member of the Legislature? Do these guys and girls die waiting for an organ or do they call Medical Branch and get a prisoner cadaver chopped up to order? Last year a former Texas governor said he was having a kidney transplant. Did he take a number and wait and take his chances like the rest of us would have to? Have you noticed that celebrities who are more than willing to talk about all the intimate details of their health, in order to stir public interest, don’t talk about transplants? Because the first question that will be asked is did he or she go on the transplant list and take their chances like anyone else? 

Frankly, even if there is favoritism—corruption—the practice should be short-lived. Medical science is moving towards artificial kidneys in the long run, or taking organs from specially-bred pigs. It’s still interesting because in the long run you may die waiting.

Maybe it’s just me. In a place that is full of bad actors like Hospital Galveston, not all of them patients, it’s easy to see conspiracy everywhere, like with those mood meds west of the Pecos. Or that last crate on the truck being traded at a truck stop. During a break one night, actually, when we were having a quiet night, the only kind of night to have actually, an online search revealed that UTMB and TDCJ were questioned by a state agency a few years ago about transplants and were asked to produce a report detailing numbers and practices. But in response to another open records request by yours truly, TDCJ said they know nothing about it. Ditto, Medical Branch. Oh well.

According to the contract between UT and TDCJ, any transplants on prisoners must be done by Medical Branch. So it’s not like we would have the wrong perp if we start by accusing Hospital Galveston. And there’s just one other thing. Again, it’s probably my paranoia though and doesn’t mean anything. But Medical Branch’s new president, Dr. Reiser, the German scientist? He’s a nephrologist, that’s his specialty. 

In other words, he’s a kidney guy.

Not that there’s anything wrong with that.

 

 

Chapter 10

 

So, like not to totally focus on pee and poop, or dissection of prisoners for body parts, this is my alma mater and my most fun moment as a nurse happened at Medical Branch actually, back in the day, during my days as a student. It was in the Children’s Hospital. 

A kiddo was having an emergency in the ICU, which would eventually be successfully resolved. To set the scene. The whole crew was surrounding the crib, and the respiratory therapist had been called to come down from the wards to help. A lot of kids’ problems involve airways, btw. So, like, everyone was doing what they had to do. The respiratory therapist, who was young, and new to the job, was nervous about what was happening, the kid’s condition and all that, and he looked up anxiously from the crib. 

The respiratory therapist asked, “Is the code team coming?” 

And the charge nurse, who was a middle-aged black woman, and hard as nails, with a heart to match, was at the crib and she glanced up at him. There was just the faintest trace of a smile on her face. It was her scene, so to speak, they are called charge nurses for a reason, and she answered the nervous therapist. This was not, btw, the South African respiratory therapist in Children’s we also had back in the day, who was a total babe, this respiratory guy was a guy.

“You are the code team,” the charge nurse said to him. 

Pretty funny, huh? 

Her answer did nothing for his nerves, actually. But it was true, the respiratory therapist was the only person coming to the rescue. 

Or maybe you just had to be there, like, if you don’t understand the humor. Let’s see, the finest moment for me in a quarter century of health care also took place at Hospital Galveston, much more recently. 

So, like, it was a Sunday morning, five a.m., and my new patient had just arrived from a unit a few hundred miles away. To set the scene again. 

This guy was my first “ad-seg” patient which means administrative segregation which means he was a bad dude or could be a bad dude or had been a bad dude on at least one occasion in prison, in addition to whatever bad shit got him locked up in the first place, is that how the classification system works? He was a white guy. Those people! What can you say? There’s just no respect for law and order among certain ethnic groups. 

So, like, with Caucasians you have to presume a level of guilt, if one looks thru a revolutionary healthcare lens, as mentioned before. 

So, like, this patient’s personal history may have involved him being a bad dude in the Free World setting, we didn’t get into any of that during the admission and, for the record too, the app was not checked. Yet. But this was exactly the kind of white guy who worries me most, btw, in Hospital Galveston and in life. Not to sound all racist or anything. He was maybe 40 and without a high school education.

His schooling came up in the patient assessment, he answered the question, at the time me still on orientation with my preceptor. Not to make any snap judgments, you know, but education levels are sometimes minimal in the Texas bubba community, and proud of it, which may have something to do with family values in communities of lack of color? It might make a good paper for a nursing journal actually, looking thru a psychosocial lens, using a masters-trained perspective. But we digress.

Anyway, this ad-seg guy had a pretty nasty leg infection which didn’t appear to have been helped by sanitary conditions at his home unit, a TDCJ pisspot somewhere near Corpus Christi. He required a lot of blood work which involved me and my preceptor bending over him with a needle, while the oncology lady’s warning about needles-in-the-eye was still ringing in my ears. With this guy, you didn’t need to guess what he was capable of because he’d already done it. That was kind of reassuring in a way because it took away any doubt. You just didn’t know details, does that make sense? 

Even with two officers standing a few feet away, you feel me, as is apparently required in an ad-seg patient care, this guy still looked dodgy and potentially unsafe. Then, out of nowhere, a white coat appeared in the doorway, just like cavalry arriving at the last minute in a Western movie. Enter the physician.

 Not just any physician but an attending physician, in other words, a Big Dog. 

He was “rounding before church” an older nurse told me the practice is called, from back in the day when Medical Branch attending docs came to the hospital to round early on Sunday morning, before going to church. Although my bet was that churchgoing wasn’t this particular M.D.’s reason for coming in early on Sunday. Maybe he was going sailing or was going to have brunch in Houston with Barbie—or with Ken. Something like that, it was none of my business who he was bonking but one guy always wonders that about another guy, especially if mating resources are scarce. Does that make sense? Not that it’s important here. He had given the residents the day off and was doing the whole admission himself. Seemed like a good guy to me, at least for a physician. 

This time with the ad-seg patient, it was this internal medicine guy, a white guy like the patient actually. The doc was maybe fifty y.o., and he walked into the room with confidence and he did something extraordinary to my newbie eyes in correctional health care, even after a quarter-century in nursing and as a proud African American warrior who knows a little bit about what the world is really like. And being totally cool and unflappable myself. With balls of steel. And whose own family has been extended guests of the State of Texas and knows what that means. 

The doc stopped a few feet from the bed, introduced himself and stepped forward and shook hands with the ad-seg guy. The Big Dog asked, “May I examine you?” Which the patient—who had probably not heard a lot of may-I’s recently, back at his home unit in Pissville, South Texas? The prisoner agreed to let the doctor do what he needed to do. 

After the examination the doc shook the guy’s hand again and thanked him for his cooperation. It was a beautiful act of humanity and humility. And in Texas! That would be my whole point, actually. 

Even though, speaking as a R.N., one would prefer to praise this kind of professionalism exhibited by a nurse, not by one of nursing’s natural adversaries, the dreaded physician. But this white doc was cool and totally empathetic. And in Texas, not to repeat myself. Which is a place—a political entity—the State of Texas—that you don’t immediately associate with empathy. Maybe we should. Shoot to wound, remember that, not shoot to kill, and all, like the hot little TDCJ officer told me? Because the worse and most racist care in my experience has actually been at another academical medical institution, the University of California San Francisco, the world-renown UCSF, in bleeding liberal Baghdad by the Bay, not here, Texas’s Island of the Damned. But we digress again. 

What was so cool was the Medical Branch doc’s courage, treating the patient with complete dignity. And being fearless. While personally, at that moment my back was against the window, the one that looks out towards the docks and Galveston Bay? My eyes searching for a potential escape route, in case this healthcare encounter started to go south which it did not. My sphincter held. But just barely. My balls remain firm as steel but my sphincter can get loosen, depending on circumstances.  

It’s like they tell you when you’re hiking with a friend in the woods and you run into a bear? It’s not the bear you have to outrun. If there had been trouble the doc and my preceptor would have been on their own because Lucius would have been, like, gone. “TDCJ does not negotiate” was on my mind, yeah. That and thrr needle in the eye. There was not the warm sensation of urine running down my pants leg, but it wouldn’t have taken much. My job description is to render care not hinder escape, you know? 

Anyway, the patient’s infection made an attack unlikely, because of the distance he would have to cover on a bad leg. But unlikely doesn’t mean impossible, and that morning as the sun rose over the Texas Gulag, some of the most humane care that it’s been my privilege to see at bedside was displayed at Medical Branch by a white doc. Can you believe that shit?

Those people! 

Btw, mostly the nurses don’t care what you’re in for, actually, unless you give us reason to wonder and we check the app.