September 1, 2012
by Dan Williams, Psy.D.,P.A.-C.
Working part time with inmates in county jails can be an awakening. Some are state, some are federal crimes that have been correctly convicted and yes, some are innocent and wrongly convicted. Those are the minority. Doing primary care medicine with inmates does not go over well with many providers. They have dreams of pristine offices, with the lingering odor of alcohol and peroxide, with tongue blades incased in clean glass jars. This is not the case in the department of corrections for obvious reasons. Deciphering the malingering from the legit from the drug seeker to the true patients in pain and are afraid. There are those who are afraid to voice they are afraid. Men and women, white and black, crime knows no bias of race or income level. It was last week where I was haunted still by memories of tears, screams, and psychological and physiological withdrawal. To complicate this case this late twenty something female was three days post severe life trauma. She will clearly qualify for a Post Traumatic Stress disorder (PTSD.) She was brought to me in the customary orange jump suit, handcuffed wrists, sobbing, crying and literally hysterical. She was going through physiological as well as psychological withdrawal of heroin. This was her first offense. She is married, hiding her addiction from her husband and was caught making a drug deal after the fact. She was caught for possession, and her next home was a six by eight foot jail cell, no window and a large, thick metal door with a small twelve inch by four inch slot for food to be brought to her. There is no exaggeration when others parallel these living arrangements to an animal in a zoo. The behavior of chronic inmates mimics that of larger mammals pacing back and forth with swaying heads to and fro. Back and forth, back and forth with head down, and walking the same repetitious path. Out of sight out of mind. How many times do we contemplate what really goes on behind the scenes in a prison, or in a poverty situation?
Never the less our young lady was crying so hard, so scared I could hardly make out what she was saying. Her tears would flow heavily down her face, her mucous from her nose help matte her shoulder length brown hair against her cheeks as she struggled to wipe her face with both shackled hands. Even reaching for tissue reminded me of a Houdini trick. My heart was broke, she was not malingering and was in clear emotional pain. Vitals fairly stable, but mentally stable was far from this woman’s soul. I have treated many, too many heroin withdrawals and something seemed grossly amiss. I was not sure if it was just the incarceration, the severe claustrophobic penning of a human soul or was something more horrifying at work here. She was begging for medication to help her detox. She was screaming for any benzodiazepine as she rattled off a few. Xanax, Librium……please anything , please please..in between sobs and screams she would try to verbalize what she needed. I held firm as I attempted to scribble down a detox regimen for her. It was at that moment when I was writing, when I redirected my attention from here when she tried pointing to her tail bone. Through sobs and screams, she mumbled over and over, ” I am hurting , my tailbone , my tailbone. I glanced at the nurse and we explained the importance of an exam. As we tried to stand her up where we needed to unlock her handcuffs with a female guard in a supportive role she disclosed. “I was raped, I was raped”…sobbed, tears flowing, breaths short and labored. Through direct eye contact, holding her head between my hands and begging her for details she disclosed. Her dealer, who she buys heroin from anally raped her with two other men and then threatened to kill her if she disclosed who. There would be NO disclosure of names, this was for sure. Not at this moment of time. I proceeded with the exam. Black and blue marks around her lower back, and both buttocks. Anus was not torn, and the exam itself was horrifying for her, as we repeated over and over we are trying to help, I must examine you. I stopped myself from the normal human, knee jerk reaction of, “It will be okay.” I know it will not be okay, in fact it will haunt her for the rest of her life in some format.
Her thread of life as painful as her past may of been, led her on a search for peace. On a search for an altered reality. Many who end up hooked on heroin have so much inner turmoil, so much emotional pain they need to find a chemical high, a relaxing euphoria to help numb all memories of despair. A synthetic “peace.” Yes, of course many non-medical do not understand this scenario. Find God, find peer support, find other means for peace. Lately in the Midwest at least Vicodin, Norco and Oxycontin are so expensive on the streets Heroin has become the cheap high, the cheap alternative, the cheap utopia. If you do not know how to find peace, how to avoid your horrendous life trauma, how to intellectual seek out different resources and for you it feels as if your soul is tortured you turn to the easier alternative. It frustrates me when so many wonder why. “How could anyone do this?” Really it is easy for me to understand why? It is difficult for me to understand the lack or non-existence of familial love and a zero support system.
She was going through withdrawal and was three days post being raped by three men anally. Her presentation was not only withdrawal but psychological shock, being extremely violated emotionally and physically. At some point she was looking for an escape. She was looking for inner peace. An ability to run from reality. Her life has now changed forever, and her backpack of memories just become much, much heavier. I was able to get her transferred to rehabilitation and out of the county jail with the help of a caring guard. Her path is bleak without the right support, the right key ingredients, and even a move out of her area would help move her into a right direction. A complete removal of her sources would help. Yes, of course she could find some mind altering substance elsewhere, however it is helpful to remove your sources out of your life, especially when you do not have any support from family. Heroin will give you transient internal peace, however it is a ruse, a con of your current situation. When one has severe emotional pain, severe feelings of despair, and that feeling of literally o where to go , no where to turn in life it does not take much to understand how this can occur. Only the grossly uncaring, the pretentious, blinded souls will not understand how one can turn to a mind altering substance. Yes I suppose I need to cover myself for the cynical for those that see all sides. Yes, there are many that abuse and seek out heroin for the naive search of pleasure, the experience if you will, the peer pressure, the thrill of the risk. However, many seek the road of peace due to inner demons, and an inability to either know how or do not know how to find an alternative. It is a delusion of peace and a road to hell. As health care providers we can do all we can to just make a tad bit of a difference to fill a few pot holes along their road of life. One individual may not end up at a dead end but just might see some alternate routes. Giving them a GPS with alternative routes cannot hurt. They must choose, for when they choose and they see the outcome, they become empowered to drive their own route to avoid the delusion of peace to authentic serenity. It is not short, and it is not without the need or want to turn around and re-visit that hell again, for it is familiar. It is the unfamiliar that one must make attractive to the heroin addict so they just might risk a new path of peace.