Pancreatitis Prisoner

‘Pancreatitis of unspecified origin.’
‘Pancreatitis from heavy alcohol use.’ 
‘Pancreatitis due to obstruction.’

It was my first week of internal medicine, and the theme for the day was pancreatitis. I digested information nestled in patient charts while sipping my morning coffee. As I rapidly read though EMRs, like a violinist playing staccato notes, I pieced together fragments of patient histories to better understand their medical problems and the lives they lived outside of the hospital walls. A ’55-year-old male, incarcerated since 1990, admitted for acute onset nausea and abdominal pain’ gave me pause. This patient had been locked out of society for as long as I have been alive. Curious to learn more about his story, I slowed my tempo to review his clinical encounters and hospital notes. While searching for an explanation, I noted the context of his incarceration was missing. Maybe I would find out on rounds.

I thought through physical exam findings specific to pancreatitis and important questions to ask before leaving the hospitalist workroom, stethoscope in hand, to interview the first patient of the morning.

I lightly knocked on the door before entering Mr. Jenkin’s room. My outward appearance, unphased by the smell of sweat perfuming the room, the guards sitting at the bedside, and Mr. Jenkin’s ankles shackled to the foot of the bed. I proceeded to introduce myself.

‘Good morning, Mr. Jenkins, my name is Diana. I’m the medical student on your care team. How would you like to be addressed?’

Calmly laying in bed, he extended his hand to shake mine as he smiled and responded, ‘Rob.’

We were off to a solid start. Rob shared the events leading up to his current hospitalization and allowed me to perform a thorough physical exam. I summarized our interview, my physical exam findings, and asked if he wanted to share additional information that he thought important for his care team to know. He had none and thanked me for my time.

I did not ask about his incarceration history. It did not feel right to ask him such an intimate question after our brief initial interaction. Maybe it would come up during tomorrow’s rounds.

The next morning, I followed up with Rob and learned that he had not made much progress. The guards were stationed  at the bedside while we discussed his belly pain and rated it on a scale from one to ten as I palpated each quadrant. Again, we did not broach the subject of life in jail.

Why did I feel like it was such an important topic to know? It would not change the management of his pancreatitis. But I also did not think it would change the way I would personally interact with Rob. Maybe by directly asking him, I would overstep my boundaries. Maybe asking about his story would attack his dignity or cause injury to his journey toward redemption.

By the third day, Rob and I had developed a morning routine. He knew what I was going to ask and what I was looking for in my physical exam. He proudly pointed out a slit in his gown to make it easier for me to get a good listen to his heart, he rolled to the side to help me auscultate his lungs, and he stretched his arms in my direction for me to check both radial pulses simultaneously. When I asked about his concerns, he said he was worried about staying for more than ten days because ‘they’ll put me back in the wall.’

Confused, I responded ‘the wall…what do you mean?’

‘They’ll put me back in maximum security…I’ve been in low security.’

We were in the same room and yet we were worlds apart. I did not know the difference between high and low security conditions or anything about jail life for that matter. Finally, this was my chance to ask Rob how he came to be incarcerated and get a glimpse of his life confined to a jail cell. Still, I did not ask. Instead, I tried to be reassuring, and said, ‘I’ll share your concern with the team. We’ll do our best to help you get back to your regular routine before then.’

According to a Prison Policy Initiative report, “2.3 million Americans are incarcerated in the US”^[1] and “123,000 Minnesotans are behind bars or under criminal justice supervision.”^[2] Rob was my first patient confined to life in jail, and he will not be the last. He reminded me about a segment of the population that is stripped of basic rights and ignored by greater society.

Things turned around for Rob on his fourth day in the hospital. He reported his pain well managed and appetite restored. I smiled wide, glad that Rob was feeling better, and that I witnessed his recovery as a part of his care team. After discussing his progress with the attending doctor, it seemed like he would be medically cleared for discharge the next day.

I was not in the hospital on the day of his discharge. I did not ask him his story. And even if I did, would he have trusted me enough to share his truth?