It would be hard to miss her. She walked into the atrium, towering tall in a bright orange jumpsuit. She was led down the hallway, her handcuffed arms held straight out in front of her, palms parted as though to grasp a bouquet of flowers.
When we saw them later that afternoon, they were uncuffed, poking through flimsy sleeves of the hospital gown she was given. Without her body wrapped in its orange uniform, or the security guard sitting at the foot of her bed, you wouldn’t know she came from the prison. She now matched her neighbors, donning that sad sky blue material, that pitiful excuse for a color. The one decorating most healthcare facilities, the one that is supposed to warm up sterile rooms and hearts alike while failing at both.
But none of that is what we came to see. We walked in to see the 30 something year old woman who most likely had cervical cancer, stage III. The introductions and pleasantries follow in slow Southern fashion. She meets us with nods and ‘yes, sir’s. These continue as the doctor explains her possible diagnosis. Her nods shake loose the tears, which slid down the crevices of her plastered smile.
Does it make sense? Yes, sir.
Does she have any questions? No, sir.
Except for one. Would the doctor call the warden so she could get permission to call her family? To tell them that she was in the hospital and why.
Of course. The doctor replies. Also, do you have Medicaid?
Yes, she nods.
We walked through the hallway heading back to the office, the doctors discussing calling her lawyer to try to get her released with a medical excuse.
Good thing she has Medicaid, the doctor said. If not, we shouldn’t ask so her treatment will be covered.
The team moved on to talk about staging and grading of cervical cancer. A disease mostly found in resource-poor countries, with limited access to regular healthcare access, vaccines, and screening procedures. But see that is the thing. We aren’t in a developing country. We are in Alexandria, Louisiana. A state, in the United States of America; also a state with the highest incarceration rate in the world.
As the residents get pimped with questions on clinical symptoms and diagnosis, I am stuck on one I know has no evidence-based answer: what kind of a society do we live in that one would get better healthcare if imprisoned with cancer than free without insurance?
And this was only day two of my ObGyn clerkship.
It is a long road ahead, with many stories to be told, questions to be answered, lessons to be questioned, and hands that will be cuffed and uncuffed. I only hope that when the surprises stop being surprising, the shock of the truth never ceases to stir my blood and rattle my bones.