I am a doctor on Rikers Island. My patient does not need to die in prison.

I didn’t take care of Tyson directly, but I was talking to a doctor and lawyer in his hospital: I wanted to release him before he passed, but before it happened He was not released. This makes his death situation seem like a coincidence in timing—it seems that they did not result from a decision made by someone, but were updated implicitly by refusing to make it . And it has the truth. He had been detained for parole violations, and the paroles often appeared to crank like rusted, autonomous cruel machines. Once someone is trapped in the gear, it is difficult to withdraw them or identify the engineer (lawyer, judge, bureaucrat, interim director, governor) who can intervene. But usually there are several people who keep smashing gears along the way.

My job is to take care of the oldest sick patients on Rikers Island. I’m thinking of preventing custody as the center of my work. Sometimes this means trying to stop before suicide, overdose, or injury occurs. Sometimes it means diagnosis and treatment of serious illness. However, some people die occasionally because of incurable illness or their tired body unable to fight. In these patients, death cannot be prevented, but deaths still occur in custody. In such cases, we will pursue “caring release.” For patients in pretrial detention, that is, someone who is presumed to be nominally innocent, this often means finding an alternative to prison: home, hospital care, and nursing home admission. .

When you imagine people getting stuck behind the Rikers bar, they usually don’t imagine the people I care for. My man is old, winding and hesitant to dig down the hallway with people walking. Paraplegic patients who rely on nursing assistants to turn around and change dirty diapers; young people with advanced cancer who are handcuffed when taken to hospital for chemotherapy. The patients were too demented to know exactly why they were arrested. According to our census records, Almost 15% New York City prison population is over 50 years old. I took care of many incarcerated people over 80 and over 90.

Prisons are very scary places to get sick. This is not due to our medical staff. There are a lot of individual acts of kindness: the doctor maternally rolls her eyes on a favorite patient who boasts of his girlfriend. A policeman telling an unreasonable patient to go on an appointment for his physiotherapy; a nursing assistant carefully draws a privacy screen around the bed, muttering reassurance before trimming someone’s wound. However, by its very nature, prisons are places characterized by violence, indifference and distrust. The pain and nausea that my patients feel due to the disease often exacerbates the discomfort caused by being trapped in pens, cells, or dormitories with strangers. Their movements are restricted and, like any opportunity to exercise a personal institution, choose clothes and food, turn lights on / off freely, go out and feel the sun, Or take the medicine on a schedule. This limits my ability to really reduce physical discomfort. When you lie down in a crib and spend the day, it is difficult to relieve someone’s back pain. It is difficult to help someone sleep when he is afraid of what will happen to him when he drifts.

Treatment of physical symptoms is not the hardest part of providing palliative care. The majority of my patients have been detained in pretrial detention or on parole. The average length of a jail is About 73 daysHowever, I have been taking care of patients who have been detained for six years before trial. They are trapped in a sort of waiting room and do not know which doors will be unlocked. Doors that send them to the prison system upstate or release them to the community. Existential distress is the common experience of those in prison and those who are dying. For those who are ill and in captivity at the same time, suffering can emanate from their bodies, witnessing the lowest I can offer and the best I can. It can be difficult to tolerate access to that much pain. I often interview patients, leave the guards at the gate of the prison, and feel the need to drive immediately from the island.

When caring for a dying patient during medical training, I talked about a double agenda. I tried to help them understand their diagnosis and create a moment of meaning and control on the last day. Some patients are passionate about maintaining a small vanity when their health deteriorates, discussing trimming nails and where to buy wigs. Others wanted to live to see their daughter’s graduation ceremony and their grandchildren. Circle those dates in your calendar and consider what you need to get there.

These conversations are quite different in prisons. When I started this job four years ago, I was wondering how I used clumsy stock phrases to get to know the patient. “If your time is short, what is the most important thing for you now?” They want to eat their mother’s food again, relive their favorite vacation, see their children marry before they die Did you think I’ve acknowledged. But they have been cut off from those opportunities. My conversations with incarcerated patients revolve around different purposes. That is, think about how they make sense while staying in the cage and figure out if the doors will open before the time runs out.

Palliative care physician Ira Bic said,Dying job“: I say I love you, sorry, I forgive you, thanks and goodbye to those who were nearby. My patients can often do it. Visit time For a patient in her 80s, I arranged a family meeting with him and his estranged son, who knew this patient as a former Marine in Stoic with serious dementia When he heard him, he replied boldly, “Okay.” The moment he met his son, he started crying. In the last 35 minutes I learned more about him than last year.

In other cases, the urgent task for my patients is to talk about them. Some say they are most afraid that they will spend the last moments unknown to the people around them and be forgotten by outsiders. For these patients, my team sometimes conducted and recorded structured interviews and invited them to reevaluate the highlights of their lives for posterity.

But sometimes, patients cannot do this due to illness. Then the work is the rest of us. We can make the experience of someone leaving this world less sad when we do our best to respect their dignity and the complexity of identity and life experience. To do so, it is essential to open the cage. Keys, such as politicians, amendments, district prosecutors, judges, etc., must recognize that allowing a person to die while in custody is a death penalty served regardless of the offense. No. In what is called the justice system, death in such situations is a failure.

Many detainees and prisoners can die of covid-19. What is “social distance”? Not possible in orthodontic facilities. People sleep in cribs four feet away, share bathrooms, watch TV, and sit in small, common spaces that gather for therapy sessions. Staff travel daily between residential areas and in and out of prisons, where dozens of people can be infected. Despite the best efforts of health services and the Office of Corrections to identify, test, and quarantine potentially infected people, New York City’s prison system is fully responsive to the spread of the virus. People are very sick. Tyson was one of them.

I didn’t know Mr. Tyson, and I can’t guess what he couldn’t do because he was lying dead in a hospital with a correctionist outside the door. Moulting on a mass scale Urgent public health demand Outbreak mitigation strategies—and such population-level concerns should not obscure the individual consequences of removing the liberty constraints of liberated individuals. No one deserves to die in handcuffs.