Ely State Prison 1

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March 8. It's 1 A.M. as I start this. I am four weeks past my last chemotherapy and today the fuzziness in my head seems completely gone. I'm having a little bit of difficulty with word finding. My mood is very good. Current meds are dexamethasone 4 mg daily (more than twice what the body generally needs), hytrin 5 mg once or twice a day to battle my prostate, omeprazole 40 mg a day to keep from making stomach acid and decreasing my risk of developing an ulcer from the dexamethasone, and Levaquin 500 mg a day to treat what is probably a pneumonia that has been around for a week or so.  I'm having some pain from the left diaphragm from tumor fluid and I took a short-acting fentanyl a few minutes ago.


Ely State Prison
Jasmine and I had met in 1997. Her fellowship in Forensic Psychiatry ended on June 30 of that year. She had originally planned to return to her home in Orange County but decided to accept employment at Atascadero State Hospital instead. I was already committed to Atascadero for the forensic fellowship. She moved in with me in Morro Bay and we had a wonderful first year of romance. For me it was an opportunity to observe a Zen master. For her it may have been something analogous to a Jane Goodall field study.
Unfortunately, "lived happily ever after" was not an option at that time--the world was rapidly changing. Although the youngest in her family, Jasmine is the matriarch of her family of origin and provides needed medical services to various family members. She had delayed her return to LA from 1997 until 1998. However, her 89 year-old father had stopped driving and was becoming more frail. Both her dad and step mother had ongoing medical problems and needed assistance on a regular basis. She believed that she had no choice but to return--out of love for him.
There is a phenomenon that I call the illusion of independence, where the elderly stay in their own home but require a mountain of assistance in order to do so. Her father was at this point in his functioning and it was not something that was going to change.
Atascadero State Hospital was changing, also. After the Polly Klass murder, the legislature had passed a statute that required certain types of sexual criminals, Sexually Violent Predators (SVPs), be committed to a state hospital for treatment upon completion of a prison sentence. Atascadero State Hospital had been designated as the treatment site for all of these cases until a new hospital, Coalinga State Hospital, could be constructed specifically for the needs of these "patients." Neither Jasmine nor I had any real interest in doing psychiatric work with that population.
I was unable to imagine myself living in the bustle of Los Angeles. (Jasmine would always tell me that she lived in Orange County, not Los Angeles--but it all looked the same to me.) Sometime in May I received a job offer from the old company, Correctional Medical Services. The position as psychiatrist at the maximum security facility for the state of Nevada was available. It was a job with medical benefits but no retirement plan. However, the contract offered twice the hourly rate as my position at Atascadero...it was an offer I couldn't refuse.
Jasmine and I scoped the job. We flew to Salt Lake City and rented a car and drove the 250 miles to Ely, where we took a tour of the medical facilities in the prison and had a meal with the medical and mental health staff. It was very convivial. The next day, I met the warden and I was impressed. He was an enormously big man--both large framed and carrying an extra 100 lbs. He was articulate and opinionated enough to make me comfortable that his decision-making was likely to be clear and decisive. I didn't see anything not to like.
The job required that I spend 35 hours at the facility per week when averaged over a month. This provided an opportunity for a great deal of flexibility in scheduling. However, a key to that flexibility was the relationship with the medical director, Dr. Eric Stokmanis, a young internist who had been at the prison for a couple of years. Given my background in Family Practice and prison medicine, I could actually provide him with medical coverage and permit him time away from Ely several times a year. It turned out to be a great arrangement. We were both capable of examining one another's patients and discussing the cases by phone in order to develop a reasonable treatment plan. We did this for the next four years.

Ely Nevada. Low resolution shot that captures the mountainous feel to the place.

Ely is in a beautiful location at about 6500 feet above sea-level with a high desert climate. The summer weather is next to perfect with very dry days in the mid-80's with intense sun. Although it was not unusual for night-time winter temperatures to dip to zero, the average daily temperature during the winter months was in the 40's. I found it much more comfortable than Billings MT.
http://en.wikipedia.org/wiki/Ely,_Nevada

Aerial View Ely State Prison: The 8 squares are housing units.

On my second or third day on the job, I was still within the facility in the afternoon after the departure of Dr. Stokmanis. I was called to one of the housing units. When I arrived, there was a man lying on his back outside of a cell. There was a very ragged cut that extended from one ear almost to the other. The man on his back was dead and had been for a while because the body was cool.
On the floor alongside the man was a coffee can lid with sharp edges. It had been folded over and rolled slightly to provide a handle. Home made prison knives are called "shanks." Most are constructed to "puncture" and penetrate rather than slash. Generally shanks do their damage by piercing vital organs in blows to the neck, spine, and chest. The shank I was looking at was more sophisticated and specifically intended for use as a blade to slash the trachea, jugular veins and other vessels in the neck, like the carotid arteries.
Inside of the open cell, a naked inmate was on his knees, cuffed in the back, and pressed against the wall by two correctional officers. This was the cellmate. The body had been discovered during the afternoon "count." (Several times a day, a count of all prisoners is performed--to ensure that all that should be there, are in fact there.)
About an hour after pronouncing the man dead, the warden invited me to a conference room where a recorded telephone conversation between the dead man and his mother was played. The victim had been scheduled for release on parole within the next days. His mother was a card dealer in Vegas who spent several minutes informing him how important it would be to obtain credit.
It was suspected that the victim had been unwilling to comply with a request from a gang.
Despite the murder in the first week of work, I have never felt safer working in a prison.  Movement of inmates was strictly controlled. Patients brought to the medical unit were shackled at ankles and wrists. There was also a "belly" chain to which the shackled wrists were attached. And then there were either one or two escorting officers who walked beside the inmate and maintained a  hand grip on the upper arm.