Author: Amanda Brown
This surprisingly engaging book turned out to be a fast-paced narrative brimming with extraordinary characters. The author, a general practitioner by training, portrays the challenges and thrills of medical practice inside the highest security prisons in the United Kingdom, home to its most notorious convicts. Even though the setting is of crime, violence, and tragedy, what stand out are the touching humanity and compassion that infused each story. The author sensitively explores the complex lives of the prisoners, highlighting the adverse circumstances which mark them out as both victims and villains. Whilst depicting the unique risks and challenges of prison medicine, the author also conveyed the sense of satisfaction and fulfilment she derived from doing the ‘little things‘ which helped the convicts to cope better with their dismal plights (page 137).
The author is eminently suited to characterise the nature and diversity of prison medicine because she worked in the most notorious prisons in the UK: HMS Bronzefield, ‘the largest female prison in Europe’ and ‘home to seventeen out of the twenty most dangerous women in the UK’; Huntercombe prison which is ‘home to 360 of the country’s most troubled teenagers’; and Wormwood Scrubs, the Victorian men’s prison that is ‘infested with rats and cockroaches‘ (pages 9, 29, 41-42, 77, 87-90). The author described how the extreme security measures in these prisons constrained her medical practice, typified as it was by frequent searches, alertness to personal safety, and secretiveness regarding the movement of her patients (pages 40, 105, and 109). She also portrayed the cruelty that marked prison medicine, graphically reflected by the ubiquitous ‘sickening brutality which pervaded the emergencies she attended (pages 79, 99-110 and 140). So ominous were the settings that they evoked panic and apprehension every time she was paged (page 139).
Notwithstanding the harsh backdrop, the most striking features of the book are the touching and tragic stories of the prisoners. Take the case of Jane for example, ‘tall, attractive, highly intelligent and articulate’, but who repeatedly self-harmed by swallowing foreign objects (page 215). Or the ‘almost unbearably sad‘ story of Paula, ‘addicted to alcohol, cocaine, and heroin for over twenty years’; her life ‘went completely off the rails at the age of 15 when her father left home for another woman’ (pages 219-225). The author explored many of such ‘deeply disturbing‘ stories, illustrating how the female prisoners almost consistently had a history ‘of abuse, of being beaten, raped, and controlled‘, and arguing that this background explained their ‘seemingly never-ending cycle of drugs, crime and prison’ (pages 219 and 228). It was however by helping these women that the author found satisfaction and fulfilment; she was so touched by their tragedies that she committed herself to caring for, befriending, and counselling them ‘as long as I was needed’ (page 261).
Perhaps the most inspiring feature of the book is the author’s ability to maintain her compassionate and empathetic care despite the harsh circumstances of prison. Stressing that ‘I wasn’t there to judge them’, she looked past their criminal records, and their intimidating behaviours, to discharge her medical responsibility. ‘Regardless of who they are and what they have done’, she asserted, ‘my job was to try and make people better‘ and to ‘take the edge off their suffering‘ (pages 5 and 29). She adopted an almost saintly understanding of the conduct and demeanour of the prisoners, such as when she explained away their anger as their way of masking their hurt (page 156). In this way, she connected with many of the prisoners who felt enabled to share their deepest fears and concerns, for example Jared who was moved and used poetry to open up about his tragic childhood (page 69). A poignant indicator to her impact was the bar of soap she received from a prisoner, on which he had painstakingly carved a racing car, a gift for her ‘being kind and not judging me’ (pages 147-148).
Expectedly, many of the narratives in the book are disheartening, and this is often a reflection of the impact of prison life on the mental health of the convicts. For example, the author noted significant aggression in the teenage prisoners, something she attributed to ‘too much testosterone in too confined an area’. She also encountered a high tendency to self-harm in the young convicts, a trait she felt was an outlet for ‘the pain they feel in their minds’, pain caused by an ‘overwhelming sense of helplessness and hopelessness‘, and an ‘intense feeling of claustrophobia from being locked up’ (pages 43 and 62). Obsessive compulsion was another outlet used by the convicts, such as Azar who seemed to be ‘channeling his frustrations into cleaning his cell’ (pages 135-136). The book explored many other consequences of incarceration including depression, anxiety, panic attacks, and drug addiction (pages 29, 41-42, and 125).
Throughout the book the author highlighted the contrast between her life as a general practitioner, and as a prison doctor. She particularly reflected on how her experience as a prison doctor afforded her a deeper perspective and meaning on life. For example, she came to better appreciate the freedom, love and security she had, and to undervalue material things which ‘suddenly seemed so trivial‘ (page 68). Indeed she came to feel ‘increasingly unforgiving towards the residents of my wealthy neighbourhood’, and to feel ‘more kindly disposed to the prisoners’ who ‘felt more real‘ (page 154). Conceiving her old life as shallow and empty, she said ‘my values were changing, and my heart was clearly in another place’ (page 189). She came to value the lessons she learnt from each prisoner, saying ‘they all, in their different ways, had enriched my life and made me appreciate everything I had’ (page 175).
This is an insightful window into the practice of medicine in a most unusual environment where social etiquette and human relationships are severely constrained. The author described the unique circumstances and bizarre clinical practice behind prison walls, from the sublime to the brutal. She however never forgot to see the convicts as no more than human, with the same desires and concerns as other patients. She demonstrated how empathic and compassionate care should transcend circumstances, even those as challenging as the one she faced. With lucid and elegant prose, she demonstrated how pertinent it is to make a difference to any patient’s life, and how every experience alters our world view.
This unique book highlights the responsibility of doctors to maintain the highest level of clinical practice wherever they find themselves. The author’s non-judgmental approach to the lowest in society is a particularly valuable lesson for all doctors. The book is however more than just a narrative on prison medicine, but a mirror on a society that pushes many to fall into the vicious trap of crime and punishment. The author’s understanding of the unfortunate social and personal backgrounds of the convicts is therefore worthy of emulation, and I recommend the book to all doctors.
Publisher, Place, Year: HQ, London, 2019
Number of parts: 3
Number of pages: 263
Star rating: 5