The Diagnosis

When my supervisor Ms. Thurman told me that I’d be getting a coworker I didn’t like it one bit.

Dream Realized

Working in the prison library was my dream job. Growing up, whenever I’d move to a new town or school, which was often, the library was always my place for solace. The new environment and all the strange kids was intimidating, frightening. Being surrounded by books made me feel comfortable, safe, happy. I think I always got along better with books and the people in them than those in the world around me. People in books are less demanding.

Behind prison walls I was inundated with new people and relationships to navigate. For a person whose most comfortable setting is to be alone, this was a nightmare of sorts. When I unexpectantly got the job in the library I was thrilled, and I quickly came to love my new position for several reasons.

Benefits

Being around books all day once more gave me a sense of belonging and contentment. I enjoyed helping the library visitors find their selections and even make a few humble recommendations of my own. My duties required me to be organized, meticulous, and detail oriented, which fit my natural tendencies perfectly. I also liked that there was always more to be done. Not only could I cross things off my to-do list, (yes, I mean that very literally) but when I finished there was an actual pile of books completed, which gave me an enormous sense of accomplishment. Working in this way I was provided a certain amount of autonomy and was often all by myself. This solitude allowed me to put my head down, focus on the task on hand, and get my work done. It also served as a beautiful respite from the crowded and loud cellhouse. I thought getting a coworker would ruin everything.

New Guy

Ramone was a few years older than me. He was a slightly built Mexican guy who was slim but obviously lifted weights regularly. He spoke Spanish fluently as well as English, albeit with a thick accent. Prior to his imprisonment Ramone had gone to college for accounting, mostly for the money. After interning at an accounting firm for a summer the idea of doing that for the rest of his life seemed a form of insanity. Ramone switched majors to kinesiology. He had been thinking about maybe physical therapy or sports medicine, but as is too often the case, his plans were derailed by a bad decision that snowballed and led inevitably to a series of even worse actions. I could sympathize.

Training

I took it as a sign of her confidence and trust in me when Ms. Thurman tasked me with training Ramone. Ms. Thurman saw my end results but wasn’t necessarily privy to all the steps of my particular process, which was probably for the best. Ramone was a quick learner, but I wasn’t the best teacher. I’d been doing it on my own for long enough that it became second nature, and so my instructions amounted to little more than to just do it. Given a little time I was able to adjust and not only show him step by step how to perform the tasks properly, but also explained why we do things certain ways so it didn’t seem arbitrary. My fears of losing all solitude and independence turned out to be unfounded.

Bonding

As long as we weren’t too busy Ramone liked going to the yard and gym, which was fine by me. During the course of our work we talked and got to know each other. I liked him. He was intelligent and inquisitive. Like myself Ramone was voracious reader, but he studied business texts, psychology case studies, and self-help books. Very little fiction. We had meaningful conversations about relevant issues, but also goofed around and had some laughs together. Our relationship grew so that it wasn’t all business. However, Ramone was also like me in that he was capable of quietly focusing on work and getting things accomplished. A rare thing in or out of prison.

My Diagnosis

For months Ramone had been complaining of back pain. There were times when he’d be working on labeling or repairing a stack of books and he’d have to stand up to do it, or he’d have to sit down to relieve the pressure. Often he’d just walk off, maybe stand in the corner and try to stretch. Nothing he did seemed to help much. More than a few times I told him he could leave, that I’d manage without him for the day. Since I had suffered with my own back pain issue in the past, I described for Ramone what I had gone through, the scans and treatments I’d had prior to my incarceration. I demonstrated a series of stretches and recommended some rest and recovery with walking being the most strenuous activity he was to engage in. One look at Ramone’s physique indicated that this diagnosis and course of treatment would be abhorrent to him. He loved working out. Lifting weights, playing soccer, running, these were how Ramone filled his days and did his time. He wouldn’t stop, no matter the pain. So naturally I made fun of him.

Ridicule

“What’s wrong?”

“My back is killing me today.”

“Did you play soccer yesterday?”

“Yes,” Ramone managed to squeak haltingly, lowering his head sheepishly.

“Well, that was dumb.” This is the kind of good-natured ribbing that I often needled him with.

Sometimes Ramone would claim that running actually made his back feel better, but I always disputed this as largely psychosomatic. I pointed out that these feelings didn’t last long and were in fact unsustainable because he couldn’t run all day every day. He was describing the aftereffects of a runner’s high, his body flushed with adrenaline and endorphins. Once that ebbed, he was right back to agony. I told him countless times that he needed to cut out all the exercise and let his body heal.

When he bragged about deadlifting 315 pounds—an exercise which is particularly stressful to the back—I called him an idiot.

One day he came in and immediately laid down on the floor. I told him that he should’ve just stayed in the cellhouse. He claimed he didn’t want to abandon me without any help. Then he spent most of the morning on the floor providing me zero assistance. This was a fact that I made sure to mention multiple times as I found reasons to walk over and around him despite the fact that he had chosen the most out of the way section of tile to quietly collapse on.

Deliberate Indifference

Ramone endured the kind of criminal negligence that I’ve come to understand as customary in prison healthcare. “Deliberate indifference” is a legal term used to characterize medical care that is obviously inadequate. One threshold that is used is whether a reasonable person, without any medical training, could look at the issue or complaint and deem it serious enough for further treatment.

For nearly a year Ramone sought appropriate medical attention. They gave him 200 mg ibuprofen for the pain. After months of return visits he received a prescription for muscle relaxants. Eventually weekly appointments with the physical therapists were added. This treatment was actually more extensive than most guys get. None of it did much to help the pain, and it did nothing at all to properly identify the cause of Ramone’s symptoms. He did finally have to dramatically cut back and then cease his exercise regimen. He kept asking for an x-ray or MRI scan. He was repeatedly refused. After receiving news from what he considered a reliable source, Ramone decided to try transferring to another prison. There was a degree of desperation in his decision, but after months of constantly worsening pain and being consistently denied the MIR he believed he needed, he was feeling fairly distressed. Ramone’s understanding was that the new prison was much quicker to approve guys for an MIR, and as much as he didn’t want to leave his good job and comfortable surroundings, he felt he had to take the chance. When he left I wished him well and hoped he would get the help he needed.

Ramone’s transfer was granted and executed with remarkable swiftness. That was a fact that I would revisit many times after I received the news. I would wonder if these people somehow knew and wanted to pass Ramone and his problems off to someone else.

The Diagnosis

I was working alone in the library. Ramone’s position hadn’t yet been filled. He’d been gone a little over two months. Ms. Thurman walked in with a purpose. She called my name. “Stop what you’re doing. Come over here. I have something to tell you.” I complied quickly, always eager to jump to any new task. Ms. Thurman was a very no-nonsense kind of person, professional and often all business. This tendency generally rubbed people the wrong way, but it was what I liked about her. I always knew where I stood with her. Until this moment. The look on Ms. Thurman’s face had me unbalanced. She was clearly disturbed.

“Do you want to sit down?” she asked, and I didn’t understand—it seemed out of context or apropos of nothing. “I have something I have to tell you.”

“Okay,” I replied mostly because I thought some response was expected. I didn’t sit down. Between us there was a short bookcase with three shelves. It was part of the reference section and contained an encyclopedia of anatomy that Ramone had studied endlessly for clues to his malady. Ms. Thurman was direct.

“I checked and saw that Ramone had a medical writ today. It wasn’t the first time that he’d been taken out to the hospital, so I called someone I know down where he is.” She paused an instant but pressed on. “He had his MRI and they did find something. A tumor. Ramone has spinal cancer. It’s very advanced they said.”

Later, I would contemplate how many confidentiality regulations Ms. Thurman violated to procure this diagnosis. In that moment though, I looked into her dark eyes, examined her face, analyzed her body language. I was searching for some slim sign that this was all a tasteless joke. Nothing in our relationship or time together should have led me to believe that this was a prank, yet my mind rejected it as wholly impossible. It had to be a ruse. I waited for Ms. Thurman’s mouth to turn upward into a grin. I waited for what felt like a very long time.

“He’s going back today for more tests. They’re going to see what their options are.”

“Options,” I said, not a question. “Okay. Alright. Options.” I was pretty sure his “options” were nil and none. “Spinal cancer. Alright. Okay.” My legs were gone. They weren’t numb. Or weak. There was nothing below my knees. I felt like I was bobbing unsteadily in a rushing torrent.

“Are you alright?” It was a stupid question and it unnerved me all the more because I knew Ms. Thurman was in no way a stupid person. “Do you want to go back? You don’t have to keep working. Just wait here.”

She was gone and I was sitting in a chair. I don’t remember either happening. I thought about all my jokes and jabs at Ramone about his back pain, and I felt like a world-class jerk. Guilt began to dig at me and take hold.

“Options,” I said to no one at all.

Unfeeling Assessment

Ms. Thurman had arranged for me to see a QMHP—quality mental health professional. She didn’t want me going back to my building until I’d talked to him. Apparently she saw something in my face or demeanor that she didn’t like. I agreed to it.

I was hurting, raw, confused, angry. A lot of that I let out to the mental health counselor who had thick glasses and looked like a hundred-and two-pound twerp. I spoke of my faith in God and his larger design, and how I couldn’t reconcile that with this new tragedy. The counselor ignored all else and seized on this. He recommended that I just trust God. His words sounded hollow, platitudes of the worse kind, and entirely insincere. They were a slap in my face to rouse me from my stupor of sudden grief. I silently chastised myself for opening up to this total stranger who clearly didn’t give a tinker’s damn about me. I shut everything down. Though he wasn’t particularly quality like his job title would suggest, he did notice this much. He resorted to the default query.

“Do you feel like you’re going to hurt yourself or someone else?”

I’d heard the question before and knew it was a trap. It was designed to cover the department of corrections from a liability standpoint rather than actually being concerned for my mental well-being. I snarled my response.

“No, I’m fine. I’m not going to do that.” I was dismissed a short time later.

Walking back to my cellhouse, I felt the burden of guilt for Ramone’s condition weighing on me. It wasn’t mine to bear, but I carried it all the same.

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