I was raised to be a pretty old-fashioned girl,… that is, unti I discovered my passion for social justice and probably swing on the opposite end of the political spectrum from my family,.. but in any case, there is no shortage of respect, politeness and esteem in my body towards elderly folk.  Many of whom have lived through some of the most important chapters of our history, not the least of which are WWII and The Civil Rights Movement.  To my white family, the pride is in “the greatest generation,” who fought for the US.  We never really talked about the Civil Rights Movement in my family.  My patients, however, being predominantly black, have lived through some seriously horrific times.  And like many, mistakes are made along the way, some of which land people in jail.  It is here that I find myself in the most curious of situations.  The irony overwhelms me, I feel sad, out of place, and often I honestly don’t know what to feel in order to reconcile the deep respect I have always had for older generations, with the sheer reality that I’m in a position of power at the jail, and essentially micromanage the medical choices of my patients.  We all do.

I am not even sure how to set this up.  So, in the jail, we have to be very controlling and cautious with pain medications, even ones that are over the counter.  You pretty much need to have just been shot or operated on in order to get a narcotic out of us.  Chronic back pain?  Do whatever it takes to stay OUT of jail, because you’re not going to get what you can get on the street, and I guarantee the hard beds, lack of pillows, and general lack of activity will exacerbate any aches and pains.

We can do short courses of NSAIDS.  There are a few providers who “cheat” and will prescribe a total of 60 pills of tylenol or ibuprofen (doled out in packs of 12 over the weeks), but they are few.  We have a PT who comes every few weeks, and sometimes we can refer chronic pain to him for some interventions, but not much more than that.

So now let’s imagine that I’m in my office and in walks a 75 year old man with a cane.  He’s got chronic back pain.  He’s got Diabetes.  He’s got a heart condition.  He has poor circulation.  He’s got hypertension.  He’s miserable.

You gotta help me, Doc, I can’t take it.  The pain is constant and I can’t sleep.  I take percocet on the street!

So now what.  Here I am, (again- all those things that makes me feel uncomfortable when I have these patient encounters- young, white, privileged, in a position of power,..) and I’m faced with the fact that I very much so respect the elderly, but I have clear limits as to what I can do for ANY inmate, because he’s not just a 75 year old I’d pass on the street, at this moment, he’s an inmate.

Does anyone else find it crazy to imagine telling someone, “I’m sorry- you can only have 12 tylenols at a time,”  or ibuprofen,.. things you can buy by the hundreds at Costco?  “No you can’t have any benadryl because everyone wants it to help them sleep, and we can’t treat for insomnia here,” even though, ANYONE would have trouble sleeping in a jail.  I get to say these things, almost daily, but it really gets to me when the person I’m saying it to might be smeone who lived to see his comrades die in the race riots?  Maybe had family members born as sharecroppers?  Grandparents who were slaves?  Maybe he was a freedom rider?  Maybe he fought for his country in WWII even though he didn’t have full rights?  Someone who I could well agree deserves my deference?  Respect?  Whatever you say, Sir?  And yet, he’s having to convince me that his back pain is worthy of all the resources we’ve got, because he probably IS miserable, and I can’t do it because look, it’s a jail and we can’t give them whatever they want here?

Honestly I feel petulent, and a little ashamed.  I know that in those moments I have to do my job, but damn, if I passed him on the street, strolling with his cane, wearing a WWII vet hat and POW/MIA vest, my behavior would be completely different.  I am the kind of person who does look people in the eye and say “thank you for your service, Sir.”  I am that respectful young person who recognizes that the rights and freedoms that we have, we did not always have.  And that the “greatest generation” fought like hell to get us where we are.

And I don’t know what fool thing these old guys do to get themselves into jail, sometimes it’s pretty serious stuff!  But, truly,. I feel a little ridiculous.  I feel condescending.  I try so hard to maintain the dignity of my patients, but in these interactions, it is really hard to do so.  I couldn’t imagine having been through what these guys have been through over the decades of our history, only to find themselves locked behind bars when they should be playing with their great grandkids.  Lord help me communicate respect and dignity in these moments.