A Willie Nelson Interview

 

Working one night as a fill-in covering pigs for the City Desk in the World Capital of Live Music. To set the scene.

There was a shooting at a lake house on the western edge of the county. That meant drugs. It was a given, westside gunfire inevitably meant dealing, usually large quantities as cocaine became widely fashionable. While trouble on the eastside meant using and smaller quantities for sale. 

The sheriff caught the case.

 At the Travis County Courthouse that night—me trying to sort out who was who—someone pointed out a wiry good-looking white kid who had been at the house when the gunfire started. “That’s Billy Nelson,” my informant whispered to me, Billy Nelson as in country music star Willie Nelson’s son. The days passed and there was more whispering about Billy, that he was involved in an after-school activity other than band. He dropped out of sight.

 A tipster told me that even if Billy was in hiding, Willie himself, the Red Headed Stranger of the album, was around. 

This was the “old Austin” and whatever celebrities lived here did not hide. They couldn’t, not in a small town. In between albums Willie was said to like golf, living next to a golf course south of the river. To set the scene again.

A check of the newsroom located a music writer who was able to give me the name of the golf course but not much more. The idea that began to take shape was getting to Billy through his dad—dirty work indeed for a reporter—but the kind of task that suited my ethically-immature skill set. Still you had to be careful. Willie Nelson was the city’s most prominent citizen, more important than the mayor and better-liked than the new governor, who was the first Republican in a century. To set the scene again. An odd sense of decorum suffused my very soul as the American-Statesman staff car carried me south of the Colorado River to an area that wasn't normally my hunting ground. 

The problem was that my source did not know what address, on which street beside the course. He said only that the house was next to the green. 

My plan? To knock on every door. 

At the first door The Man himself answered.

Willie Nelson answered his own front door, no maid, no assistant, no manager or life coach, no gofers or groupies. Willie was wearing funny-looking golf shorts and spiked shoes and was very gracious—the whole good host thing. He was cool with a complete stranger and it was genuine because he was polite before he saw my business card. 

You could tell right away that he knew what was prompting the visit. When kids fuck up, their parents always seem to know. Covering cops you ended up talking to a lot of moms and dads who had the sense to fear what their children did not. 

You could tell that Willie was steeling himself for a response to something about his boy. There was no need for him to worry because my nerve failed. The questions never got asked. Sympathy for the interviewee has not been a big factor in my work either before or since that day, beside a golf green in the World Capital of Live Music. But Willie Nelson was different. The circumstances were different too. 

This wasn’t the Lieutenant Governor driving drunk after hours with a babe not his wife. It was not the Speaker of the Texas House of Representatives taking $5,000 in FBI-marked bills and putting it in his safe and forgetting about the money because, as he explained later to a federal jury—in a justification the jurors accepted—so many people gave him cash. 

It was Willie Nelson, superstar and, ultimately, a father worried about his son. My almost-talk with this particular dad would only be important as a counterpoint, because another prominent Texas father with a wild child influenced-by-coke was coming my way on the cop beat, a high-level Democratic politician and his errant daughter. For whom there would be less reason for consideration. 

So, like, all that hard-ass crap you hear about low-life police reporters, how we’ll sell our own mothers for a story, is true or mostly true but not always true. In the newsroom, after my visit to the golf course, the City Editor looked at Willie’s autograph on my business card, flipped the card front to back as if he were looking for something more, notes of an actual conversation—evidence of an interview? Then he looked at me, like, what's up with this? Didn’t get the interview, no. My instincts proved right though. 

Billy Nelson got into a lot of shit over the years, including booze and drugs, we all did, in this town the pussy alone could drive a man—or woman—to ruin. 

Which is what it presumably did to Billy. He got out of Austin but he left too late. That’s my take, not that it's my business now. Killed himself somewhere out east, Tennessee or the Carolinas, somewhere in there, Billy Nelson did, after escaping River City. It was too late for him, Austin had already taken a toll. They say Billy’s death broke Willie Nelson’s heart and began a long bad stretch for him too. 

Austin! 

That was practically all the coroner needed to write on the autopsy report.

We saw it all the time, back in the day. You started out so high, literally—good weather, good vibes, good drugs—the lake, fine pussy and all. Dick if that’s your thing. And after that it was just so easy to spiral down or spin completely out of control. You'd start out the weekend drinking on the patio at Scholz's and by Saturday you were "out on the lake," which could mean anything. 

If you've lived in River City, and everyone has lived here, everyone knows the town, you know it's true. Everyone comes here for the music and maybe ends up out on the lake too. My day chasing Willie was important only, looking back, as my first introduction to the power of the press. Cornering a worried father wasn’t pretty but someone had to do it. 

It wasn’t Billy’s fault, it was the city, ATX, the Live Music Capital of the World. That was my feeling at the time. 

Notes from the Texas Gulag (Part 2)

 

iv)

 

As a newbie, you get to see most of Hospital Galveston pretty quickly but there’s a lot to take in. 

So, like, you can come to work at your home unit, mine is 7C, and the charge nurse tells you that you’ve been floated to somewhere they need a nurse more. My assignment for one whole shift was the Infirmary which is a kind of a shithole basically, the Infirmary at Hospital Galveston is. It’s a large room in a basement somewhere—that’s what it felt like, being underground—only been the one time and needed the help of my preceptor to find it. There were a couple of Officers circulating continuously across the room, about 30 beds in rows, all filled the day of my visit. To set the scene. And an apparently secure glass-paneled nurses station. 

There was a TV “lounge” for the inmates who could walk or had wheelchairs. This area was supposed to be off limits to the nurses actually, nobody told me and the whole first half of my shift was spent going in and out, getting the guys watching TV to take their meds or whatever. 

These prisoners had been brought to Sin Island for specialist appointments or for procedures or surgeries or because they were sick but were better now, or reasonably well, and didn’t need to be in the main hospital anymore. Awaiting transport back to their home unit. Waiting for their ride, to use the vernacular, that big white TDCJ bus to take them back to the Pissville Unit, in Piss County, which is next to Shithole where the Shithole Unit is, in deep East Texas? These patients in the Infirmary were stable, the medicine practiced at Medical Branch is pretty high level. The practitioners know how to do the right thing even if it’s not always done? That’s true of a lot of healthcare environments at one time or another. Nobody can give 100% all the time. 

So, like, the nurses get maybe ten patients each in the Infirmary which sounds like a whole lot and in an ordinary hospital would be too fucking much. In ordinary circumstances the Board of Nursing would probably take your license anyway, just for being dumb enough to accept that kind of patient load, whatever the circumstances and however the shift turned out. You can practically hear the investigator from the Board of Nursing asking, a little irony in her voice, “And you thought 10 to 1 was a safe assignment?” So, like, you’re kind of fucked either way. To say nothing of bad care for the patients. 

But at the Infirmary a heavy patient load seems okay because all you have to do is pass the guys their meds and do a quick physical exam and write a note on the patient’s condition. Or maybe do a dressing change, which is how my time was passing, about midway through that shift in the basement. To set the scene. Still on my new nurse orientation which was 6 weeks and began on day shift, God forbid, this place is busy. So, like, changing a dressing on a diabetic inmate who had just had a leg amputation? He was a Brother which is important to me, younger than me—in his black prime so to speak, maybe mid-forties. A man that age, there’s still a lot of booty to hit, you feel me? But having lost his leg now and being locked up didn’t help his chances in the pussy domain. He seemed to be adjusting okay though or as well as can be expected, what can you say? He was already in TDCJ, what’s losing a limb after the loss of a Black Man’s freedom? You may never give up The Struggle but—believe me, Brother—eventually we all give up The Ghost. To set the scene again. 

This guy who had the amputation was learning to use a wheelchair but he said that he hadn’t showered in 10 days. Which is, like, a long fucking time. Me and the nurse’s aide got him under the water, we offered to lift him onto the shower bench but he wanted to do it himself. He did super, btw, he had already taken ownership of his new life. Soap and water on the wound itself, that was healing well. A lady from Physical Therapy came by and worked with him and she gave me a few tips too. Got him back to his bed to put on a fresh dressing, and you know how, like, my thing is to listen? Not to talk unduly about myself. Not to act like a Black Savior or anything. But helping this Brother taught me something special. How to steal, actually. Which was interesting in itself, worth the trip to the Infirmary, being totally honest myself and not knowing about the activities that may have led some of my patients to be incarcerated in the first place. 

So, like, me working on this dude’s missing leg, and sitting across the aisle from me on another bed was a prisoner who was explaining to yet another inmate, on the bed next to him, how to be a successful thief. So, like, wrapping a stump is straightforward, you just got to make sure it won’t fall off when gravity goes to work. When the patient stands up on crutches or hobbles around or goes to the pisser or whatever, is that too much information? This black guy could maneuver whatever was left of his leg, there was just nothing on the end. 

So, like, me wrapping the bandage and listening at the same time to the guy across the aisle explain how to steal. Being a scrupulously honest person myself, this was, well, an education. 

The guy doing the explaining was white, maybe fifty, he looked kind of like a small-town bank president or a successful insurance salesman, actually. Pillar of the community and all that? He looked like a guy working for the Chamber of Commerce in Pisspot, Texas, back in 19 and 58. He had a full head of conservative cut hair, greying at the temples, prosperous-looking in a small-town I-like-to-screw-other-guy’s-wives kind of way. Does that make sense? Not that there’s anything wrong with that. The guy who the bank president was talking to on the other bed was also white, younger but scrawny looking, also in a small-town Texas way. Hardscrabble, that’s the word you hear out west, a Hardscrabble Texas white boy or maybe an Okie in the original meaning of the word, like he really did come from Oklahoma? A cracker in today’s Negro street vernacular, if one wished to be rude, which is not my intent. 

As crude as the word may sound, cracker is nonetheless descriptive of the pallor and dry skin of a certain kind of cigarette-smoking poorly-hydrated Southern white guy or white girl, and is like half the adult population of the Panhandle, Oklahoma and Texas varieties both. Not to generalize or anything. Not to sound racist. Some folks call themselves crackers, actually, and who are we as POC to dispute The White Man or The White Woman? So, like, it was just two guys talking. The scrawny white guy was hanging on the prosperous white guy’s every word.

 “What you do, see,” began the bank president as he explained how he had ripped off his boss back in his Free World days. He didn’t work in a bank, it turned out, he was a truck driver and he said that the key to stealing at work was not delivering all the merchandise that he was carrying. And that made a certain sense. 

There was always a missing last crate, the truck driver said, and he knew because he took it. It was that simple. 

What he did with what he stole was a little surprising. “If you’re hauling eggs, see,” he told the younger guy, “then you hold onto that last crate. And when you’re done with your route you go to the truck stop and you meet up with the other drivers that have something to trade. See?” The younger guy smiled and nodded. Oh wow, so that’s how you do it! The Okie was clearly impressed. 

A crate of eggs must be a whole lot of eggs and you can find other drivers at the truck stop who have ripped off cargo from their own deliveries to exchange with. A kind of a flea market for thieves. Oh wow, how cool is that? 

“Another driver might have shampoo for example, but it’s too much shampoo for him to use. So he’ll trade for some eggs. See? That’s how you do it.” Now we know. This guy talking was my patient too and he was in Hospital Galveston with a diabetic wound not yet as bad as whatever had caused the black guy to lose his leg. 

The white guy’s dressing had to be changed too and his blood sugar needed to be checked and his sugar was, like, in the ozone. He was heading along the same path as the legless black man, maybe towards an amputation if he didn’t watch out. That would happen in a few months or a few years, after he returned to his cell in the Gulag. At Hospital Galveston on in-patient acute we check diabetic blood sugars before all meals and at bedtime, btw, four times a day just like in a Free World hospital. While in the prisons where these guys live for years at a time they’re routinely checked only twice a day. Or so the prisoners say. That may be the problem, not to sound like a SME, a subject matter expert. Twice is not enough to maintain good blood sugar control? That's the way they taught us to apply informatics at Texas Tech.

What would that look like? A lot of neuropathy, a lot of diabetic ulcers and a lot of amputations, is that right? Hmmm. With a little research, it might make a good paper for a nursing journal. Or it’s all the starch they’re eating—all the white bread. That’ll kill you too. That would also make a great paper—nutrition in the prisons of the Texas Department of Criminal Justice, aka TDCJ. Except nobody in the Free World wants to know. And you have to be careful. Putting on my Statistical Hat—that the instructors taught us to use in grad school—would mean judging the rate of diabetic amputations among TDCJ prisoners against the number in the Free World, where it’s not great either. 

Anyway, the State of Texas defends itself by saying that you can’t judge TDCJ healthcare outcomes harshly. Many of these patients are folks who may not have been going to doctors even before they got locked up. 

Their health was already compromised in the Free World, that’s the State of Texas’s argument and it has a certain inherent truth. But when you take someone’s liberty you also take responsibility for their health, right? The U.S. Supreme Court ruled that, in 1976, based upon a TDCJ case. Hello! The ruling presumably involved one of the shithole prisons in or around Huntsville, back in the day, because that's where they were. My best professional opinion—if you asked me as an almost master’s-prepared nurse-scientist, diploma already in the U.S. Mail? Health care in the Texas Gulag is bad but not as bad as it could be. Like, not as bad as in the Soviet Gulag, for example, the difference being that it’s hot in Pisspot, and in Siberia it’s cold? Or not like being a Roman galley slave or anything like that, back in the day. Not like row or die. Not that bad. 

Or not like burning for eternity in the sulfurous flames and fires of Hell. Although it's just as hot there on the units, in Shithole and in Pisspot both. The quality of TDCJ health care is probably at a level exactly where the majority of people in the Lone Star State want it to be, bad but not fatal. Or slowly fatal, not so fast as to draw attention of the courts. Unless it comes time for the Big Needle, that works within minutes, the TDCJ-administered medicine that cures all ills. 

One thing is certain. Hospital Galveston is the fastest-changing patient population during my time in the saddle as a bedside nurse. To set the scene. You can be taking care of some guy when the shift begins, at 7 pm, and you look up and suddenly it’s 2 a.m. and standing there is a guard with a wheelchair and handcuffs or who has brought a gurney, and the Officer says, “He’s going back to his unit,” and of course it’s the first you’ve heard about the transfer. 

TDCJ’s primary mission is to prevent escape not provide health care. 

The primary concern is the logistics of the transfer, not necessarily the prisoner getting his or her next round of meds. Once or twice it’s been a tragedy to me personally—a middle-of-the-night transfer. Not to sound all self-centered, this is only mentioned in order to show how a night shift can roll, here on Texas’s Island of the Damned. 

So, like, instead of me having a quiet night—which is the only kind of night to have, actually. Instead of me keeping the six patients they gave me at the beginning of the fucking shift—not to sound unprofessional. Instead of me keeping the patients who are known quantities to me by two in the morning, oh no, we can’t do that. Instead, the next admissionwill be mine. To get me back up to six patients like everyone else. 

Which is a pisser and means a lot of extra effort with admission paperwork and labs and all that. Which is all going to upset my qi, because boy-nurses are all about rhythm and being in tune with the energy of the nursing unit. That would be my argument to the charge nurse, suggesting that she give the admission to some other more deserving nurse. Btw, the guards don’t want the inmates to know when or how they will be moved because TDCJ doesn’t want the guys or girls to have a chance to make a plan. Which these guys and girls in leg chains do far better than the State of Texas does, make a plan that is. You know? Not to be rude about leadership in Huntsville or in Austin. 

You can be talking to a patient and even in those rare cases when you know exactly at what time the Officers will come for him—or her—for the ride back to his or her unit, and he or she asks you, when are they coming for me? You still don’t tell. There may be a bunch of guys going back to the same unit for example, in Pisspot—the guard is telling you this in the middle of the night. The White Bus is waiting, headed to some unit somewhere in the vast and lonely expanse of the Lone Star State, not to sound all dramatic. On the boundless prairie of West Texas or more likely among the pine trees of the east. Maybe on the coastal plain around Sugar Land. And you just looked up while charting in the hallway and there was an Officer standing there, or two Officers if it’s a bad dude. TDCJ is transferring your guy or girl in the middle of the fucking night, back to the fires of Hell, because it’s more convenient to do that right now. Or safer. Who is a mere nurse to judge? My boss warned me once—in interactions between security and nursing—everybody needs to stay in his or her “own lane.” Which sounded like good advice. But my lane is still kind of a mystery to me. The comings and goings from Hospital Galveston, by ambulance or by prison bus, are complicated by security—by the roads of the Lone Star State. And by medical condition. There are actually prison cells somewhere on campus too, no shit, even though this is a university. These holding cells, someone told me about them one night. My colleagues said they’re just like regular prison cells, for guys and girls who have been discharged from the hospital and don’t need to tie up a bed anymore, and who are waiting to go back to Shitville. Maybe after an appointment with a specialist. To set the scene. So, like, the jockeying for beds is intense, so many people coming and going, particularly interesting is the lot of the writ-writers, who may have longer stays on Sin Island than other prisoners do. Maybe they end up in the cells because there’s air-conditioning.

Writ-writers are the guys and girls who sue the State of Texas over the abominable conditions? Who complain to the courts about the heat in the cells? And the filth? Or the violence? To say nothing of the damn food. Bitching may actually serve a purpose. The squeaky wheel gets the fan, you know? 

A few of these writ-writers get kept at Hospital Galveston past their scheduled discharge, including a couple of my recent patients, because the lawyers or the judges or whoever is in power in Huntsville has decided that these particular guys or girls can only be housed in well-ventilated cells. Which are extremely rare in the Texas Department of Criminal Justice, at the units in Pisspot and in Shitville both. 

So, like, in the inmate’s absence his cell was taken over by someone else, maybe while the writ-writer was on the white bus to Sin Island. There’s nowhere cool available on his unit right now for him to return to. Still, all in all, the care at Hospital Galveston seems almost nearly—kinda—okay. From my viewpoint, given the circumstances and given that it’s industrial health care intentionally stripped of the humane element. And given that it’s what the public will pay for. “Bad” with an asterisk, you might say. Based upon my prior experience which is considerable but not in correctional heath. Take this opinion, therefore, for what it’s worth. This is my first and will be my last experience taking care of prisoners. Still, there are certainly some very good people at Hospital Galveston. No doubt about that. Don’t underestimate the skill of the providers. Dr. Ojo the medical director is a Nigerian-American cat and is totally cool. He’s like one of only two Brothers of my acquaintance in the role of physician anywhere on the whole fucking campus, back in the day or today. And there have been, like, only two sisters. This island is still the Old South, literally. 

One of the two black women docs was an internal medicine resident who came to 7C, at dawn, a couple of weeks ago. She ordered every test known to modern medicine? And was super-hot, like an easy 9 or 9-and-a-half? Think she was from the Caribbean, actually, and had more ice on her ring finger than the Titanic. Not to sound jealous. Not that that’s important here. So, like, this cat Dr. Ojo, who is the Big Dog at Hospital Galveston? He is super-competent. 

He actually rounds on the units and asks the nurses what’s going on? What a pleasant change from my prior experience where you only see the bigwigs at the Christmas party or maybe during Nurses Week, when they come by to bring you some little shitty giftbag that cost like $3. Not to go all radical union member only because this is Texas and at Medical Branch there is no nurse’s union.

The first time Dr. Ojo saw me—new to in-patient acute—he walked over to me at the nurses station and took my badge in his hand in order to pronounce the name. He asked me what my last hospital was, seemed to approve the answer, then let me go. This wasn’t mere courtesy, he was vetting me. This is said with complete love and respect for the Nigerian peeps. They are awesome. But in Nigeria people run so many games that Nigerians who come here to the Land of the Free—and Home of the Brave—are still always worried that someone is running a game on them? Not to sound all racist or nationalist or whatever. But speaking as a noble slave-descended Black Man, who is a natural-born straight-shooter, we slave-descended Negroes don’t run games. At least not on other black people, although it’s always open season with white. For me personally, the most important quality of the Nigerians living in the United States—personally? A lot of African women are hot and will give it up to an American Brother, as a show of Black Unity, so to speak. Not that that’s important here. Let’s see. You may ask, what is my approach to correctional nursing? 

That’s a fair question. 

It’s pretty much like any other kind of in-patient care except you’re more rushed in a prison hospital than in the Free World because of the demands of security. At Hospital Galveston you have less total time to complete tasks than a civilian RN does. Doors to patient rooms and the doors to the nurses station are locked and you have to ask someone to buzz you in or get the guard to bring the key. Literally. All of that takes time because there’s not always someone around to open the door. We’re supposed to have two Officers on 7C at all times but quite a few of my shifts this spring there’s only been one. That adds time to tasks too, because maybe a dozen times each night you have to find the lone Officer and disengage him or her from doing something for another nurse and get him or her to do something for you. You have to cultivate the Officers btw, and respect them, they hold a nurse’s balls/ovaries in their hands. Depending on how fast they move. So, like, weaknesses in my nursing practice? That’s a fair question too. Being organized during the shift is not my strong point, to be honest. 

After all these years. If you asked about my work style, my mantra is to be proactive in order to avoid trouble or in order to have the most time to deal with it. It’s always appropriate to take another set of vital signs, for example. Turn patients who have surgical wounds because you may find a bed full of blood underneath. That’s what our instructors warned us back in the day in school. And make sure you get a look at people’s skin, it’s one of my few rules. The ultimate goal is that in the morning everyone is in at least as good health as they began the shift. That means you have to prioritize. A lot of these ladies and gentlemen are really sick. My thing, my idiosyncrasy of practice is always to look at the patient’s feet as the best outward sign of chronic disease. Especially in TDCJ because it’s a shithole and feet are the point of contact with the institution. The worst luck at bedside is to catch a problem late, it seems to me, after it’s had time to fester. If you catch it early on you don’t have to do the paperwork later or you don’t have to call the docs and start taking orders, which is more shit to do in an already shit-filled environment. The nurse’s interest and the patient’s interest are the same most of the time. We both want a quiet night. My primary overall professional goals can be summarized in only two rules. Not to hurt anybody and to get home on time. Not to repeat myself.

 So, like, you may ask, what about shortcuts? It’s hard not to use them when you’re super busy, with a nursing shortage and all, but bad practice can have big costs. Our instructors back in the day talked to us about that too. 

Once at Hospital Galveston—it’s embarrassing to admit, as a seasoned RN. This happened not long after my arrival on 7C. So, like, once—due to rush, although that’s really no excuse. We were passing meds. And, like, not that this would be my usual practice, because the instructors taught us better. But leaving some medications unattended on a computer in the hallway? In order to go into a room to talk to another patient? Does that sound reasonable? It’s actually bad practice. To set the scene.

And returning to my computer, my preceptor who was this uber-competent African chick? 

She was standing there, waiting to chew a little proud Black Man ass. To set the scene.

My preceptor was from French-speaking Africa, and she was hot—and a very good nurse. In fact, she was far better than me. She was actually a newly-minted nurse practitioner, still looking for a first job in advanced practice. This chick was my principal preceptor on days, for three weeks, and a Filipino guy picked me up for orientation on nights. The Filipinos and Filipinas who studied at home are some of the best nurses that it has been my honor to meet. There was a PICU nurse at Medical Branch back in the day, during my time, who was an anesthesiologist in her home country. Anyway, this African chick was always right, the Cameroonian lady, you know the way African women are always right? Like sisters here at home but the accent is different when they are lecturing somebody? Skilled in nursing and skilled in chewing a Brother’s ass. 

Because black chicks literally are right most of the time. 

This one, my preceptor, could put this proud black boy-nurse to shame on his skills. At that moment she was standing there with my abandoned meds in her hand. To set the scene. This chick was having a coronary event. 

“Do you know,” she asked me, holding up my medications to make sure every pill was visible, turning her head to the side like a German shepherd trying to understand human speech, “what would happen if Dr. Ojo found these sitting here?” 

One of the other nurses had already told me what would happen, actually. Not to sound like a smartass. But speaking of Dr. Ojo, the other nurses said, basically, “He’s very nice. Just don’t screw up.” Which is fair, right? Because medication safety can mean people’s lives. And leaving meds out is bad practice, especially in this environment. 

Medical Branch as an institution though—that’s another story. This place is a totally sketchy spot in the healthcare ecostream. Just like Galveston Island is a totally sketchy spot on the Gulf Coast. Completely dodgy, bro, actually. Some people come here in order to do the wrong thing. 

Not to sound petty but for Nurse’s Week, you know what the fucking nursing administration did? 

The Chief Nursing Officer, or whoever? They gave all of us a giftbag with skin moisturizer and lip balm. Hello! What about the guys? That was my question when the charge nurse gave me mine.

 Fucking hell. What is this shit? That was my question to myself at the time. Not to sound like a Neanderthal but the African American male—descended from warrior stock—does not use moisturizer or lip balm, bro. Again, not to sound like a cave-dweller.

Besides, boy-nurses know old African wisdom—how to moisturize your skin. It’s best done from the inside, bro, with water, not outside with creams and potions. But that’s the way chicks like to do it, by putting stuff on. They like to get all tarted up, you know? 

Or a pink bow in her hair, if it’s pediatrics. 

Like, coming to work on a hospital nursing unit and you’re wearing makeup? You ought to be able to suspend a RN’s license for that alone! Especially if it’s a guy. Not to sound like a Neanderthal again. Does the Medical Branch Nursing Office even understand that there aremen in the profession now? How about giving us something really useful during Nurse’s Week, like condoms, or a few of those little blue pills? 

Like for E.D.? 

Which doesn’t mean Emergency Department, although it can be an emergency when it happens, you know? So, like, anyway, something just began to worry me about Hospital Galveston. Call me paranoid if you will. Maybe call me a good nurse. So, like, this is exactly what it’s like to worry in a health care environment, btw.

 Sometimes it’s a question of good care vs bad care, you see that everywhere from time to time, in many healthcare settings. Good practice versus bad practice, too. But it can also be about someone taking advantage of a vulnerable patient population. 

Worry in a hospital takes the form of intuition as much as lab results, experience telling you that something bad is going to happen or already did happen and you’re fucked. Or the patient is in trouble. That’s nurse’s intuition which may be backed up by a look of panic on the patient’s face because the first person to know the patient is going bad is usually the patient. And my experience working with children, where emergencies are usually respiratory. If you wait until the airway is already closing, you’re fucked. Not to sound dramatic. But that’s nursing intuition too. It’s what led me to worry on Sin Island or Island of the Damned if you’re being formal. Our part of the Lone Star State’s sunny Gulf Coast. 

Like Devil’s Island but closer to shore and there aren’t as many sharks in the sea. But there may be more on land. 

 

 

 

v)

 

You’ve heard of the Nazi medical experiments on concentration camp prisoners? The Allies hanged a few nurses too after the war. Who absolutely deserved it—not to be critical of another RN’s practice, you don’t really know if you didn’t work the shift, isn’t that what people say? The Japanese also experimented on prisoners and the US military seized the data in order to bring to American scientists, because of its supposed value. That’s a very incomplete history of gross medical malpractice as seen thru a correctional care lens. 

Domestically maybe the second best documented example of healthcare evil in this country, the famous “Tuskegee Experiments” of the U.S. Public Health Service, in the 1960s. You’ve probably already heard about that. Letting black patients suffer the effects of illness in order for doctors to watch the progression of the disease. Which in the Tuskegee case was syphilis. You couldn’t make this up. 

And of course the most famous victim of medical exploitation, in a very crowded field, was Ms. Henrietta Lacks of Baltimore, Maryland, who had samples of her cancer cells grown, through years, across biological sciences, after doctors at Johns Hopkins took them from her. In order to commercialize her immortal genes, hence Oprah’s movie and the book by Rebecca Skloot. So, like, of my eight hospitals in the last two decades or so—working as a staff nurse in each—a low-level grunt in the Big Picture of American medicine? UC San Francisco was my first step into this pitiless white abyss of unethical patient care and/or unethical research. 

Which may also be the template for operations of the University of Texas Medical Branch on Sin Island. 

The first whiff of evil, if you will, was at the University of California in Baghdad by the Bay—as S.F. is called by those in the know, The City of San Francisco is kind of in a class of corruption by itself. In fact an unethical series of experiments has just come to light at UC’s S.F. campus, which is called Mount Parnassus, located in S.F.'s Sunset District on a big hill. To set the scene. 

Looking through a West Coast lens actually, Medical Branch becomes totally sus too and for the same reason. “Sus” being short for “suspect,” as young people like to say. UCSF is a medical corporation with an academic façade, in fact that’s all the campus does, all health care all the time, just like UTMB. 

UCSF—also like UTMB—conducts well-funded healthcare research and has a big patient population, and wants it bigger. The San Francisco campus just took over two hospitals in Hawaii, and is famous for attention to its business side. UTMB on the other hand has a lesser academic reputation but bragging rights with a Level Four Biosecurity National Lab. Don’t you wish you had one? 

Where presumably scary shit grows, about three blocks from my crib actually. And a short walk across campus from the prison hospital. Not that there’s anything wrong with that. Like UTMB, there’s a long and cherished history of racism at the University of California San Francisco that continues today. If Mount Parnassus is not the belly of the beast, it is the beast, as seen thru a business-of-healthcare lens. The longtime Chancellor at the San Francisco campus is a pediatric researcher named Sam Hawgood, who drinks POC blood during the day and hangs from the ceiling upside down at night. Not to be critical of the good doctor or his service to the University of California. Back in my day in Baghdad, which is not that long ago, at Mount Parnassus you could walk the halls and hear people speaking obscure foreign languages but no Spanish even though Latinos already were half the population of the state. 

UCSF has historically been a white and Asian institution, like UTMB is still, but for the longest time UCSF was almost solely white even with the large Asian population in town, to say nothing of niggers. Black people were the patients and research subjects. Which is also a pretty good description of UTMB today, white faculty with some Asians. what a small world in which we live. 

So, like, the Mission District where my UCSF clinic was located was almost exclusively Latino, at the time of my arrival, but was becoming not just white like the rest of the city but super-white. Silicon Valley white people, techies all, with high brows and high incomes. Not to stir racial animus. You’d see buses full of Google people coming and going, a few Asians but no blacks and definitely no Latinos. No lie. Not to be judgmental. It wasn’t al bad. A lot of those Baghdad girls are freaks, btw, that was nice, not to stereotype but you didn’t even have to work hard to get laid in San Francisco, even at the hospital. In my experience. Which is another similarity to Medical Branch actually because Sin Island is a party destination too—like Baghdad by the Bay. There are a lot of chicks and a pretty good selection of freaks. Just like its Pacific homologue San Francisco, in Galveston there’s a beach for late-night shit and the ocean to wash away any traces of the sin. But we digress. 

During my time in Baghdad, people knew what was going to happen to the old San Francisco but it hadn’t happened yet. Gentrification. But because UCSF is an academic research institution and still needed research subjects to test medicines and procedures and similar shit, for new protocols, or whatever, or new products, the University of California was fucked. Like, completely bent over—no Vaseline—no kiss—no nothing.

These new-to-town high-tech parents from Google or Apple or wherever wanted nothing to do with research on their perfect little white kids. No way. Not to stir racial animus again. S.F. was gentrifying big time. A lot of wealthy white San Francisco moms wouldn’t even allow their children to be vaccinated—because of mercury, don’t you know? Much less let little Madison or young Harper—who plays forward in soccer and is learning Chinese—be a research subject? Oh please are you fucking kidding me? As the surprised herb-eating White Mom might ask when the idea of participation in research is first brought up in clinic. No way. 

Like, there was no way a Silicon Valley mom’s little Ms. Perfect was going to be taking any untested med, thank you very much, something that was not FDA-fucking-approved? And even a lot of FDA meds weren’t going in little Kendall’s mouth either, not in Baghdad by the Bay. And in my capacity as the nurse, advocating for Mom, not that she needed it, my feeling was, “Good for her. She’s got sense.” Because you can’t trust academic medicine in the U.S. They’re always up to something, that would be my first point really. 

Some other moms didn’t have that option though. That’s my second point. This is part of UC’s history of exploitation of vulnerable populations. 

The University of California is the same group of people who brought you the Atom Bomb, what do you expect? UC doesn’t take prisoners. There’s more evil, including racism, in the University of California Office of the President (UCOP) in Oakland than there was in the Reichstag. The difference between UC and the Nazis has turned out to be that UC does better science. So, like, something had to be done to supply research subjects for the great university’s healthcare business plan in Baghdad by the Bay, right? After minorities got gentrified out of town. To set the scene. 

So, like, UCSF recruited black children from across the bay—in Oakland—a heavily African American town, where the patient families wanted health care and got it in exchange for cooperation with research. Is that how it works? This was all during the period of my time at UCSF too, when Dr. Hawgood was Dean of Medicine and was sharpening the analytic skills he uses now to keep UC profitable and on top of medical science today. UCSF has been on a buying spree recently, as mentioned, gobbling up a number of smaller hospitals in and around San Francisco and monopolizing health care—not to be judgmental of the famed hill in Outer Sunset, home of the medical gods. Which was also my neighborhood during my time there, you know, between the campus and Ocean Beach? The bottom line is that San Francisco is another dodgy town, just like Galveston! But it’s a different ocean and a different vibe, if one is speaking in terms of the cosmic dimension, which masters-trained nurses may be called upon to do. Blacks are especially important in Baghdad because black DNA is more varied and better for research. So, like, no one in San Francisco blinked an eye about UCSF’s research protocols. 

And on Galveston Island they used to sell niggers—not to sound judgmental of practices in the Old South. Except it’s still like that today. There’s not a whole lot of free-floating ethical concern in Galveston, any more than there is in S.F., let’s be brutal here. Not at Johns Hopkins either. 

UCSF eventually solved its research supply problem by buying Oakland Children’s Hospital, in order to get to the kids, renaming it “UCSF Benioff Children’s Hospital Oakland.” After the Tech Guy—What’s-his-Name Benioff, of Salesforce—like it’s a royal title. So, like, those affluent and well-educated parents in San Francisco who didn’t want their kids in research studies really were right, that would be my point. 

The great Charles Blow of New York Times just reported that two black children died during testing of a RSV vaccine, back in the day. Without the families being told the kids were research subjects? The RSV case was not at UCSF but it’s not for lack of trying by the white gods of Mount Parnassus. And now it turns out there’s a totally different research scandal at UCSF, actually. It's more unearthed history involving vulnerable patients at UTMB’s research cousin on the Pacific. 

This abuse involved state prisoners. 

The medical exploitation which has been documented and confirmed was uncovered by a black lady doc at UCSF. You may wonder why be suspicious about your alma mater? It’s a hospital and a university, they’re probably doing the best they can. They help people. But, for example, my antennae are raised all the time here, on the Cancer Coast. Where there are not many black doctors to speak up. So, like, this was the report on UCSF’s racist research on National Public Radio. It was what the black lady doc or whoever discovered the disease and has since been proven true in Baghdad and may be the template for Sin Island too. 

UC was called out by faculty that—back in the day—there were experiments on dark-skinned California prison inmates, that consisted of injecting them with pesticides. To determine the effect of the poison and to see if the results were based upon skin color. Kind of like the Tuskegee Experiments, back in the day, intentionally injuring a patient of color, who in this case was a prisoner of the State of California, in order to study the results. To set the scene. It was like something the Nazis would have thought of, the difference being that this American version of medical experimentation on prisoners of color was performed by a couple of Jewish physicians who were UCSF faculty, like similar experiments on prisoners at the University of Pennsylvania about the same time. Which has its own academic medical research operation, the University of Pennsylvania does, like UTMB and UCSF, the difference being that in Pennsylvania the docs used asbestos injections instead of pesticide. 

In San Francisco the experiments were on dark-skinned prisoners to see the effects of darker skin, literally, in case you missed that the first time. Which sounds totally sketchy and is almost perfectly racist. 

The University of California conducted its own investigation, confirmed that the report was correct—and then started shoveling high and deep. But there was just too much shit and too much stink, you know? 

So, like, one of the original UCSF researchers from the pesticide experiments was still on faculty when the radio report aired a few months ago and his counter argument, delivered by his son, was that his medical department—dermatology—was being unfairly singled out, because other medical departments of UC were doing unethical work on patients too, for over two decades. Hello! And UCSF said that he would not be disciplined. 

All further explanation has been buried by UC President Michael Drake who, by trade, is a UCSF physician, not that there’s anything wrong with that. He’s a Brother, btw, although you wouldn’t know it from his actions. He was faculty at Mount Parnassus for years before he began his rise in University of California administration. So, like, one of President Drake’s mouthpieces, a lawyer named Scannell, said it was “harassment” to push for more details of UCSF’s racial experimentation. The most obvious other possibility—the most likely next shoe that could drop in San Francisco—is that the university was also involved in sterilizations of vulnerable populations. Including prisoners. But we digress, because this is about Texas. 

The point is only that UCSF has gone to extraordinary lengths to obtain a vulnerable patient population for whatever reason. UTMB already has one. TDCJ prisoners. 

The medicine is good but there’s always risk of exploitation at academic medical institutions, of which there are six in UC System, and six at UT, depending on how you count. It makes you worry as a staff nurse at Medical Branch, especially working in Hospital Galveston. Prisoners are particularly vulnerable. Speaking up for and advocating for them, as a masters-trained nurse and all that? It doesn’t look good for Team Longhorn, bro, let me tell you that right now. But that can’t discourage a Red Raider. The truth must be told. 

The 150,000 prisoners of the Texas Department of Criminal Justice are at risk big time of exploitation. Because UTMB has the same business model as UCSF, it’s in the same “endeavor,” as Chancellor Hawgood on Mount Parnassus likes to say. Like the Cosa Nostra, actually. An administrator in the UCSF School of Nursing was just sentenced to federal prison for stealing $1.5 million by having the nursing students make out their tuition checks directly to her. That’s abuse of another vulnerable population, btw, students, and is what UC does best. There are a lot of unconventional and bright minds working in academic medicine but what they’re actually working on can be pretty scary shit. Specifically the whole “endeavor” thing that the UCSF chancellor Dr. Hawgood talks about is just Big Business—Big Money—and Big Medicine. In Baghdad by the Bay just like at Medical Branch now. 

So, like, the announcement about UCSF’s experiments on prisoners only heightened my sense that something was stinky on Sin Island. All these prisoners—it gives you pause, being a prudent nurse. You have to assume the University of Texas is up to something because, historically, UT always is. Speaking as an alum. Longhorns are even worse than the damn Aggies when it comes to intrigue, but the Horns are actually not as good at it as Aggies. Frankly, it seems now, not to lecture anybody, it seems that only Red Raiders have the required high level of ethical purpose that promotes trust in Lone Star public health care. It’s because of Tech’s close-to-the-land West Texas roots, that’s my personal belief. “The West Texas ethic,” yeah. That’s my feeling, approaching graduation from the School of Nursing in Lubbock. 

So, like, the history of unethical behavior in academic medicine is long and varied and it’s hard to know what exactly to fear, especially when there are so many possibilities for UT to do wrong on the 66 square miles of the Island of Texas Damned. Or how about Texas’ Island of the Damned, which is my own preferred name for my workplace? With so much evil that is so totally fucking do-able on prisoners, for example, as we’ve learned from the University of California. The prudent nurse has to worry because our professional responsibility is to the patient, not to the hospital. Not to the docs—God forbid. Nor to our supervisors. You can lose your license by forgetting that a RN’s responsibility, what the Board of Nursing is looking at when it hands out discipline, is to the patients under care. And because nursing discipline—like the Texas criminal justice system—falls hardest on black men. RNs of color have to be especially careful. When the Board punishes, it’s not Kimberley with a bow in her hair who gets suspended, it’s Jamal with eight inches in his pocket. 

Who is a natural Black Man and the chicks feel threatened by his uber-masculinity and report him on bullshit violations of practice? But we digress again.

Still, sorting out cause and effect in a chaotic environment is difficult, you feel me, when you’re busy wiping booties and passing meds. For example, this was remarkable, a couple of transgender patients were admitted to 7C recently and it was my first time to work with this patient population. How did you know they were transgender, you may ask? 

Seriously. 

A patient with a big penis and big breasts is a big sign. To set the scene. One of the ladies kept letting her hospital gown slip down to reveal boob. Please.

Also, this was another clue—never having had a trans patient before—while passing these two prisoners their meds there was a lot of drama. You know what chicks are like, drama queens and all that? Not to sound completely Neanderthal. But one of the patients was falling in with gender expectations already, not to sound totally cave-dweller. 

Both patients were getting the same testosterone-blocking pills, estradiol and medroxy-progesterone, have you heard of that particular cocktail? This was my first time to pass these two meds together for this purpose, to the best of my memory. In the old days in nursing school the instructors taught us, “Don’t give any med that you don’t know what it's for.” Fuck that. 

Nowadays it’s hard to do because there are so many new treatments, health care is advancing more quickly now even than at the beginning of my time in the saddle, which is a couple of decades more or less. And everything is much much more costly. It can be hard to keep up with all the new meds alone. And the prices will blow your mind. A lot of expensive shit keeps appearing, to use a non-clinical description of the modern technology of health care. Anyway, TDCJ’s rule is that transgender prisoners must be alone in a room, presumably to prevent assaults. A dive into the charts of these two also produced “TRANSGENDER,” like a stamp, which was another big clue. 

An Officer said later—this was her explanation—that some prisoners are already transitioning before they are condemned to prison and TDCJ is obliged to continue the treatment. Which makes perfect sense. But the second of my two patients—doing time for an alleged kidnapping of a kid—was already behind bars for 15 years. This is so totally not meant to sound racist but the prisoner was Caucasian, you know what those people are like! There’s a demonstrably far greater chance that she really was guilty than the average black TDCJ guy, according to my calculations. So, like, obviously the transition must have begun while in the custody of the State of Texas. Even though Governor Abbott would have a heart attack, and although Lieutenant Governor Patrick’s head would turn a full 360 degrees and he would begin to speak in long-extinct Biblical tongues. If they knew. But there may not actually be much that the Governors can do. According to my online research there was another TDCJ inmate a few years ago—a guy from Brenham, actually? Which is my other hometown, what a small world in which we live! 

This prisoner from Brenham wanted to transition and sued TDCJ and won in federal court. To set the scene. This is my understanding from looking on the Web. His win was overturned on a technicality by the legendarily conservative 5^th Circuit Court in New Orleans. But the appeals judges made clear that they were not ruling on the merits of his claim that he has a right to change genders while in custody of the State of Texas. So, like, this was my understanding, not being a lawyer myself, just tell me how much blood to send to the lab, you know? 

So, like, the appeals court only made its ruling based on the procedural error this Brenham-born writ-writer made. Some of the writ-writers are wonderful writers, btw, you can only admire their descriptions of the horrors of drowning in the Texas Gulag, not to sound all literary. My bet is that they write so well precisely because they are not lawyers—although TDCJ also houses no small number of members of the State Bar, rest assured! 

The point is not that there’s something wrong with being transgender, which there most definitely is not. The point is that a lot of shit happens that you never hear about in Huntsville, which is synonymous with Medical Branch, my employer and alma mater. No light escapes. Because society doesn’t want to know what’s really happening in prison, and especially not in prison health care. 

That would be my whole point, really.

 

 

 

vi)

 

My bedside career that’s now ending has included eight hospitals and two nursing homes. One of the hospitals was tiny, in West Texas, a so-called “critical access” facility with a few beds and sketchy care. In the High Chihuahuan Desert, actually. Sometimes we had federal prisoners who were picked up by Border Patrol on foot out on a rancho somewhere, dehydrated and blistered and all that. They were lucky to be alive and needed IV fluids, you know? There was always a Border Patrol guy or Border Patrol girl at bedside because the patient was technically in custody. 

From the hospital their next stop was Marfa—not to see the famous Marfa Lights. Instead to see the inside of the Presidio County Jail where the feds keep/kept their peeps in the Trans Pecos. To set the scene. 

A couple of my former employers were old-fashioned county hospitals—in Minneapolis and in Austin. Another was part of a huge private corporation, HCA, where the care was pretty good and super expensive. My lone nonprofit gig was in Seattle where one of my patients almost bought the ranch one night—the Big Ranch, up in the sky? 

Seattle was my only brush with unexpected death during my entire nursing career, thank you very much, over a quarter-century. Not to brag. Included in my healthcare tally however, through the years, is breaking an old lady’s hip during a bad lift, back back in the day, working as a nurse’s aide. The patient was a stroke victim with one side much weaker than the other and getting here out of bed, into her wheelchair, we went to her weak side and her leg buckled and she went down like a sack of potatoes. To set the scene. The hospital paid all her bills and gave the victim $50,000. Luckily all my patients have gotten out alive over a quarter century, thank you very much again, except one patient, also in Seattle, who was already “actively dying,” an odd phrase really, when the shift began. 

Another guy in Seattle on that same neurosurgical unit where the guy almost bought the ranch? This other guy had just whacked his wife and was spending the night on neuro, to await an A.M. mental evaluation. 

A sheriff’s deputy was with this guy non-stop. Like within reach, unlike the Border Patrol guy or girl in the hospital in Texas who could be down the hall talking on the phone and the prisoner wasn’t even handcuffed to the bed. The guy who whacked his woman was handcuffed to the bed, or ankle-cuffed actually. 

So, like, the hospital kitchen in Seattle insisted on sending the wife-whacker his meal trays with metal cutlery, including a steel knife? Questioning the use of metal cutlery with in-custody patients might make a good paper for a nursing journal, actually, what do you think? Two of my employers have been academic medical centers—UTMB and UCSF, the later being the venerable University of California San Francisco. 

Which is said to be the most prominent public medical campus in the world. To set the scene. UTMB and UCSF are examples of academic medical centers like the University of Pennsylvania in Philly. Or Johns Hopkins in Baltimore. At institutions like these the care is almost always statistically better than in private hospitals or “at the county.”

 But these university hospitals are also the most dangerous—big time—for the patients, ethically. 

Because there’s a culture in medical research of exploitation of vulnerable populations, previously for medical advancement and now for financial ends. There’s obscene amounts of money at stake. Not to sound cynical. 

Just a few decades ago, back in the day, patients were exploited for the prestige of the researcher and now they’re exploited for the money, or the prize that may lead to money. Not to sound jaded as a staff nurse. Btw, we have a genuine German scientist leading health care on Sin Island now. Not that there’s anything wrong with that because the Europeans can’t be any worse than American docs. The physician who replaced Dr. Raimer a few months ago as President is a cat named Jochen Reiser. The good doctor might as will have “Big Pharma” stamped on his forehead. He’s a Big Medicine/Big Money kind of guy in the tradition of Dr. Hawgood in Baghdad by the Bay, who is all about the business of health care. 

That’s because Medical Branch is gearing up for commercialization— bigtime—which isn’t in conflict with its research mission, they’re the same thing. There’s not much transparency, either. The only thing we know for certain is that on any given day as many as 1500 TDCJ inmates are traveling the roads of Texas, going to or from appointments, on Sin Island or at Tech in Lubbock on the noble dust-blown prairie. That’s what TDCJ said in the report on the murder of that family up near Buttfuck, in Buttfuck County, by the prisoner going to see a doctor in Huntsville? 

The most-discussed unit in TDCJ may actually not be in Huntsville, btw, it’s probably Dalhart, located up at the very top of the Panhandle. The Dalhart Unit is famous because it was built as an economic boon to two counties, a wider target than Texas’s traditional porkbelly politics in which only one local community feeds from the state’s trough at a time. 

Dalhart is near the old home of the great cattle spread, XIT Ranch, in an area that is now known for large-scale dairy operations. To set the scene. There’s a community hospital nearby, which is a good thing, but serious cases at the Dalhart Unit have to be shipped to Texas Tech’s university hospital in Lubbock. What there mostly isn’t locally—near Dalhart—is housing. For that reason this prison is famous within the Department of Criminal Justice for being chronically understaffed by Officers and under-populated by inmates. Which may be good because the prisoners are not overcrowded in the cells, is that a felicitous possibility? 

Dalhart is a perfect example of how not to build a prison, actually, in Texas or anywhere else. It was the result of a serious planning fuck up by the Texas Democratic Party, btw, that last generation of D’s in power, in Austin and in Huntsville, including the late great Governor Ann Richards. Richards was actually leaving the Governor’s Mansion and George W. Bush was moving in, the same year that Dalhart opened. The Democratic idea was tougher penalties—longer sentences—in order to please conservatives. 

Which also presented the opportunity to build more prisons in order to meet the increased need for incarceration and to offer employment to folks across the state, especially in rural communities, jobs in construction and as Officers. All meant to save the Democrats at the next election and when that didn’t happen, the Republicans took over and liked what they saw because Republican voters like long prison sentences too. What a small world in which we live!

Some of the guards who work in Dalhart today actually live in Oklahoma and commute to Texas to do their shifts. If you asked me what is the worst TDCJ unit—well, there’s apparently a lot of competition for the title of worst prison in Texas, isn’t there? Let’s be honest here. 

The two you hear about most frequently as the closest to resembling Hell on earth are Coffield Unit, up near Palestine in northeast Texas, where bad boys go, and the Stiles Unit just down the road from Hospital Galveston actually, in Beaumont, in the southeast part of the state. To set the scene. Again, according to the Officers and inmates both the level of terror at these two units—TDCJ prisons are invariably called units, like the guards are called Officers not guards. The level of degradation is reportedly pretty fucking unreal, PFU, to use the non-technical acronym. But it’s hard to know exact details because everything in the Department of Criminal Justice is highly non-transparent and meant to be that way. Especially the violence and dehumanization. 

A white prisoner from Coffield, a guy with lightning bolt tattoos who had a neo-Nazi thing going on? To set the scene.

We kind of bonded during his time on 7C, don’t ask how. It’s still unclear to me how we even got started talking. Anyway, he told me that Coffield is a scary place even for him. He hinted that the only reason he’s a white supremacist at all is because racial allegiance offers a level of protection in certain lock-ups, especially it seems, the units around Palestine, which is in the armpit of the Lone Star State. In my opinion. Never having been there, personally, and refusing to go. Basically, all the units around Huntsville are known for old-fashioned white racism. Although there’s a lot of competition for that honor too, just like most talked-about prison. It’s pronounced “Pales-teen,” btw, like the Texas shithole it is, not “Pales-tyne,” like the beautiful country that will be. 

This Lightning Bolt guy said he has done federal time and TDCJ time and federal prison is definitely the way to go if you have to be locked up. But we all know that, right?

 So, like, a Black Muslim patient who did time in Beaumont’s infamous Stiles Unit said that there isn’t much difference between the Officers and prisoners at Stiles. “TDCJ recruits in the projects,” this Muslim brother explained. 

He was speaking of the poor areas of the three oilfield towns down the road from Galveston, shitholes all, that make up the Texas “Golden Triangle” leading to the Louisiana state line. Beaumont, Port Arthur & Orange, respectively, each worse than the other. Meaning that some young brothers and sisters who grow up in or around Beaumont for example, and who are poor—despite the city’s wealth and fame as home of the Spindletop gusher that made Texas rich? Despite plenty of white people with money, there aren’t many ways to escape your birth if you are Negro. Which is the kind of thing that you might even hear from an Officer who has dropped off a patient at Hospital Galveston, or is picking one up and has time to chat. A lot of the Officers are black and are aware of systemic inequities in Texas even though they work for the system. Some of the folks who grow up in Beaumont for example go to work as Officers and others clock in as prisoners. 

Luckily for “public safety,” and to satisfy the demand for prison cells in Texas, there’s also a federal prison in Beaumont that is nicknamed “Bloody Beaumont” for its level of violence. 

If you accept the premise that conditions in federal lock-ups are better than in state prisons, like Lightning Bolt said, imagine how bad Stiles must be if it’s worse than Bloody Beaumont? It might actually make a good paper for a nursing journal, looking at the number of jaw fractures, for example at Stiles as compared to the federal prison during any given year? Let’s see. To smuggle a phone into Stiles can cost $2000, paid to an Officer, which seems like a lot of money to me. But that’s my information and the source is good. 

Prison corruption cuts out the middleman and has the Officer receiving the payoff directly from prisoners’ family members. No money changes hands at Stiles itself. 

A reliable TDCJ-related source said that phones are bought by syndicates of prisoners, each inmate chipping in a certain amount of money, a dozen guys let’s say. The phone is hard for the warden to find during a search of the cells because it only stays in any one prisoner’s hand for one day and then moves to the next member of the syndicate. Not that it’s important here but the phone is always moving. The prisoners say that their odds of not having it confiscated are better that way. 

Other than how to smuggle a phone though, of which my knowledge was detailed, my understanding of TDCJ’s inner workings was slim to none. It’s hard to judge an organization that you’re part of, especially if you’re low-level and can’t see the Big Picture around you. And never having done time, state or federal, thank you very much. Just a few months ago, starting work at Hospital Galveston, my knowledge of TDCJ as an organization was nada. To set the scene. The public hears a lot about Texas prisons in the media, even people living outside the state know the horrific acronym TDCJ. Like Dachau, without the ovens? Although it’s still pretty damn hot.

 In my circle of Black Men for example, not me personally but brothers of my acquaintance who have gotten on the wrong side of the judicial system for whatever reason? Like some of the black guys in Hospital Galveston no doubt. Knowing more than a few men of color who were political prisoners of the State of Texas. 

As an outsider to TDCJ you usually only hear about the gory details of an “incident” on one of the units, of civilians who get whacked or raped by an escapee, like that family in Buttfuck last year. Or the insufferable heat in the cells—you hear a lot about that. Conditions that are cruel and inhumane, which is the way the State of Texas likes it. You don’t hear more, because it’s a closed system. TDCJ is a closed complex social environment, like Sin Island itself actually—and is an economy of its own. That now includes Medical Branch. 

To know what “they” were up to at Hospital Galveston, speaking as someone who sees conspiracy everywhere and was at the same time concerned about his patients? You needed to find out what was really going on in TDCJ as an institution. 

That meant the town of Huntsville and the proto-plantation life that still exists in Lone Star prisons, originally in East Texas but now spread across the whole damn state. Not to sound paranoid. 

Happily, there was a way to do just that! 

By talking to the Officers who came and went on 7C, delivering patients and guarding them at night. And of course by talking to the patients themselves, most of whom were longtime observers of TDCJ, you could say. As in years, if not decades. And, frankly, listening to shit that didn’t concern me, which some people might call eavesdropping, but is my thing anyway, not to sound like a freak. Trust me, you can bust a nut listening to TDCJ’s greatest hits, Huntsville’s worst episodes of violence alone, across the years, will take your damn breath away. 

And then—by contrast—you’re completely blown away by an occasional breath of institutional humanity in the Gulag. No lie.

 What follows is coming from a very smart young black female Officer. She was/is smoking hot actually and liked/likes to listen to rap. Music is always playing low in the background at her work station. To set the scene. 

So, like, she told me early one morning, both of us tired as shit and waiting for the morning peeps to show the fuck up. Even though it was still two hours before they were due to come to work? To set the scene again. So, like, she was talking about TDCJ the institution and she said that during her training she was taught that if she’s working on a unit somewhere—in Shithole, let’s say, which is next to Pisspot, in Piss County? It’s up in North Texas but before you hit the High Plains. 

So, like, if she’s guarding the fence line from the tower and she has a rifle. Can you picture that? Let’s say someone is trying to escape through the fence, or over the wall, or whatever, trying to get off of the unit, wherever. Prisoners are trying to get away. The instruction she received in her TDCJ training was that if she has her rifle, “Shoot to wound.” She said that was what she was told. 

“But if you accidentally kill, you won’t get in trouble.” 

How cool is that? 

Doesn’t that make you totally proud to live in the Lone Star State? 

And that totally surprised me actually, not to sound all jaded again. But expecting to hear the exact opposite from TDCJ, really. Knowing a little more by that point about the Department of Criminal Justice and all. But sometimes even as a liberal in Texas you can be wrong. Even as a Black Liberation Warrior who is critical of everything the White Man and White Woman do? Even as a radical African American you can still be pleased by an act or policy of the State of Texas, rare though it may be and almost certainly accidental in nature. 

So, like, instead, TDCJ could have said, “Shoot to kill but if you accidentally wound, you won’t get in trouble.” That sounds more like State of Texas, don’t you think? Medical Branch goes to great lengths about security, btw, to avoid escape. There’s not a fence line to electrify or guard tower to shoot people from but there are certain safety practices that involve secrecy. What follows is just between you and me. So, like, there are no signs pointing to the prison hospital on campus. Hello!

You either know where you’re going or you don’t, in which case you’re totally SOL. Good luck finding my patient care area—med-surg—aka in-patient acute. If you don’t have detailed instructions you’re fucked, doomed to wander the endless halls of the University of Texas Medical Branch forever, like the damn Flying Dutchman out on the Gulf. What good does that do actually, having no signs pointing the way? Because frankly, the lack of geographical clues on campus has confused me up the ass on a couple of occasions already. This may be partially due to advanced age but just as likely it’s due to the campus layout. 

So, like, you probably haven’t heard about a political incident—you could call it—back in the day in Washington, during the Eisenhower Administration? About the CIA?

So, like, what happened back then in D.C. illustrates the Hospital Galveston conundrum, in the context of subterfuge for security reasons. So, like, it was the mid-1950s—must have been, when General Eisenhower was President. This applies to finding the prison hospital at UTMB too. So, like, it’s about President Eisenhower and his driver and the President’s brother who needed to get to the CIA headquarters. Have you heard that one before? 

So, like, the President was in a White House car with his brother who was also some kind of public official and the President’s brother needed to be dropped off at the CIA, wherever it was, before Langley. And the Secret Service driver couldn’t find the CIA offices because signs had been intentionally put up that were misleading or that didn’t name the CIA or Office of Strategic Services or whatever name the spy agency used, back in the day, during the 1950s. Have you heard that one before? The camouflaging of the spook headquarters was intended to confuse foreign spies or Soviet paratroopers or whoever.

And President Eisenhower made a command decision, that not being able to find CIA headquarters was probably not helping to keep the nation safe. He ordered that the correct signage be posted. 

That’s kind of my whole point about working in Hospital Galveston, actually. Does not being able to find the front gate really help to stop prisoners from escaping? 

It’s a very practical question, actually. Because Hospital Galveston is in a big building that contains a lot of other shit and getting to work at night requires going up these elevators and down this hallway and turn here, turn there—go up these stairs, whatever, and swipe. And swipe again. There are at least three Officers in glassed-in posts to get past, maybe a pat-down too. Getting to work is just do-able at my age if you’re highly caffeinated and the buzz hasn’t worn off. And if you still have good blood levels of testosterone or estrogen or whatever and you’re ready to begin night shift in a correctional healthcare environment, where some guy who the press dubbed the Mad Fiend can roll thru the door at any moment. An oral surgery resident told me the other day about a patient who had part of his face bitten away by another prisoner. Not that that’s important here. So, like, if you’re a new employee like me, getting off work in the morning and trying to get out of the building at 7 a.m.? That can be a mofo too.

 Going from all that artificial light and stumbling outside into the glow of morning. It’s disorienting. So, like, it was hard to master—even for an almost masters-trained nurse, you know? It was two whole months before finding the exit of this motherfucker became totally routine and unconsciously do-able. Not to sound all special needs. You may say, well, you still sound pretty fucking dumb, but it’s not me, it’s working nights. It’s a killer. There was a study a few years ago that night nurses lose five years off their lives. 

From metabolic disorder or whatever, and a few of them probably clock out and leave the building in the morning and walk into traffic. Like, by accident? Fatigue dumbs you down. Your reaction times are slower too. Speaking of mistakes—speaking of dumb—any discussion of TDCJ safety practices has to include the biggest security errors, right? 

So, like, right now we’re actually marking the 50^th anniversary of the Huntsville Massacre, aka the Huntsville Prison Siege. Have you heard of the killings at the Walls Unit, back in the day? 

It was a particularly bloody example of Texas’s Great Age of Carnage—the 1970s when so many peeps were getting whacked over drugs. More even than today, actually. The drug of choice then was cocaine, not weed or heroin. And a lot of other peeps were being sent for prolonged stays in prison for killing them. Does that sound familiar? 

That’s how it’s known, the Huntsville Massacre. It was a bloody day in East Texas, at Walls. To set the scene. That bloodshed led to TDCJ’s non-negotiation policy today that the lady Officer told us about during safety orientation. Huntsville negotiated that time—a half century ago—before the Rangers or whoever started shooting. Unlike the policy today which is that the Rangers shoot first and negotiate after. Unless it’s Uvalde, where they never shot at all. 

That time 50 years ago at Walls, the Governor actually agreed to a lot of the prisoners’ demands, really, just not guns obviously. But the escaping inmates didn’t need guns because guns had already been smuggled in. To set the scene. You can read all about it yourself but the important part, noted by Wikipedia, “The convicts made a number of demands, such as tailored suits, dress shoes, toothpaste, cologne, walkie-talkies and bulletproof helmets, all of which were provided promptly. With the approval of Texas Governor Dolph Briscoe,” who was from Uvalde actually, and was member of that dying breed, a Democrat at the Governor’s Mansion, and for good reason. The D leadership, just like the hostages, were Dead Men Walking but didn’t know it yet. TDCJ was a big part of the reason. 

At the Walls Unit everybody got whacked except one inmate who was executed later for his part in la matanza. The dead hostages were both prison librarians—not nurses—but my point is exactly the same, you feel me? Anyway, that’s some of the history of TDCJ, known as the Texas Gulag. "Security" makes the Gulag impenetrable but it is possible to describe its shape. 

Originally the prisons were arranged like a crescent or an arc in East Texas. A former warden said that if you’re looking at a map of the state and look down from Huntsville, to the south towards the coast, there have always been prisons in Brazoria County for example, and just north of Brazoria in Sugar Land too which is the Sugar Land of The Sugar Land Express—an early Spielberg movie, with Goldie Hawn. To set the scene. The film was about an escape from TDCJ. 

That movie—spoiler alert—ends with a Ranger’s bullet and is taken from actual events. 

If you look up from Huntsville on the map, which means looking at northeast Texas there’s a pisspot called “Tennessee Colony,” which sounds very antebellum, pre-Emancipation—pre even Jim Crow—moss on the trees and all that. It’s part of the larger East Texas shithole surrounding Palestine. Again, don’t be a tourist, it’s “Pales-teen” if you’re talking about the town. “Pales-tyne,” if you’re talking about the land of milk and honey. East Texas is corrections country, the same way it used to be cotton country, not to repeat myself. This arc of area from Brazoria in Southeast Texas up to Palestine in the northeast part of the state—with Huntsville in the middle—has always included the state’s lockups, now known collectively as TDCJ. The cells were segregated until the 1960s, the towns and prisons both, actually. 

That arc is part of the Lone Star State’s old plantation economy which extends into the cotton-rich Brazos River valley, where Daddy’s people swung a scythe back in the day. Where there were once slaves doing the work that the prisoners would do later. 

For the longest time actually prisoners were required to work and were rented out as farm laborers or road crews, for construction, or whatever, by wardens. The prison system has also always owned its own land for growing food, and raising animals, prison farms where inmates worked and work still. That’s what the Officers say. TDCJ was self-supporting in food production at one time and provided good food, or reasonably good, but that changed as the prison system has turned to selling its best products. Maybe not exactly that scenario—but close enough when you’re talking to somebody in the middle of the night, as they’re putting cuffs on your patient and you’re trying to get the last meds down the guy or girl’s throat before the White Bus arrives. 

That’s what you hear from the experienced guards who rotate in and out, coming from the units or wherever, spread across the Lone Star State. This information may actually be a few years old but that doesn’t mean it’s not still good! That’s the beauty of TDCJ. Change comes very slowly to Huntsville.

 “The pigs and chickens eat better than the inmates do,” said an Officer who works on a unit that has a big agricultural operation. 

A lot of people complain, btw, about China and Xinjiang cotton—or whatever—produced by prisoners? Our own Texas Gulag also has some fine products to display. For example all the highway signs in Texas are produced by prison labor, an Officer told me that. You didn’t know, did you? Me neither. This Officer who was a black guy working at a prison in Shithole, East Texas, said that TDCJ owns a lot of acreage across the state and he said there’s a big plot of prison land being sold to developers right now. A fact that was confirmed by my Internet search. To set the scene.

So, like, exact details of the sale have been ruled confidential by Ken Paxton, our esteemed Attorney General, whose office has been kind of Corruption Central in Austin for a few years now? Not that there’s anything wrong with that. Like, even if he is the chief law enforcement officer of the state. 

General Paxton has decided that TDCJ does not have to reveal who the buyer is, where the land is or how much it’s selling for. Oh wow. So much for Republican demands for transparency in governmental operations, huh? 

So much for draining the swamp. 

Hearing about this land deal is actually when my paranoia first got going, but it's probably an unrealistic fear. Like an earlier theory of mine about the vast number of mood meds used by TDCJ? Not because General Paxton is honest but because what he's doing with real estate doesn’t really affect the health of my patients. Not for that reason, but instead just to dish dirt on TDCJ, let's get into the real estate deal anyway. The transaction is being handled by Texas Land Commissioner Dawn Buckingham who is a plastic surgeon by training and is also a graduate of Medical Branch. What a small world in which we live! 

Medical Branch is a very connected campus in the halls of power of both the Lone Star State and in D.C. too. UTMB actually produces quite a few docs whose specialty is politics, like other docs are renal or pulmonary specialists. For example there’s a black Republican UTMB doc who is an elected Galveston County commissioner. So, like, before we get all paranoid about Medical Branch alums—let me just assure you, there will be time for that later. To get all paranoid about the medical practitioners on Sin Island. So, like, this is the oldest medical school west of the Mississippi River. It’s also a very political campus and bigtime conservative too. The quality of the medicine comes and goes, UTMB was very good for a long time and may be on the rise again. 

One time back in the day, working in the Children’s Hospital almost exactly 20 years ago, which was also the time of the American invasion of Iraq? To set the scene. 

On a break one afternoon, you know, going to the campus cafeteria—and guess what? The French fries had officially been replaced on the Medical Branch menu by “Freedom Fries.” The horror! The horror! Definitely left a bad taste in my mouth. This whole fucking campus is beaucoup conservative and totally sketchy on top of that. Not to sound all suspicious, but as a prudently paranoid nurse. 

For example not to carry tales—not to gossip, which boy nurses don’t do. We only share information. 

But a very good RN who worked with me in Children’s back in the day, at the time of the Freedom Fries incident, you could call it, during the Iraq War, this chick was totally pro-Bush and pro-invasion and we got into it a few times, let me tell you. It’s not just the whackjob docs who you have to worry about at UTMB, there are plenty of whackjob conservative nurses too. 

Anyway, this white woman who worked in the PICU had to be schooled by a RN of color about oppression, you know? 

But only up to a point, because she was a very good nurse and she did a lot of important shit for me, not to sound all mercenary. When she helped me that made up for some of her political failings, you know? She wasn’t even hot and we still became friends, call me noble if you will. Medical Branch is a Republican campus, not that there’s anything wrong with that. Unlike UCSF on the Left Coast where everyone claims to be ultra-liberal and they do even worse shit to people of color. 

So, like, Dr. Buckingham who is the incumbent elected Texas Land Commissioner may not have been the one who sold the prison property to the developer in the first place. She’s not the first person to suspect, actually. And she’s a good person even if she is rightwing nut like practically everybody else in the Texas Republican Party. Not to generalize or anything. She would only be like number 3 or 4 on my list of suspects about the prison land deal.

Besides, Dr. Buckingham is not a boob-job kind of plastic surgeon, she’s the real thing, her specialty is reconstruction, if memory serves our paths crossed once morning back in the day. 

Not that this is important but the last hour of my shift had been spent doing a beautiful dressing change on a kid with burns and this young blonde chick walked in at 6 a.m. and took the dressing completely down, destroying my noble work, my edifice of patient care? Which pissed me off big time, because she could have called and said that she was coming and the dressing could have been changed after she finished. That's called coordinating with the nursing staff and is much appreciated. My idea at the time was to ask, “Who’s you're attending?” Like you wound say if you were schooling an intern on the power of nurses? But it turned out that this white chick was the attending physician. She was kind of hot, actually. That was Land Commissioner Buckingham, if memory serves. She’s kind of a hottie. And she has a heart.

She would be for example the doc to help those indigent burn victims from Latin America who are staying around the corner from my crib. One hesitates to criticize someone who really helps others, unlike the liberals who just talk, even though, not to repeat myself, Dr. Buckingham is apparently a total whackjob conservative. 

The land deal which has become my favorite TDCJ conspiracy may actually be more about her predecessor—another one of the Bushes, nephew to the President. You can blame the Bush Family for all kinds of shit in Texas, that would be my point, including over a hundreds executions at TDCJ. But you can’t find out the exact facts about the land sale because General Paxton has sealed the file. And Dr. Buckingham is responsible for asking him to make the deal confidential. 

The land is probably in East Texas, btw, which is the fastest growing part of the state, did you know that? Not Austin or even the Big D. 

All we know for sure is that the uncle of the Land Commissioner Bush who might have sold the land was responsible for the Freedom Fries in the UTMB cafeteria and the deaths of tens of thousands of innocents in Iraq. Which is bad enough. But anything else would be speculation on my part. 

The land being secretly sold probably includes old plantation fields, which have historical value but don’t really affect the health of the prisoners who are my patients today, right? Which has to be a concerned RN’s primary concern. Not to worry about corruption in Texas government, which may be pretty fucking overwhelming, but instead wonder how might patients be at risk? 

So, like, you had to look somewhere else. 

In order to discover what TDCJ was really up to at Hospital Galveston. 

You had to look at the institution itself, in order to find what was really going on. The key to the prisoner’s health care at TDCJ was Medical Branch itself. 

 

 

 

vii)

 

The political profile of Medical Branch is prominent for such a small school. This campus was for a time considered a dying institution, that has been re-born with the help of prison patients and powerful friends in D.C. and in Austin. To set the scene. 

So, like, Galveston was Texas’s most important port until Houston began to grow—and the same is true of Galveston’s healthcare infrastructure. Medical Branch used to be the most important medical institution in the state. A research university like UTMB is judged not just by its doctors and facilities, however, but also by the patient base, by seeing many different kinds of patients and a lot of them. A lot of people coming for care or coming for procedures or for research, or for all three. That was Johns Hopkins’s road to fame and success in Baltimore, btw, there were a lot of black charity patients who traded being studied or being used to teach procedures, whatever Hopkins needed them for, in exchange for receiving medical care. Is that how it worked? 

Which was also the origin of UCSF’s interest in black kids in Oakland. Health care is a cynical trade everywhere and medical research can be a dirty business indeed, especially in S.F. and in Baltimore. Maybe on Sin Island too. 

Gradually, coming to Galveston Island was no longer worth the trip for many patients in Texas, not worth the extra mileage past Houston which eventually had more hospitals and more providers to choose from. At one time the majority of surgeons practicing in Texas were educated on this island—a lot of white guys basically, not that there’s anything wrong with that. These Galveston-trained docs were still in senior positions in the county hospital in Austin at the beginning of my career in healthcare. That number dropped precipitously as schools in Dallas and San Antonio grew and claimed patients and medical glory. The only reason UTMB was not closed entirely after any one of the bad hurricanes that have hit the island—we’re due one now, btw. The only reason why Medical Branch survived the storm politically is that UTMB survived the storm structurally, or so we are told. UTMB’s former graduates are older now and in positions of influence in the State of Texas and want their alma mater open. Which is my alma mater too and, you know, you can’t help but feel sentimental ties, old school ties and all. It’s an exceptional campus, inbred like the island itself. 

While UCSF is international—like San Francisco.

Both places are sketchy as hell. 

Not to get all metaphysical but UTMB is closed and incestuous, like East Texas? The brother of the last Speaker of the Texas House of Representatives graduated from Medical Branch, btw, neurosurgery or something hands-on like that, and is now the state representative in a district that includes part of Galveston County. Congressman Ronny Jackson of Shithole, West Texas, is a Medical Branch guy and was Physician to the President for both Bush and Obama. Representative Jackson was a Navy admiral but he just got demoted after revelations of sketchy shit that he allegedly did in the White House. Still, anyway, there was the matter of not enough patients coming to Galveston until—thirty years ago exactly—UT got the contract to provide health care to most of Texas’s prisoners, ensuring a constant flow of patients for practice and study, the tab going to the State Legislature. To set the scene. 

After the TDCJ contract was signed, Texas’s powerful Congressional delegation chipped in—during the Presidency of former Texas Governor Bush? What a small world in which we live!

The Texas delegation in Congress succeeded in getting a National Lab placed on the island, Wuhan-on-the-Gulf you could call it. Even though common sense might question building a laboratory with dangerous organisms a few hundred yards from a prison hospital with locked-in patients? Not that there’s anything wrong with that. Although prisoners do still try to get away. Let’s see, what else bad can one say about TDCJ? How much time is there in your day? 

In a spirit of transparency, and as part of the same critical appraisal that we apply to Chinese prison labor? Western ethicists and journalists like to make disparaging comments regarding prisoners in the People’s Republic, right? Regarding inmate-produced goods and exploitation of prison labor. And taking prisoner’s organs for transplant. Shouldn’t the same standard be used in judging TDCJ? Clear labelling, bro. Our prison system also profits from human bondage, after all, in the cotton fields or onion fields, or whatever, of the Lone Star State. 

The Officers say for example that a percentage of meat sold in Texas supermarkets, including big chains, comes from prison farms. To set the scene. Shouldn’t that beef or chicken or whatever have a “Inmate Labor” label like everyone wants from Xinjiang? Wouldn’t that be fair? What’s sauce for the goose is sauce for the gander and all that. 

My revolutionary idea could be a great marking tool, actually. Or not. 

How about TDCJ having its own food label, “Prison’s Best”? 

Or how about “Prison’s Pride”? 

What do you think? The trademark image would be a sweating bare-chested black guy in leg chains. Or better yet he’s attached to a ball and chain, like the kind Great-Granddaddy wore when he was in Huntsville. 

But this prisoner is smiling and holding up an organic tomato in manacled hands? 

What do you think?

Prison’s Pride. 

Also on the exchange economy inside TDCJ’s walls? A black woman who was an unwilling guest of the State of Texas for a few years near Waco told me that in her lock-up the currency of exchange was blowjobs. Giving hummers to the Officers was how you got what you needed. “I wouldn’t suck,” she told me proudly, although her quality of life was rougher for that reason, she said, because she wouldn’t go down. 

Huntsville, home to TDCJ, is a cesspool although it’s a pretty little town just like before, back in the day in the post-bellum/Jim Crow era when the wardens rented out chain gangs and they lynched niggers in the town square. 

Up the road aways from Huntsville is Anderson County—county seat Palestine—smack in the middle of East Texas where the good people especially liked their Negroes swinging from a rope. Texas’s great early 20^th century Golden Age of Lynching was in and around Anderson County, where the prisons are an evolution of the plantation and wholly designed to keep POC down, that’s my hypothesis, as seen through a nursing equity lens. 

Everything affects health care, including imprisonment. A particularly well-informed Officer and a poor toothless Brother who had experience doing time in East Texas, both these black guys told me the same thing, actually. This is just so fucking scandalous. They said that unless a TDCJ unit produces watermelon for example, which is a fruit near and dear to the black peeps—and to our Pali brothers and sisters—or peaches or whatever, and it’s harvest time, and there’s a superabundance of produce—so to speak—the inmates don’t get much, even though they’re the farmers who raised the shit in the first place. Is there no justice in the Lone Star State? This Officer who has several years in was a middle-aged black guy like me which means totally trustworthy, at least to me. He was working on 7C a couple of nights, you know, and he was speaking to me brother-to-brother in the context of the evil that White Men do? He told me a couple of things actually. To set the scene. 

He was maybe 15 years younger than me, not that it’s important here. He said that of the 21 meals served to an inmate during a week on his unit, five are real food and the rest is just slop. 

Nutrition and health care are weaponized at TDCJ, actually. If you have a bunch of guys and girls who are in good shape, in good health, they have a better chance of jumping the fence when the chance comes, or kicking the guard’s ass in a fight. You feel me? Bad nutrition and bad health care are part of the game plan, a second line of defense after the steel bars and fence. Because state leadership says that’s what the public wants and it probably is. The Texas public is a bloodthirsty crew and tight with its pesos. Not to be negative or disparaging because TDCJ is not all bad. Only like 75% bad, or like two-thirds bad, in my opinion, which may be biased. If you asked people who know me, what’s that cat like? Somebody might say, “He likes to listen. The same way other niggers like to talk.” Not to sound cool or anything. What else? You soon realize at Hospital Galveston that everybody has a story, even if it’s not true. And what you hear sometimes is totally bizarro and depraved. Not to sound all in danger in the frontlines of health care or anything. 

Or if that kind of shit is your thing, you know, and you look at the app. That’s not me, to get all curious like a chick, that’s not the way a strong Black Man rolls, not to sound better than everybody else but my interest in other people’s personal lives is zero, after a quarter-century doing this job. There’s absolutely no prurient interest left on my part, speaking as someone who cleans shit for a living. 

But there’s some kind of odd smell here. Around this place—Hospital Galveston—like when you know a patient has taken a dump and you haven’t even opened the diaper yet. 

Once in Seattle, this might make a good paper for the annals of bedside care. An infectious disease guy appeared at the doorway of my patient’s room in Seattle and told me just from the smell as he entered the room what bacteria the patient’s wound was infected with. It gives you a bad feeling because something stinks here too. 

The problem with having a bad feeling in a hospital is that you may not know what the feeling is about. It may be unfocused or generalized? Or there are so many possibilities about what is wrong. And frankly—having made a mistake previously in this regard, to be honest—having previously had a completely unfounded suspicion about health care in the prisons of Texas. To be totally honest. And that first time being totally wrong. Because God knows that you don’t have to make up bad shit about TDCJ. It’s happening all the time. My mistake that time was a false interpretation of data about medications being purchased by the prisons. To set the scene. That time turned out not to be really bad shit in health care, despite my suspicion. TDCJ was actually innocent of wrongdoing, for a change, that was the way things worked out. Me blaming Huntsville for something bad that they really didn’t do, finding conspiracy where there was none. As a nurse-scientist you have to report that too. 

Because sometimes it’s not what you think. So, like, the same data can have a lot of different meanings. My big mistake, you could call it, was believing the worst interpretation of something happening at TDCJ because it’s such a shitty place, you know, Huntsville and the prison farms and executions and all that. Believing something that upon closer inspection turned out not true. Clarification came from working at Hospital Galveston actually. How cool is that?

So, like, to start at the beginning, some records came into my hands a few years ago showing massive purchases of mood stabilizers for the prisoners that Texas Tech cares for, in Lubbock. This was long before my studies there. To set the scene. So, like, maybe six or eight years ago? And out west, basically, west of the Pecos River. Not geographically but cosmically, where Tech handles health care for prisoners, not UTMB. 

In one of the areas where TDCJ had expanded beyond its historic East Texas roots. That’s not exactly geographically accurate but it’s close enough. Comanche territory basically, if one is making one’s Indigenous Land Acknowledgement. My first impression of the medication purchases was, oh wow, that’s how TDCJ controls the prisoners! That’s why we don’t hear about riots or Officers getting dismembered in the penal hellholes of the Lone Star State! Again, how cool is that? 

The inmates are all on mood meds, bro! 

Paxil or Prozac or whatever, that was my inexpert analysis of the data on the purchases. By keeping everybody artificially mellow the State of Texas avoids mayhem. That was my premise as a wannabe nurse-scientist. It would make a good paper in a nursing journal. The only problem was it wasn’t true. There’s a big caveat, it turns out, when drawing conclusions about stats generally. This is something our instructors hammered into us as Red Raider nurses, graduates of the Health Sciences Center. You have to be careful about what inference you draw. The numbers may be right but that doesn’t guarantee that the numbers mean what you think they do. TDCJ has a unit for inmates with psychiatric problems out west, somewhere in West Texas, and it might make sense that there are large purchases of that class of meds in that part of the state. Lubbock, basically.

On Sin Island, on the other hand, at the hospital that covers prisoners across the rest of Texas, the average medication profile appears to be quite different. At least based upon my experience on 7C, passing a lot of meds pretty quickly to a lot of people. A cross section of prisoners you could almost say, maybe not exactly but close enough. 

Only one of my patients been on a mood stabilizer actually, so far.

He was a young white guy with tats who looked kind of edgy like he needed something. In fact a couple more of my patients probably need to be taking something too, but that’s above my pay grade, and it’s apparently not really the way things roll at TDCJ. That’s not the institutional culture of the Texas prison system. You’re there to do the time and feel every minute of it. So, like, call me a worrier or call me a good nurse, there’s just been this nagging feeling that something is wrong on Sin Island, besides the gambling and the whores. And not to mention the historical slavery? Here on the sunny Gulf Coast, home of the first medical school west of the Mississippi and all that that. That’s my whole point really, Medical Branch is up to something, evil and corruption running amok on the beach at night. There’s always evil in big academic medical centers and there’s been a lot of historical evil on Galveston Island and Medical Branch is where two bad influences meet, you could say, not to sound all puritanical or anything. But what it is—what’s been bothering me—is lost in the fog on Galveston Bay. How does that sound? Be honest, is it too dramatic? 

Just out of sight in the mist, as one might say.

Back in the day during my studies in Galveston there was a doc named Raimer, who was a jefe in TDCJ health care actually. Twenty years ago he told me about a Death Row patient who had tried to kill himself. To set the scene. The means of suicide was saving up his pills and taking all at once, alone in his cell? If my memory serves. The circumstances were a little unclear even at the time but poisoning oneself is popular in prison, kind of like suicide by hanging used to be in county jails or being hanged with the help of the jail deputies, which happens too. 

Anyway, the poisoning earned the condemned guy an ambulance ride from Huntsville to Hospital Galveston and a stay in the ICU. To set the scene again. Dr. Raimer telling me this as we talked about correctional health care long before it became my work area at Medical Branch. So, like, the ICU fixed up the Death Row guy and returned him to Huntsville and TDCJ whacked him. That’s the bottom line. That’s what this cat Raimer said. 

In the prison health context, poisoning is an especially popular way to pull the plug on Death Row. A couple of the last guys sentenced to death from Austin—a Negro who killed his girlfriend’s mother? He was in the news quite a lot if you were in River City at the time. 

And an Asian guy who capped a cop in a Wal-Mart? You don’t hear of Asians running amok that often, not to sound all racist or anything.

Both these guys cheated the hangman. At least one of them is known to have used a practice called “cheeking,” when a patient pretends to swallow scheduled medication but actually hides the pill in the inner cheek. In order to do the deed later—after collecting multiple doses—he or she takes everything all at once, maybe a week’s worth of heart meds, or whatever, and it’s good night, nurse. 

And goodbye too. What else is there to say of morbid interest? Medical Branch had the dubious distinction last year of being sued twice in 12 months by young black female doctors, who are extremely rare on campus, and who were dismissed from their residencies for “professionalism.” In other words after a subjective view of them by faculty, one renal and one something else, as opposed to their objective skills as physicians. Dixie never died on Sin Island. 

Speaking from my personal experience, mostly dealing with the on-call residents at night, very few trainees of color have passed my way unless they’re Asian. This campus can be a brutal place and a good hospital. And at least those black female MDs were on campus, as short a time as it was. Because other than Dr. Ojo, no black male doctors have physically crossed my path at Medical Branch. Asian or white is mostly what you see. 

There are not even many Tejanos, speaking of diversity in a state that is half-Latino. Just like UCSF, Medical Branch was built upon a caste system. UCSF also has a history of showing minority trainees the door and Mount Parnassus has actually been studied and in the literature on UC there is said to be a “black tax” for studying there. The tax is psychological and means everything is more difficult for minority students at UC San Francisco. There’s a racial hierarchy on both campuses, actually, if one looks thru a social justice lens. In Galveston’s case this funky little island is where the Old South still lives, just like in the plantation lands around Huntsville. So, like, being especially curious about the two dismissed young black female doctors, you know? 

And sending an email to a reporter who wrote about the first woman? 

This reporter replied that she didn’t actually come to Medical Branch for her story. But she said that she was told something special about Galveston Island, to prepare her if she did have to come. This comment was made to her by a source who gave her a description of the character of our very own place in the sun, here on our very own Texas Gulf Coast. 

“Galveston is like something out of the 1960s.”

That’s what the reporter said. But the island is actually more like something out of the 1950s. 

Galveston was like Las Vegas before there was a Las Vegas. What follows is an absolutely true anecdote and more telling even than President Eisenhower looking for CIA headquarters to drop off his bro. So, like, the Texas attorney general back in the day, in 1956 actually—unlike the guy who holds the office now—was serious about law enforcement and not a thug, again, unlike the guy now. To set the scene. 

Attorney General Will Wilson came to Sin Island with a squad of Texas Rangers—in 1956—and shut down the gambling and the brothels. Before that, Galveston was Sinatra country, a playground for high rollers and the Mob, including Frank Sinatra himself and his presumed Rat Pack. Until then, the authorities had always turned a blind eye to what happened on the island. Seen thru a morality lens, if you asked my opinion? The real problem at Medical Branch right now is that there hasn’t been a good hurricane in 15 years and a lot of moral detritus has built up, just like plaque on your arteries. It’s like what happens when you don’t clear your gutters, too. In academic health care it’s often about exploitation of vulnerable people and the doctors at Medical Branch must have a degree in that, too. 

So, like, Dr. Raimer who told me about the Death Penalty patient? He eventually became President of UTMB and he lasted until a short while after my hire on 7C, actually. Just a few weeks ago Dr. Raimer was removed by the Regents for something weird, involving a vulnerable population, in this case male students. 

His crime was inviting them to his home in order for the good doctor to style their hair? 

Details are scant, although no other touching was said to be involved. Just the hair. What would you call that, freaky deaky or not? It’s certainly something new in the annals of academic misadventure. 

Dr. Raimer told the Galveston Daily News that the real reason he was removed was for clashing with the campus diversity guy, who happens to be married to a high-ranking official at UT System offices. That sounds more likely but both could be true. There’s always a lot of drama at UT, like at UC. On Sin Island there are a lot of storms and high seas, it’s not just the location in the Gulf, it’s the institution. Medical Branch is an academic medical center—a research school. The patients are sicker, the outcomes are supposedly better, although that’s been challenged recently, and the ethics are almost always worse. There may be some evil shit going on here, that would be my masters-level opinion, something being done to the prisoners not by them, that would be a preliminary nursing diagnosis. American university medical centers like UCSF and UTMB are Ground Zero for sketchy shit, really. You have to measure that against the good they do. Speaking of which—the good that UTMB does—around the corner from my crib is an apartment building full of poor families from Latin America whose kids are burn victims. You have to weigh that kind of service to humanity against Medical Branch’s sins. 

We pass each other—me and these indigent families—walking to and from the Seawall. The kids are in wheelchairs or some of them on foot and bandaged like mummies. Or missing limbs. So, like, no one denies Medical Branch’s history of service but in addition to the good, UTMB also likes more sketchy endeavors. Previously, as a Longhorn, it would never occur to me to say something like that. But now—speaking as a Red Raider? The truth must be told. Let the stats fall where they may. 

So, like, what follows is an example of data theft by UTMB. It’s NFD, no fucking doubt in my opinion, again as a masters-level nurse. 

Call it what you will. 

So, like, all prisoners who are admitted to Hospital Galveston sign three pieces of paper when they arrive. Just after they roll through the doors in fact. To set the scene. 

It’s all part of the admission process that goes along with a doctor’s exam and blood tests or CAT scan or whatever, to settle him or her in. If the patient is cognitively with it and can participate. Each signature is witnessed by the nurse. Indeed, nursing provides the paperwork, together with a clipboard and a pen, these two items being religiously removed from the room afterwards. We don’t want idle hands trying to make something, do we? So, like, the admission process is where prisoners get their shit stolen by the State of Texas, in the persons of the faculty of the University of Texas Medical Branch, my alma matter and present employer. 

The first form the prisoner must sign is a consent to be treated, that is standard in any hospital. 

The second form is a promise not to do anything stupid that might lead to a fall, like getting out of bed without using the call light or without talking to the nurse. The third form is actually the one that is problematic. 

So, like, it’s a blanket consent allowing Medical Branch to use the prisoner’s healthcare information for any purpose whatsoever. Hello! You have to read the fine print, which nobody does, but it’s there. Not to get all paranoid, but what do you think about that? It’s totally sketchy, that would be my view. It’s exploitation of a vulnerable patient population, in my almost-done grad-student opinion. They taught us about shit like this in class actually, not to sound all uppity educated Negro or anything. Not this specific bullshit but the possibility that researchers will exploit vulnerable patient populations for data, yeah. Most students in the healing professions are probably being taught the same thing today. What’s interesting is that at Hospital Galveston it's the State of Texas you have to worry about as the thief. 

The prisoner is signing away his or her information when he or she arrives and agrees to care. At a vulnerable time, btw, when he/she is sick and wants to be treated. To set the scene. Having assisted in this process myself without recognizing the dubious ethics, it makes me guilty of a certain complicity, not like the nurses in Dachau or wherever, but bad enough, you know? The patients don’t know because the nurses don’t know and wouldn’t have time to talk about it even if we did. The only reason this is even vaguely on my radar is because we just learned about it in class, not to repeat myself but we’re Red Raider nurses now, in my case not a mere Longhorn anymore. And God help me, not a fucking Aggie. 

Healthcare data is a big business in the United States, worth a lot of money to a lot of people. 

Big medical data sets like TDCJ’s can be golden. To train A.I. or whatever. Not to sound like a s.m.e. And the prisoners at Medical Branch are being asked to sign away their privacy and/or commercial rights, that’s my whole point, really. The accent is supposed to be on “informed” in “informed consent” but instead, on Sin Island, it’s on consent for commercialization. Some of these guys and girls have been locked up for a long long time, you know, or their education levels were not that high to begin with. Which is what a lot of inmates have in common, poor formal schooling. Hello! The only thing that they may know about DNA is that it’s what got them busted in the first place. No disrespect intended. 

You know what you call that? A vulnerable patient population. 

And then there’s the matter of hatred. Some of these guys and girls don’t like TDCJ very much and they don’t like how the State of Texas treats them and when it’s 4 in the morning—time to draw labs—they refuse because it’s their only act of defiance in the Lone Star Gulag, LSG is the appropriate acronym. Maybe they’ll give up their data for research, that’s possible if the prisoner really did the deed, that’s my theory. If he or she really is guilty and feels guilty? It’s possible, not to go all Freudian. They’re penitent, like he or she wants to make it up to society? Don’t hold your breath in Texas. Do you know what the Old School social pecking order is in the prisons? High up are murderers and bank robbers, sure, but the top of the heap are the prisoners who have successfully escaped, even if they got arrested again later. 

 If it’s black peeps behind bars of course—remember that only a third of us got locked up for something we really did do? The rest is just damn racism. According to my calculation. Most of my brothers and sisters in custody of the State of Texas today are actually political prisoners, that would be my professional view. The hijacking of prisoner data is exploitation of a vulnerable population, a practice that has a long and ugly history in health care and appears highly likely here. So, like, if you were concerned by the karma on Sin Island and asked me, bro, what’s Galveston really like? 

What’s the real deal at Medical Branch? 

My answer would be that there used to be a market just down the street for selling people. What does that tell you, bro? 

History actually is the necessary backround for sussing out, as our British cousins say, what’s been bugging my intuition at Hospital Galveston. So, like, there are clues in the past, like that alleged picture of those black residents being forced to clean up dead bodies after the monster 1900 storm. A big hint actually came from my student days at Medical Branch, back in the day, working weekends in Children’s. 

So, like, it was the appearance in my life of Dr. Raimer, when purely by chance we met on campus. Raimer is a white guy, not that there’s anything wrong with that, especially since that’s what there mostly is at Medical Branch, white guys. So, like, at the time we met—it’s not important how we met but my memory is that we just started talking one day at a meeting or something and he offered me a job in the prison hospital and my response was, like, no thank you. Being happy at Children’s, liking that patient population and the care. 

My response was kind of like not in this fucking lifetime, actually. Or NFW, as in no fucking way? 

That level of negativity but expressed politely? That chance meeting turned out to be an augur of my future at HG, Hospital Galveston as it is known by the correctional cognoscenti.

 

 

 

viii)

 

So, like, my feeling of suspicion at work began to focus one morning while emptying a bag of pee, actually. It had nothing to do with bad food or medicine purchases, as it turned out. You may ask, well, what happened? What did you see? And there’s no real answer. It’s just nurse’s instinct. 

So, like, one of my patients was a white guy in prison for child molestation. To set the scene. Something caused me to look him up on the app. Not that he was difficult, or threatening, just that he was strange? With some patients it seems prudent to find out something about them in order to know if there’s a history of violence, for example. So, like, this guy was in the hospital for a kidney resection because of cancer, which means the surgeons had cut out the bad part of one kidney. To set the scene. A partial resection like this guy’s surgery is theoretically still cool because you can live with only one kidney or maybe even a part of one. He would be okay if the surgeons got all of the malignancy, is that right? So, like, it’s six one morning, me kneeling on the ground beside this Kidney Guy’s bed in order to drain the urine at end of shift. 

His pee looked like pink Kool-Aid which can be normal because kidneys contain a lot of blood. Not being a renal specialist—a nephrologist—or anything but having taken care of a few of these patients over the years, child and adult both. Kidneys can bleed like a mofo, to use the nontechnical term. That’s pretty much the limit of my expertise. 

So, like, me on my knees filling a urinal in order to chart the amount, and a couple of medical residents came to bedside. To set the scene again. They were doing morning rounds. And they were happy to see me doing the end-of-shift output because the overnight urine flow is important and the nurse sometimes forgets, including me. And my question to them, since they were standing there, me holding up the urinal full of the guy’s Kool-Aid in my hand, “Is that the color you expected?” In order to give report to the next nurse who may not know normal. That’s called collegiality which is not exactly my middle name but does happen. Especially if the RN who is going to follow me in the morning is hot or nice or whatever. Or has been collegial with me. Or it’s particularly important to the case, like here. “That’s exactly the color we expected,” one of the docs said.  

That patient raised my suspicion subliminally. His stay was completely unextraordinary and would have passed out of my memory like most of the others over the years. Except, a couple of days later, there was another kidney resection patient who was extraordinary. An extraordinary pain in the ass, actually. To call a spade a spade. 

So, like, this patient was already in a room upon my arrival for work at 7 p.m. and she had given the day nurse a little trouble but not much. Only because the patient barely just arrived. 

This Kidney Lady and me would be spending the whole night together which turned out to be highly emo, you know, a lot of drama. Not to be critical of women. But it was all her fault. This lady had already lost one kidney to cancer and just had the second one partially resected. Theoretically she still had enough working tissue to survive without dialysis. Hopefully. Or so the doctor’s notes said. It was a long night. Let me say that at the start, the Black RN always perseveres, you know? Not to sound all noble. 

This particular patient the Kidney Lady complained about everything, madre bloody mia. From pain to nausea to the nurse. Just to prove it wasn’t me, let me tell you what happened about a week after the Kidney Lady came to 7C. So, like, one night we had three women in a room, including her, and we almost had to break up a fistfight. 

When the nurses entered, after hearing a commotion thru the impenetrable security glass of the nurses station? The three ladies being just a tad loud. 

Kidney Lady was sitting on the side of Bed 3, gathering her strength to get up and go after the patient in Bed 1. The background to the dispute was never revealed. And it was odd that the Kidney Lady was going to kick a little ass because she claimed to be on death’s door every moment from the time she arrived on 7C the week before. 

Even that first night, the week before, her medical condition in my judgment was cool and the gang actually, she was progressing. In a bedside job you need to be honest about your own skills and mine are not perfect but are competent, that’s me. Knowing when not to worry is a skill just like being able to start an IV and my judgment was that she had a good first night. The Kidney Lady was getting an opioid for pain, although it was never enough. Except there was no physical indication that she was in discomfort. She just bitched all night. 

Pain levels are the patient’s call but when they tell you it’s 10 out of 10 and they’re having a normal conversation until you walk into the room—and then they’re suddenly dying—the experienced RN has doubts, you know? What you’re hearing may not be grounds enough to call the on-call physician to increase the dose. She complained of a lot of nausea that first night and said that she had vomited and—this may be gross. But she puked into a cup and showed it to me and there was barely anything there. 

After a quarter century working in hospitals—having seen more than my share of puke, not to sound like a guy. But considering myself pretty spew-competent as a nurse, my experience ranging from a newborn baby’s dribble to medically-induced launch of bodily fluids that can stain your scrubs from across the room. Not to get all cocky. If you’re not even going to hit the wall from your bed, don’t even bother to use the call light, you feel me?

Just joking! 

She had retched, okay, but ma’am—this was my explanation to the Kidney Lady. Ma’am, you just had surgery and consumed a lot of medication. Sometimes the best way to deal with nausea after surgery is to get everything out of your system, you know, does that make sense? And a good spew—aka Technicolor yawn, like we used to say as kids? It can be a good thing.

This Kidney Lady was getting Zofran for nausea, that is routine, and the docs also ordered a med called Phenergan, to be given IV, at the nurse’s discretion. This nurse chose not to give it. 

So, like, Phenergan was the first med that my clinical instructor warned me about back in the day, third semester nursing school after learning how to wipe booty and things got serious. The instructor said Phenergan can have a lot of unpleasant side effects, although it is effective for nausea. To set the scene. The head of trauma surgery at the county hospital in Austin, who was another Medical Branch-trained guy, told me that he gave Phenergan to the cattle on his ranch because it was cheap—a dollar a dose. Which was not the best recommendation, you know? Phenergan was already on my radar as a new nurse, entering the profession at the turn of the 21^st Century, as a measure of medication price inflation and an indication of the changes about to take place in health care. As hospitals and doctors became more profit-centric. Not that there’s anything wrong with that.

We were just exiting the era of cheap drugs like Phenergan, effective but with drawbacks. Appearing now were meds like Zofran, that the doc ordered for the Kidney Lady actually, and was originally intended for the mind boggling nausea of chemo patients? But was suddenly being more widely used. And was much more expensive—$120 a dose for Zofran at the turn of the century, in the county hospital, as opposed to a buck for Phenergan out on the ranch. Zofran was better at targeting symptoms, or doing whatever, and Phenergan became a second line drug. A lot of Old School nurses have views about using it and mine is not to give Phenergan IV unless absolutely fucking necessary. AFN is the nursing abbreviation. 

Which did not describe the Kidney Lady’s condition that first night. Phenergan wasn’t AFN.  That was the patient outcome during the night, actually, she did okay, everything went well for her in my opinion. But the Kidney Lady was on the rag in the morning at the end of shift, which was her right. It was that first morning after her arrival when everything kind of turned to shit for me actually, not to sound all self-obsessed as a member of this selfless profession. 

So, like, bright and early the next morning four residents showed up outside the Kidney Lady’s room. To set the scene.

Morning is usually a good time for me personally. Night shift is going home for one thing, which means me. And two—not to sound totally superficial! 

But number two, sometimes the docs on morning rounds are hotties? 

A little end-of-shift eye-candy helps to raise a Black Man’s blood sugar and can give him that final burst of energy to reach the door, you know? 

The four residents broke up and one of the women went into the Kidney Lady’s room. Looking through the glass, the patient was clearly giving the medical resident an earful about the Nursing Service’s shortcomings. The doc stepped back out of the room. “How was her night?” she asked. 

The doc was kind of hot actually, Asian chick or partially Asian, an easy 8 on my personal scale. Asian chicks and Latinas are kind of my thing, btw, not that it’s important here. 

“She did okay.” 

“That’s not the story in the room.” 

Giving the attitude right back to her. “There’s a lot of drama in there.” 

The Black RN admits mistakes but will stand up for good care. Clearly, nonetheless, the resident believed the patient. That's cool, it's all cool, you feel me?

Then all four of the doctors kind of confronted me. 

They wanted to know why the Phenergan hadn’t been given? 

Because it was my call whether it was necessary. Which was true. Being nice about it but that’s the way it is sometimes in a hospital. It falls on the shoulders of experienced nurse leaders like myself—many of us masters-trained—to teach young doctors which way is arriba. 

Especially boy-nurses like me who have huevos grandes like mine. Not to sound all cocky or anything.

 If you use a med that the doctor says may be used, and it has bad side effects, the Board of Nursing may question your judgment later. “Didn’t you know,” the Board investigator might ask, “that Phenergan has a lot of side effects?” It's a valid question. You can’t win. But you can lose. The Kidney Lady was getting Zofran and, for all intents and purposes, the vomiting had stopped. The patient still felt nausea that first night but is that reason enough to use an iffy med? 

My judgment was that her anxiety was making her feel worse and that was communicated to her civilly and as the advice of her nurse. So, like, one of the four residents who were grilling me was European, he sounded Eastern European actually. You could tell that he was pissed off. 

Part of the problem for doctors from other countries who have come to the U.S. for further training is that nurses in the United States exercise judgment. We’re not merely the physician’s assistant—although we do assist. We have our own practice and make our own decisions when they are our decisions to make. It’s not like that in some countries where the nurse is basically the doc’s bitch to order about and the physician tells you what you need to do on a micro level. But seeing that these guys and girls were not happy—it was time for an apology to the rounding physicians. They have hard jobs.

 The nurse’s ego comes second to what’s best for the patient. And having apologized to a resident maybe five times in my entire career and four of those were insincere? That did not dissuade me from making amends this time too. 

My words of contrition would move the ball forward, so to speak. Because it wasn’t about me, it was about the Kidney Lady’s needs and getting the team on the same page. Like, in the past, one of my apologies to a resident, maybe even the senior resident, might have been something like, “Yeah, I’m sorry that didn’t get done. Can I get an order for an enema for Bed 3?” That had mostly been the nature of my apologies in the past. This would be my sixth insincere apology to a medical or surgical resident, over more or less twenty years. But it was completely called for, in part because these docs were standing between me and the door at 7 a.m. 

“Maybe I didn’t handle this very well.” 

That seemed to smooth the waters. And what’s interesting is that any one of these guys and girls—the unhappy trainees? They could have changed the order to require use of Phenergan but did not. In my report to the morning nurse, the same African chick who oriented me to 7C actually? And who was a better nurse than me, remember her? 

Telling her in change of shift report that the docs want the Phenergan used. 

And coming back that night and checking the Medication Administration Record she didn’t give Phenergan either. And soon it became clear why this patient, the Kidney Lady, was a train wreck. She was with us a couple of weeks, and full of drama. 

Someone looked her up on the app and googled her and the backstory was passed from nurse to nurse during report. “She killed her child.” Because it was pertinent. She was in prison for killing her own kid. She had a lot of emotional issues—psychosocial issues we say, especially after advanced nursing study. That view was eventually shared even by the doctors actually, the more they dealt with her. Although the docs did not address it. 

Can you imagine being a mom in prison for killing her own kid? Locked up with thousands of other mothers, many of whom would give anything just to see their children? Child molesters probably have it better, by comparison to child killers in prison. The Kidney Lady was going mad and no one cared because she was an inmate. 

Crazy, btw, can be the least of your problems in TDCJ. 

Or being crazy is a way to escape, as seen once again thru a psychosocial lens. Crazy as an escape for those prisoners who will never make it over the wall. There are a lot of crazy people in prison, btw, if you aren’t fucked up mentally when you arrive in Huntsville, TDCJ sees to it that you will be when you leave. If you leave. So, like, my original diagnosis that there was a lot of drama with this patient turned out to be correct. 

One night a doctor came out of the room after seeing the Kidney Lady and mentioned that the patient was odd. “She killed her own child,” was my explanation. Boy-nurses call it the way it is, unlike the chicks who like to sugarcoat. 

And this doc, who was kind of hot, actually? She stopped and looked up at me and nodded. Like that explained it. Which it did. “We never hear about that, you know,” she said. She meant what the patient is in prison for, like it was not a consideration in the deliberations of the medical team. 

But maybe it should be? 

Because maybe cellulitis isn’t the same on a member of the Mexican Mafia as on the guy who barbecued his mother-in-law. Maybe healing is influenced by who the person is and what their life story was before they got sick? That’s my soon-to-be masters-trained professional opinion. This lady doc was saying that the docs already have a lot on their plates curing physical illness, without bothering with what the patient is locked up for. Where the prisoners’ heads are at is something different altogether, apparently, unless they’re stark raving mad, and they get sent to a unit out west of the Pecos River.

So, like, a couple of weeks later, you know what happened? 

One night when my patients happily did not include the Kidney Lady, by luck of the draw? 

Standing at my computer in the hallway, doing my charting, like 3 a.m. To set the scene. 

The Kidney Lady walked by in handcuffs, accompanied by an Officer. She was being taken back to her unit, in Pissville. The White Bus had finally come for her. 

She stopped and turned and looked at me when she reached the gate. “Bye, Lucius,” she said. Like we were BFF. When in reality she had driven me crazy, from 7p to 7a, on any number of occasions. 

It made you sad because she was such a young woman. My headstone will be mossy, and the inscription will be faded, long before the Kidney Lady sees the Free World again. If she ever does. 

Anyway, as it turned out she was why my nursing intuition was worrying me, here at Hospital Galveston. My intuition focused on kidneys. Don’t ask me why. 

My nursing diagnosis was corruption, something festering and putrid, like an infected wound. And that stinks just like damn pee. 

Kidneys made the most sense for any number of reasons. 

They’re worth about $50,000 each and the trafficking in body parts we blame on the Chinese is just as likely in this country with our burgeoning transplant industry. There’s beaucoup unfilled demand. With  a lot of the surgeries being done at academic research institutions, there’s big money that appears to be nonprofit, rather than straight up Wall Street which it really is. Like at UCSF. Not to be critical but these people are capable of anything. The American transplant pipeline is already described as hopelessly corrupt and there is a move by the President to change it completely. 

To set the scene. 

 

 

ix)

 

The largest number of transplants in the United States are kidneys, but you also got your livers, lungs, corneas and hearts. The family of an inmate who died in state prison in Alabama just announced a lawsuit against the State of Alabama because his body was delivered to his family for burial without a heart. Literally.

There’s probably a lot of harvesting of organs going on actually, not just in Asia but closer to home. Which is totally cool with me, to tell the truth. My feeling as a HCW is that when you give up the ghost, you also give up the body, but a lot of people don’t feel that way. Especially in the conservative South like Tejas. 

What American medical centers call using cadavers for “research,” may be more like spare parts than anything else. Major research schools ask for bodies to be willed to the university, supposedly to teach anatomy thru dissection, or for other kinds of study, but just as likely now for transplantation. That’s my masters-educated guess.

UCSF for example has an aggressive body donation program, for “research” purposes. But where are the body parts, for those 800 transplants that Mount Parnassus does in a year, come from? California law prohibits using state prisoners for research, actually. The biggest difference between UCSF and UTMB is that UTMB has a better source of cadavers. 

All those inmates who were given exorbitant sentences and died in custody and there’s no one left to claim the body? 

Kidney transplants can be done with live donors, btw, which have the best outcomes, but the vast majority are from deceased donors. 

The waitlists are being gamed, we already know that from the White House. Some Free World patients break the implicit rules and go on the transplant list in multiple states, like Steve Jobs did back in the day, to get his new liver. To set the scene again. That’s the transplant pipeline in a nutshell. It’s corrupt, like academic medicine itself. 

The Kidney Lady piqued my interest not because she didn’t really have cancer and her kidney was not really diseased, but because of the possibility of a kink in the transplant line. Medical Branch is probably involved in a lot of shady shit, actually, let’s be honest here, we’re in Texas, it goes with the territory. And medicine is particularly problematic, as we know from Tuskegee and from San Francisco. Practices that may or may not lead to “better” medical science, not just related to transplants, are acceptable in medical centers like UCSF where big money is the biggest player. It’s a commercialized environment and there’s good reason to think ill, that there’s a hidden market for kidneys on Sin Island too. Cargo ships still arrive at the dock in Galveston, from Latin America, with bananas and sugar. Are kidneys going out? They used to import niggers here, and sell them, kidneys ain’t no big thing as seen thru the lens of Galveston’s ethical history.

A former TDCJ warden told me that there’s a cemetery in Huntsville where they bury prisoners who have died in custody and whose bodies are not claimed by family, and that every year as many as one hundred prisoners are interred there. What’s that, like, 200 kidneys, 200 lungs, 100 livers, 100 hearts and 200 hundred corneas? The beautiful thing about kidney transplantation is that recipients and donors both can be well into middle age. Transplantation is not always about exact matches, either, there are degrees of matching, that we won’t get into here. It’s also a fairly-straightforward and much-in-demand surgery. You just need a supply of organs. The hot young black female Officer who liked rap and told me about how to handle a rifle if you’re standing guard for the State of Texas on a prison wall? She told me something else. 

She said that earlier during the spring there were a total of 13 suicides and homicides on one TDCJ unit alone. All that testosterone, hundreds of deaths in units across the state, Medical Branch could be running a chop shop for prisoner parts, not that there’s anything wrong with that. There used to be a market for whole human beings down the street, what are a few especially in-demand human organs? That’s the fear that taking care of the Kidney Lady provoked. Not that she didn’t have cancer, Medical Branch didn’t harvest hers, most kidney transplant donors are dead, or so it is said. Just think how easy it would be to take someone’s organs if the bodies are headed to a pauper’s grave in Huntsville? Parts poached from a vulnerable patient, literally, in a population of the most vulnerable in society. You may say, well, that’s not proof, but there’s proof too. It’s circumstantial but still pretty damning. Let’s dish some dirt.

So, like, doing an open records request to Medical Branch, the university’s lawyers didn’t know me from Denzel Washington, right? 

UTMB Legal didn’t know that this guy asking for records as a citizen is actually an employee who works across campus, you know? My request was for the total number of kidney transplants done at Medical Branch in the last couple of years. And UTMB refused to say, which was a tad odd. 

So, like, the university appealed to the Texas Attorney General—the venerable Ken Paxton, chief law enforcement officer of the State of Texas—to allow Medical Branch to refuse to release the information. Which he did. Just like with that TDCJ land purchase, the A.G. decided that everything was confidential. 

And which was, like, odd because universities usually like to brag about their accomplishments, how many transplants they’ve done and all that, but not Medical Branch. The answer from the university lawyer, a cat named Taylor, quoted the head of the UTMB renal transplant team saying that the number of live kidney transplants—that is from living donors—had not increased from a handful in the last couple of years. UTMB’s lawdogs gave me a link to an academic source. If the university is up to no good, it would be from cadaver donors, all those guys and girls who die in custody and TDCJ disposes of the bodies. This is where it gets interesting. 

So, like, the stats reported by Medical Branch were for a couple of years “post” pandemic, and showed like 90 or so one year and 100 the next, kidney transplants that is, with cadaver donors. About 40% of the kidneys were sourced from willed bodies, including presumably TDCJ inmates who left their bodies to science. A small number came from the national transplant network. But over 50 came from ”other” sources. And you can’t know exactly what that means because Attorney General Paxton has declared any other info is confidential. What do you want to bet that some of those “other” donors were wearing TDCJ white uniforms at one time? Transparency in high-demand transplants is up to the most corrupt official in the state. Not that there’s anything wrong with that. 

Some information came from UC San Francisco, which is totally sus in its operations too, enough said. The University of California is as bad as the damn CIA but the CIA has better ethics, that's my dicho. To set the scene. 

So, like, recently there was a pro-Palestinian disruption on a bridge leading to San Francisco and UCSF issued a press release saying that the bridge closure was endangering the 800 transplants that Mount Parnassus does every year. Which is a huge number, almost 1% of all the transplants done in the country every year done by UC San Francisco alone. Obviously if Mount Parnassus, which is the head of the dragon that is UC, says it’s doing that many, there is no reason to doubt that UCSF has the surgical suites and the surgeons. The real question is where the university is getting the body parts? 

Both UCSF and UTMB have willed body programs, in which people leave themselves to medical science for research, yada yada. But not explicitly as spare parts, you know? And it's easy to see how this would play out on Sin Island, with access to prisoners. Take for example Attorney General Paxton himself, who is already under indictment for securities fraud, trial to begin “shortly,” and who has admitted the facts leading to a multi-million dollar judgment against the State of Texas for his malfeasance in office and who was just acquitted but not absolved in an impeachment trial? 

That Ken Paxton. 

Not to be a Ken-Paxton-basher, because it's too easy. There's a lot of drama with this Attorney General, what can you say?

So, like, suppose one of his mistresses has end stage kidney disease. Does she get on the transplant list and take her chances like everybody else, undergoing the pain and indignity of dialysis, three times a week? And maybe take the risk of death like the dozen to two dozen members of the American public with end stage renal disease, mostly minorities, who die every day waiting for a kidney transplant? Or does she call Sex Pax, as he is said to be known to his women? Does she call him and say, “Pax Daddy,” another diminutive that the state’s chief law enforcement officer is said to like, “I need to find a kidney or I’m fucked”?

Or General Paxton himself needs the transplant. Or one of his big money donors, like a rightwing nutjob oil guy who lives just up the coast from Sin Island, in Houston? What a small world in which we live.

Or it’s a University of Texas Regent, or ex-Regent. Or someone high up in UT System Administration? Or a member of the Legislature? Do these guys and girls die waiting for an organ or do they call Medical Branch and get a prisoner cadaver chopped up special? 

Last year a former Texas governor said he was having a kidney transplant. Did he take a number and wait and take his chances like the rest of us? Have you noticed that celebrities who are more than willing to talk about all the intimate details of their health, in order to stir interest, rarely talk about transplants? Because the first question that will be asked is did he or she go on the transplant list and take their chances like anyone else? Frankly, even if there is favoritism—corruption—the practice should be short-lived. Medical science is moving towards artificial kidneys in the long run, or taking organs from specially-bred pigs. It’s just that in the long run, you may die waiting.

Maybe it’s just me. In a place that is full of bad actors like Hospital Galveston it’s easy to see conspiracy everywhere, like with those mood meds west of the Pecos. During a break at night, when we were having a quiet night, the only kind of night to have, an online search revealed that UTMB and TDCJ were questioned by a state agency a few years ago about transplants and were asked to produce a report detailing numbers and practices. But TDCJ in response to another open records request said they know nothing about it. Ditto Medical Branch. 

According to the contract between UT and TDCJ, any transplants on prisoners must be done by UTMB. So it’s not like we would have the wrong perp if we start by accusing Medical Branch. And there’s just one other thing. It’s probably just my paranoia though and doesn’t mean anything. But Medical Branch’s new president, Dr. Reiser? He’s a nephrologist, that’s his specialty. 

In other words, he’s a kidney guy.

Not that there’s anything wrong with that.

 

https://abc7chicago.com/eddie-johnson-chicago-police-superintendent-surgery/2358329/ 

 

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So, like not to totally focus on pee and poop, or dissection of prisoners for body parts, this is my alma mater and my most fun moment as a nurse happened at Medical Branch actually, back in the day. It was in Children’s. 

A kiddo was having an emergency in the ICU, which would eventually be successfully resolved. To set the scene. The whole crew was surrounding the crib, and the respiratory therapist had been called to come down from the wards to help. A lot of kids’ problems involve airways. 

So, like, everyone was doing what they had to do. The respiratory therapist, who was young, and new to the job, was nervous about what was happening, the kid’s condition and all, and he looked up anxiously from the crib. The respiratory therapist asked, “Is the code team coming?” 

And the charge nurse, who was a middle-aged black woman, and hard as nails, with a heart to match, was at the crib and she glanced up. There was just the faintest trace of a smile on her face. She answered the nervous therapist. This was not, btw, the South African respiratory therapist in Children’s we had back in the day, who was a total babe, this respiratory was a guy.

“You are the code team,” the charge nurse said to him. 

Pretty funny, huh? 

Or, maybe you had to be there. 

Let’s see, the finest moment for me in a quarter century of health care also took place at Hospital Galveston, much more recently. 

It was a Sunday morning, five a.m., and my new patient had just arrived from a unit a few hundred miles away. To set the scene. 

This guy was my first “ad-seg” patient which means administrative segregation which means he was a bad dude or could be a bad dude or because he had been a bad dude on at least one occasion in prison, in addition to whatever got him locked up in the first place, is that how the classification system works? He was a white guy. Those people! What can you say? So, like, you have to presume a level of guilt, if one looks thru a revolutionary healthcare lens, as mentioned before. 

This patient’s personal history may have involved him being a bad dude in the Free World setting too, we didn’t get into any of that during the admission and, for the record, the app was not checked. Yet. This was exactly the kind of white guy who worries me most, in Hospital Galveston and in life. Not to sound all racist or anything. He was maybe 40 and without a high school education.

That came up in the patient assessment, he answered the question, at the time me still on orientation with my preceptor. Not to make any snap judgments about those people, you know, but education levels are sometimes minimal in the Texas bubba community, which may have something to do with family values in communities of lack of color? It might make a good paper for a nursing journal actually, looking thru a psychosocial lens, using a masters-trained perspective.

This ad-seg guy had a pretty nasty leg infection which didn’t appear to have been helped by sanitary conditions at his home unit, a TDCJ pisspot somewhere near Corpus Christi. To set the scene. He required a lot of blood work which involved me and my preceptor bending over him with a needle, while the oncology lady’s warning was still ringing in my ears. 

With this guy, you didn’t need to guess what he was capable of because he’d already done it. That was kind of reassuring in a way because it took away any doubt. You just didn’t know details, does that make sense? 

Even with two officers standing a few feet away, you feel me, as is apparently required in an ad-seg patient care, this guy still looked dodgy and potentially unsafe. Then, out of nowhere, a white coat appeared in the doorway, just like cavalry arriving at the last minute in a Western movie. Enter the physician.

 Not just any physician but an attending physician—a Big Dog. 

He was “rounding before church” an older nurse told me the practice is called, from back in the day when Medical Branch attending docs came to the hospital to round early on Sunday morning, before going to church. Although my bet was that churchgoing wasn’t this particular M.D.’s reason for coming in early on Sunday. Maybe he was going sailing or was going to have brunch in Houston with Barbie—or with Ken. Something like that, it was none of my business who he was bonking but one guy always wonders that about another guy, especially if mating resources are scarce. Not that it’s important here. He had given the residents the day off? Sounded like a good guy to me. 

This time with the ad-seg patient on Sunday morning, it was this internal medicine guy, a white guy like the patient actually, maybe fifty y.o., and he walked into the room with confidence and he did something extraordinary to my newbie eyes in correctional health care, even after a quarter-century in nursing and as a proud African American warrior who knows a little bit about what the world is really like. And being totally cool and unflappable myself. And whose own family has been extended guests of the State of Texas and knows what that means. 

The doc stopped a few feet from the bed, introduced himself and stepped forward and shook hands with the ad-seg guy. He asked, “May I examine you?” Which the patient—who had probably not heard a lot of may-I’s recently, back at his home unit in Pissville, Texas. 

The prisoner agreed to, to let the doctor do what he needed to do. 

After the examination the doc shook the guy’s hand again and thanked him for his cooperation. It was a beautiful act of humanity and humility. And in Texas! That would be my whole point, actually. 

Even though, speaking as a R.N., one would prefer to praise this kind of professionalism exhibited by a nurse, not by one of nursing’s natural adversaries, the dreaded physician. But this white doc was cool and totally empathetic. And in Texas, not to repeat myself. Which is a place—a political entity—the State of Texas—that you don’t immediately associate with empathy. Maybe we should. Shoot to wound, remember that, not shoot to kill and all? Because the worse and most racist care in my experience has been at another academical medical institution, the University of California San Francisco, the world-renown UCSF, in bleeding liberal Baghdad by the Bay. But we digress again. 

What was so cool was the Medical Branch doc’s courage, treating the patient with complete dignity. And being fearless. While personally, at that moment my back was against the window, the one that looks out towards the docks and Galveston Bay? My eyes searching for a potential escape route, in case this healthcare encounter started to go south which it did not. My sphincter held. But just barely. 

It’s like they tell you when you’re hiking with a friend in the woods and you run into a bear? It’s not the bear you have to outrun. The doc and my preceptor would have been on their own because Lucius would be, like, gone. 

“TDCJ does not negotiate” was on my mind, yeah. 

There was not the warm sensation of urine running down my pants leg, but it wouldn’t have taken much. My job description is to render care not hinder escape. Anyway, the patient’s infection made an attack unlikely, because of the distance he would have to cover on a bad leg. Unlikely doesn’t mean never, you know, but that morning as the sun rose over the Gulag, some of the most humanistic care that it’s been my privilege to see at bedside was displayed at Medical Branch by a white doc. Those people! 

Mostly we don’t care what you’re in for, actually, unless you give us reason to wonder and we have to check the app.