Professional Courtesy

I arrived at the Receiving and Diagnostics Unit of the New Hampshire State Prison in June. It was a sultry summer. R & D is not known for its accommodations. My cell was a five by seven foot metal box that I shared with another inmate. There was barely space for a bunk and the stainless steel toilet-sink combination. We spent twenty-two hours a day locked down. A few tattered paperback novels provided the only distraction.

For two weeks I lived in cell 10 of Two East. The east side of the building faces the street. The windows are permanently closed to prevent communication with the outside world. The heat was intense. To make matters worse, cell 10 is next to the showers. It was a perpetual sauna. I lay on my bunk dressed in my white, prison-issue boxers and I sweated. After a few days of this, I noticed a rash spreading over my chest. "Probably a fungus," I thought. I found anti-fungal cream listed on the prison canteen order sheet and ordered a tube. I used it twice a day. The rash showed no sign of going away. “A doctor who treats himself has a fool for his doctor”, I reminded myself, “and a fool for his patient.”

I was reluctant to go to sick call. The thought of facing members of my former profession made me hesitate. I wanted to stay anonymous in my shame. The rash, however, felt no need to remain incognito. It spread. Finally, I signed my name to the sick call list. The next morning a guard escorted me and half a dozen other green clad inmates up the sloping corridor that connects R&D to the infirmary. He locked us in a bare room. We milled around. Some sat on the floor. The guard sipped coffee and peered at us through the large curtain less windows. After about an hour, he called my name and led me to a triage area.Photobucket

"Oh, so you're Dr. Homer," said a portly male nurse. "I'm Dave. I read about you in the newspaper."

Great, I thought. No flying under the radar here.

"Dave," I said, untucking my shirt, "I've got this rash." I hurried on, trying to maintain some sense of control. "I thought it was fungal. There's a lot of heat and humidity in R&D right now. So, I tried the anti-fungal cream they sell in canteen, but it's not getting any better. I'm pretty sure it's eczema, although I can't rule out a resistant fungus.

Dave looked at the rash, and announced, "Well, I guess I'll make an appointment for you to see the doctor.” He began flipping through a large appointment ledger. "The soonest I've got is a week from Monday," he said. He wrote down my name and inmate number. I felt frustrated. What was I supposed to do until then?

"Couldn't you give me something for it now?" I pleaded. "I'm pretty sure it's eczema. How about some hydrocortisone cream. Just half-percent. You know, the over-the-counter stuff. It doesn't require a prescription."

Dave looked at me hesitantly. I could see I was putting him in an awkward position.

"I'm really not supposed to," he said. But he was wavering, caught between two loyalties, professional courtesy and prison rules.

"It can't hurt," I continued, pressing my advantage. "I'll keep the appointment with the doctor. But, if it is eczema, it will be getting better by then."

I guess the professional appeal won out. Dave went to the cabinet and produced a 15-gram tube of .5% hydrocortisone cream.

"Here. You know how to use it," he said, then turned quickly away. I returned to the holding cell, triumphant.

The rash started to get better. A week later I went back to the infirmary to see the doctor. Another nurse pointed me to an exam room. I entered and sat on the exam table. The doctor stood with his back to me, reading my chart.

"So, I see the nurse gave you some cream for the rash. Has it gotten better?" he said without turning.

"Yes," I replied, taking off my shirt. "But it hasn't gone away completely.”

"I'm going to give you some medicine in case it's an infection,” he said, scribbling in my chart.

"Don't you want to look at it?" I asked.

The doctor half-turned, peered over his bifocals, and then returned to his writing.

"And, I'll give you a stronger cream," he said.

I wanted to say that I didn't need an antibiotic or a stronger cream. I wanted to tell him that I had correctly diagnosed the rash and was certain that it would resolve completely with the half-percent hydrocortisone alone. But that would mean revealing my professional credentials and answering a lot of uncomfortable questions.

I said, "Thank you."

The next day I received a bottle of 500 mg. cephalexin tablets and a tube of triamcinolone cream. I put them in my bag of property and continued to use the hydrocortisone cream. The rash went away. A few months later I gave the antibiotic to another inmate who had an obvious infection.

"Don't tell anyone," I said. I wondered what the penalty is for practicing medicine without a license. The triamcinolone cream sat in my footlocker until well past its expiration date. The guards confiscated it during a routine cell search.