County Jail

So for the past week, I've spent my mornings seeing patients at the women's clinic at the county jail. I caught the train to downtown, carrying my white coat in a bag so no one would mistake me for a rich doctor and try to mug me. After getting off the train, I'd walk about 5 blocks to the jail. Coming in the front doors, I'd change out my hoodie for my white coat and proceed to the thick glass window to check in. I had to leave my bag and my cell phone in a locker in the lobby. Then, I'd go through the metal detector while a deputy rifled through my white coat. Then, the airlock: a guard would buzz me in one door, examine my ID's through bulletproof glass, then buzz me through the far door. The two doors could not be open at the same time. After that, I would walk past holding rooms packed with people waiting to go to one of the clinics and eventually arrive at the women's clinic.

The smell walking in every day was one of thick air, a place where so many people are breathing and simply existing in a place without windows that the air is heavy and stale. The first few breaths are the worst--then you get used to it, until you walk outside and realize the air smells sweet.

The clinic was run by two nurses, both of whom had been there a long time. They were tough ladies, indeed. Clinic was a tightly-run ship, pumping patients in and out. Two inmates would enter, weigh in, and be put in "rooms," separated from the rest of the clinic by a curtain. They wore bright scrub-type clothing and sandals, no handcuffs.

Seeing patients for the day: an OB intern, myself, and an OB attending to sign the charts. There were two types of patients: OB and gyn. OB patients in county custody receive free clinic visits and prenatal care; delivery takes place at [county hospital]. I'd go see them, make sure they don't have preterm labor or pre-eclampsia symptoms, measure their fundal height, listen to the baby's heart tones, and then leave to present the patient. We'd take the standard prenatal labs, and if they had any vaginal complaints we'd do a pelvic exam. For gyn patients, the usual complaint was vaginal discharge; we did have one complain of amenorrhea (she looked like PCOS). They all got pap smears and pelvic exams. OB visits are free; gyn visits are $15.

After the exam, we'd perform our own wet mount at a really crappy old microscope (hence the whiff tests I essentially refused to do). The organism at the top of the page was spotted yesterday in a gyn patient with the standard complaint; we gave her a dose of Vitamin F (my attending said it should be put into the water supply). Otherwise, everyone had BV, BV, BV, with the occasional Chlamydia trachomatis and Neisseria gonorrhoeae thrown in. Chlamydia was especially prevalent. The nurses kept a bottle of azithromycin and a few vials of ceftriaxone in the cabinet for just such occasions. I'd venture a guess that up to 25% of the patients and charts I saw documented a current STD; upwards of 50% had a history of an STD.

For the most part, I felt the patients I saw were honest with me. Most would admit a history of drug use ("yeah, I took crack and Xanax"), STD's, etc. I didn't ask why there were there; I only asked how long they were staying. None were mean or rude to me; most were simply happy to be heard.

All in all, a very strange week. I don't have anything particularly deep to say about the experience; I was just thrilled to get to leave every day, and I'm kinda happy not to go back.