The Prison Doctor: Women Inside

I looked into the waiting area and saw her sitting down with her head in her hands. Rather than jump up and greet me with her usual toothless grin and a ‘Hello, Doc!’ I could see she was agitated and crying. She was wearing a grubby blue tracksuit. I glimpsed the top of her head; her auburn hair was matted and greasy.

‘Shannon?’

She looked up and slumped back in her chair for a moment, a look of relief on her haggard and pock-marked face.

‘Come on,’ I said as I led her to my little room.

I shut the door and she gave me a hug as the various smells associated with living rough, like body odour, dirty feet, and foul breath, soon filled the air.

‘What’s happened? You’re never normally like this?’ I asked.

‘Doc… it’s good to see you. The judge… he said…’ She started sobbing. Messy and loud, snot-filled sobs. ‘He called me a worthless wretch.’

A worthless wretch, I thought, what an awful thing to say.

I was momentarily stunned by the language the judge had used. Judges can use their summary judgements to say what they like and whilst this is normally a standard administrative process, this judge had obviously made his personal views known. I couldn’t help but think about the vast gulf between the day-to-day lives of Shannon and the judge who had just sentenced her. Society and the judge might see Shannon as a useless criminal, but she didn’t see herself like that, and neither did I, because I understood the dreadful details of her life that inevitably had led Shannon to commit crime.

‘You are not worthless, and you are not a wretch,’ I told her firmly. ‘I really believe you can make something of your life. And I am sure you will, if you can get the help you need.’

I tore off a large piece of paper towel from the roll and passed it to her. She clutched it and wiped her dirty face. Shannon had substance misuse issues and I could already see the signs of withdrawal. Beads of sweat were visible on her forehead and she had goosebumps on her track-marked arms.

We started to go through the routine medical questions, though I knew Shannon’s medical history well. After all, this was the ninth time I had seen her in around two years.

‘Okay, let’s sort out your medication Shannon, so that you can go over to House Block One as soon as possible to get your methadone,’ I said.

Before my time in prison I had worked as a GP for twenty years in the community near where I live in Buckinghamshire, but had very rarely treated patients who had ever been involved with the criminal justice system. Like many others, the mainstream media soundbites meant that before I started to work in prisons, my opinion was condensed down into a narrative of ‘good people’ and ‘bad people’, with a clichéd list of ‘bad’ characters ranging from violent psychopath to petty criminal. The reality is far more complex.

Female offenders are some of the most vulnerable people within our society. Women make up just five per cent of the prison population in England and Wales, and the vast majority are imprisoned for non-violent offences, and are often sentenced for a matter of just weeks at a time. Many of them are caught in a vicious cycle of domestic violence, drug abuse and homelessness. Written off by society, they disappear into a world that most of us are oblivious to, of lost invisible souls who have no voice. I am now all too aware of the awful lives so many of them have to endure, as are many other people and organisations who work tirelessly to try to help in all sorts of different ways.

These are often brave, funny and kind women, who are trapped, and without hope so often of a better life, and they are at risk of being dismissed and vilified by society. They are human like us, and they face the same battles many of us do, yet their lives are just much harder.

There are many, many issues and obstacles in the way of them rehabilitating and breaking free of the way of life they are caught up in. Their lives are often desperate and can spiral into the most savage circumstances. Far too many of them are sleeping on the streets. If they are lucky, they may ‘sofa-surf’ with friends and family, but all too often they inevitably head back to the streets, having outstayed their invitation. The last time I had seen Shannon, she had been sleeping in a stairwell near Victoria station. She’d told me the day before her release that she was planning to return to her old spot and had given me a scrappy piece of paper with biro scrawl, which read ‘Elizabeth Bridge, Victoria.’

‘Come and try and find me, won’t you? When you’re next in London,’ she’d said, like any old friend inviting me round for a coffee. I wanted Shannon to hope for a better life for herself, however impossible it may seem given the shocking life she was living on the streets. In reality, her life was one of despair and hopelessness. Despair was sadly evident in so many of the people I had come to know through the course of my day-to-day work.

By far the majority of the women I see have experienced or continue to experience some kind of trauma. Many have a history of domestic violence and sexual abuse. They live in terror and this leads to substance abuse, self-harm, suicide attempts and serious mental health issues.

‘What are you in for this time?’ I asked her gently.

‘I nicked a laptop from Currys. Thought I could sell it to my mate, Mike – he’s always got cash.’

‘How long are you here for?’

‘Just twenty-eight days. I was only out two weeks ago.’

Women often serve far shorter sentences for minor crimes like theft and shoplifting and are locked up for a matter of weeks, before leaving to go back onto the streets, only to reoffend and come back in – hence the frequent flyer moniker. The longest sentence Shannon had received was two years when she was in her late teens.

She was now 26 and had been using drugs for over a decade.

‘How much heroin are using at the moment, Shannon?’ I asked. ‘Are you still buying benzos and pregabs as well?’

‘I usually spend about 100 quid on crack and a 100 quid on heroin every day,’ she told me. ‘I’m also taking about 40mg of diazepam and as many pregabs as I can get my hands on. The drugs and booze just get me through. Some days I feel like I’m drowning. It all just helps me to forget the evil shit I’ve been through.’

‘How much are you drinking now?’ I asked.

‘A bottle of vodka a day, if I can get it,’ she replied staring at her feet.

Shannon sat forward, grasping her stomach and wincing in pain because she had really bad abdominal cramps due to withdrawal.

‘I think I’m gonna be sick,’ she said, clutching her hand to her mouth.

I looked around the room for a disposable bowl and fortunately found one in the corner, which I quickly handed to her.

‘Here you go, Shannon,’ I said.

I sat and waited in silence until she felt able to continue talking.

‘I live from one hit to the next. I owe my dealers money and I spend my life in fear. They keep coming after me. Say I owe them more and more. I’ve lost track of it all now, and I don’t know how I’m going to pay them back.’ She sounded terrified. Women were not simply scared of violent partners. Men dominating these women came in all guises. Many women turn to sex work to keep their dealers happy.

She had also been sleeping rough for the majority of her adult life, heading to the streets with a measly bag of possessions and a sleeping bag to find somewhere she could call her own – even if this was a shop door, in a stairwell or under a bridge. Solving housing issues for this section of society is hugely challenging. Many organisations use online systems to process requests and details, but women without their own phone or access to the internet cannot get near them. Shannon always sold the cheap phones she got her hands on for drugs, and aside from the odd night in a hostel, she was on her own. She had no bank account. She had fallen through all the nets.

Over the many hours I had spent before then with Shannon trying to tackle her drug and alcohol dependency, I had heard her story in full.

‘My dad beat up my mum so badly when she was expecting me, it’s a miracle I’m here at all,’ she said. ‘Even after all that, she stayed with him. He was locked up when I was two and I never saw him again.’

Her mum worked three jobs to put food on the table and became involved with another man. Her new stepfather soon moved into the house.

‘He was a bastard. Mum had two more kids with him. He would play us all off against each other. It was like some sort of weird power game of cat and mouse.’

Her face looked pale and impassive.

‘We would all be beaten in turn. I was always the last because I’m the eldest. Listening to my sisters cry and scream before me was unbearable.’ Her voice started to crack.

‘I would hide under my duvet and put my pillow over my head, but nothing would drown out the noise.’

The tears started to fall as she relived the memory. I gently placed my hand on her arm, a little comfort as she talked.

‘My stepdad would beat and rape my mum in front of us, and he would come into our rooms after Mum left at night. She worked as a cleaner at the local leisure centre.’

‘He sounds like a really evil man,’ I said, deeply sickened by her awful tale.

‘First, it was just weird touching, but when I was eight, he started raping me. I could never scream, as he was so heavy. I felt I couldn’t breathe. I would just look at the tree outside my window and pray it would be over,’ she told me. ‘I never told my mum. I didn’t want her to be upset.’ The lengths people would go to protect the people they loved never ceased to amaze me, and often left me speechless. I frequently met people who took the blame for crimes they did not commit; from mothers who claimed the drugs in the house were theirs and not their kid’s, to girlfriends who provided an alibi or who covered up for their partners in other ways.

‘Me and my sisters were always hungry, and I sometimes passed out at school. I was terrified about my mum getting into trouble, so I would lie and say that I’d had some toast or cereal for breakfast.’

Thankfully, Shannon’s mum met someone new and their lives changed for a few years. The abuse stopped and there was more money for food, and birthday and Christmas presents.

When Shannon met her first boyfriend at 14, sadly the cycle of abuse started again. She became dependent on drugs and alcohol and started bunking off school. Her grades had never been good, and she was struggling to keep up. Eventually, her mum threw her out, because she didn’t want her drug use to influence her sisters. She ended up on the streets. She had no qualifications, and having lost contact with her mum and sisters a long time ago, she also had no support network on the outside.

‘I’ve got no one and nothing. Not even my own teeth,’ she said, showing me a gappy mouth with a few rotten, brown teeth, worn down to stumps from the years of drug use and neglect.

Those words seemed to sum up the story of so many women I had come to know during my time working at Bronzefield.

I knew Shannon’s history and needed to help her manage the symptoms of alcohol withdrawal, and to stabilise her on methadone whilst she was in prison. Realistically there was not enough time for her to detox from methadone, and there was also a risk of her overdosing on heroin after release if she was on too low a dose. It was not going to be easy for her; it never was.

I had learnt early on in my time at Bronzefield that the women themselves had to want to stop using drugs and conquer their addictions. No matter what I or anybody else did or said, it was up to them to make that choice and see it through.

‘I haven’t got any drugs in my lady pocket, Doctor Brown. Honest,’ she said. I knew that she had smuggled drugs into prison in her vagina before – it was an obvious way for many prisoners, as internal searches are not permitted.

She looked up and gave me a smile, so I would know. If she told me she had drugs on her I would have to report her, so I swiftly moved on to sorting out her medication. As we chatted away, the upset of the judge’s comments seemed to fade, and I started to see the old smiley Shannon emerge.

‘To be honest, in some ways I’m happy to be back and have a warm place to sleep. It’s getting proper cold out there now. My sleeping bag got soaked in the rain the other night and it just won’t dry. And I’m starving,’ she rattled on. ‘I can’t just sit there all day. Shoplifting gives me something to do. That, and riding round the Circle Line. It’s warm, and much more comfortable than just sitting on the street. I also feel safer when I’m not sitting on the street. I’m so scared the dealers will find me and beat me up again.

‘It’ll be nice to be with some of my mates again. We understand each other. I’ll keep busy in here, maybe try and learn something; get back on the education programme. It’s good to know I’ll feel safe at night again, for a while.’

This was something I heard again and again from the prisoners. Being in prison for many women is far safer than being on the outside. She was back in a place she associated with safety, familiarity, security, and even opportunity. With three meals a day and regimented timetabling, she also wouldn’t need to make many decisions for herself.

As well as addictions to crack cocaine – a crystallised form of cocaine – and heroin, Shannon drank heavily and was addicted to benzodiazepines and pregabalin. Highly addictive, benzodiazepines – referred to as ‘benzos’ by the inmates – are drugs like diazepam and Xanax and were originally prescribed for anxiety when they first came on the market in the 1960s. Many girls I see are addicted to high doses of these drugs because it calms them down. Pregabalin is another prescription-only drug used to treat epilepsy, general anxiety disorder and neuropathic pain. Like heroin, it induces feelings of euphoria and calmness and is hugely addictive, so there is a rampant black market for this drug. Many of the women I see say that it is harder to withdraw from pregabalin than heroin.

‘It’s just so awful,’ they tell me, with haunted expressions.

Shannon was addicted to so much that withdrawal from it all was medically a blurred picture. Her face was glistening with sweat and her hands were shaking. As she looked at me, I could see that her pupils were widely dilated. She would experience a whole range of debilitating symptoms over the coming days and possibly weeks, including diarrhoea, abdominal cramps, nausea and vomiting, shivering, sweating, anxiety, panic attacks and paranoia.

I started typing out a whole list of medications that she would need to enable her to cope.

Methadone is prescribed as a substitute for heroin and helps to ease withdrawal symptoms from opiates and reduce the cravings. Bright green in colour, it is a slow-acting opiate substitute and is prescribed in a liquid form. Most people that take it say that it tastes disgusting. In the past, all prisoners were expected to detox completely from methadone if they were due to remain in custody for more than three months, but this is no longer the case. Often, especially in the case of a short sentence, it has to be ‘titrated up’, to try to protect the user from overdosing on release, or to control their dreadful symptoms of withdrawal.

Prisoners are given their daily dose by the nurses at 9 a.m. but if the dose is not high enough, it won’t hold them through until the next day.

We agreed on a dose to build up to, and along with methadone, I prescribed all the other medications she would need to combat her withdrawal symptoms.

‘I know I say this every time I see you,’ Shannon grinned. ‘But you really are like a mother to me. Thank you.’

I stood up to give her another hug.

‘Good luck, Shannon,’ I told her. ‘Be good.’

‘I’ll try, I really will.’

Deep down, I knew I would almost certainly be seeing her again after her current stay. I always, always hoped girls like Shannon would get their lives back on track, but it felt like she had the odds stacked against her. The statistics state that the more previous custodial sentences a woman has had, the higher her reoffending rate; the reoffending rate for women with eleven or more previous convictions is eighty-three per cent. It’s sad but it makes sense that just as women’s paths into crime are chaotic and complex, so their paths out to a better life are likely to hit just as many bumps along the road.

I glanced at my watch. It was just past 8 p.m. and I was feeling really tired and ready to go home. Despite the fact that I had been working in prisons for many years, I had never become immune to the rawness of it; the shock, fear, relief, sadness, shame, despair. It was a melting pot of extremes, and emotionally draining. So often, I was all too aware that I had very little to offer the people I was meeting, as I could not change the fact of where they were and what they had done. All I could hope to do was to try and offer a bit of kindness and reassurance, and to relieve any physical pain and suffering they may be going through. I try my best, if I possibly can, to take the edge off their undoubted apprehension, as I realise it must be so overwhelming and intimidating for some people to find themselves in prison. It is strange that whatever their crime and however awful, it fades into the background momentarily and I just see them as a scared and shocked human being. I am so used to the environment that I feel totally comfortable within the prison walls. But I find myself trying to imagine seeing it through their eyes, and wonder how it would feel if I was sitting in that chair opposite me.

As I was finishing off my notes on Shannon, Amber popped in to ask if I would like a cup of coffee.

‘I would love one. Thank you, Amber,’ I replied without giving it a second thought. ‘How has your day been? Any gossip?’ I asked her, hoping for a little light relief. Amber always cheered me up, as she is blessed with such a wonderful sunny nature and positive outlook on life.

‘Nothing much, Doctor Brown,’ she replied. ‘Same old, same old. I’m really happy though, because my family are coming to visit tomorrow, and I can’t wait to see them. Also, I’m reading a brilliant book – a thriller – which is really gripping.’

We chatted for a few minutes about the book and then she went off to get me a drink. It felt good to have people like Amber around. During my time working in Reception, I had become very close with the women who worked there and we tried to look out for each other. I thought how lucky I was to have them with me; we were like a little family and there was a lovely sense of belonging between us. Whenever I felt a bit down, they always managed to cheer me up.

A prison officer wheeled the next patient along the corridor, manoeuvring the heavy chair with some difficulty, taking a number of turns to get into my room.

In front of me was a black woman, in clean clothes and bright mauve lipstick. She was very overweight, with rolls of flesh sagging over the side of her chair.

I glanced at her notes. Gloria was 68 and had a multitude of medical complaints, including a condition that affected her joints. I read that she had already undergone two hip replacements. She also suffered from type 2 diabetes and hypertension, and was unable to walk due to the severe pain in her knees. This explained the wheelchair.

‘Hi Gloria, I’m Doctor Brown…’ I started telling her about what I was doing and why she had been sent to see me.

I went through my usual questions, one of which was to ask what she had been charged with.

Gloria explained that she had been charged with fraud, but she denied any involvement.

‘… but I didn’t do it,’ she said. ‘I got caught up in something I didn’t understand. I didn’t realise it was illegal. I’ve been given three years, Doctor Brown. Three years! Surely that’s not right?’ She looked at me imploringly. ‘I’ve never been in trouble before in my life.’

Gloria had come straight from the court where she had been sentenced, so it was clear that whatever she felt, the judge felt differently.

Fraud is not an uncommon crime, and includes benefit fraud and other far more elaborate types of fraud, including complex money laundering. This is one of the convictions that many women really struggle to come terms with. They often feel angry that they have ended up in prison as they didn’t realise the severity of what they were doing.

I asked her about her long and complicated medical history. As we chatted it was clear that Gloria’s main support was from her husband, Reg. They lived north of Manchester on their own and didn’t have children. They only had each other.

‘It’s not going to be easy for him to come and see me, is it?’ she said, looking despondent

‘When you get to the house block, have a chat with the officers,’ I told her. ‘They’ll be able to help you, and tell you what you need to do next to try and arrange a visit.’

I knew the prison did their best to help residents maintain family ties by facilitating visits and contact, but of course, as with most things in life, there are forms to fill and protocols to follow.

‘Who’s going to help me get in and out of bed?’ she asked. ‘Reg does that for me. He gets me up, cooks my breakfast and helps me get dressed. He sits me in front of This Morning on the TV, before he goes to get the paper.

‘I’ll be lost without him,’ she continued. ‘I just don’t know how I’m going to cope.’

She continued to tell me about their daily routine, down to the finest detail, with Reg featuring in every element of her day. I felt for Gloria. Her sentence was years, not months, and it was going to be hard for her to adjust, assuming she ever would.

Thirty minutes later, I had completed her notes on the computer and prescribed everything she would need for the time being. She looked relieved but nervous.

‘They will get my pills to me on time, won’t they?’ she asked, her eyes flicking from me to the computer and back again.

For many women, the fact they are not allowed to keep their medication with them, that it is handed out by the nurses, is another loss of liberty.

‘The nurses will give your medication to you each day,’ I explained. ‘Once you are settled, you will have an in-possession risk assessment – it’s called an IPRA – to see if you can look after your own medication. But up until then, I’m afraid you’ll just have to go to the nurses for it.’

She looked resigned to the fact that there was nothing she could say to alter the situation.

She added: ‘The other thing is I also suffer from claustrophobia. I hate being in lifts, and any small space, in fact. Even being in this room makes me feel nervous.’

Gloria’s new home would be a small cell, with only enough space for a narrow bed, sink, desk and a toilet. With a door that would be locked. And many doors would be locked behind that door.

As I finished my shift that evening and walked across the car park to make my way home around the M25, I wondered how Gloria, Rebecca and Shannon, and the other women I had met that night, would cope with the new phase of their lives. How prepared they would be for the many challenges they might face, and how they would handle them.

Chapter Two

‘I know I am being punished but I don’t want my child to be punished too’

‘Just look at his tiny fingers.’

I was sitting in the little consulting room in the Healthcare wing one morning during my regular clinic. In front of me was a new mother gazing into her buggy. Inside the buggy was the most beautiful baby, his face all scrunched up, his fists clenched and hot cheeks glowing. His eyes twitched and opened momentarily like he was having the most vivid and exhilarating dream. At four weeks old, the smattering of milk spots on his nose, cheeks and forehead, a common and completely normal skin condition that babies get, were starting to fade. Megan had tucked him in carefully, with a soft grey blanket decorated with ducks, covering him to his chest. On his head, he was wearing a knitted blue hat.