Letter 18.

Dear Mr. Masked,

In this era of taking care of patients in the setting of the COVID-19 pandemic, I wonder how my care has changed.  At baseline the environment in the jail is different, but as restrictions have progressed on the outside the jail has changed too.  Fear from providers to patients has spread like the virus resulting in stark changes in which we care for patients.  The jail is a dark locked-in place filled with uncertainty that I often describe as hell on earth, but seems far worse than I could ever describe— with the same people who are disproportionately impacted by this pandemic masked and chained.  As we sat across from each other both wearing a mask, we looked into each other’s eyes.  I could see the fear in yours, I wasn’t sure what you saw behind mine.

When you asked me, “how am I supposed to stay safe from rona in here?”  You made it clear that you did not believe my answer of “there are systems in place to protect you.”  When the pandemic was initially announced, like most systems this one scrambled to come up with a plan.  Nurses would screen individuals for symptoms—have you recently… travelled outside of the country? had a fever? a cough? been around someone who was sick?  This screening tool worked at first, until too many people said yes and there was not a way to test them or isolate them.  When more tests became available, every single person who was arrested and brought into the jail was tested and would be stuck in isolation until there was a result.  Over time, signage went up, announcements began to be made over the loudspeaker, masks became required for all arrested individuals, and personal protective equipment for all employees— deputies, physicians, nursing, environmental services, etc.  I even shared that the pushes to decrease the census in the jail actually worked and the numbers of inmates were the lowest in the facility’s history.  However, very few ever talk about how the individuals experiencing homelessness, substance abuse and mental illness are faring without the shelter, food, medical and mental health treatment that the jail sometimes provides them with. 

Even though you had no symptoms, got a test, and sat amongst fewer inmates than I had ever seen before, nothing seemed to put you at ease. To be honest, I understood why; how could you trust the systems in place when historically they are the same ones that fail you and y(our) community.  I looked into your eyes and all I had left was— “your mask and washing your hands are your protection… it is all we have.”

Until we change the system,

Dr. A

Illustration by Denise Webb on https://www.wocfrontlines.com)