Prison for twenty, institutionalized forever?

February 11, 2016

Nearly three years ago, I wrote a TMM about Jorge.  This is the beginning of that piece:

“Sitting before me was a  Latino male who looked like an NFL linebacker.  His shoulders were huge, with deltoids that looked like bowling balls.  Tattoos were everywhere. I was intimidated by his physical presence.  A chart review moments before told me that my next patient had recently finished a prison sentence.  My first impression: “Wow, he really fits the stereotype.” He’s a middle-aged man, he is a person of color and he looks like he could kill me in a matter of seconds with his bare hands.

After the usual introductions, we sized each other up.  He clearly wanted to make a good impression.  He wanted no part of the drug scene. Drugs led him to prison; he had done 20 and never wanted to return.  Exercise had become his passion.  He was committed to taking care of his mom, now chronically ill.

I clearly wanted him to know of my familiarity with the prison system.  I asked him where he did his time.  He was surprised that I knew that Walpole was CJ, Cedar Junction, that I knew of some of what led to doing time at CJ and that I knew the prison medical staff by name.  We had a very positive outcome for a first visit - that being mutual respect.”

Jorge (not his real name) has been my patient now for six years.  A few months ago, he sat in the exam room beaming: he finally got his apartment.  It took his commitment to sobriety and my commitment to advocacy to make this happen after six long years of homelessness.  Celebrating with a hug, I praised him for his commitment and hard work and he showered me with gratitude.  All was good.

At his next visit, he was Jorge the inmate. Anger seeped from every pore. He was edgy, physically tense, eyes shifting and pupils dilated.  This is not the first time I’ve seen him this way.  Family members were pushing his buttons.  He had a big argument with his girlfriend. A white guy who was wasted was leaning on his truck in front of the apartment. He asked him politely to leave.  The guy started swearing at him. Rather than explode and pounce, he called the police.  The White guy, known to Jorge as a low level heroin dealer, walked away while Jorge got cuffed before the police even heard the story.  They then released him.  The White guy was long gone.  He talked about his rage and explosive nature. After validating his feelings, we talked about the explosiveness and I made a diagnosis of Intermittent Explosive Disorder and read that it often responds to SSRIs.  Two months after starting fluoxetine, he was in my office again, reflecting.

“I feel so weird.  I don’t feel like myself, don’t feel like I’m ready to protect what’s mine if something happens.  My girlfriend says, what’s up with you? You aren’t getting angry at all. I don’t think I like being so calm.”

We talked about life on the inside, always ready to defend, jacked to the max. At some level, he was missing the buzz. Then he remembered why it’s good, his grandkids.  He wants to be their role model and teach them how to live differently. 

Working with Jorge is like peeling an onion.  We are now getting in deep to undo the learned skills needed to survive behind the four walls. The extraordinary has already happened. A lifetime criminal and junkie has been sober and has not been arrested after six years of incredible challenges. Three of four individuals who spend time in prison are back in after five years.  Our relationship is symbiotic.  Given my academic interest in community reentry, I’m learning from him; and he knows that someone believes in him, trusts him and is there to help.  I feel blessed and honored to know and work with him.