Read an exclusive extract from Dr Amanda Brown’s eye-opening new book about the inmates of Huntercombe prison, available here.
PROLOGUE
HMP HUNTERCOMBE
20 DECEMBER 2013
‘I’m dead.’
The ‘dead’ man’s name was Kofi Aboah and he was a giant. Over six foot of muscle, but shrinking. I could tell by his clothes that he had lost a lot of weight. His tracksuit slumped around him, looking as defeated as its inhabitant.
Most noticeable of all was a very large swelling on the left side of his neck.
I saw from his notes that he had advanced tonsillar cancer. Too advanced.
He had only recently transferred from HMP Wormwood Scrubs and this was the first time we’d met. This was not someone I could cure; all I could offer this man was kindness and the right to as much dignity and as little pain as possible.
In the yard outside, a delivery lorry was repeatedly warning anyone within earshot that it was reversing. In the waiting room two men were laughing long and hard. But it was as if those sounds were miles and miles away. Because in my room there was nothing but this ‘dead’ man and the photo of his family that he held in his hand. ‘Dead,’ he said again. ‘My body just needs to catch up.’
He held up the photo so that I could see. Four people, his family, standing in front of their Ghanaian home, a rough-hewn brown hut on the outskirts of Tamale. The door was splintering, green skin rupturing to show sun-faded wooden bone, the thatch was threadbare. The ground all around them was a bright yellow sand. Just beyond their home a couple of women poked at the insides of a huge cooking pot with metal poles, as if whatever was cooking on this open fire needed fighting as well as heating. A small child, just apart from the cooks had noticed the camera and was staring longingly out at me, a character from a story that was just to one side of the one I was in. The family my patient wanted me to see seemed happy – happier, certainly, than this snapshot of their lives suggested they should be.
He turned the photo back towards himself and looked at it again. He had such an air of sadness about him. It washed over me and I couldn’t help but be affected – a deep, bone-aching shiver of sympathy. My thoughts must have shown on my face because he glanced at me and then winced, as if embarrassed.
‘Don’t look like that,’ he said. ‘Not until you know what I have done. You might think I deserve it.’
‘Nobody ‘deserves’ to die,’ I said, leaning back in my chair, which gave a little creak.
‘Not even drug smugglers?’ he asked, almost combative, as if daring me to disagree. ‘I have seen all the expressions.’ He smiled. ‘The faces that start off sad, then become confused, become conflicted. I am used to it. Faces that change like the weather.’
‘Nobody,’ I insisted.
I understood the complexity of this man’s feelings; he wasn’t the first prison patient I’d dealt with who carried a sizeable weight of self-loathing. Some prisoners resented their sentences, some accepted them, and some felt they deserved even more.
He winced as he shifted in the blue plastic chair next to my desk. His smooth head was shining with sweat, his left leg constantly twitching, up and down, up and down.
‘You’re in a lot of pain,’ I said. It wasn’t a question.
He nodded and looked down at the floor, as if ashamed. ‘I tell them but they don’t listen. Maybe they don’t care.’
‘That’s not true either,’ I told him. ‘Nobody wants to see you suffer.’
‘They do not have much choice.’ His eyes moved back to the photograph.
‘Your family?’ I asked, encouraging him to talk, wanting to distract him. He nodded and, for a moment, his leg stopped twitching.
‘My wife, Amba,’ he said, pointing to the woman in front of that splintered, green front door. Her hair was in tight braids, tumbling in front of a slightly distracted smile. She wore a bright yellow and red dress, her arms stretched out as she tried to keep the youngest of her three children from running out of frame.
‘She’s beautiful,’ I said, and he nodded in a matter-of-fact manner, accepting this not as an opinion but as a simple truth.
‘She is perfect,’ he said. ‘More than I ever deserved. Much more.’
He winced again and his leg resumed its shaking.
‘And your children?’ I asked, still hoping to briefly distract him from his pain.
‘They are perfect too,’ he said. ‘Two boys and a girl.’
He pointed to the girl on the far right of the picture. She was fourteen or fifteen, beautiful but with such a tired look on her face. A young woman already exhausted by her life.
‘Esi does a lot,’ he said, as if having read my mind. ‘Too much. She has to. With me not there . . . There is so much to do. There will always be so much to do.’
Outside, in the waiting area, the laughter had ceased, replaced by someone shouting, an explosion of foreign words that echoed and distorted to the point where I couldn’t tell if they were expressing pain or anger. From experience it was probably both.
‘This is Yooku,’ said Kofi, pointing at the youngest of the boys, the one trying to escape the photograph and his mother’s grasp. ‘He always wants to be somewhere else. Usually chasing a ball. He is never so happy as when he’s playing football. So much energy, so much power. The world seems too slow to him.’ His face contorted with pain and I briefly put my hand on his arm and squeezed it very gently. ‘It seems to move very quickly to me,’ he said, teeth gritted. ‘The days are so short and I am running out of time.’
I asked him about the treatment he had received for his cancer, but unfortunately, due to having been transferred to three different prisons prior to arriving at Huntercombe, he had never actually attended an appointment to get the treatment he needed. I saw the referral letters and appointments offered in the ‘communications’ section of his computerised notes, but he had yet to be assessed by the oncologist. I made a note to ensure he was referred as soon as possible.
But that didn’t help him at that moment. He was clearly in a lot of pain.
‘The first thing I need to do is sort out your medication,’ I said, as I looked at his notes.
I saw that he was only on a low dose of co-codamol, and had only been receiving it twice a day instead of four times a day. No wonder he was suffering.
‘How severe is the pain?’ I asked. ‘Does it come and go or is it there all the time?’
‘It’s always there, but then more pain comes and goes,’ he said. ‘So strong, so big . . . I’ve never known pain so big. It is really bad in my neck and left hip.’
A base level of pain coupled with breakthrough episodes. He certainly needed to be on stronger analgesia. Pain is subjective. Translating what a patient is experiencing and compensating accurately for it is always difficult, especially in prison where appeals for greater doses of medication were so commonplace they ran the risk of being ignored.
‘I’m going to increase the dose and frequency of your painkillers, as well as try you on an anti-inflammatory pill with another to protect your stomach,’ I told him. ‘It should make a big difference towards you feeling more in control of your pain.’
‘In control.’ He sighed. ‘That is not something I can imagine feeling again.’ He gave a thin, weak smile. ‘But thank you. You are very kind.’
‘I’m also going to arrange some blood tests and refer you to the oncologist to see what treatment you need. I’ll see you again next week so that I can adjust your medication further if needs be. There’s no point in you suffering more than you have to.’
I sensed that for some strange reason he felt ashamed that he needed to accept stronger painkillers. That he was not man enough to just grin and bear it. He looked at me with such sad eyes and a brief silence fell between us. He felt so far away, beyond my reach.
Then the moment broke. He offered a small smile and held up the photo of his family again. He tapped at the final child in the photo. ‘This is Kwame,’ he said. ‘He knows about suffering. He was born with a deformed spine. They tried to correct it but . . . it hurts him to walk. Just to be. Born into pain.’ He looked at me. ‘I sometimes think this is why I am here now,’ he said. ‘To suffer as he does.’
‘You’re not here to suffer,’ I said. ‘And you’re certainly not here as punishment for your son!’
He sighed. ‘Maybe you’re right, I am just feeling . . .’ He shrugged. ‘Just feeling.’ He tucked the photo into his pocket. ‘I am here because I smuggled twenty kilograms of cocaine into the country, that is all. And now I will die, alone. Here. That is that. I will never see them again. I cannot change that, I do not argue the fairness of it. I did what I did and now I pay for it. But my family are everything and I am not with them.’ The fingers clutching the photo tightened and his arms shook, pain and emotion rushing through him. ‘I have let them down. I have ruined everything.’ He took a deep breath, trying to calm himself. His body slowly stopped shaking. And, finally, barely louder than a whisper, he said four more words. ‘I shouldn’t be here.’
Prison Doctor: The Final Sentence is out now.
