I was at the prison on Tuesday and we got an interesting patient I thought I would share with you.

He looked like he was in his late 50's but was really 46 years old. He was a big black man, serving a six year sentence. I don't know what his crime was, but it couldn't have been nice- six years is a pretty long sentence. (especially when you think that most people are given these really long sentences then they are eligible for parole after a shorter amount of time. The inmates always talk about their sentence in terms of how many days left until they are eligible for parole, not how long they were absolutely sentenced to serve.) He came in, sat on the examining table and took off his shoe.

He had a funny toenail. Somewhere along the line he had stubbed his toe and gotten an infection. The infection festered along as infections do and one morning he was cutting his toenails and cut that one a little too short. The infection became exposed and pus ran out. This alarmed him so he went to the medical sick call and asked for some attention. Undoubtably, the nurse or doctor on duty looked at his toenail, observed that he had already drained it and there was little more they could do. If it was a fungal infection, the medication isn't very good and wouldn't make any real difference in the outcome. same deal for a bacterial infection. So they sent him away. The years go by and he looks at his toe and notices that it never grew back normally. After five years of looking at this toe he decides to come back to medical. Which is when I met him.

So we looked at his toe. We explain- there was trauma to your nail bed, probably from the infection. We can't do anything to fix the toe.

Now, let me set something straight here. This toe was NOT horribly disfigured. Half his big toenail was a little funky looking- a little thick. Nothing major. I've seen nastier looking toes on just about every prisoner I see in that place. It wasn't painful, it wasn't infected. Whatever had gotten in there had come and gone and left the tiniest of autographs.

No matter the size, this guy was livid. He ranted and raved at us about how his healthcare was a violation of his rights and how when he gets out of prison he's going to sue all of us. He went on and on for a long time, mostly at me because I was standing closest to him. He was pissed. He was frustrated. He was angry.

Then he showed me his other foot. He had a bunion. Bunion removal is considered elective surgery and the prison as a rule won't pay for elective surgery. That set him off again, about how his orthopedic shoes had been taken away when he was incarcerated and the shoes he is allowed to buy from the commissary weren't any good and that's why he has the bunion. And now that too was a violation of his rights.

He was pretty mad.

As he yelled at me, a few things went through my mind: First, the bunion may or may not be a result of his shoes. Hard to definitively say. But if orthopedic shoes were that important to him, he could have had someone buy them for him and bring them to the prison. It would have required some paperwork, but it's not impossible. Second, the toe is really just a toenail. It's not painful and will never prevent him from doing things he wants to do. If he wants to complain about poor healthcare he should talk to the guy who got a lipoma removed from his forehead a few weeks ago and will have a horrific scar as a result. That surgery was a crime. Ugly toenails are NOT a crime. Third, the guy is in PRISON. What about the rights of the people against whom he committed his felony? Judging by his sentence, something must have happened to get him locked up for that long.

After he left I had a chance to glance through his chart. The guy is a "frequent flier" in the prison health care system. He is constantly with complaints and requiring attention for some little thing or another. Usually when you see this you know the person probably has some psych issues. Sure enough, he had a lengthy psych history as well. The one thing that jumped out at me was the following statement:

"The inmate states he witnessed a KKK lynching when he was eight years old."

And that put me in my place. Sure, the guy is a criminal and wants some attention. But if he did indeed start his life that way, it's no wonder he's pissed off.

And he's right- in some ways all their rights are violated when they become prisoners. They have to crap in public, they never get to spend a single moment in a room all alone (unless they're being punished), they can't talk in person to their loved ones in privacy. They give up their rights when they become part of the penal system. And some of them are there because they were guilty of being black and in the wrong place at the wrong time.

This guy was complicated. But he was letting all his rage out on the wrong people, and I think he knew that too. Because when he left our little examining room he looked at us and said "thank you for being straight with me." Then he walked away, shaking his head.

all for a toenail.