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Authors: Ms. Mary E. Buser

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18

By summer's end, I'd been back at Rikers for three months. My plate was full, with a caseload that had swelled to thirty people as well as handling the accompanying paperwork demands. The inmates I met with suffered primarily from depression, anxiety, and often a combination of both. There was little time for the in-depth work I'd enjoyed as a student, but with each person I met, I listened wholeheartedly, tried to nurture maturation, and instill reasonable hope. When I packed up to go home at night, it was with the quiet sense that I was doing something important.

And in my outside life, there was cause for celebration. Alex had passed his exams and was now a full-fledged American doctor. With his long struggle over, a world of opportunities was opening up for him. And as he began exploring new possibilities, I became more deeply immersed in my work with the men at GMDC, a population of little concern to the outside world.

But if the public was disinterested in the Rikers detainees, one accused criminal
had
captivated the entire nation—O. J. Simpson. By the fall of 1995, his trial was under way and the case was discussed endlessly in newspapers, on TV, in the home and workplace. The fervor was felt no less on Rikers, where officers, civilians, and inmates alike offered passionate opinions as to whether Simpson was guilty of the grisly double murder. By early October, the trial was finally wrapping up, and on a bright autumn morning, word spread that the jury had reached a decision. Officers and civilians
crammed into a clinic lounge while inmates gathered around their house TVs for the verdict. When the words “not guilty” were uttered, a massive roar rose up over Rikers Island. The inmates were ecstatic—dancing in their houses, cheering in the clinic. The dour faces on the mess hall lines were replaced with broad smiles and pumped fists. None of my sessions was complete without a quick sidebar on the verdict. “Finally,” they said, “White justice for a Black man!”

But as the O. J. euphoria died down, and the inmates realized that his victory meant nothing for their own cases, the jail returned to its usual somber state.

At GMDC, I found a profound sense of sadness that I had not felt at Rose Singer. Not that Rose Singer was “Mickey Mouse land” by any means, but the difference, it seemed to me, was hope—hope for a better life after jail. Numerous programs prepared the women for better things after release. But at GMDC, programs were scarce, and the idea of something like the meditation group that Lucy Lopez had attended seemed laughable. And perhaps my biggest shock: for all of the Mental Health Department's efforts in denying women sleep medication, no such policy existed here. In fact, it was the opposite. Here, sleep meds were doled out freely—even encouraged—as though there was an unspoken understanding of the men as a lost cause and a desire to anesthetize their pain as best we could. I suppose with more serious charges, and the heavier sentences that waited, there was little point in focusing on life afterward.

As part of my evaluations, I asked about physical injuries, and the men whipped up T-shirts to display scars from gunshots and stabbings, the result of gang warfare and stray bullets. Before GMDC I'd never even seen a bullet wound, but now the sight of scarred and puckered abdomens was routine. Many had also suffered blows to the head, usually through accidents or fights. In one grief counseling situation, I worked with twenty-four-year-old Alex Mora, who'd just learned that his younger brother had been killed by a stray bullet. He sobbed uncontrollably, grieving for the “good
one” in the family, wishing it had been him. And it could just as easily have been. Alex had already survived seven gunshots to his back and now walked with a limp. Post-traumatic stress disorder was almost as common a diagnosis as drug addiction, but here, the walking wounded weren't soldiers returning from any war, they were victims of the violence that comes with being part of New York City's rough-and-tumble underclass.

Not surprisingly, drugs were at the heart of most men's charges. Whether it was sales, working as a lookout, “steering” customers to dealers, robbing to get money to buy drugs, or committing a violent crime while under the influence, all roads led back to drugs.

But as I got to know these men, I discovered that they viewed drug dealing as their salvation. It was not only lucrative, but within their impoverished subculture it carried prestige. As Alonzo Gomez, a soft-spoken twenty-year-old referred for attempted suicide, put it, “I had real money in my pockets, and for the first time in my life, I was a somebody!” In their insular world, drug dealers command respect. Many are viewed as neighborhood “godfathers,” doling out cash for groceries, Pampers, and other necessities. In the larger society, these men are uneducated, unskilled nobodies, but through drug dealing, they've found a shortcut to the American dream of big money, power, and respect.

But the dream is short-lived, and the downside—violence, death, prison—is horrific, as Antwan Williams was discovering. Since our initial session, I'd been meeting with Antwan regularly, and as the shock of his arrest wore off, he knew his life would never be the same—nor would the lives of his family. By the fall, his three boys, aged ten, eight, and five, were returning to school and becoming more upset that Daddy wasn't home. “I used to walk them to school every morning,” said Antwan. “That's where I should be now—taking my kids to school.”

Initially, Antwan's wife tried to shield the children from the truth, but when it became apparent that he wasn't coming home any time soon, she started bringing them on visits. “It's terrible for them to see me in here like this. My youngest, he just hugs me and
cries, ‘Papi, come home!' I can't take it, Miss B! The whole reason I did this was to help my family. I wasn't looking to buy fancy cars. It was to take care of them—and now look at the pain I've caused!”

Although medication provided Antwan with considerable relief, he still lived in a state of high anxiety, especially as he contemplated his future. Not only was he facing serious drug charges, but he was also being implicated as part of a larger operation. “They're saying I'm part of some big drug gang that I never even heard of! I wasn't in any gang. I just ran duffle bags around for a few weeks!”

Antwan was determined to take his case to trial and reject any plea bargain. “These charges aren't fair!” he protested. But after several court hearings, he was reconsidering. His judge was a woman who'd carved out a citywide reputation for the heavy sentences she imposed on drug dealers—she'd been hailed in the press and lauded by Mayor Giuliani for being tough on crime. “Just my luck,” lamented Antwan.

But there was some hope. After his arrest, his family rallied to come up with money for a lawyer and succeeded in amassing $5,000. With this precious bankroll, Antwan could hire private counsel and was hopeful of at least getting his case switched to another judge. At Rikers, a private lawyer is a rare luxury; virtually all the detainees are represented by court-appointed attorneys. Although $5,000 was a fortune for Antwan's family, sadly, it was eaten up in the earliest stages of the case and the private lawyer was gone. His spirits plummeted as he faced the same judge, but now with a Legal Aid lawyer. Although still inclined to go to trial, his apprehension about this judge was further heightened when court officers warned him against it. “These guys rush up and whisper, ‘Don't go to trial with her—nobody
ever
wins in here!
Don't do it!
' I want to go to trial, Miss Buser—I want to fight these charges, but I'm so scared of this judge. I don't know what to do. I mean, it's not like it's coming from the guy in the next cell—
it's the officers in her own courtroom!

As Antwan agonized over his case, he also faced day-to-day survival behind bars. “It's scary in here. Guys get jumped, beaten.
I can understand why so many of them join gangs—nobody messes with you. But that's not all,” he whispered, glancing out at Miss Edwards. “It's the officers too. We had a search this morning, and it was bad. All these COs showed up in helmets and face shields, and they made us strip and line up with our hands against the wall. Then they started flipping mattresses and throwing our stuff all over—pictures, shoes—and laughing while they're doing it. My muscles are shaking, and I'm just saying, ‘
Oh God—please get this over with!
' And the one in charge is yelling, ‘Don't move, don't anybody turn around.' And this one kid, he's kind of stupid, you know, and he must have turned around 'cause next thing you know, he starts screaming, and they're dragging him off to a corner and beating him. All the while, they're saying to us, ‘Don't turn around!'
Jesus!
It's like they were hoping for someone to move so they could beat the shit out of him. Then they threw some clothes on him and dragged him out. I don't know where they took him . . . maybe to the clinic or to another house . . . I just don't know.”

After our session ended and Antwan left, my mind was swirling. I don't know what troubled me more: the judge or the housing search. I thought judges were supposed to be the impartial referees of the legal system. Instilling terror in the courtroom was not our legal system as I understood it. And when it came to the search, I just hoped Antwan was exaggerating. It couldn't have been that bad.

At least, I hoped not.

19

By the spring of 1996, New York City was in the throes of a budget crisis. In a cost-cutting move, the city drastically reduced inmate support programs, with the deepest cuts in Social Services. Responsible for handling veterans affairs, social security issues, and funeral leaves, the Social Services Department provided critical personal support to the detainees. At GMDC, these services were whittled down to one person handling the needs of 2,200 inmates. The only thing that was remotely possible was notifying the men of outside family deaths.

The gutting of Social Services stoked anxiety among the Rikers health-care staff—medical, mental health, and pharmacy workers, all of us employees of Montefiore Hospital. Montefiore had assumed the Rikers contract back in 1973, when the city was desperate to comply with a court order to provide a minimum standard of care to detained inmates, and no other hospital would do it. The contract was quietly renewed at three-year intervals for the next twenty years. The white lab coats with the Montefiore patch, worn by close to a thousand jail-based hospital workers, seemed as permanent as the jails themselves. But things were changing. The new profit-driven approach to health care was making its way to the gates of jails and prisons. Valued at hundreds of millions of dollars, the Rikers contract was now being eyed as a moneymaker. For the first time, the city was in a position to choose among an array of vendors.

Anticipating competition, Montefiore sought to demonstrate its ability at capping costs. For us, this resulted in the creation of the “Mental Health Center.” A step up from the standard Mental Observation Unit, this 350-bed facility was designed to provide a higher level of care to the most severely mentally ill. In the past, inmates who couldn't be stabilized were transferred to the prison wards of local hospitals at great cost. Now, all such referrals would be to the on-island Mental Health Center instead. If a hospital transfer was still necessary, it was done sparingly and at the sole discretion of the new facility. The opening of the Mental Health Center was greeted with fanfare as the largest jail-based psychiatric facility in the country.

But while everyone was buzzing about it, I paid little attention, keeping my head low and focusing on a demanding caseload. Roughly two-thirds of my cases were from GP, with the remaining eight or nine from our Mental Observation Units. Our mission with the mentally ill was to get them stabilized and, hopefully, discharged back to population. Since medication could not be forced, the initial challenge was to persuade someone in the throes of psychosis to start taking it, which could be quite a daunting task. This is what I faced with a twenty-one-year-old schizophrenic named Michael Tucker. When I first approached Michael, he was sitting in the corner of the dayroom, disheveled and mumbling to himself. I was only able to make the faintest of eye contact with him. Conversation about anything, much less medication, was hopeless. About all I could do was get his mother's phone number from his chart and hope she might have some ideas.

When I was at Rose Singer, Janet had advised me to call the families of the mentally ill for background and treatment history. These calls were often heartbreaking. On the other end of the line were families who at their wits' end in caring for their mentally ill child. While upset that their loved one was in jail, they were also grateful to know they were safe and being cared for.

When I reached Helen Tucker, Michael's mother, she reacted with a familiar gratitude and relief: “Thank you—oh, thank you for calling me.”

After I assured her Michael was safe, she filled me in on the disheveled young man seated in our dayroom. She said he'd been the apple of her eye, an A student, a former altar boy. His schizophrenia had emerged in his late teens, when he'd become inexplicably withdrawn, neglected to bathe, and began muttering to himself, responding to a strange world within. He was started on medication, but she said the medication gave him terrible side effects, so he'd stop taking the pills and get sick again. Instead of going to school, he started wandering the streets, getting into trouble. “We kept trying to get him back on track, but we couldn't watch him every second of the day—we had to go to work!”

Like most families in this situation, the Tuckers tried to get Michael into a program where he'd be supervised, but found there were none. “He couldn't be left alone, but there was no place for him to go. They shut down all the hospitals because they were snake pits. Okay, fine! But what did they replace them with? A few programs here and there, yeah—but not
nearly
enough for everyone who needs one. It's simple math! What were we supposed to do? We had to go to work, but we couldn't just leave him with a babysitter—people don't understand.”

At a loss to secure help, Helen Tucker went traipsing out at all hours of the night, into the streets and local parks, in search of her wandering son. “Some nights I'd be on the subways at twelve, one o'clock in the morning looking for him till I found him all filthy dirty—talking away to absolutely no one. Oh, Miss Buser,” she whispered, “do you know what it's like when the bum on the train is
your
child? My sister says, ‘You can't always be running after him, you have the rest of your family to think of,' but he's still my son. How'm I going to sleep not knowing where he is with all the danger out there? How? I'm his mother! I can't just turn my back on my child—
I can't!

But many families of the mentally ill do just that. After years of chasing after a loved one, trying to procure help that doesn't exist, their energy and resources exhausted, they simply give up and leave their child to fate. For every Michael Tucker that I worked
with, there were ten more whose families were no longer in the picture.

“It's terrible that he's in jail,” she whispered, her voice quivering. “But at least I can sleep at night knowing where he is.”

Fortunately, with joint coaxing from his mother and from me, Michael began taking his meds. With each passing day, his eye contact improved, and the muttering lessened. One morning, I arrived at the MO to be greeted by a freshly showered young man who was combing his hair. “Hello,” he said, shyly. “Well, hello,” I smiled. “Welcome back.”

Getting to know Michael Tucker was a delight. Underneath the psychosis was someone intelligent and artistically gifted. He began drawing sketches for me and Dr. Goodwin, his psychiatrist, and we pinned his artwork over our desks. Goodwin also gave him meds to soften the side effects of the powerful antipsychotic drugs that he needed. As Michael and I talked about his illness and the challenges he'd face once released, he bore little resemblance to the psychotic soul he'd been just a few weeks earlier. With clean clothes and his hair neatly braided, Michael Tucker now bore the youthful promise of any other twenty-one-year-old.

His mother was overjoyed.

Being a part of Michael's amazing transformation, as well as offering emotional support to his beleaguered mother, were wonderful moments for me, filling me with a deep sense that this is exactly where I was meant to be.

But at the same time, my joy was tempered by disturbing discoveries I was making about other aspects of life behind bars. For one thing, despite my hopes otherwise, Antwan Williams's account of the housing searches was neither exaggerated nor isolated. Within the privacy of our sessions, one inmate after the next repeated Antwan's story—of the ransacking, the beatings. With terror in their eyes, they described the banging of batons on the gates at all hours of the day and night, signaling the start of another terrifying, humiliating search.

By all official accounts, the Giuliani administration's mission of violence reduction was working and publicly hailed as a great success. But the fact that these searches were, in and of themselves, becoming a whole new source of terror never quite made it to the public square.

But the brutality extended beyond the searches. Carlos Rosario, referred for post-traumatic stress disorder, told me that just the sound of jangling keys and the sight of navy uniforms set his pulse quickening and his palms sweating. His symptoms were the result of a “beat-down” in a GMDC corridor. “I was in the wrong place at the wrong time,” he said. Returning to his house from the law library one afternoon, Carlos ran into a swarm of livid officers. Apparently, someone had thrown urine at a female CO. “It was open season on the inmates,” he said. “Any inmate would do. I kept trying to tell them I didn't do anything, that I was just coming back from the library, but it didn't matter. They shoved me into a corner, cursing and yelling—they had me on the floor and they kept kicking me, stomping my groin. The women were the worst—they were trying to kill me. I lost control of my bowels and my bladder. I shit all over myself,” he whispered. “Nobody stopped them—nobody helped me. All I could do was yell, ‘God sees you! God knows what you're doing!'” Carlos stopped to wipe away the tears. “God is the only one who knows what happens in here. The planes fly over us, and the rest of the world's going about its business, never thinking about what's going on at Rikers Island.”

As his story unfolded, every muscle in my body tensed up. I was horrified. “My God, Carlos, have you reported this?”

“No! I wouldn't dare!”

“Well, what if I—”

“No! Next time they'll kill me. Don't say a word—please!”

“No, of course not,” I said. “Of course not.”

Carlos Rosario's wishes placed me in a quandary that would become all too familiar: detainees confiding the abuse they'd suffered but imploring me to say nothing. As much as I wanted to
do something, it wasn't a simple matter. First and foremost, I was bound by the rules of confidentiality, but even if I wasn't, by reporting instances of brutality I would be potentially placing someone in even greater danger for retribution. One inmate told me about someone who'd been transferred to his house, his arm in a sling. The new arrival told the others that his arm had been broken by officers in another jail. That night, a band of unfamiliar COs showed up, asking which inmate had filed a complaint against COs in the other jail. When they spotted the sling, they attacked the screaming inmate, beating him to the floor and stomping his arm, yelling to each other, “Did you get the pins—are they all out?” When they were done, they tossed a pack of cigarettes to a few other inmates and ordered them to rough him up a little more, so as to mask their own actions. Pointing a finger at one's captors can be a dangerous business.

So far, I had not witnessed brutality firsthand. DOC was circumspect in delivering their punishment, whisking the civilians behind doors, shielding them from disciplinary measures. But one morning they let their guard down. I was headed downstairs to our Mental Observation Units when an officer instructed me and a couple of nurses to hold up inside the ground-floor stairwell. He locked the door, but it had a small window and we peered through it, just in time to glimpse an inmate, white plastic handcuffs binding his hands behind his back, being marched down the hall toward the receiving room by officers in riot gear. I was already hearing rumors that harsh punishment was often meted out in the receiving room. A few minutes later, the stairwell door opened abruptly, and we jumped back as this same handcuffed inmate, now bloodied and moaning, was propped up by two COs, one on either side of him, still in their riot gear. As they clambered up the stairs to the clinic, I froze against the wall, watching in horror as the young man's limp legs dragged and bounced off the steps.

As soon as they were out of sight, I charged back up the stairs and told Pat and Charley what I had just witnessed. Their reaction felt like a flashback to Rose Singer, when I'd told Janet about the
beating in the darkened corridor. Charley shook his head somberly. “Yeah, Mary, things like this do happen in here. There's no getting around it. Unfortunately, there's not much we can do—we walk a fine line in here. You make a little too much noise and you find your tires slashed. We rely on these COs to open doors, and all of sudden the door you need to get through isn't being unlocked, or they get around to it very slowly.”

I understood what Charley was saying. One physician's assistant who'd arrived at GMDC after being bumped from another jail told me that after reporting his frank impressions of an inmate's devastating injuries at the hands of DOC, a deputy warden informed him that he should no longer feel safe in that jail, prompting his transfer out.

“But what's important to keep in mind,” Charley continued, “is that just our presence, just the civilian presence in here, reduces the overall violence.”

“Yes,” Pat agreed. “I think it would be a lot worse if we weren't in here. And don't forget, Mary, that they're being watched.” Pat was referring to the jail's oversight agency, the Board of Correction, which reviewed inmate injury reports and regularly visited the jails. “There'll probably be a report on this guy, and hopefully they'll investigate.”

This reminder that someone official was watching reassured me, and when I discussed it with Alex, he urged me to stay focused on my work. “Let the oversight agency do its job, and you do yours,” he said.

After these conversations with my superiors and with Alex, I breathed a little easier and resumed my work with my mind at relative ease, a necessity if I was to be psychologically available to those in dire emotional distress.

* * *

Perhaps nowhere did I need to be more attentive than with the dying. Behind bars, the HIV infection rate is roughly ten times
greater than in the outside community, and all of us worked with HIV-stricken inmates. One of my cases, the likeable Kirby Evans, was gravely ill. Unlike the unforgettable Daisy Wilson, Kirby Evans wasn't interested in the Compassionate Release and was not looking to go home. Knowing he was terminally ill, he'd deliberately placed himself in a position to be arrested. In a halting Jamaican accent he told me, “I tried so hard to stop using drugs on my own, and to start taking care of myself with this disease, but I couldn't—I just couldn't do it. I didn't want to die in the gutter, miss—and that's what would've happened. I needed help. Coming to jail was the only way I knew that two things would happen: one, I'd be cut off from drugs, and two, I would get medical treatment. Crazy, huh?”

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