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The Prison Doctor
Dr Amanda Brown


‘Extraordinary’ Daily Mail As seen on BBC Breakfast Horrifying, heartbreaking and eye-opening, these are the stories, the patients and the cases that have characterised a career spent being a doctor behind bars. Violence. Drugs. Suicide. Welcome to the world of a Prison Doctor. Dr Amanda Brown has treated inmates in the UK’s most infamous prisons – first in young offenders’ institutions, then at the notorious Wormwood Scrubs and finally at Europe’s largest women-only prison in Europe, Bronzefield. From miraculous pregnancies to dirty protests, and from violent attacks on prisoners to heartbreaking acts of self-harm, she has witnessed it all. In this eye-opening, inspirational memoir, Amanda reveals the stories, the patients and the cases that have shaped a career helping those most of us would rather forget. Despite their crimes, she is still their doctor.







DR AMANDA BROWN is a GP at the largest women-only prison in Europe, Bronzefield. She was a regular NHS GP for a number of years, until she gave up her practice to move into the prison service. She worked at a teenage detention centre, before moving on to Wormwood Scrubs and then finally to Bronzefield where she continues to practice to this day. The Prison Doctor is her first book.


THE PRISON DOCTOR

DR AMANDA BROWN






ONE PLACE. MANY STORIES


Copyright (#ulink_6a35d6a8-e2b2-5b6d-863d-07c2f3ee6951)






An imprint of HarperCollins Publishers Ltd

1 London Bridge Street

London SE1 9GF

First published in Great Britain by HQ in 2019

Copyright © Dr. Amanda Brown and Ruth Kelly 2019

Dr Amanda Brown and Ruth Kelly asserts the moral right to be identified as the author of this work.

A catalogue record for this book is available from the British Library.

This novel is entirely a work of fiction. The names, characters and incidents portrayed in it are the work of the author’s imagination. Any resemblance to actual persons, living or dead, events or localities is entirely coincidental.

All rights reserved under International and Pan-American Copyright Conventions. By payment of the required fees, you have been granted the non-exclusive, non-transferable right to access and read the text of this e-book on-screen. No part of this text may be reproduced, transmitted, downloaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins.

Ebook Edition © May 2019 ISBN: 9780008311452


‘The mind is its own place and in itself can make a Heaven of Hell, a Hell of Heaven.’

– JOHN MILTON, Paradise Lost


Contents

Cover (#u81884585-a21f-57fc-b064-f267492f4913)

About the Author (#u012b516e-ffc5-5d7c-93bf-bc6cd22825d6)

Title Page (#u2e7e43e8-23c3-52d1-b608-5c40b8f98990)

Copyright (#ulink_68a19def-7c7c-5b6f-9d48-58344e836db9)

Epigraph (#u94f84fb1-5473-5012-b162-a3831a55e74d)

Prologue (#ulink_a79a797b-c17e-575d-a1f9-e71cae3818c0)

PART ONE (#ulink_2b3a6625-1f15-56d1-ae3e-1c6abae4bb32)

Where It All Began (2004–2009) (#ulink_2b3a6625-1f15-56d1-ae3e-1c6abae4bb32)

Chapter One (#ulink_bfcfede6-d696-540e-b3c1-1d7687d00091)

Chapter Two (#ulink_c78fcf1d-ced4-533d-b826-feb572a19b08)

Chapter Three (#ulink_fb4e74d9-1c09-56a6-b630-df92b24bcf0b)

Chapter Four (#ulink_6f9fe845-50ba-5a8f-8397-57e34f307bf8)

Chapter Five (#ulink_ba33af1a-cb40-55e4-a5dd-86008c2277da)

Chapter Six (#litres_trial_promo)

PART TWO (#litres_trial_promo)

The Scrubs (2009–2016) (#litres_trial_promo)

Chapter Seven (#litres_trial_promo)

Chapter Eight (#litres_trial_promo)

Chapter Nine (#litres_trial_promo)

Chapter Ten (#litres_trial_promo)

Chapter Eleven (#litres_trial_promo)

Chapter Twelve (#litres_trial_promo)

Chapter Thirteen (#litres_trial_promo)

Chapter Fourteen (#litres_trial_promo)

Chapter Fifteen (#litres_trial_promo)

Chapter Sixteen (#litres_trial_promo)

Chapter Seventeen (#litres_trial_promo)

Chapter Eighteen (#litres_trial_promo)

Chapter Nineteen (#litres_trial_promo)

Chapter Twenty (#litres_trial_promo)

Chapter Twenty-One (#litres_trial_promo)

PART THREE (#litres_trial_promo)

HMP Bronzefield (2016–present) (#litres_trial_promo)

Chapter Twenty-Two (#litres_trial_promo)

Chapter Twenty-Three (#litres_trial_promo)

Chapter Twenty-Four (#litres_trial_promo)

Chapter Twenty-Five (#litres_trial_promo)

Chapter Twenty-Six (#litres_trial_promo)

Acknowledgements (#litres_trial_promo)

About the Publisher (#litres_trial_promo)


Prologue (#ulink_9905d0c5-b96e-5ee0-be75-a8a7891e30ad)

HMP Bronzefield

I arrived to shouting and screaming. Prison officers were sprinting across the corridor and up the metal stairs.

‘What’s happening?’ I shouted, thinking a fight must have broken out.

I’ve seen and heard a lot during my fifteen years as a prison doctor, but the reply shocked me.

‘Someone’s having a baby!’ one of the officers yelled, repeating the news into his radio. He called for back-up, an ambulance, nurses, for all medical staff to come to House Block One.

‘Oh bloody hell!’

I followed the stampede. We sounded like a small army trampling up the metal stairs.

The deep stench of overcooked vegetables from lunch lingered in the air, green and ripe, sweet and rotten, mixed with sweat and cheap soap.

The prisoners heard us coming, thumping their fists on their cell doors. Metal thunder, filling the air.

Half a dozen officers were already crowded outside the entrance to the tiny cell at the end.

‘Coming through!’ I said, squeezing past them.

A shaft of light poured through the small barred window. Hiding in the shadows of the corner was a tiny young woman, standing and shaking. Her nightie was soaked in blood from the waist down. The walls were splattered too; violent red sprays, like protest graffiti.

She looked completely shell-shocked. In that moment, she didn’t know where or who she was. Her wiry black hair was drenched in sweat and glued across her face.

But where was the baby?

I tried to appear calm, stepping closer, trying to reassure her.

‘Hi, sweetheart, you’re going to be okay.’

Who knew if that were true? I suspected the prisoner was a heroin addict currently on methadone. The majority of prisoners on House Block One had a history of substance misuse.

The banging of the doors grew louder. Shouting and swearing, the air full of heat and sound and pressure. When the prison was like that it felt as if a spark could blow the place sky high.

The woman started screaming.

‘Get it out of me! Get it out of me!’

She must have meant her placenta because there, partially hidden by the bed, lying in a pool of blood on the cold prison floor, was a tiny baby girl.

I looked around, trying to see something I could use to wrap her up. The umbilical cord was torn, presumably ripped apart by her mother. The baby was so small I suspected she was a good few weeks premature. But was she alive? Was this poor, poor girl ali—

To my overwhelming relief she started to cry.

‘Has anyone got any clean towels?’ I asked.

‘Here you go, Doc.’ Becky, the prison officer, handed me the only clean thing she had to hand – a blue bed sheet.

I scooped her up into my arms, wrapped the prison sheets around her and held her close, desperately trying to warm up her fragile body. What a way to come into the world. She nestled into my chest and her crying settled a little.

I looked along the landing, desperately hoping for a sign of the ambulance. Both mother and baby needed to be transferred to hospital as soon as possible. The mother had clearly lost a lot of blood and as the placenta had not yet been delivered she was at risk of a postpartum haemorrhage, a major cause of maternal mortality.

While we waited, I checked for active bleeding. Thankfully there was no sign. But however relieved I felt, it was no comfort to her.

‘Get it out of me! Get it out of me!’ she continued to scream, over and over again, showing no interest at all in her baby. I worried she had not wanted the child, and wondered if she had been raped. I met so many women who had been the victims of gruesome sexual assaults.

The fear for the baby was that she may well have been subjected to drugs during the pregnancy. Any addictive substance that the mother may have used could also cause the foetus to become addicted. At birth the baby’s dependence continues, but as the drug is no longer available symptoms of withdrawal can occur. This is known as neonatal abstinence syndrome. Symptoms can begin within twenty-four to forty-eight hours and require very careful management.

‘Make room for the paramedics!’ someone shouted, and relief washed over me as I heard the thumping of boots.

They came into the cell and one of the officers handed me a white towel for the baby. It might seem trivial in such a horrific situation, but I found a great deal of comfort in knowing that beautiful creation – with a mop of dark hair plastered to her head, a mirror of her mother – would be wrapped in a soft, warm towel rather than prison sheets.

The paramedics placed a blanket around the mother’s shoulders and gently guided her into a wheelchair. She was still screaming ‘Get it out of me!’ as they started wheeling her away. She stared briefly at her baby in disbelief and disappeared from view.

Two prison officers would be needed to escort her to hospital, with one officer cuffed to the prisoner, just in case she tried to make a run for it. I didn’t think I’d ever get over the sight of that, however much I knew it was necessary. I’d been taught that no prisoner is ever too sick to make a dash for freedom. The story of a new mum who jumped from the first floor window of a hospital maternity ward still does the rounds.

One of the paramedics turned to me, opening her arms: it was time to hand over the baby.

I gave the little girl one last cuddle, gently stroking her cheek with my forefinger. She wrapped her whole hand around my little finger and I said a little prayer in my head, hoping for the best.

If she was allowed to stay with her mum they would be located on the Mother and Baby Unit, on return from hospital, for a maximum of eighteen months. If the mother’s sentence was longer, the child would then be taken into care. However, if it was decided the mother wasn’t fit to care for her baby they would be separated very soon after birth.

Being a mother myself, I can’t imagine what it must feel like to have your baby taken from you. To spend the days and nights in prison, imagining how she is growing up, what she looks like, who is taking care of her when she cries.

What would happen to the baby? I could look into it, of course. I could ask. I could follow the case through. But could I bear to know?

My contribution to the prisoners’ lives is limited. I can’t rewrite history for them, but I can take the edge off their suffering. I can help wean them off their addictions. I can be a listening ear.

My job is not to judge them but to care for them, and helping people, regardless of who they are and what they have done, is what I live for.

Everyone filed out and I was left alone, staring at the stained walls, the bloodied footprints. The claustrophobic grimness of the cell.

‘You all right, Doc?’ Becky asked.

‘Yes, mate,’ I sighed.

I followed her back downstairs and threw on my armour. It wasn’t just the prisoners who needed to be strong to survive being in there. If I took everything I saw to heart, I’d be a mess.

I had a job to do – other people were waiting for me.


PART ONE (#ulink_3c3fd65f-565f-55b5-99c4-09174e7cfd48)

Where It All Began (#ulink_3c3fd65f-565f-55b5-99c4-09174e7cfd48)

2004–2009 (#ulink_3c3fd65f-565f-55b5-99c4-09174e7cfd48)


Chapter One (#ulink_12a49c1b-cac2-594d-9e5b-eb2ac9102c01)

HMP Bronzefield

2019

‘Wait up, Doc!’ I spotted Gary, a prison officer, running towards me.

Many of the gates in the prison are alarmed, and staff have about thirty seconds to lock them before the sirens start blaring. I held the gate open. He weaved himself through in the nick of time.

I pulled the heavy gate shut, the resounding clang ringing through our ears. I locked it with one of the five keys chained to my black leather prison-issue belt. I knew which key I needed without looking; I’ve locked and unlocked those gates so many times.

We were in the central atrium at HMP Bronzefield. The largest female prison in Europe. Home to seventeen out of the twenty most dangerous women in the UK. Some high-profile murderers have been locked up here. Serial killer Joanna Dennehy, Becky Watts’s killer Shauna Hoare, Mairead Philpott who helped start a fire that killed six of her children. Then there was Rosemary West, of course, also once a prisoner there – or ‘resident’ as they are referred to in Bronzefield.

The atrium roof is surrounded by windows; daylight, bright and beautiful, 60 feet above your head. In the middle of the room, five very tall synthetic trees reach towards the light. Even the plastic trees are trying to get out of there. It’s bright and airy, a far cry from the tiny cells where the prisoners spend so much of their time.

‘You’re looking tanned!’ I told him.

Gary grinned at the memory of his week of freedom.

‘Seven days and six nights in Spain. All inclusive, the missus loved it. I didn’t want to come back!’

But I knew that wouldn’t be quite true. The shifts can be long and exhausting, physically and emotionally, but for some reason we do still want to turn up for work. And it’s not just because it pays the bills.

It gets into your bones. The drama, the camaraderie, the highs and lows. I can honestly say I would rather spend a Friday evening working in Reception – meeting prisoners arriving from court, a diverse range of people, from different backgrounds, different cultures – than be out socialising.

But then, I’m not very good at small talk any more.

After hearing the sorts of stories I have over the years, I find it hard to engage in social chit-chat. I find it hard to talk about things that are trivial. You’d think I’d relish the break, the relief from the seriousness, but I don’t think of it like that. Every day I’m part of something important. I think of it as an honour, a privilege, that people, often from completely different worlds from mine, will choose to confide in me and relate to me.

I don’t know if it was his break away from the place, but Gary was in a philosophical mood. As we walked towards the gates which lead on to the Healthcare unit, our keys jangling with every footstep, he turned to me and said, ‘You know what, Doc, I’ve been thinking.’

‘Uh oh!’ I teased him.

He flashed me a smile and then suddenly looked serious.

‘I’ve been thinking about life. This place, and why people end up here.’

I was intrigued. ‘Go on.’

Gary had been at HMP Bronzefield for fourteen years and was one of the good guys. He liked the challenge of dealing with the emotional needs of prisoners; he wanted to see them reformed.

He frowned, thinking for a moment. ‘I think most prisoners have had a Sliding Doors moment,’ he said. ‘You know, that point in life where your life could really go either of two ways.’

I stood back while he opened the next set of gates. Like me, his fingers found the right key without ever having to look.

We made our way into the medical suite, a selection of rooms off a narrow corridor. I waved hello to Soheila in the pharmacy.

‘It could happen to anyone, couldn’t it?’ he continued. ‘A moment, a random moment when your whole life hangs in the balance. Like . . .’ He tried to think of an example.

‘You’re having a drink in a pub, a fight breaks out, you hit someone, that person falls back and smacks their head. They die. The next thing you know, you’re banged up inside for manslaughter.

‘Your life can change in the blink of an eye. You know what I mean, Doc?’

Of course I knew. After all, it was just such a moment that had led to me being there.

Buckinghamshire

2004

The warmth of the central heating blasted into my face as I walked through the entrance doors of my GP practice.

I was greeted with a smile from Kirsty on reception.

‘Morning, Amanda!’

I had no idea how she managed to be so cheerful, so early in the day.

As usual I felt daunted at the thought of how many patients I was likely to be seeing that day, but I loved my job as a GP – however exhausting it was.

I tugged my gloves off with my teeth, and picked up a pile of letters and notes Kirsty had put aside for me. So much paperwork.

‘How’s today looking?’ I asked.

‘Fully booked. Biscuit?’ Kirsty waved the packet under my nose.

I shook my head. ‘Don’t forget the lunchtime meeting.’

‘All scheduled, she said, tapping at the calendar on her computer screen with her biscuit.

My stomach somersaulted thinking of the meeting, and the changes it might bring to my cosy practice.

In less than a month, on 1 April 2004, the new GP contract would be introduced, in which the whole pay structure for general practice would change. The basic pay would be reduced, but bonus payments could be earned if certain questions were asked and checks were done during the consultation.

I think it was intended to make GPs perform better, but I knew I’d struggle with it – gathering such information when perhaps a patient was deeply depressed or had recently been diagnosed with cancer, might feel inappropriate.

After twenty years my patients knew me too well. They would be able to see through why I was asking the questions, and I knew I couldn’t do it just for the sake of it.

I reflected on how things had changed in the two decades since I’d started the surgery from scratch. The practice was within easy reach of London, and I’d managed to build my list up to about four thousand patients.

I’d moved with the times, always adapting to the changes within the health system and my surgery, but this latest scheme was threatening my core beliefs and principles concerning patient care. I was deeply concerned that I wouldn’t be able to change my consultation style and gather the information required to earn the bonus payments. I also had a terrible inkling that my practice partners would demand I do so.

At 1 p.m. I steeled myself for what was to come, grabbed my note book and pen, and headed along the corridor to the meeting room.

Pretty pictures of landscapes, seascapes and flowers lined my way. I’d worked hard over the years to remove the sterile feel a new-build can have, to create a welcoming environment where people could feel relaxed. Small touches like that mattered to me.

I was the first to arrive.

I sat down to wait for the practice manager and my two partners, who now co-owned a share of the surgery. They were both excellent doctors, young and ambitious, and as I had never been particularly good at managing money or the business side of running the practice, I was more than happy to let them take charge.

The door swung open. Rohit, one of my GP partners, walked in, rubbing his hands. The other two followed close behind. They took their seats.

The tension was palpable. I sat there, legs crossed, anxiety building. My heart was pounding and I felt sick.

Rohit looked directly at me. ‘So, how are you feeling about the changes, Amanda?’ he asked.

We both had strong personalities and didn’t always see eye to eye.

I leant forward, crossing my arms on the table. My shirt tightened across my back, absurdly making me feel even more trapped.

Rohit leant back, giving me a tight little smile.

‘Well . . .’ I started, and didn’t stop until I’d expressed how unhappy I felt about the new scheme. I was open and honest with them about what I was – and, most importantly, wasn’t – prepared to do.

They glanced sideways at each other.

We were all silent for a while.

Rohit cleared his throat. ‘Well, if you don’t pull your weight financially, we will resent you,’ he said in an icy tone.

I felt like the wind had been punched out of my lungs.

Resent me? I was the one who had built up the practice!

I felt furious. Unappreciated. But most of all, hurt.

Resent me? To be made to feel so worthless, to be expected to live with their resentment, or toe the line to make more money . . .

I couldn’t work like this. I wouldn’t work like this.

It was my Sliding Doors moment. In the blink of an eye, my life took an unexpected turn.

‘Well, I’m leaving then,’ I said.

All three stared at me in disbelief as I slowly peeled myself out of my chair and walked out of the door.

I must have looked white as a ghost, as Kirsty on reception asked if I was all right.

‘No, I’m leaving.’ I choked back tears.

I heard her gasp, but whatever words followed were lost as I walked through the front doors, out into the cold. The wintery air hit my lungs, making it even harder to breathe.

What was I going to do now? I was forty-nine and turning my back on my career, my income, on everything.

I spun around and stared at the surgery I had created from nothing all those years ago. With it’s pretty rhododendron hedge that I’d planted to give it a more welcoming, community feel. The building my property developer husband, David, had built for me. I thought about the thousands of patients on my list, many of whom had become like friends. I’d watched their children grow up, I’d listened to them when they worried, seen some make huge life changes. I’d held the hands of heartbroken elderly patients as they cried with loneliness. I hadn’t been just a doctor: at times I felt as if I’d been a counsellor, a social worker, a vicar, a friend, all rolled into one. I had loved my life as a village GP, and over the years I had grown to know and love so many of the people I cared for that I used to joke I could write a book on many of them. Apart from my family, my surgery had been the most important thing in my life.

And just like that, it was all over.

*

I couldn’t sleep.

I’d been staring at the same spot on the ceiling for hours. David held my hand while I lay there, chewing over my decision. My husband, my boys – Rob and Charlie – they were everything to me. Doing something that lurched us into financial risk wasn’t something that sat well.

David had reassured me it would be okay. Luckily he had a good job and would be able to take care of us. I wasn’t used to someone taking care of me though. Ever since I was a little girl I’d wanted to stand on my own two feet. I loved working, it gave me a purpose, I didn’t want to give that up. I also loved helping people, that’s why I became a doctor. My thoughts went back to my patients. I felt a huge pang of guilt for walking away from them.

Guilt, fear, sadness, anger – a cocktail of emotions were turning and churning around in my mind, growing louder and more intrusive in the quiet of the night, until I finally snapped.

I peeled back the duvet, tiptoed across the room and slipped into my thick fleece dressing gown that was hanging from the hook on the back of the door. The cold fabric, chilled by the winter air, sent a shiver down my spine.

David stirred. ‘Are you okay?’

‘I’m fine, go back to sleep.’

Downstairs, I made myself a cup of warmed milk. I took a seat at our chunky wooden table and stared through the kitchen windows into the night. The infinity of black felt as dark as my future.

I didn’t have a formal agreement with my partners about my notice period. We had agreed I would leave the surgery in just three weeks’ time.

Leave my surgery – those words stoked my anger again. I didn’t feel it was right! GPs shouldn’t be getting paid bonuses for doing their jobs!

I took another furious slurp from my mug.

My partners had also been keen that I keep appointment times to ten minutes, and only address one problem in that time. But often my patients had been waiting weeks to see me, and if they came in with more than one problem I didn’t have the heart to tell them they would have to book another appointment, that they would have to wait another three weeks to tell me the rest of what was bothering them. More importantly, one ailment could be related to another; it was important to hear the full story.

I felt more indignant than ever.

I stared through the kitchen window again. But this time I looked past the darkness to see my own reflection.

My hair, short as it was, had managed to find entirely absurd, startled shapes. I flattened it down the best I could with my hand, and swept my fringe from my eyes.

I looked utterly exhausted but I knew I wouldn’t be able to get back to sleep until I had got everything off my chest.

I made my way to the study.

I didn’t need to switch the light on, the moon was beaming through the large sash windows, illuminating the cluttered room.

The shelves were so packed with medical journals they were warping under the weight, sinking in the middle like a hammock. The desk which overlooked the garden wasn’t much better. Either side of the computer were mountains of paperwork. The weight of a life, mountains and mountains of paper, and I was throwing it all away.

Beside the keyboard were silver-framed pictures of my boys in their school uniforms. They sported proud grins. Were they proud of me?

Twenty years. Twenty years of looking after people and it was all over.

I switched on the computer and reached down to turn on the electric heater by my feet. It rattled and hummed, the noise strangely comforting.

I started writing. Pouring my heart out at half past three in the morning, tipping all of my emotions onto the blank page.

It was everything I wished I had expressed in the meeting earlier, every argument against the new contract and their new policies. Explaining exactly how it had forced me into quitting the job I loved.

I wrote for nearly an hour and then sunk back into the padded leather swivel chair, letting out a huge sigh of relief.

What I should have done was pressed ‘Save’, slipped back under my duvet and snuggled into David, now that I had got everything off my chest.

Instead, I pressed ‘Send’.


Chapter Two (#ulink_1020868a-8022-5f67-a81c-98c6a57ffc88)

I didn’t expect to make the front page!

Sitting in my room at the surgery, I found myself staring at my own words, splashed across the pages of Pulse, a national magazine for GPs.

‘I just ride off into the sunset and no one gives a toss.’

That was what I’d said, but I didn’t think they were going to quote me word for word!

I cursed myself for being so impulsive and emotional. What I meant by that line was that I’d worked so hard to try to do a good job, for nearly twenty years, but it felt like it counted for nothing in the end because no one cared. All they wanted to see was boxes being ticked.

I wished I’d packed a pair of sunglasses to hide behind.

But there was nothing I could do about it now. My opinions were in black and white for all to see. The best thing I could do was straighten my back and get on with working out my three weeks’ notice at the practice.

I was yo-yoing back and forth between anger and regret again. It wasn’t a healthy place to be and thank goodness I had a half-hour break in my schedule. I grabbed my bag and made a run for some fresh air.

Everywhere I looked I was reminded of what I was losing. As I walked through the waiting room, I could feel dozens of pairs of eyes staring at me in disbelief – the leaving letter I’d written to patients was pinned to the notice board.

I crossed the tree-lined street to the coffee shop opposite the surgery, but the atmosphere in there wasn’t much better. Sandra, the pharmacist from the chemist next door, was in front of me in the queue. She’d been dispensing medication as long as I’d been a GP in the area. I thought she was going to mention the article, but she had other news for me.

‘It’s as if the village is in mourning,’ she blurted.

Sandra had become a close friend over the years. She had the kindest face, which was framed by her masses of chestnut hair. She wasn’t much over five foot tall, and looked up at me with her dark eyes.

I couldn’t respond. I had no idea what to say. She carried on, every word tugging at my heart.

‘Your patients are so sad. They don’t know what they’re going to do without you. Amanda, do you really have to go . . .?’

I gently squeezed Sandra’s arm. Really I wanted to throw my arms around her and give her a bear hug.

‘I’ve made my decision, and I’m just going to have to see it through now. I feel terrible though,’ I admitted. The urge to cry rose up in me. That was the last thing I needed: to burst into tears in the middle of a coffee shop queue.

Then came the big question. ‘But what will you do now?’

Well, yes, what indeed?

‘I guess with your experience you could easily get a job in another practice,’ she continued.

That was the last thing I wanted. I’d be faced with the same problems, just in a different location. But what was I going to do? I felt like I was going through a bereavement. I felt sad, lonely, lost, unable to see a way forward, a thick dark fog of self-doubt and guilt obscuring my vision of the future.

Suddenly, the roasted aroma of coffee beans smelt acidic, nauseating and unbearable. The sounds of the café, the white noise of chatter, the hiss of the milk steamer . . . It all felt more than I could bear. I felt waves of heat rush up my neck and I was desperate to return to the chill of the winter air outside.

It was torture. What had I done?

‘I’m going to have to get back to work,’ I said to Sandra.

‘But you haven’t even had your coffee. We have to do drinks before you leave . . .’ Her voice trailed off as I gave her the thumbs up and dashed for the door.

Outside, I took a few deep gulps of air, drinking up the freshness in place of my coffee. I felt like crying. It was all too much. Seeing my outburst in the magazine, hearing how my patients were feeling and then, of course, the final panic: the realisation that I didn’t have the faintest idea what I was going to do with the rest of my life.

Back inside my consultation room, things went from bad to worse when Mr Collins knocked on my door.

If only I could have hidden behind my desk for the afternoon, but there was no getting away.

‘Come in,’ I said, hiding behind a cheerful voice.

Brian Collins was one of my long-standing patients. He was 56 years of age, tall, with grey receding hair, and was always clean shaven. He had long spindly fingers that always made me think he should play the piano.

Brian poked his head around the door and gingerly made his way across the mottled carpet towards my desk. His steps were uncertain; a man whose confidence had taken several knocks.

He’d been on and off antidepressants for as long as I could remember. They eased his depression, but then he would stop taking them, convinced he was feeling better, only to fall back into a depressive slump.

Brian was typical of so many of the patients I saw at my practice. Wealthy, successful, middle class, well-spoken. The stereotypical pinstripe-suited man who travelled into the city every day. When I’d first started working in the area, he was the type of man I must admit that I felt a bit intimidated by, as I thought they might not trust a young female doctor. But, to my surprise, I managed to win him and many other patients over. I think as much as anything else it was by showing them that I really cared about them. I’ve always believed that the root cause of many illnesses can be found in the emotional problems that lie bubbling underneath. The problem then became that many of my patients seemed to depend on me as a counsellor, more than as a doctor . . . Mr Collins was no exception.

‘What can I do for you, Brian?’ I asked, my voice gentle, warm, doing my best to set him at ease.

His eyes were downcast as he slumped into the chair opposite.

‘Is it really true you’re going?’ he said, his eyes filled with worry.

It was the first time I’d come face to face with the effect my departure was having, and it was unbearable. The tension in my little consultation room was palpable.

‘Yes, I’m afraid so.’

He fell completely silent for a moment, staring, intently, at one spot on the carpet before finally looking me in the eye. I could see the tears. It was heartbreaking to watch.

He tugged free a tissue from the box on my desk and dabbed the corners of his eyes.

His voice trembled. ‘But what will I do without you? You’re the only person who understands what I’m going through, and I find it so hard to open up to people.’

His fears were completely natural, and were shared by many people who might feel anxious about changing their doctor.

‘Will you be moving to a surgery nearby?’

I opened my mouth to speak, but nothing came out. I was going to tell him no, but the question had thrown me – all the way back into that pit of uncertainty. I swallowed hard and whispered. ‘I don’t think so.’

His eyes dropped again, crestfallen, and then he suddenly lurched onto his feet.

He shot out his hand, as I imagined he had done hundreds of times in his board meetings, disguising his distress with formality.

‘Well, I wish you all the best for the future, Doctor Brown.’

I felt a lump rise in my throat as I shook his hand.

‘You’ve been wonderful and I really appreciate everything you’ve done for me over the years,’ he carried on in his rigid, staccato voice. ‘And anyone who has you as their doctor next is blessed.’

I bit my lip – hanging on by a thread to stop myself breaking down in tears. Hiding behind my medicine, I told Mr Collins to continue with the same dose of antidepressants, and to review how he felt in three months.

I walked him to the door and we had a moment’s silence, both aware of each other’s grief. ‘Things will get better,’ I encouraged.

With that, he slipped out of the door and I broke down, the avalanche of the day’s emotions crashing in on me.

It was no good; a doctor’s life is a constant flow of difficult situations, of emotional patients, of pain and sadness and death. I needed to be stronger than that – I was stronger than that, always had been – but I just couldn’t see how I was going to get through the next few weeks.

My phone rang.

I wanted to leave it ringing, and I almost did, but I needed something – anything – to pull me out of the low mood I was descending into.

‘Is that Doctor Brown?’ asked a voice on the line.

‘Yes, who’s speaking?’

‘It’s Doctor Phil Burn here. I saw your story in Pulse.’

My stomach lurched.

‘I’m recruiting doctors to work in prisons in the South East of England.’

‘Sorry?’ I wasn’t sure I’d heard correctly.

‘I’m looking for a doctor to work in a prison,’ he repeated.

I was stunned by the thought. I had been so locked away in my village practice that alternative placements like he was suggesting hadn’t really occurred to me.

Dr Burn continued to explain the job. It was a part-time position at a youth prison for 15–18-year-olds, HMP Huntercombe in Oxfordshire, not too far from Henley-On-Thames. ‘Would you be interested?’ he asked.

The thought of prison conjured up images of fights, stabbing, hangings – the horror often portrayed in films. Could I really see myself working in that world?

On a deeper level, of course, I knew that my immediate mental image of prison life could hardly be accurate. And I needed to do something . . . Something new, something that would challenge me, something that would make all of this feel worthwhile. Something that might help people.

‘Yes!’ I said, actually shocking myself. I hadn’t given myself time to think deeply, I was relying on gut instinct, I had no idea what the salary was, I should have been asking so many more questions . . .

But how bad could 15–18-year-olds be? My boys, Rob and Charlie, were that age, so hopefully I would be able to relate to the inmates and perhaps they would view me as a mother figure and not a threat.

Had I really been that naïve? Yes. But I would learn.

He went on to explain that not many doctors wanted to work in prisons, as it was seen as an intimidating and unpleasant environment, dealing with difficult, unwilling, unpredictable and possibly violent people.

‘But’ – and he laughed as he said it – ‘anyone as outspoken as you should be able to handle a challenge!’

I couldn’t believe it, my candid words in the magazine had opened up a whole new world of possibilities. Dr Burn had recognised the fighting spirit in me.

Just because I was nearing fifty, why shouldn’t I try something new? It’s never too late to start over. Whether it be your career, your marriage, your lifestyle. That’s what I’d been telling my patients for years, and now it was time to embrace the unknown myself.

And maybe I could even make a difference to these boys’ lives.

*

Dear God, what have I done?

Back at home, I was questioning my decision. Had I been rash, accepting a job I knew practically nothing about?

I was sitting at the kitchen table doing some background reading into Huntercombe prison.

It was officially classified as a young offenders’ institution, having housed teenagers since 2000. It had originally been built as an internment camp during the Second World War and was turned into a prison in 1946.

Unlike adult prisons, which are categorised by letters, from A to D, depending on the seriousness of the crimes of the prisoners locked up, a young offenders’ institute has no grade. That didn’t reassure me though.

I’m not frightened easily, but I was filled with self-doubt as I read up about the crimes some of these teenagers had committed. It wasn’t just theft and burglary but also murder and rape.

I turned to David for advice.

‘Do you think I can do it?’ I asked

He was peeling the spuds for dinner and laughed. ‘Don’t be ridiculous, of course you can, you’re more than capable.’ He smiled. ‘You always are.’

I loved the fact that he was so supportive of both me and my career. God knows how many evenings he’d spent alone, looking after the boys while I’d worked very long days or been called out in the middle of the night. He understood my drive and my need to help others. He understood I had worked too hard for my career to give it up.

‘I’m going to be treating teenagers who have committed some very serious crimes!’

It was hard to comprehend that boys my sons’ age could have killed someone, raped someone, abused a young child.

‘But they need a doctor, too. And I can’t think of a better person for the job,’ David said.

He was right. I wasn’t there to judge; my job was to try to make people better.

‘But it’s a prison. Have I got the guts to handle it?’

I heard the plop of another peeled potato being dropped into the saucepan of water, then David turned around and looked me in the eye.

‘Do I have to remind you of some of the brave things you’ve done in the past? Do you remember that bloke who had a knife to his throat . . .?’


Chapter Three (#ulink_a9c8a32e-fbd8-539c-aa30-8112339c380d)

Four years earlier . . .

Buckinghamshire

July 2000

It was a scorching summer’s day and I was sipping on an ice cold drink and having a quick bite to eat at my desk in my lunch break.

A gentle breeze lifted the curtains as it blew into my consultation room, tickling the back of my neck.

I battled to keep my eyes open; in that heat I could easily have dozed off for a few minutes. Suddenly the peace was broken by screaming and the sound of footsteps hurtling down the corridor.

My door burst wide open. One of my patients, Jenny Scott, was standing in front of me, breathless, panic stricken.

‘Amanda, you have to come with me now,’ she screeched.

Her normally perfectly styled hair was windswept and tangled. Her usual composure was shattered.

‘It’s Jonathan – he’s got a knife and he says he’s going to kill himself. I don’t know what to do. He’s at home . . . please come.’

Jonathan was Jenny’s husband, an alcoholic who suffered from severe mood swings. I’d been treating both of them for years. Without a second thought, I grabbed my bag, filled with all the equipment and medicines I carry to my home visits, and chased after her into the surgery car park.

She sped off in her car, but I knew exactly where to go. I’d been to their house on many home visits in the past.

It was less than five minutes from the surgery, in a pretty lane with beautiful houses on either side. Large homes, with large gardens and expensive cars parked in the driveways. Many people would look at the area and think that the people who lived there surely had to be happy. But, from my experience, inside many of those magnificent houses, behind the seemingly perfect façades, there lurked a lot of anguish and unhappiness. A significant proportion of the medical problems I treated were brought on by stress and financial pressures. I learned early on in my career that money very often doesn’t buy happiness

Turning into their road, the dappled sunlight trickling through the trees was replaced with the blue and white flashing lights of several police cars. They were parked outside the Scotts’ home. Half a dozen armed police officers wearing protective vests surrounded the house. I parked and got out of my car. What had I walked into? It looked like a hostage negotiation scene from a film.

Jenny was standing behind one of the police cars. She beckoned me over. A police officer stepped into my path, his hand outstretched, ready to stop me.

‘It’s okay, I’m his doctor,’ I explained.

The police officer moved aside and Jenny ran forward, a look of relief washing across her face.

‘Thank God you’re here, Amanda.’

Her whole body was trembling, but she wasn’t crying. Jenny was a tough, resilient woman, and could cope with a great deal. Goodness knows she’d had to over the years. It wasn’t uncommon for Jonathan to lose his temper, but I never thought I’d see the day when police cars were parked outside their house.

‘So, what’s happened?’ I asked.

‘I don’t know, I don’t understand, one minute he was fine and the next . . .’ Jenny paused to compose herself. ‘We were having lunch together. I got up to get the salad cream out of the fridge and noticed three of the wine bottles were missing. Three!

‘I know he likes to drink, Amanda, but three bottles by lunch was a lot even by his standards. I was tired, I was angry, and I asked him where they had gone.’

Her voice started to tremble and, knowing Jenny, she was blaming herself for whatever happened next.

‘He started shouting that I shouldn’t have asked him, and the next thing I knew he’d pulled the carving knife out of the drawer and was holding it against his neck. He was telling me he didn’t deserve me, and he was going to kill himself.’

She looked to me for reassurance. ‘This is my fault, isn’t it?’

I squeezed her arm. ‘No, Jenny,’ I stressed, not for the first time. ‘This is not your fault.’

I felt deeply sorry for her. I couldn’t imagine what she had suffered over the years. And being the strong, independent woman that she was, I imagine she had kept a lot of her pain locked up inside. I also felt deeply sorry for Jonathan, living with anxiety and depression, turning to alcohol to numb his pain.

‘I tried to get him to put down the knife,’ she said. ‘But that only made him hold it closer to his neck. I was terrified, so I ran. He listens to you, Amanda, please will you talk to him?’

I felt the pressure building.

I turned to one of the police officers and asked if they had approached Jonathan.

‘Not yet. We have to wait for legal authority to enter. Won’t take long but right now . . .’ He shrugged. ‘Well, we’re stuck here.’

‘What about me?’ I asked. ‘Can I go in?’

‘Legally? Yes, you’re his doctor, and have reason to assume he may be hurt.’ He looked at me and the fear in his eyes, the concern for my safety, nearly changed my mind. ‘You shouldn’t, though. You should wait for us to get clearance and then we’ll all go in together.’

But that was no good, was it? Jonathan needed me. Jenny needed me. It was my job to help and I was obliged to carry out my duties.

I walked up the driveway.

The Scotts’ house was very beautiful, with a large weeping willow in the middle of the lawn, and flowerbeds filled with stunning roses and brightly coloured summer flowers. Rectangular flowerboxes hung along the wall by the front door, and flowerpots filled with pansies and lavender lined the driveway.

My heart pounded as I drew closer to the porch. I was nervous about what to expect on the other side of the door. There was a chance Jonathan could turn the knife on me.

It felt like one of the longest walks of my life. I turned back to see everyone’s eyes watching me. Jenny’s hand was clutched over her mouth and the police officers were poised, their hands hovering over their weapons, ready to jump in at any moment.

I took one last look back and then plunged in.

The front door was ajar. I pushed it open with my fingertips, stepping into the hallway. The house was eerily quiet, my shoes sounding far too loud on the wooden floor.

I called out. ‘Jonathan?’

Silence.

‘Jonathan, it’s Doctor Brown.’

There was still no reply but I kept moving, into the kitchen, bracing myself for what I was about to see.

But he wasn’t in the kitchen any more.

I called out, again. ‘Jonathan? It’s Doctor Brown. I’ve come to see if you’re okay.’

I heard a noise coming from the living room.

The nervousness I’d felt had left me now. I needed to find him as quickly as possible. I moved into the living room.

‘Oh, Jonathan!’ I gasped as I turned the corner.

He was standing in front of their leather sofa, his slim frame outlined by the sun streaming through the skylights. The knife, pressed hard against his throat, was glinting. He was swaying slightly, drunk, a sweat glistening on his forehead, his lips wet.

He stared at me, not saying a word.

I was shocked. I knew him well, as he had confided in me over the years about his problems, and I’d come to regard him more as a friend than a patient. My heart went out to him that he felt so desperate he wanted to kill himself.

His lips were white, his face drained of colour. His eyes were agitated, his whole body tense. But still he didn’t speak; he just kept the knife clamped to his throat.

I didn’t have any choice but to try to take it from him.

I started to gently walk towards him. My voice was soft as I said, ‘Please, please, Jonathan, give me the knife.’

He was frozen to the spot.

‘Let me have the knife, it’s going to be fine.’

Still no reply, as I softly, slowly moved forward. What was going through his mind? Was he about to cut his own throat? Was he about to turn the knife on me?

The sound of police radios and talking were coming from outside the window.

I couldn’t see any lacerations on his neck, but the tip of the knife was pressing hard against his skin. Any trigger could set him off.

‘Jonathan—’ I started, but didn’t finish my sentence. Suddenly, he lurched towards me, the knife in his right hand.

It all happened so quickly. I froze, suddenly certain that I’d made a terrible mistake, that I was going to die, there in that opulent living room. Blood spilling onto a carpet few could afford. I’d gone there to help but Jonathan was too far gone, too lost to see clearly. His arms stretching out towards me, the knife shining, looking sharp enough to cut a slit in the air itself.

Yes. I was about to die.

He flung his arms around my neck and flopped onto my shoulders, letting go of his grasp of the large carving knife. It made a small thunk as it dropped onto the living room floor behind me. Part of my brain heard it fall, recognised that the danger was past; the rest of me was occupied with the sobbing Jonathan. I stood there, holding him up, as he sobbed and sobbed and sobbed.

‘It’s going to be okay,’ I said, stroking his back as I would a child who desperately needed a hug and reassurance.

When his breathing had calmed a little I told him we needed to go outside, that Jenny was waiting for him.

His voice was thick with tears. ‘How can she ever forgive me?’

‘She loves you, we all care about you. Jenny would be distraught if anything happened to you,’ I said.

I led him out of the living room and towards the front door.

He was wobbling still, drunk and disorientated, and I propped him up as we walked into the sunshine together.

I was relieved to see the flashing lights of an ambulance.

‘I want you to go to the hospital for me,’ I said. ‘They’ll help. Can you do that for me?’

He nodded.

Jenny ran towards us, taking her sobbing husband into her arms. I was so thankful that he was safe. I looked at the two of them, unable to shake the thought that one – or both – of them could have died today if things had gone differently. Ultimately, while I may have helped to ground him, Jonathan had held on to enough strength – just enough – to stop himself from doing something that would have torn their lives apart.

I stood back as the paramedics helped him into the ambulance, to take him to the psychiatric ward of the local hospital. Jenny followed in her car. He was in need of expert help, more help than I could give him.

I watched as they disappeared from view and then got back into my car and drove slowly back to work. I had other patients to see.


Chapter Four (#ulink_9e1723e6-4e50-5e89-9c8d-ecc099d7b47c)

November 2004

HMP Huntercombe

I remembered those nerve-racking steps towards Jonathan and Jenny’s house, as I walked towards the entrance of HMP Huntercombe. My heart was pounding just as much, my palms moist with anticipation as to what was around the corner.

And then suddenly, just as it had all those years ago, courage kicked in.

I straightened my back and walked on with confidence and purpose.

It was daunting but exciting. I was reinventing myself.

My thoughts were broken by the noise of a large white van rolling up to the prison gates. It had the distinctive tiny blacked-out windows running along the sides, the ones the paparazzi try to reach their cameras up to when high-profile prisoners leave court. I wondered who was inside it.

As the huge metal gates opened, I was able to get a brief glimpse of what lay on the other side. A concrete yard, some more fencing, half a dozen prison officers . . . and then it all vanished from view as the gates slammed shut.

The intimidating façade of the prison wall, with its barbed wire twisting over the top, was a stark reminder of what life held in store for those being dropped off.

I arrived at the gatehouse, where a thick glass screen separated me from the officers who kept a close eye on the monitors to see who was coming and going.

It was like being at passport control at the airport, slowly being given the once-over.

‘What’s your name?’ asked a small stocky man with a thick Essex accent.

‘Doctor Amanda Brown,’ I replied, loudly, just in case he might not hear me through the thick glass screen.

‘Have you got your ID with you?’

I pulled out my passport and driver’s licence from my bag, and passed them through the hatch that he clicked open.

There was a long pause as he checked my ID, and then I heard the rumble of a big heavy metal door sliding open.

I stepped forward, taking another half-step to make sure the monstrous door didn’t clip me as it closed.

I was now on the other side, standing in a narrow corridor. An officer spoke through another glass screen, and told me that someone from Healthcare would come along soon to meet me. I moved along the corridor slightly, to a small room lined from floor to ceiling with lockers. This, presumably, would be where my belongings would be stored, the things I could take inside being limited for safety reasons. Straightaway, a reminder of what I was facing: a job where the contents of my pockets could get someone killed unless I was careful.

The head of Healthcare arrived, greeting me with a friendly smile and a handshake. I hadn’t seen Dawn Kendall since my interview, six months previously – the process of getting security clearance and having contracts drawn up for the job had taken that long.

She had a clipboard in one hand and a large set of keys in the other, which clinked as she rolled them between her fingers. She looked like she meant business, with her black trouser suit and white blouse.

I was given a locker in which to store my phone, bag and coat, then she unlocked another large solid metal door, and I followed her through. That was locked behind us, the sound heavy and horribly final. A large metal gate followed; again keys jangled, locks turned. Then – finally – we were in the prison grounds.

‘Once you have your key training you’ll be able to do this yourself.’

She turned around and grinned at me. ‘But for now, you’re stuck with me escorting you.’

I’d liked Dawn from the moment I met her. She was a large lady with a big personality to match. I got the sense she wanted to mother the boys because, somewhere, deep down, I’m sure she felt sorry for them.

I believed that most of the staff genuinely wanted to make a difference, and I hoped I was also going to be able to.

We walked across the courtyard, then through another metal door and another gate, and finally we were in the Healthcare department of the prison.

The walls were brightly coloured and there were a variety of drawings and paintings stuck on them. ‘All done by the boys,’ Dawn proudly announced.

She walked briskly ahead, filling me in on some facts that belied the innocent-looking appearance of the place.

‘Huntercombe is home to 360 of the country’s most troubled teenagers. Sadly, many of the kids inside here have come from troubled families. Violence is all they’ve known.’

We turned a corner and I skipped to keep up.

‘The UK has the most juveniles locked up behind bars in Europe. This age group, 15–18-year-olds, has the worst reoffending rate of all: 82 percent are likely to commit another crime within two years of being released.

‘You’re not shocked easily are you, Amanda?’ she asked as she unlocked the door to the clinical room.

I shook my head.

‘Good, because these boys can be rude, they can be aggressive, particularly when they don’t get the medication they want.

‘Some of them will have had drug addictions, and will want you to prescribe them strong painkillers and sleeping pills. These need to be avoided at all costs; they’re highly addictive and can sometimes be used as currency, to trade for cigarettes or items of clothing. Some of the boys can also be bullied, attacked for them. Drugs are a commodity here; we need to be careful.’

In the twenty years I’d worked as a GP I’d only looked after one patient who was addicted to any medication. My experience wasn’t going to be much use to me. I had so much to learn.

The Healthcare department was where the prison GPs ran their clinics, alongside other healthcare professionals, including the dentist, psychiatrist, optician and GUM consultant – a doctor specialising in sexual health.

Dawn informed me that there were a lot of self-harmers in Huntercombe, and to prepare myself for seeing some horrific scars and shocking wounds.

She sighed. ‘It’s very sad, but often it’s an outlet for these boys. They are lonely, depressed, some just want to die. They turn to self-harming as a way of offsetting the pain and stress they’re feeling inside their heads.

‘A lot of these lads don’t want anyone to see their wounds, or the scars from cigarette burns, the scalds made with boiling water.’

I felt a huge pang of pity. It was awful to think boys the same age as my sons felt so desperate and helpless that they needed to self-harm in such a way. No one should suffer like that.

Again, I hadn’t seen many patients who self-harmed while I worked at my surgery. More to learn.

I wouldn’t be dealing directly with mental-health issues; they would be handled by the psychiatrist. However, I might have to tend to their wounds, particularly if they had become infected and needed antibiotics. I might also have to represcribe antidepressants if the psychiatrist wasn’t in.

I had been expecting to deal with the common complaints that teenagers usually present with, such as acne, asthma, skin infections and rashes, etc – conditions I’d seen hundreds of times over the years in my old practice. But now the type of patient would be very different.

A couple of nurses were popping in and out of rooms along the corridor, and Dawn called them over to introduce me. I was given a lovely warm welcome by both.

‘The turnover rate of doctors is high in prisons,’ Dawn explained, ‘so everyone is hoping you’ll stay with us. We need some consistency here.

‘Apparently, working with the 18-to-21 age group can be the most challenging of all. They’re the most notoriously difficult. Too much testosterone in too confined an area. They’re always fighting, with each other mostly, but sometimes with the prison officers as well.

‘That’s why I like working here.’ She stopped outside a pale green painted door. ‘Despite the government statistics on reoffenders, I feel like we still have a chance with boys this age, to help put them on the right path in life.’

Dawn unlocked the door and pushed it open.

‘And this is where you will be working.’ She stood back to let me pass.

It was a far cry from what I was used to, but it wasn’t as bad as I had expected. It was small, clean, and had the essentials. There was a desk and shelves, all compact and well designed, as if it had come straight out of IKEA. There was also an examination couch on the other side of the room, with blue tissue paper placed on top, ready for my first patient.

The lovely thing about the little room though, was that there was a window – even if there were big metal bars in front of it! I wasn’t expecting to have natural sunlight, so although the view wasn’t up to much I was grateful. I peered out on to the tarmac yard outside.

‘Can get a bit noisy when the boys are walking across the yard,’ said Dawn. ‘Silence is a luxury in this place!’

She was standing on the opposite side of the room, stroking her top lip with her forefinger as she tried to remember any details she may have forgotten. I had so many questions but I decided it was better to just get on with the job and save them for later. It seemed to me that this was the kind of place that you learn as you go along; sink or swim.

‘A nurse will run the clinic with you, she will let the boys in and out and tend to all the minor things through there.’ Dawn pointed to an adjoining room.

‘Ah speak of the devil.’ Dawn took a step backwards to make way for a petite, pretty lady, in her early sixties, wearing blue trousers and a long blue tunic top. A biro was peeping out of the top of her breast pocket.

She may have been five foot nothing, but I could tell I wouldn’t want to get on her wrong side. Nobody would. She had an authoritative air about her.

Dawn introduced her.

‘Amanda, this is Wendy – or Matron, as the boys like to call her.’

Wendy stared up at me through her thick dark fringe. She had a blunt bob cut which was striped with grey hairs. Her face was stern, but she had kind eyes.

‘Wendy must be one of our longest-serving staff. Thirty years now.’

‘Thirty-two next May,’ Wendy corrected her, as she busied about doing her things, darting in and out of the room.

‘If you have any questions, she’ll be able to help you.’

Just as Dawn was leaving, she spun around and looked me straight in the eye. Her voice was hard now.

‘One last thing. Make sure you do not reveal anything personal about yourself to the boys. Keep where you live, any details of your family, private.’

The words were chilling.

I nodded obediently.

‘It’s not permitted for any prison or medical staff to have any sort of communication with inmates after their release.’

I nodded again. Things suddenly seemed to get a lot more serious. I’d been so used to being entwined in my patients’ lives at the surgery. I had followed their journeys over the years, visited them at their homes, watched their lives evolve. This was a completely different way of approaching medicine. I would be seeing prisoners in my clinic who I might never see again.

Dawn softened as she saw my flash of concern. ‘You’ll be fine. It’ll be a challenge.’

With that, she disappeared along the corridor.

*

My thoughts were interrupted by a thud on my desk. I looked up to see Wendy had given me a large plastic box of files. Inside were orange A4 folders, of varying thickness, each marked with a number – the prison number of the boys I would be seeing that morning. It was wrong to make the assumption that the thicker files would be the more demanding patients, but from everything I’d heard that morning, I couldn’t help but jump to that conclusion.

‘Doesn’t make for light reading,’ Wendy grimaced. ‘And here’s the list of boys you will be seeing.’ She placed a sheet of paper on the desk.

‘Thank you,’ I smiled, grateful for her help. I knew I could do with having Wendy on my side.

She carried on whizzing back and forth between rooms, making the final preparations. I glanced at my watch.

‘What happens now?’ I asked, as she reappeared.

Wendy explained that the officers from the various wings were collecting the boys, who had either put in a request to see me, or who one of the nurses had decided needed to be seen.

‘They then wait in the communal area until I call them in,’ she explained.

I peered out of the door to look at the waiting area, which had approximately twenty plastic chairs set out in neat rows.

‘Everything is plastic here,’ Wendy explained. ‘From the chairs to the cutlery.’

‘Oh?’

‘To try to prevent them from self-harming,’ she said.

And again, I was forced to face the reality that some of these young people felt so desperate that harming themselves seemed the only escape.

‘You’d better get set up, they’ll be arriving any minute.’ Wendy nodded, and left the office again.

I returned to my desk and glanced over the names of the boys I was about to see. What had they done? I couldn’t know about their crimes, that was a detail not recorded on their medical notes. Besides, I would have hoped that knowing about the severity of their crimes wouldn’t have affected my ability to help them. Yes, I would hope that . . . but it was a relief not to have to prove as much. Who were they? What were they coming to see me for? Of course, it was no different to any new patient, not really . . .

By the time I’d read to the end of the list, the noise from the waiting room had swelled into loud chatter and raucous laughter.

An authoritative voice bellowed, ‘Oi, keep it down in here!’ That must have been the prison officer in the waiting room.

Which only led to more sniggers.

And to the prison officer becoming even more irate.

‘Keep it down in here, I said!’ he shouted, banging his fist on the door.

‘Ah, you can fuck off an’ all!’ came the reply.

Then, in a flash, chairs were screeching across the floor, more shouting, more swearing, scuffling, threats, then silence.

I nearly jumped out of my skin when Wendy knocked on my door.

‘That’s what happens if you put a bunch of rowdy teenagers in a small room together,’ she said, poking her head inside and rolling her eyes. ‘I’ve got Jerome Scott here.’

I pulled Jerome’s file from the plastic box. It was as thick as a book.

‘Come in!’ I called out.

I prepared myself to meet my first patient in prison.


Chapter Five (#ulink_21f8374a-ca55-5295-bd93-6773b27c30ac)

Jerome was tall, skinny, and wore his grey prison tracksuit bottoms low enough to show off his boxer shorts. He was pale, spotty and had a diamanté stud in both ears. His hair was shaved along the sides and spiked with gel on top. He looked like every other teenager who had spent too many hours indoors playing video games.

It was only his eyes that told a different story. They were bloodshot, puffy, hollowed out by the shadowy purple circles underneath. He looked as if he hadn’t slept in months, and I prepared myself for his request for sleeping tablets.

‘Come on in, take a seat.’ I welcomed the teenager in the usual friendly manner I’d always greeted my patients with, in my old surgery.

Jerome swaggered across the room and slumped into the chair opposite. He automatically slipped into a slouch with his left leg outstretched and his right elbow hooked over the top of the chair.

‘How can I help you?’ I asked, leafing through his most recent medical notes to familiarise myself. Antidepressants, medication for anxiety. Bruising to ribs and left cheek and cuts to forehead, following a fight with his cellmate. I looked up to check how well the wounds on his face had healed.

‘It’s my feet, Miss.’

I was taken aback a little. After such a build-up, and a complex history, I wasn’t expecting such a seemingly minor complaint.

‘Oh dear. What’s wrong with your feet?’

‘They hurt when I walk. It’s these shoes, innit.’

Jerome lifted one of his black trainers into the air, which I assumed must be part of the prison uniform. He then returned to his slouch and started biting his nails, or the little bits of nail he had left. I noticed a tattoo of a snake wrapped around a sword on his left wrist, the tip of the blade peeping out from under the cuff of his jumper.

‘What sort of pain are you feeling, and whereabouts on your feet?’ I could believe those shoes weren’t the most comfortable.

‘I’ve got blisters everywhere, Miss. I can barely walk, it’s so painful. I can’t be doing with these trainers.’

It was strange to be called Miss, but I suppose Jerome saw me as an authoritative figure, like a teacher – unlike my previous patients who, on the whole, had viewed me as a friend. Did I want that responsibility? Could I take it?

I moved around to the other side of the desk to take a closer look, asking Jerome to remove his socks and shoes. He waved his slightly smelly bare foot in the air to reveal the tiniest of blisters on his right heel.

His eyes looked sheepishly to the ground.

‘It’s killing me. I can barely walk!’

He didn’t seem to have any problems swaggering into my office a moment ago, I thought. I started to wonder if there was a bit more to his complaint.

‘Why don’t you pop next door, and the nurse can give you some plasters for your blisters.’

The words had barely left my mouth when Jerome fired back with his own diagnosis and cure.

‘Can you just write me a note saying I can wear my own trainers? That way I won’t get blisters no more.’

I suddenly cottoned on to what was going on. There must be some sort of loophole whereby the prisoners could wear their own shoes on medical grounds. Whether the trainers would be sent in by his family, I didn’t know, but I was pretty sure that’s what Jerome was after.

It was my first day on the job and I needed to be careful not to break any rules.

Turning a little firmer with my tone, I suggested, ‘Let’s try out the plasters first and see how that goes.’

Jerome huffed loudly.

‘But Miss,’ he whined.

He sat there for a moment, sulking, waiting for me to come around to his way of thinking. Nibbling on his nails.

I thought about what I would say to my boys if they were trying to get their way.

I smiled and explained it was my first day in the prison and that he needed to use the plasters first, but I promised I would find out the rules and regulations surrounding the boys wearing their own trainers instead of prison-issue shoes.

After more huffing and puffing Jerome reluctantly agreed to try the plasters, and as he walked off to see Wendy in the next room he turned back and flashed me a mischievous grin.

‘See you next week then, Miss.’

*

The rest of my morning surgery was a succession of minor ailments, with at least three more trainer requests, all with similarly feeble excuses.

Two of the boys complained of achy feet, the other of painful toenails. It seemed ludicrous that a doctor’s time was taken up by dealing with kids wanting their own footwear. It was something I would have to take up with Dawn, but first I needed to tell Wendy about the massive faux pas I’d made with one of the other boys.

‘I told him I liked the orange jumpsuit he was wearing. That it was a bit more bright and colourful than the grey tracksuit. He said “Thanks, Miss, I get to wear orange because I tried to escape!”’

Wendy howled with laughter.

‘I suppose he won’t be making a run for it again in that jumpsuit. He’ll stick out like a sore thumb!’ I laughed along with her.

For a moment I looked at the severe Wendy, and she looked at me, and I felt reassured. Yes, we were going to get along just fine.

It was funny, but it was also strange to think that someone I was treating for something as routine as a minor ear infection had tried to break out of a high-security prison, maybe hours earlier. I was dealing with the ordinary in what was otherwise an extraordinary foreign world.

I turned to Wendy and asked, ‘So what’s with these boys wanting trainers?’

If anyone would know what tricks the boys were up to, Wendy would.

She chuckled. ‘It’s not “cool” to wear prison shoes, and they’ll do anything to try and wear their own trainers. It allows them to maintain some sort of identity in here.’

Wendy looked me in the eye. ‘You’ve just got to be firm with them, or they’ll run rings around you.’

I’d worked that out pretty quickly. If I gave into one, they would all be queuing up – kids demanding trainers all week long.

‘These boys are crafty. If they see you’re a soft touch, they’ll immediately take advantage,’ she warned me. ‘They’re constantly testing you, pushing you to the limit. Like most teenagers. But don’t forget some of them are very experienced at lying and manipulating. It’s easy to forget they’re in here because they’ve committed a crime.’

Wendy was right. It was easy to blot out the fact that the boys were criminals, when I was treating them for very run-of-the-mill medical problems. Apart from their bad language, on the whole, they seemed quite well-behaved.

After three weeks in Huntercombe, apart from getting thoroughly irritated by the trainer requests, I realised I was having an invigorating time in my new world. It was different and challenging and I felt like I’d been given a new lease of life. The cloud that had hung over me when I left my practice was rapidly lifting. I was beginning to feel accepted and to enjoy feeling worthwhile again. Might I even be making a difference?

I was living in a bit of a bubble in the Healthcare department. I knew little about the other areas of the prison, what went on in the wings, even what the cells looked like. I knew nothing about the boys outside the fifteen-minute consultations they had with me. I’d only run into the governor once or twice. I was in and out, twice a week, now with my own set of keys, treating seemingly ordinary spotty teenagers, with ordinary medical complaints. I was even liking my new name: Miss.

But as with every bubble, it had to burst at some point. And Wendy’s words of warning came true sooner than expected.

I blamed the waiting-room system. There was a high likelihood that putting a lot of teenage boys together in a confined space could lead to trouble.

My Wednesday-morning surgery had started like all the others so far. A big pile of files on my desk, and a list of the boys I would be seeing over the next few hours. As usual, I had no idea beforehand of what they were coming in for.

I knew they were a rowdy lot, though, as there had been a great deal more laughter and shouting coming from the waiting area than usual. The prison officer had screamed at them to shut up a number of times, but I was too far away to hear what they had been saying, other than a load of effing and blinding.

When Wendy knocked on my door, her face said a thousand words. Her mouth twisted into a grimace as she wished me luck.

‘Thanks, Wen,’ I said, before taking a large sip of coffee from my mug. A caffeine hit before I started my clinic.

There were only nine boys on the list that day, and the first one, Danny Farr, had been to see a doctor three weeks ago about his feet. Three guesses what he’s come back for, I thought, as the 17-year-old made his way into my room.

Short, stocky, and wearing his own clothes, Danny sank down into the chair opposite me. He had strikingly chiselled features, with high cheekbones and a shaved head. His legs were spread wide apart, his arms dangling by his side as he assumed a relaxed pose.

I started things off.

‘Morning, Danny, how are you today?’

‘I’m okay, Miss.’ He coughed loudly. ‘Apart from, I got this problem.’

‘Go on?’ I encouraged him.

‘Well, it’s a bit embarrassing, Miss.’

I smiled, trying to put him at ease. I knew boys could feel awkward confiding in a woman. ‘Don’t worry, there’s nothing I haven’t seen or heard before.’

‘It’s my . . .’ he dropped his gaze to his crotch. ‘I think I’ve got a . . . a spot on my . . .’

‘Penis?’ I finished off his sentence to speed up the guessing game.

It wasn’t really my job as a GP to deal with sexual health, that was left to the ‘Dick Doctor’ – as the boys called him – the doctor who ran the GUM, or genitourinary medicine clinic. But of course I would have a look if they needed me to.

He looked bashful. ‘Yes, Miss.’

‘Okay, would you like me to have a look to check it for you?’ I said, trying to spare his embarrassment.

He dropped his boxers. At first glance I couldn’t see the spot, and we had a good look for it, just to reassure him, but it wasn’t there.

As he zipped up his jeans, Danny grinned, showing his crooked teeth. ‘I could of sworn I saw it. I thought I’d caught some disease or something.’

‘No, you’re fine, but you can put your name down for the GUM clinic if you find any more spots or blisters,’ I said as he disappeared out the door.

Two minutes later I had Dave Samuel sitting in my consultation room, with surprisingly much the same complaint.

‘Got a lump on my balls and I’m scared I’ve got cancer,’ the teenager confessed.

At that moment I heard an eruption of laughter from the waiting room, fading into the corridor. I thought I saw a smirk creep across Dave’s face, but if one had, it was gone seconds later.

‘Well, we’d better have a look then,’ I told him steadily.

Dave stood up, towering over me. He had the same pasty, blotchy skin as most of the teenagers I’d seen, and a scruffy bit of stubble on his face.

I asked him to lie on the couch so that I could examine him. Wendy was busy in the adjoining room so could not chaperone me in the clinic that day.

I pulled the screen around the couch and with his consent I examined his scrotum, and found no lumps or anything abnormal.

Another thunderclap of laughter exploded next door, sending Dave into a fit of giggles.

‘Sorry, Doc, I laugh when I get embarrassed.’ He stifled his sniggers with his fist.

‘You’re fine, you can get dressed.’

‘What a relief. Thanks, Miss,’ Dave said, then quickly scuttled out of my room.

I sighed. What a morning.

I took another sip, of my now lukewarm coffee. Wendy popped her head around the door for a quick moan about how noisy the boys were being.

‘I can’t think why they’re making such a racket,’ she hissed. ‘There’s a new PO on duty and he hasn’t taken them in hand. I’ll do it myself if he doesn’t.’

Wendy was feisty, I didn’t doubt her for a second.

‘I’ll send in the next lad,’ she said.

The next boy complained of exactly the same thing, a lump in his scrotum. I examined him and found nothing abnormal, and on it went. Every boy in my surgery that morning came in complaining of something wrong with his genitals.

Of course I had twigged that something was up, so to speak, by the time the fifth lad walked into my surgery with an erection holding up his tracksuit bottoms like a tent pole.

He was tall, well-built and oozing confidence. His tracksuit bottoms were hanging around his backside, and a wry smile curled across his mouth. He swaggered towards me and dropped his trousers and boxers and practically plonked his erection on my desk.

‘Is it big enough miss?’ he smirked.

A rush of anger came over me. I was furious at his attempt to intimidate me. How dare they come into my office and try to abuse me? Wasn’t I doing everything I could to help them? I cared! I wanted to make things better, and all they could do was this? A male doctor wouldn’t have had this problem.

I didn’t – couldn’t – show I was fazed by it, though, as that would have given him the satisfaction he was hoping for. I’d mastered a poker face over my years as a GP, perfecting an ability to hide shock – mostly so I could put people at ease, but in this case, to put someone in his place.

I shrugged.

‘It seems pretty normal to me,’ I said dismissively, and then got rid of him pretty sharpish. He was just trying to wind me up and I had no time for it.

There was another eruption of laughter as he walked back to the waiting room, no doubt getting a high five from all the boys. The clamour eventually died down as the prison officers took the teenagers back to their wings, while I sat there, raging.

I couldn’t wait to vent my anger to Wendy.

‘What was that all about?’ I exploded. I told her about the boy with an erection and she was shocked and appalled.

She shook her head in dismay. ‘That shouldn’t have happened, Amanda.’

‘Seeing their dicks isn’t a big deal to me, I’ve seen hundreds over the years, but I don’t like people trying to intimidate me,’ I said, still angry.

It was horrible to think that boys the same age as my sons could act in such a threatening manner. But in a way I was glad; their behaviour had removed any illusions. These were not just any teenagers, these were not just any patients.

‘I totally agree. I’m going to report this to Dawn, don’t you worry about that,’ Wendy said, her hands on her hips. ‘I thought there was a lot of whispering and laughter going on in the waiting room. They must have hatched a plan when they arrived. That’s the problem with putting them all together. They’re bored, looking to make mischief.’

‘Testing me to see if I will break,’ I said. ‘Well, I won’t.’

*

I was glad to have David to offload on to that evening. As usual, he was his calm, rational self. He listened as I ranted about the boys, and then reminded me I didn’t have to carry on if I wasn’t enjoying the job.

He turned the sports channel on mute as I kicked off my shoes and threw myself back into the sofa.

‘I can’t run away from a job because they try to wind me up one day. It’s a fact of life that sometimes you have to deal with things that are insulting and degrading.’

‘You don’t have to convince me,’ David said.

‘I mean, I’m incredibly privileged to see a world most people wouldn’t have a clue about,’ I continued.

‘As I said, you don’t have to convince me.’

I sunk a bit further into the worn folds of the leather, lifting my feet onto the footstool. I closed my eyes. Maybe David had a point. I was trying to convince someone: myself.




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