It was after working hours, but I was still in the prison clinic, reviewing lab work, reading X-ray reports and noting recommendations from specialists to whom I had referred patients. From the clinic officer’s radio I heard a call to officers assigned to the emergency response teamthey were being ordered to a recreation yard in this large maximum-security state prison. Surely violence had taken place, was probably continuing, and perhaps escalating. I continued focusing on my paperwork, though, because I knew that the response team was well trained and the evening nurse one of the best we had.
Soon I heard the officers rushing in and the nurses gathering in the triage room. Only slightly distracted by the familiar noises, I continued reading, interpreting, planning. I stopped when I heard the triage nurse’s insistent voice. "Jean, I need you right away." Now I knew there was trouble.
Entering the triage room I saw a man being placed on the exam table. I saw dark brown skin, prison-green pants, prison boots and, ominously, a prison-green sweatshirt soaked with blood.
"Cut off his clothes, I said, while pulling on latex gloves; cut off his clothes now!" The nurses had already unlocked the cabinets (all potential weapons were locked and counted by the nurses three times a day). With large scissors two nurses and I cut through the man’s sweatshirt, over his right arm, left arm and chest.
Several wounds were revealed immediately. One was just below his sternum; one was under the right side of his ribcage. They both looked deep. "Turn him over," I said, so that I could search for more wounds. "Cut off his pants."
"Miss Carbone," the inmate quietly spoke, "Miss Carbone, please help me." It was then that I looked at his unmarred face. "Oh my God," I thought, "I know this man." It broke my heart to realize that he was following the two "rules of respect" I had established in my job as a physician’s assistant: don’t call me by my first name and don’t swear.
"I will help you," I replied.
We worked quickly. Some of us were gathered around the exam table; others stood near cabinets, ready to hand over the supplies that I asked for. "Start a line, no, two lines, lactated ringers, wide open," I said. "Hand me the xeroform dressing, get the E.K.G. monitor on, start the oxygen, get the ambu ready, call the ambulance, hand me a Foley catheter." Nurses, one physician’s assistant and correction officers worked to save the inmate’s life.
"Miss Carbone," he said, "I can’t breathe. I can’t breathe, Miss Carbone." Air hunger caused restlessness. The man began thrashing his legs. I was inserting a Foley catheter into his penis, and I was in a position to be hurt by his kicks. The officers-attentive and protective-reached in to hold him down. This caused him even more distress.
"Mr. B.," I said, "Don’t kick. This is Miss Carbone. You don’t want to hurt me, do you?"
"No, Miss Carbone, I don’t want to hurt you. I don’t want to hurt you, Miss Carbone." His legs stilled; the officers withdrew their hands.
With the I.V. fluids running, the wounds plastered with airtight dressings, the nasal cannula delivering oxygen, the Foley catheter draining urine and the E.K.G. showing a steady heart beat, I stepped back.
"When’s the ambulance supposed to get here?" I called out to the triage nurse. "How long did they say it would take?" This man might bleed to death. There was nothing much more we could do for him in the prison clinic.
"Miss Carbone," he said, "I’m thirsty, give me some water. Please Miss Carbone, why won’t you give me some water?"
"You can’t have anything to drink now, Mr. B. You are going to need an operation, so you can’t drink now."
"Miss Carbone, I can’t breathe, I can’t breathe, help me, Miss Carbone."
The E.K.G. monitor went flat. It was not a mechanical problem-the man’s heart was no longer beating, his lungs no longer breathing, his blood no longer circulating.
"Ambu him," I yelled as I jumped onto the table to start chest compressions. "One one-thousand, two one-thousand, three one-thousand, four one-thousand, five one-thousand," I counted, while kneeling in this man’s blood. The nurse squeezed in a breath. I continued, but with each compression blood spewed from the wounds in his abdomen. What if the weapon had lacerated his liver, sliced his inferior vena cava, nicked his abdominal aorta? The blood in which I was kneeling became deeper.
Yet his heart started beating again and his lungs breathing.
"I’m thirsty," his quiet voice stated. "Please give me some water, Miss Carbone, please."
"You will need surgery," I said, "You can have nothing to drink." And then, knowing that he was bleeding to death, that he would probably not make it, that he would be leaving us never to return to prison to finish his 37-to-life sentence for murder, I said, "I cannot give you any water now, but when you return you can have all the water you want."
"Miss Carbone, he said, I’m dying. Please help me."
The ambulance team rushed through the prison halls pushing the stretcher on which lay a man who was not breathing, a man whose heart was not beating. A nurse ran along the head of the stretcher, continuing to bag the man. Kneeling in a dead man’s blood, I continued to compress his chest. "No one dies behind the prison walls," was the rule at this prison. "They die in the ambulance, they die in the emergency room, but they do not die behind the wall."
Three days later the local newspaper ran the story: "Stabbed twice in the chest with a homemade knife, [J.B.], 28, died late Friday night as an ambulance rushed him to a hospital."
"I feel sorry for his mother, was all I could say to the many prisoners who approached me the next day to thank me for trying to save the man’s life. I feel so sorry for his mother."
"Few would mourn the death of [J.B.]," the journalist wrote. In July 1986, at the age of 18, Mr. B. had robbed a hamburger stand, "forcing a 19-year-old employee into a walk-in refrigerator, ordering her to kneel on the floor, and then firing a shotgun blast into the back of her head."
For the next few days the prison was locked down. All inmates stayed in their cells 24 hours a day while the prison was searched. The murder weapon was never found. A few days later, cars drove up, and a 30-year-old inmate already serving time for murder was taken to another prison.
"Did he tell you who did it? Did you ask him who it was?" I was asked by the sergeant, the captain, the detective, the D.A., the capital defense lawyer and the grand jury.
Who did it? During my failed attempt to save this man’s life I had not wondered, nor had I asked, who did it? When it became obvious to me that I was with a man who was bleeding to death from stab wounds deliberately inflicted by another man, my only words were about water, thirst, satiety; my only image was of this man (reincarnated here on earth or living in heaven, I did not know) in the midst of green trees and lush vegetation. He is up to his waist in a pool of clear water. Waterfalls gently cascade around him. He has drunk of the cool, clean water. He shall never thirst again.