Behind Bars | Behind the Times

When I think of the prison system in America, I think of my high school self. I was grounded so many times that I believe the only thing it taught me was to act out smarter. Luckily, I developed a frontal cortex and realized I shouldn’t be doing the things I was doing, but point is: punishment doesn’t work.

Like being grounded, does time in prison really prevent people from doing what they did to get in there? Let’s look at the numbers.

According to the National Institute of Justice, 68% of prisoners released in 2005 were re-incarcerated within three years. There’s even a term for it: recidivism. This means that going to jail once means, odds are, you’ll go again. If the point of jail is to end the behavior, then doesn’t this number defeat the purpose of going to jail in the first place?

Our penal system doesn’t take into account the bigger picture. More than a matter of right or wrong, we need to examine the circumstances which puts people in jail in the first place. If the situation is the same going in as getting out, not much can change. Consider factors like substance addiction.

Imagine a patient prescribed opioids for pain after an accident. Opioids are highly addictive, and this patient craves more after her prescription is finished. With Florida’s new E-Forsce system, doctor shopping for more pills falls through. She resorts to friends of friends, and eventually winds up not with Vicodin but full blown heroin—and a nasty addiction. She gets caught and goes to jail. Will being behind bars extinguish her addiction? Without proper attention, her post-incarceration chances of relapsing are between 40 and 60%–the greatest risk being within the first three months of her release.

More than 65% of United States prisoners meet criteria for a substance use disorder, yet less than 20% of these people receive treatment of any kind while in prison.

When rehabilitation programs are properly implemented, rates of recidivism have been shown to drop, but less than one-fifth of the prisoners who need these programs receive them–due to overcrowding, lack of resources and poor consensus on methodology.

Our current regimen is inadequate, calling for a re-examination of our approach to substance abuse rehabilitation in prison.

Now consider the fact that in 2015, American taxpayers contributed $51 billion per year towards prison upkeep. Funds are preferentially given to prison maintenance over prevention because, like anything else, that is where money can be made. If our theoretical heroin addict has around a 50% chance of relapsing, has this small fortune accomplished anything? Excuse the conspiracy theorist in me, but could it be possible that our government is suppressing actions which would help these prisoners stay out of jail, all so it can get more money?

Here’s my thought: why not start treating addiction as a health issue, rather than a crime?

What if we took those 65% of addicted prisoners out of jail and put them in intensive rehabilitation programs? What if we devoted just half of the $51 billion per year to actually fixing the problem, rather than investing over and over in what is clearly a sunk cost?

Believe it or not, Mexico is one of the world leaders in prison reform, and experts at MAPS (Multidisciplinary Association for Psychedelic Studies) are attributing it to their incorporation of a naturally occurring indole alkaloid called ibogaine into their rehabilitation programs. Although ibogaine is a Schedule I drug in the United States and most of the European Union, countries like Mexico, New Zealand, South Africa and Brazil have legitimized its use by medical professionals specifically for the purpose of drug rehabilitation. Multiple studies have been conducted worldwide (notably few in the United States) showing that ibogaine may reduce withdrawal symptoms, diminish drug seeking behavior, prolong drug-free intervals following release from prison, and improve post-incarceration employment rates.

Ibogaine plant

My first thought was that ibogaine must be giving some kind of opioid-like high. Au contraire. Although its pharmacokinetics continue to be unraveled, it’s been found that ibogaine does not act on opioid receptors at all. It is an antagonist at the NMDA receptor—a mechanism similar to that of Alzheimers drugs and ketamine.

More clinical trials on humans under controlled environments are needed before anything can be claimed as “fact,” but the initial results are promising. And if it looks and smells like it could be a cure to the prison paradox, shouldn’t we at least be looking into it? Or should we kick back our heels and throw $51 billion each year at a system we know is broken because “drugs are bad”?

The war on drugs is ending thanks to research and awareness. Maybe it’s time we look to the earth to figure out just what kinds of tools were put here for us. I’m no expert, but I have a feeling we may have been given just what we need.

To learn more about ibogaine and its medical uses, visit: https://maps.org/research/ibogaine-therapy


Mental Health in Medical Providers

So far, two of my medical school classmates have taken their lives, and we still have two years to go—in addition to residency. Mental health is consistently undervalued in the medical field, leading to a rise in suicide and burnout.

The first two years of medical school were undoubtedly intense. We had around 40 hours of lecture each week to master, and at the end of the two years we sat for a cumulative board exam–Step 1–which determines what kind of doctor you can be and thus, how much money you can make. Walking around the hospital with your Step 1 score embroidered on your white coat is not much of an exaggeration.

The deaths were a huge tragedy and wake-up call, and I was soon to realize, now as a third year medical student, that the pressure is only just beginning.

After spending twelve weeks rotating through the surgical specialties, I got a feel for the life of a surgeon. While there are exceptions, I found that overwhelmingly, the surgeons I encountered were curt, dismissive, hard, impatient, and short-tempered. And I was soon to find out why. The surgical residents were overworked and underpaid and under tremendous pressure. They weathered high expectations from their superiors and, perhaps more significantly, from themselves. It comes as no surprise that their interpersonal skills would suffer over time.

I’m not here to complain about a process that has been ironed into medical education since the dawn of Western medicine—whether you want to call it professional hazing or not. I’m here to reflect on the wellbeing of medical workers in America and the vicious cycle into which they are swept due to an innocent desire to help those in need.

Residents run the hospital, a fact which is chalked up to their need to learn and, less publicly, the money their cheap labor saves hospitals. The result is low wages and long hours, which leads to sleep deprivation, resentment and often, burnout. What an odd thing, I think to myself, to take the people whose role in society is among the most important and force them into these working conditions.

It wasn’t until 2003 that residents’ hours were regulated—a development which only occurred after patients started dying on the table from medical error. The regulation? Eighty hours over six-day weeks, averaged over a month. That’s double what the average American works. Further, residents have examinations which require studying after what is often a 14-hour shift. By the end of the week, you’ve got an exhausted doctor craned over an operating table with somebody’s fate in their gloved hands, running on four hours of sleep and a gallon of coffee. After six years of this (ten if you count medical school), it is not hard to imagine a morning where this doctor wakes up to all the aspects of her life which she has neglected and becomes suddenly overwhelmed. It is not hard to imagine why this resident decides to scream at the medical student standing in the corner; or swerves into a tree on her way home because she fell asleep at the wheel; or hangs herself in the closet when she gets home because people are dying all the time and deep down she feels she’s been dead a long time, too. It is these conditions which lead physicians to have among the highest suicide rates.

Two of my classmates have committed suicide, and it never reached the news. Who are the people sitting on the medical boards who continually sweep these deaths under the rug, tucked away from the public eye? Who is to say this number won’t grow as the pressure builds? What will it take for something to be done?

Doctors are expected to be super humans—the white coat their capes. They are not to show weakness, sadness, or fatigue. They are to be there for their patients before they are there for themselves. But doctors are people, too, and in adapting to the demands of medical work already I have seen how it can affect people. I have stood all day in a sterile operating room, demeaned for things over which I had no control, unable to defend myself due to the hierarchy which defines the hospital. I have had days where I had to pull over on my drive home because I couldn’t see through the tears. I have stolen away to find an empty room where I could scream, grieve for the patients I had seen, mourn my own new-fangled fate as some sort of machine. Each day I go in, I am reminded of my classmates who never made it to third year, pushed over a fine line which led them to take the action they did. They started as bright minds with a desire to help; they ended a statistic.

We need to protect our doctors for the sake of our patients—for the sake of all of us. We need to stop treating mental health as a weakness, especially in medical providers where emotional demands run high. We need to stand up when we are mistreated because nothing is worth the trends we are seeing. They say there is a shortage of doctors, so why are we making it so hard to keep the ones we have?


On Dissecting Humans

Today I held a human brain in my hands. It weighs about four pounds, slightly pink, squishy, and dense—just like you’d expect from the movies. We removed it from our cadaver, who we’d christened Agatha because we were never provided anything but her age and cause of death. Before we reached the pearl, though, we had to crack the oyster. Our professor presented our two grisly choices: bone saw or bone chisel?  We selected the former, which was essentially your everyday chopping device with the word “bone” tacked on the front. And off we went into the bony orb that holds so much, with such nonchalance that I began to question what the hell kind of person I was becoming.

8243262473_29fd1a62e7_o“Whoa,” I’d told my lab group. “Shouldn’t we say a few words or something? I mean, this is her face here. People used to recognize that face. She used to smile with it.”

My comments, of course, went unheeded. Not, as I must point out, because my lab group members are heartless, cold scientists. The field of medicine is like any other: a business. There are procedures you follow to achieve certain ends, and in medicine, emotion is not a part of the procedure. In fact, emotion can get in the way of what is at stake, particularly when it comes to cutting into some body.

So, while my team members were sawing and hammering at Agatha’s skull, I sat back. This body was someone—maybe not anymore, but once. She had lips and hair, fingernails painted dark, dark blue. This brain worked for Agatha her entire life, and here we were in our lives, making use of the parts she no longer needed.

Before long I succumbed to the joking, the poking, casual words exchanged over Agatha’s exposed parts. I made cuts, removed the top of her skull—skin and hair attached—and then her brain. Because what else can you do?  We all have a purpose in life, and each of them has certain rules of the game. To win at anything, you have to play by them.

Different people are cut out for different endeavors. For instance, I don’t have a competitive bone in my body, and things like team sports have never been my friend. Other people are artists, and they might be horrified at the dry science and anatomy of medical school. At first, I felt like I fell into such a category. All my life I’ve been a writer, a wanderer, a yogi. And yet I was keenly aware of the underpinnings of human functioning, the intricate pathways that made our amazing machinery operate, and I was fascinated by the ways it could go wrong. But when I started medical school this year, the two sides of me didn’t want to meet. It felt like I was trying to lead two lives at once: one was scientific, rigorously pursuing logical explanations for phenomena that the other life, the yogi, felt and experienced.

Every person is looking for the same things in life—fulfillment, answers—but in different ways. The yogi seeks transcendence, liberation from the external stimuli to understand the patterns of existence. A doctor pursues scientific explanation for how things work, and understanding on such a minute scale the details of human functioning allows a doctor insights into the bigger picture—why we’re here, why we act the way we do. One is a top-down approach, where the other is bottom-up: two means to the same end.

We can’t fight who we are, and we can’t fight destiny. I come from a legacy of physicians, and for the longest time I resisted falling in line with the rest of the family. I wanted to be an artist, to be different. I scoffed at their reductivist views of life and the world. But after taking the year after graduation to travel the world, write, and teach yoga, I realized there was something more that was calling, another layer to my purpose, and the longer I waited, the harder it was to ignore. I was meant to be a doctor, and I realized that having an art-loving yogi inside my white coat would only add to the potentials afforded by either field alone.

I’m not saying it hasn’t been difficult. Medical school is so busy that I find myself desperate for time to exercise my creative passions, and every day I am surrounded by types who are quite different from those that I am used to surrounding myself with. It is a strong lesson for me to appreciate the nuances of the medical field and the very different sorts of people who are attracted to it, all while maintaining my own distinct identity. But despite the setbacks, being the oddball has proven to be a boon.

In that frigid anatomy lab, with gloved hands trembling and the stench of formaldehyde a thick cloud overhead, I took hold of the scalpel and looked Agatha dead in the face. I made an incision here, one more there, and with a little help from my friends retracted Agatha’s brain from her skull. The artist was there, though, so much so that the whole time I was handling Agatha’s brain my own was shouting reassurances at me, coaching me to breathe deep and slow and not to stop.

Future docs!

Future docs!

Throughout the cool callousness and analysis, the artist in me is able to tap into the bigger picture behind all the parts, pathways, labels, and medical jargon to realize that it’s all part of a greater effort. Day by day, through the collective efforts of different individuals in their different roles, we fill in the picture of what it means to be human, what it means to be alive, and why we’re here in the first place. We play our roles to keep moving forward, toward that light at the end of the tunnel that some call God. When a road block arises—say, a brain—you take a deep breath and remove it. You may be revolted,  but gradually you grow accustomed to the change. Poke it, appreciate it, and learn from it. Give thanks for the path you are on, and keep heading forward. In our own ways, it’s what we are all meant to do.