An unusual feature of the building is the ring bolts in the floor.\u00a0 Most of the rooms have at least one or two of them, including ours.\u00a0 Made of steel, the rings are about 4 inches in diameter and \u00bd an inch thick.\u00a0 They are set deeply into the concrete and would take a good deal of jack-hammering to remove.\u00a0 The rings keep the patients from running away.\u00a0 Not all the patients; only some of them\u2026the incarcerated ones.\u00a0 Prisoners are driven across town from the city jail by bus to our hospital.\u00a0 Always in hand-cuffs and sometimes shackled around the waist or ankle when transported, the prisoners are brought for whatever medical attention they need.\u00a0 While in the hospital the prisoners are escorted by one or more Sheriff\u2019s deputies.\u00a0 Transferred to our care the patient is changed out of his prison garb and prepared for the medical encounter.\u00a0 In the case of our department, they are moved from a hospital gurney to the procedure table wearing nothing but a hospital gown.\u00a0\u00a0 Once on the table, they are covered in sheets, like any other patient that comes to us.\u00a0 But unlike other patients and to ensure an escape-free medical encounter, the deputy chains the prisoner to the ring bolt in the floor.\u00a0\u00a0 Secured from any attempts at escape, we can begin our work which sometimes lasts several hours.\u00a0 Usually, and at several points, the table has to be moved along with the prisoner on top.\u00a0 Shackled at the ankle or wrist and with chains running to the ring bolt, movement of the table with the prisoner-patient on top causes the chains to rattle. \u00a0It is not a sound usually associated with the medical setting and can be attention-getting when first heard.<\/p>\n

Because our procedures are invasive, pain control and sedation are required, induced by liberal doses of powerful narcotics delivered through an intravenous line in the patient\u2019s arm. \u00a0The drugs are really quite potent; some being 10x more powerful than heroin. \u00a0To exaggerate only slightly, the nurses can inject drugs of sufficient quality and quantity to subdue an angry rhino, let alone a human being with thoughts of escape on his mind.\u00a0 Given the medication, the prisoners are only too happy staying put.\u00a0 In fact, they are not going anywhere and the chains seem unnecessary.\u00a0 Indeed, our pharmacologic restraint works better than any physical restraint ever could.\u00a0 Nobody bothers to struggle or even thinks to struggle.\u00a0 But the deputies insist on the extra precaution of using the ring bolt anyway.\u00a0 Unless the prisoner is firmly attached to an immovable object, the deputies are just not happy. They have their methods and we have ours.<\/p>\n

The medical staff isn\u2019t supposed to ask the deputies what the prisoner has done to earn his time in jail.\u00a0 It\u2019s none of our business really.\u00a0 Nevertheless, some of the deputies like to chat-it-up and let slip a detail or two about their charges.\u00a0 A rapist here.\u00a0 A murderer there.\u00a0 But mostly the prisoners are short timers doing a stint for purse snatching, auto theft or some other non-violent offense.\u00a0 Very occasionally, we get prisoners from the state or federal prisons.\u00a0 Except when in our direct care, prisoners are dressed in bright orange jump-suits with a big \u201cCity Jail\u201d or \u201cDOC\u201d – as in Department of Corrections – emblazoned across the back.\u00a0 It makes them easy to spot at a distance just in case somebody has to chase them down the hall during an escape attempt.\u00a0 To be sure, the incarcerated are amongst us.\u00a0 Part of the ambiance of the place entails the possibility of hours of detailed, pain-staking work going down the tubes in the event a prisoner makes a break for it and isn\u2019t seen again or is shot dead.<\/p>\n

Amongst both the incarcerated and un-incarcerated patients are street prostitutes. \u00a0Not the well-manicured ladies-of-the-evening of imaginative fiction, but working girls applying themselves in the backseats of cars parked in a downtown parking lot.\u00a0\u00a0 As their sort of work is illegal in this town, they move between being jailed and not being jailed. \u00a0Because they frequently have medical problems related to their line of work, they become our \u201cregulars\u201d, as they themselves would describe it.\u00a0 Rene was one of our most frequent regulars.\u00a0 He would get arrested, be in jail for a time and need medical attention for his chronically failed kidneys.\u00a0 Or, if Rene was out of jail and working the streets, he would come to us like any other patient, through the out-patient clinics.\u00a0 As the techs and the nurses got to know Rene, a usual greeting developed.\u00a0 When he walked in the room, the staff would call out in unison \u201cHey Rene . . . are you in or are you out?\u201d \u00a0The in or out referred to whether he was in jail or not.\u00a0 It was obvious whether Rene was in or out by the route he came to us, the presence or absence of the deputy, use of the ring bolt, etc.\u00a0 The greeting came about as a friendly salutation in recognition of Rene\u2019s frequent encounters with the law.\u00a0 He took it in the good humor in which it was intended.<\/p>\n

Rene was unusual for a prostitute.\u00a0 He was skilled in the ways of what is by and large a woman\u2019s trade catering to men.\u00a0 Artifice and concealment were part of Rene\u2019s stock-in-trade.\u00a0 Usually in flamboyant female dress and heavily made-up, his craft consisted of discerning quickly and accurately another person\u2019s leanings.\u00a0 He could be seductive and aggressive in quick succession, going back and forth between the two in an effort to elicit an emotional response he could play on.\u00a0 This was part of his line of work.\u00a0 He had to make quick decisions to adapt his mannerisms and patter; all to engage potential clients.\u00a0 On the street he had to appeal to everyone that came along.\u00a0 His livelihood depended on it.\u00a0 Once hooked \u2013 and they\u2019re called hookers for good reason – Rene could be anything the customer wanted.\u00a0 If the customer wanted a heterosexual entente, Rene tilted towards the female.\u00a0 If the customer was looking for a same sex encounter, Rene could do that too.\u00a0 Rene\u2019s oeuvre revolved around not having to turn anyone away.\u00a0 With us, he made no attempt to alter his mannerisms to accommodate the medical setting.\u00a0 Rene was angling all of the time; probably because it was the only way he knew how to act.\u00a0 I imagine he did this in jail too where alliances between prisoners were a matter of survival and sex is used as currency or coercion.<\/p>\n

Most times, the concealment and misdirection were successful enough that Rene\u2019s satisfied customers had no idea they had just been had by a man.\u00a0 In fact, it was a point of pride for him.\u00a0 Apart from encounters with the law, however, the times Rene got into serious trouble were in putative \u201cheterosexual\u201d encounters, when the John would discover Rene was not anatomically female. \u00a0In the midst of passion – or as much passion that can develop in a dark, trash filled alley – Rene\u2019s male parts would be uncovered, literally and figuratively. \u00a0Shock and rage resulted.\u00a0 Violence would ensue and Rene would get the shit kicked out of him.\u00a0 Needless to say, payment for services rendered was not forthcoming.<\/p>\n

One day, it occurred to us we hadn\u2019t seen Rene in a while.\u00a0 It had been a few months and we began to wonder about him. \u00a0There is no easy way to track someone like that as they live under inconstant circumstances.\u00a0 When the Sherriff\u2019s deputies came through with other prisoners, we asked if they knew of his whereabouts.\u00a0 None did.\u00a0 We never did find out what happened to him.\u00a0 My guess is that Rene died, either murdered while working the streets or from his kidney failure.\u00a0 It\u2019s the way things are for many patients at an indigent care hospital \u2013 a tenuous and uncertain existence followed by untimely death.<\/p>\n

Of course, another aspect of the hospital\u2019s services to ladies-of-the-evening included the treatment of diseases transmitted through sexual activity.\u00a0\u00a0 Sexually transmitted infections are considered a matter of community health and resources are allocated from the public purse to combat them.\u00a0 One of those resources is the sexually transmitted disease clinic.\u00a0\u00a0 It looks like any other clinic, but caters to the population most affected, i.e. people in the sex trade.\u00a0 The street walkers become regulars with the older and smarter ones coming to get tested regularly.\u00a0 It\u2019s the newly recruited girls – the teenagers – that come in emotionally distraught; with the first case of whatever they have.\u00a0 After the fourth or fifth case of some disease or several diseases, a resignation takes hold and becomes just part of their job.<\/p>\n

The occasional odd fish comes through the STD clinic now and again.\u00a0 They are the businessman or businesswoman or other professional type that doesn\u2019t want to share their problem with their usual uptown doctor for fear of being stigmatized.\u00a0 They know where they\u2019ve come and risk being seen in the company of hookers for a reason.\u00a0 Or they\u2019re doltish, found the clinic in the Yellow Pages, it seemed like the right place to come, and have no idea who they\u2019re sitting next to in the waiting room. \u00a0\u00a0In either case, they have the legitimate fear of having their problem shared with third parties like insurance companies.\u00a0\u00a0 Then there are the marrieds.\u00a0 They\u2019ve gone outside the relationship they have with their spouse, fear takes hold about being found out and they want some balm to sooth their minds.\u00a0 That is they want something, usually antibiotics, before any possible disease has had time to incubate and produce actual physical symptoms.\u00a0 They are panicked more than anything else.\u00a0 You usually just have to tell them to come back if they develop symptoms and give them a canned spiel about risky sexual behaviors along with a colorful pamphlet to take with them.\u00a0 There really isn\u2019t any medicine to ease a guilty conscious.<\/p>\n

As women continue in this line of work, it becomes difficult to separate out medical problems from their living circumstances.\u00a0 Working on the street, a physically abusive partner, alcohol and drug addiction all take their toll with mental and emotional problems thrown in on top.\u00a0\u00a0 They all roll into one, exacerbating and feeding off each other.\u00a0 The medical and rehabilitative communities do the best they can to tease each problem out and offer solutions.\u00a0 Sometimes though, and it is difficult to admit this, individuals become hopeless with the medical and psychiatric establishments incapable of offering any substantive remedy.\u00a0 It no longer is \u2013 and maybe never was – a medical or rehabilitative problem.<\/p>\n

Unfortunately, there is another version of sex-for-sale.\u00a0 This version is seen on TV and in the movies.\u00a0 It is a sanitized and romanticized version; the whore with a golden heart as she is famously depicted. \u00a0Western intellectuals also like to indulge in this sort of fiction.\u00a0 To form solidarity with some of society\u2019s most forlorn individuals, the intellects like to say they are pro-prostitute or go so far as to say they are pro-prostitution.\u00a0 In exquisitely tortured, high-minded rhetoric they say things to appear tolerant and knowing.\u00a0 They imagine prostitutes to be just like the girl they know next door; all smiles and innocence, biding her time taking money for sex until deciding to go into another line of work.\u00a0 It\u2019s just another way for a woman to use her sexuality, they say; like it\u2019s a choice on life\u2019s menu of endless possibilities. \u00a0\u00a0It is a noble but ultimately pointless and misguided sentiment. The subjugation and violence are glossed over and even willfully ignored.\u00a0 And in the case of the young run-away, having to turn to prostitution as a way of escaping a troubled life, emotional and economic restraints keep them in a very real form of human servitude. \u00a0In the mind of Hollywood and the intellectual, it all becomes an abstraction to be used for dramatic or political purposes.\u00a0 I suggest the abstraction is absurd and the intellectuals need a remedy for their artlessness.<\/p>\n","protected":false},"excerpt":{"rendered":"

An unusual feature of the building is the ring bolts in the floor.\u00a0 Most of the rooms have at least one or two of them, including ours.\u00a0 Made of steel, the rings are about 4 inches in diameter and \u00bd an inch thick.\u00a0 They are set deeply into the concrete and would take a good deal of jack-hammering to remove.\u00a0 The rings keep the patients from running away.\u00a0 Not all the patients; only some of…… <\/p>\n