April raindrops tap on the tin roof as if a giant is standing outside pouring a bag of rice onto the bus. Doc only vaguely hears them over the rumbling engine, but he can see as they slide down the thin horizontal windows across the aisle. After today, his life will never be the same. But that’s not why he’s here, so he makes a point not to dwell on it.

Conversations hum in a quiet monotone, mixing with the rattling of chains and scraping of metal on metal. A couple voices, however, have distinguished themselves above the murmuring over the past six hours, one of which belongs to a man in a cage near the front who boasts of the two people he shot and killed. Next to Doc, Marty sits quietly, staring straight ahead. He’s overweight, white, with black hair and glasses. They’ve spoken periodically during the ride, but as they’ve edged closer to their destination, they’ve both grown progressively more reserved. They’re on a winding forested road in Western Washington, but Doc can’t see ahead because there are multiple layers of plexiglass and woven steel separating him from the windshield and the driver.

A pale gentleman sits behind him, for the most part, quiet and observant. His head is shaved to the skin, and he’s of medium height, with a build which is currently a mystery beneath an exaggeratedly baggy orange jumpsuit. Among him, a small group of men stand to peer out the tiny windows at passing conifer trees. Words are being uttered like “ray-poe,” and “rat.” Somebody near the back says, “My partner just got kited outta Monroe.” Doc will soon learn that a “ray-poe” is a sex offender, and a “kite” is a mode of communication between inmates and Department of Corrections staff. None of this was covered in high school or during his ensuing 14 years of education which ended with multiple degrees, including an MD from New York Medical College.

It’s dark on the chain-bus. They call it that, he imagines, because most of its occupants are shackled, handcuffed, and chained at the waist. His father has told him his entire life that everything happens for a reason. It’s a cliché, he knows, but he finds it mildly comforting to meditate on the idea that his life is somehow enigmatically etched into a transcendent plan for the greater good of humanity. His family came from India when he was twelve, and due to the vast difference in the educational systems, he found himself so far ahead of his class that he really had no choice but to become the youngest graduate in his school’s history at fifteen. They landed in Ohio with his father’s sister, and the transition wasn’t too difficult because he’d gone to an English-speaking school back home. Eventually, they settled in Texas where his parents raised him and his brother as friends, rather than subordinates. They were provided a very comfortable upbringing, consisting of good food, good education, and good neighbors. His father was a mechanical engineer and his mother a homemaker, but that’s not why he’s here, either, and he’s trying not to think about it too much.

Doc’s family has been supportive and understanding throughout this ordeal. They flew in together from Dallas two days ago for his sentencing and then watched as he was taken into custody and sent to Walla Walla County Jail, where he was ushered into a steel and brick cage like an animal. That’s where he slept on a one-inch mattress on the cold concrete floor. That’s where he met Billy and Chris. Billy was being sent to Missouri from where he had been a fugitive for quite some time. Chris let Doc use his pin number to make phone calls, and explained to him that he could be out of prison and into a work-release facility in eighteen months. Other than his interactions with Billy and Chris, Doc was quiet and reserved in County, much like he has been since stepping onto this bus.

Somebody sitting near the back mentions Airway Heights. Doc knows he’s referring to an institution in Eastern Washington, because he learned a month ago that he would be going to prison, and he’s since been researching the various facilities. In a few minutes, the bus will pull into Washington Correctional Complex in Shelton, which is used as a hub for classifying and processing incarcerated individuals out to where they’ll end up serving their time. He doesn’t know this yet, but Marty will be his cellmate, and they’ll form a friendship which will soften the blow of prison for both of them. He’ll learn that Marty is twenty-six years old and has a five-year-old daughter. That he’s serving two years for a fight with his girlfriend. Marty will learn that Doc is serving five for a similar domestic dispute. Doc will see brawls in the dining hall and cough when guards deploy pepper spray in the gym. He’ll wait in gruelingly long lines to call his family, and in three months, he’ll be sent to the Washington State Reformatory in Monroe.

But right now his hands are shaking because though he’s never been to prison, he’s seen movies and documentaries. When he stepped onto the bus this morning there was nothing but exposed metal seats and a mere six occupants—including the one in the cage. Doc will later learn that he’s there for his own protection. The bus stopped in county jails, picking up passengers until every bit of chrome was covered by prisoners in orange suits, and now the air is muggy and smells of gingivitis and body odor. Everybody was given a bottle of water, but most haven’t opened them because on a six-hour ride, drinking would mean eventually hobbling down the thin, crowded aisle to the back of the bus where a filthy metal toilet sits exposed next to an armed guard in a plexiglass cage. When they slapped the shackles around Doc’s ankles, they rolled up his pant legs in order to apply them to bare skin, and it’s made the slightest movements unreasonably painful, so he’s not eager to make that trek.

After Marty, his cellmate will be J.B., who had a traumatic brain injury (T.B.I.) from a heroin-induced coma. When J.B. learns he’s rooming with a doctor, he’ll tell him of his residual loss of partial memory, and muscle weakness in his lower extremities. Doc will quiz him in the cell by saying, “Remember these three things: a watch, a ball, and a pencil,” and then ask him later what they were, monitoring his time-lapses to see how long he can remember. When Doc discovers that J.B. has never heard of rehab therapy for T.B.I. patients, he’ll recommend vocal, memory, and speech therapy. Once released back to Seattle, J.B. will pursue all three and the two men will maintain a friendship thereafter. And though there’s no way for Doc to know this right now, maybe that’s why he’s on this bus, headed to prison.

His water bottle rolls off his leg and onto the floor. He considers attempting to lean down and pick it up, but decides to just let it go when a deep, calm voice behind him says, “Here ya go, bud.” Turning, he sees the man with the shaven head offering his own unopened water and spots a small swastika tattooed on one of his fingers.

“Thank you,” Doc tells him, accepting the plastic container and holding onto it so tightly his knuckles turn bone-white. More people stand and gaze out the windows, and the murmuring grows in volume. The man in the cage says something about being ready to get out of these chains, and into a shower. Doc stands to see a gun tower looming over concrete structures that could almost be mistaken for industrial buildings if they weren’t surrounded by razor-wire fences. All that separates the bus from the prison now is a thin layer of dark-green trees, spaced far enough apart that they hardly obscure his view. Somebody says, “That’s it, we’re home,” and Doc’s body grows so light if it wasn’t for the low metal ceiling a mere few feet from his head, he might float away because this isn’t his home. His breath runs shallow, and he becomes aware that his palms have begun to perspire when one clenches around the water bottle and his fingers slip over its surface.

And as all this is happening, it doesn’t occur to him that he might be here because Jerome was shot and walks on crutches due to a knee infusion. Doc will meet him a little over a month from now, and learn that he’s been trying to obtain the medical care he needs, but it continues to be postponed because Jerome keeps getting in fights. Doc will be tempted to smile at the thought of a man in crutches fighting in the big yard, but instead, he’ll examine his swollen knee and tell him it needs to be drained, and the fluid sent to a lab for testing. Jerome will go to the medical wing and relay this recommendation, thus acquiring the proper attention.

Everything that’s transpired in the past two days has been so surreal he’s finding it difficult to believe it’s anything more than a bad dream. But as the chain-bus slows down, preparing to turn into the compound, Doc knows in a way he’s never known anything before that it will soon turn very real. So he plops back down, hearing his chains crash into the metal seat so loudly his ears ring. He takes a deep breath. Holds it in. Lets it out slowly. Considers his father’s words, unaware that sometime this month the Medical Director in the Washington State Reformatory will be fired for misconduct after seven incarcerated patients die under her watch. It will later be revealed that she never completed an approved residency, nor was she board certified. A criminal investigation and multiple lawsuits will ensue.

While in WSR, Doc will read an article in a Seattle newspaper about this case, and explain to a group in the yard how absurd the details are. They’ll trust he knows what he’s talking about because they’ll know by then that just months ago, at thirty-five years of age, he was heading up an ICU at a prominent hospital with nine doctors working under him. These prisoners will have taken to calling him “Doc,” after he writes a letter as physician to a judge on behalf of F.S., who will have been chronically suffering from intractable pain caused by left upper scapular soft tissue mass (lipoma). The Department of Corrections will have been continually declining the proper treatment of this condition on the grounds that it’s not a medical necessity. However, Doc’s letter, which will demonstrate definitively that it is, in fact, a medical necessity, will result in the court ordering the treatment.

It will become clear early on that the health services in Washington State prisons are inadequate. That even in extreme cases, a trip to the medical wing tends to render no more than a checkup with a nurse practitioner. That Doc is the only doctor most of his neighbors will get to see during their stay. Consequently, almost daily (and sometimes multiple times a day), he’ll find himself standing at the bars in his six-by-nine foot cell, or against a wall in the gymnasium, giving a diagnosis to somebody who has been unable to acquire it through official channels.

Like Jesse, who had quadruple coronary bypass graft surgery, and multiple myocardial infarctions with depressed ejection infarction. Jesse will tell Doc he suffers from early morning dizziness, constipation, and bilateral leg swelling. He’ll express his frustration after going to sick-call multiple times with no remedy. So Doc will inquire into his medical history and learn that he’s currently taking a calcium blocker which has notorious side effects, including dizziness, constipation, and leg swelling. He’ll recommend Jesse decrease his dose from 10mg to 5mg. As predicted, his symptoms will abate, and Jesse will be very happy.

But right now the bus is stopped, and the fear of the unknown is swelling inside of Doc’s chest. The engine seems to have somehow grown louder, like an angry dog, or a chuckling monster. He doesn’t want to be here. He doesn’t belong in chains. Some passengers are laughing because they’ve done this before, others are as quiet as him. There’s a conflict waging inside his body because though his father has always been a fountain of wisdom, and Doc trusts his words, he can’t begin to surmise how any of this could serve a greater purpose.

Maybe it’s because A.F. has chronic pulmonary disease, secondary to heavy smoking, with uncontrolled symptoms of shortness of breath and coughing with minimal exertion. A.F. has never had pulmonary function tests (PFTs), so Doc will inform him he needs to be on a dual steroid inhaler in conjunction with a rescue inhaler to stabilize his pulmonary function. After passing this recommendation onto the nurse practitioner, he’ll be placed on both with additional therapy. A.F. will slowly regain his cardiovascular strength, and thus, a longer/better quality of life.

Doc is physician. He took an oath. But now the bus is turning, and Marty is standing to gaze out the window. Almost involuntarily, Doc springs once again to his feet and spots two uniformed guards clutching assault rifles. A chain-link gate slides open, and the bus passes a modular house with a plastic jungle-gym in the back. Somebody says, “That’s where they have conjugal visits,” and it crosses Doc’s mind that his mother, his father, and his younger brother, V, are all back in Texas already, while he’s on a chain-bus pulling up to a building which reads “Administrative” above the door. V received his MBA from DePaul University in Chicago. He now owns four Mediterranean grocery stores. Their parents are very proud of V. Though Doc can’t see behind the vehicle, he imagines the gate is secured now, which means he’s officially in prison. And though he doesn’t know it, it may just be because Terry’s a schizophrenic who speaks to himself all day in different dialects that respond to one another. But he’s maintained enough of a grasp on reality that when Doc recommends he try to have his doses of Thorazine and Seroquel upped, he’ll request it of DOC’s mental health department, and it will be granted. Terry’s symptoms will subside, thus allowing him a semblance of normalcy which will help him to socially navigate his way through the insanity of prison.

Doc’s thinking he wants off this bus, but he’s also thinking that’s the last thing he wants because exiting now will mean stepping through that terrible administrative door. He’s never felt so out of place. Not even coming to America as a young immigrant. Here, among people who boast of killing and stealing, he might as well be from a different world altogether. One where doctors exist, and medical attention is a basic human right. But this world is utterly alien to him, and he’ll soon learn there can be dire consequences if he offers to help his sick and afflicted neighbors, because though the Department of Corrections doesn’t provide adequate healthcare and people are dying as a result—there are rules prohibiting him from even attempting to bridge that gap. But how can he not? The first line of the Hippocratic Oath is, “Do no harm.” The very oath which he took when he entered into practice.

So when he learns that prisons in Washington are ridden with uncontrolled diabetics with no sense of therapeutic regimen, it won’t even cross his mind that honoring that oath could result in solitary confinement, loss of phone privileges, or even loss of good-conduct time, postponing his release-date. Diabetes is a chronic debilitating disease, that can cause multi-organ damage if not managed properly, yet he’ll encounter countless prisoners with poorly controlled diabetes based on their hemoglobin A1C (HbA1c) levels, all because the oral anti-diabetes regimens or insulin therapy they’re on is nowhere near sufficient. Regrettably, there will be little he can do to help them because DOC won’t offer the appropriate novelty drug regimens since they’re too expensive.

Now the bus is lowering as if air is deflating from its tires. The engine coughs a couple times, then dies, and Doc’s feet tingle as the floor suddenly stops vibrating under them. Marty takes a deep breath, and then exhales, causing a circular fog to grow on the window. It has stopped raining at some point, but outside seems to have somehow grown darker and greyer. Doc takes a seat just as a door near the front opens, and the man in the cage lets out a yelping laugh, reminiscent of a hyena. Somebody sitting in his general vicinity chuckles along and calls him a fool. Doc silently reminds himself that everything happens for a reason. It might be because in early 2020 the world will enter into a time unprecedented since more than a hundred years ago, when Spanish Influenza claimed tens of millions of lives worldwide. Maybe he’ll be in the right place to fill a void and save some from a virus which will have the entire world on lockdown until economies crash and morgues are overwhelmed and overflowing. And though he doesn’t wish to be named in this narrative, it’s possible he’s just here to be a witness to an indifference which has allowed countless people to suffer and die at the hands of an administration that seems unable to function without the employment of lies and coverups.

Right now, he’s unaware of what the future holds. All he knows is that the steel gate at the front of the bus is swinging open and a tall, bearded guard is stepping through. Almost instantly, the conversations curtail and all that can be heard is his shallow breathing and that of the other first-time prisoners. The guard is thin and bald on top. He stands erect with his chest out and glances around at the passengers as if examining the cargo in a garbage truck. His eyes land on Doc and he pauses briefly before readdressing the small crowd and saying, “All right, let’s start unloading. The quicker we get through this, the sooner you’ll be comfortable in your new cells.”

– Michael J Moore