For Dr Amanda Brown, a village GP in Buckinghamshire, the idea of working in a prison was so off the radar that when the offer came, her first reaction was surprise that such jobs existed. “It had never occurred to me that doctors even worked in prisons,” she says. “How stupid was I? But I thought it sounded fun. Interesting. Different.” The offer arrived at one of the lowest points in her life: she was crying in her consulting room when she took the call that would turn out to be the solution, or in her words, “a blessing”.
It was March 2004, Brown was 49 and had angrily and impulsively resigned over government plans for new GP contracts, which would reward surgeries for meeting certain targets, such as checking cholesterol or completing mental health questionnaires during consultations. Although Brown had started the practice from scratch 20 years previously – and her husband, a property developer, had actually built the surgery – her partners had informed her they would “resent” her if their income fell because she refused to tick boxes and meet targets.
“I couldn’t work that way and had no choice but to leave,” Brown says. “I was nearly 50, that was my pension, I had two kids and a mortgage, but it was my ‘sliding doors’ moment.” She resigned and wrote a blistering article for the GP magazine Pulse. A recruiter for the prison service spotted it and called her.
Her second career, a midlife leap into the unknown, is set out in Brown’s book. The Prison Doctor is a fascinating, sometimes funny, often gruelling account of working behind bars. It also charts her own journey as she morphs from GP in a quiet, comfortable patch of England to passionate advocate on behalf of prisoners.
Her first post was a relatively gentle start in HMP Huntercombe, then a male prison for juveniles aged 15-18. “My sons were that age so I’d gone in thinking I understood how boys are,” she says. She is refreshingly honest about her utter cluelessness. On her first day, she complimented one of the boys on his cheery orange jumpsuit. He explained that he had to wear orange because he’d tried to escape. “What shocked me when I got there was how many were already fathers and how many had grown up in care,” she says. “So many of them had no one who cared about them.”
At Huntercombe, there was nothing “medically challenging”; Brown’s abiding memory is the stream of appointments about “aching feet” as the boys sought special permission to replace prison footwear with their own trainers. Self-harm was rife – as it has been in all the prisons Brown served in. A psychiatrist would address the behaviour while Brown treated the injuries.
The hardest adjustment was the complete change required in her working methods. As a GP who’d lived near her surgery and frequently made home visits, Brown’s life had always been entwined with those of her patients. She welcomed babies and watched them grow. She diagnosed illnesses and saw patients recover. At Huntercombe, she was forbidden from divulging any personal information and heard nothing about how the boys had come to be in prison. She often saw them only once and had no way of learning if she’d helped, what happened next or how their lives would unfold.
Brown recalls one prisoner who presented with a bad back and difficulty sleeping. He had the standard buzz-cut, tattooed knuckles, lacerations on his wrists (he’d used a plastic yogurt pot) and old cigarette burns on his back. As they talked, it became apparent he’d grown up in care and had no family. Brown mentioned she liked to write when she couldn’t sleep and a few weeks later the boy returned with a poem he’d written. She was so moved by its contents she cried. As he began to write more, Brown bought him a dictionary and thesaurus only to learn that giving it to him was against the rules. It would be seen as “conditioning”. “It wasn’t the book,” she says. “He could have got that out the library. I just wanted him to know I believed in him.”
Huntercombe was like a “holiday camp” compared to Brown’s next placement, as duty doctor at Wormwood Scrubs, the notorious prison which holds more than 1,200 male inmates. Here, consultations took place with Brown seated closest to the open door and an alarm close to hand. Shortly before she arrived, a nurse had been taken hostage by a prisoner. On the segregation wing, she saw patients through a hatch – sometimes to be met instead by a stream of abuse, saliva, or worse. “One of the challenging things was never knowing what might be waiting on the other side of the door.”
Brown functioned in a state of high alert, a constant charge of adrenalin. She might be called to an attempted suicide, a violent psychosis brought on by spice (smuggled drugs were by far the most frightening problem for her) or a horrific prisoner attack – she recalls being called to the showers where a naked man had been scalded with boiling sugar water.
For the most part, Brown had no idea why the men were in prison, and she preferred it that way. She only saw the patient, never the prisoner. “For that reason, it’s easier not to know,” she says. “If I was treating a paedophile who’d been attacked, I only allowed myself to see the old man as he was then.”
Over the seven years Brown spent at Scrubs, she felt increasingly at ease and involved with the prisoners’ lives. When a young man who spoke no English arrived in a wheelchair because he’d jumped from a window fleeing police and his shattered legs had both been amputated, she cried. “I cry a lot and it’s embarrassing, but the day I lose my compassion is the day I stop working”. When a violent prisoner from the segregation ward presented her with an intricate miniature racing car he’d carved from a bar of soap – in thanks for “being kind and not judging” – she floated home on a high.
Her final move was to HMP Bronzefield, the largest female prison in Europe. Brown calls it her “happy place” and, at 65, has no wish to leave. The women have been more open, seem to care more what she thinks and she describes her more regular patients as “almost friends”. “But the biggest difference from the men,” she says, “is how many women prisoners are victims themselves,” says Brown. “They are victims of abuse, violence, rape. Their stories are heart breaking, overwhelming. I get lost for words when I think about them. At Bronzefield, you do learn what they’re in for and it’s usually shoplifting, theft, breach of licence. You do question whether prison is the right place for them – except for the fact that so many tell me it’s a refuge. One of them, who has a violent partner, told me it’s the first time she had felt safe in bed for seven years.”
Brown admits that the closer she has become to her patients, the less kindly disposed she has felt towards former friends. She swears more. She has less patience at social events and finds it harder than ever to tolerate social bragging. “I don’t really go to parties any more – no one invites me!” she says. “My husband would say I’ve become more assertive. I see people who have absolutely nothing. My eyes have been opened and it puts a different perspective on conversations that start with, ‘So what are your boys doing now?’ I hope this book can be a voice for the prisoners.”
There are many unforgettable stories and lives in Brown’s book. One is Andrea. She became a heroin addict after being attacked with a hammer, taken prisoner for two days and raped multiple times. She was 27 and had been on the way home from giving a talk on computer programming. Another is Trudy, sexually abused by her stepfather since the age of four.
Brown doesn’t know what’s become of them. “I’ve got a folder stuffed with letters that prisoners wrote to me while they were there but, of course, I’ll never see them again. If they’re not back inside a few months later, I have to thank God and hope for the best.” She pauses, then adds: “That’s the worst part of prison medicine for me. You never know what happened next.”
The Prison Doctor by Amanda Brown is published by Harper Collins at £8.99 on 13 June. Buy it for £7.91 from guardianbookshop.com
