Put your faith in resus...

Hail,
Two am, that time of the night that normally gives rise to meditative thoughts. Thanks for the comments, by the way, will respond individually when I am back on normal schedule.

Well, today we had a resus. This is not a particularly unusual event, we have a few a day, but this one I was reasonably central to, and some other stuff went on, so it got to me a bit. Not that it ever doesn't. I think if resuscitations ever became mundane to you, it'd be a sign that you'd burnt out some vital part of something.

The box went off (we have this small black box in the middle of the "fishbowl", where all the doctors and nurses work) around twelve, and we all trotted towards the resus room, and a few minutes later the ambos brought in Mr Stone, a large-framed, sweaty man in his sixties who was struggling to breath.

There wasn't much Mr Stone could say, and we got lines in and started the appropriate therapy (intravenous salbutamol, which is the stuff asthmatics have in their puffers), steroids, high flow oxygen, etc., etc. And while we were doing that the others were scurrying around trying to get an ECG and making sure his airway stayed open and some of the nurses were trying to reassure him, and we stuck needles into him and cut his clothes off and put a hissing mask over his face.

He looked bad. His skin was mottled, his blue eyes were staring wide over the mask, he was sheened with sweat, and his chest was pumping but no air was moving. In pre-terminal asthma the air gets trapped in the lungs and no matter what you do, no matter how hard you breathe, nothing moves. His body lurched with each useless breath, like an animal out of its element.

Anyway, we were talking to Mr Stone, trying to reassure him, while one of the junior nurses was sent to fetch the notes. The notes documented that Mr Stone was not for resuscitation. What had happened last time is Mr Stone had come in, and had been extremely unwell, almost identically unwell, and had needed to be sedated and anaesthetised and paralysed, and had needed a plastic tube slid down his throat, and had eventually got out fo intensive care... and for some reason decided that he never wanted to do that again.

Mr Stone, by the way, had made that decision while in his right mind and in full command of his faculties. The signature of the medical registrar who had listened to him that night, three weeks ago, attested to that fact.

But that was then. This, unfortunately, was now. And in these cases, apparently the hospital policy is that we must bear in mind the possibility that Mr Stone had changed his mind. And in the evidence of any proof to the contrary, we must assume that he had changed his mind, and we must assume that despite his express instructions in an identical situation three weeks ago and his considered response to that situation, he now wished to be sedated and anaesthetised and paralysed, and have a plastic tube slid down his throat.

So that's what we did.

(You could ask why we did not ask Mr Stone himself, who was there before us, very much in the flesh. But his lungs were not working, and the level of carbon dioxide in his blood was enough to change his blood to Fanta, and under those circumstances the brain is not what it normally is. He was moving, and his eyes were staring, and he was taking those deep, useless gasps, but it was more like the random jiggling of atoms, a somatic version of Brownian motion. We spoke but he could not respond).

Anyway, someone tubed him and away he went. Presumably to start the whole process again.

I feel angry about this. I don't know who to blame, I don't know who to shout at, but I want to know.

Yesterday (strange sleep patterns on these shifts, I get up at eleven some days, the sky is bright and the birds are still in the trees), after this, I had a dream, a strange one, where I was walking around in a supermarket. I was trying to buy something but there were too many things to buy.

I feel sometimes we are allowed the small choices to distract us from our lack of choice in the great. We cannot choose if we live or die, if someone will shove a tube down our throat or not, but there are seventeen different kinds of toothpaste down at the local Bi-Lo.

I am going to start a popular movement about this. We are all going to march on Parliament House, chanting and shouting through megaphones and being an uprising of public opinion. Our placards will demand "Bigger cages, longer chains".

Well, enough morbidity. Things are actually going well. But there is something wrong with our attitude to death. in the end, death is not the enemy, pain and terror and indignity are the enemies. It seems often that much of medicine stops when it comes to actually considering death, as if we have run across a vast land and suddenly we are confronted by a shore, and we dare not even stick a toe in it. But death isn't the enemy - if it is, why bother fighting? It always wins.

I don't know. It's part of medicine. It's something we should be better at.

John

PS: Happy stuff next time. Seriously, things aren't bad, but last night did shit me.

Whys

Hail, and sorry this has taken so long.

What's been going on?

Well, made a bit of a career decision in the last week or so, which I am now going to talk everyone through.

Emergency trainees like me are expected to move around the hospitals, learn new stuff. I've been at Florey two years (one of them half-time) and it's pretty much time for me to move. So I was looking around and after excluding the obviously unsuitable (too far away, too small, regularly mentioned on "Today Tonight" and similar tv shows, run by certifiable psychopaths), I was left with two.

Option one was the Royal. The Royal is the city's top hospital. It has a neurosurgical facility. It has the burns unit. It has the biggest paediatric and neonatal intensive care departments, it has the spinal unit, the "secure" psychiatric institutions, one of the only two transplant facilities in the city, craniofacial surgery and so on.

It's where the top people go. It makes you a top doctor. It inculcates and accepts nothing less than the highest standards. It's the logical next step. It would seem, one of the senior consultants said last week, "wise to consider the Royal. People who don't go to the Royal tend to ..." and here he paused, "stay in their comfort zone. They take a long time to go through the training programme."

The alternative is Lazarus General. The ED at Lazarus was pronounced clinically dead a few years ago. It's thrid director in as many years had resigned in disgrace. Multi-million dollar payout disgrace, but still disgrace. It was avoided by ambulance staff and was no longer on the trauma pathway - every significant motor vehicle accident in that part of the city went straight to the Royal. Finally it was denied accreditation by the College of Emergency Training - as far as the College was concerned, if you did five year's work at Lazarus it meant you were no more highly trained than someone who'd done none. They've only just got back on their feet.

Anyway, I picked Lazarus, and I've never felt better.

I tried to pick the Royal, I did.

But I was thinking about what the senior consultant said about it being "wise" to go to the Royal. It was a word which had struck me as unusual, archaic, almost incongruous in the ED (you rarely hear someone in the ED saying "I believe it would be wise to give this man some magnesium"). On a quiet night you might hear words like "evidence" and "guideline" and "protocol", but you don't hear "wise".

"Wise" to me suggests the product of considered reflection, of careful, unflinching self-analysis, of teasing out the truth from amongst the probable, the plausible and the palatable. So I'd tried to do a bit of that over the week I had to make my decision and this is what I'd come up with.

I could not take myself seriously at the Royal. The head of the Royal, in discussions with the minister, recently referred to Florey as a "first aid station", in an off-hand way, as if he were describing the weather. I could not sit by while someone talked unutterable crap like that. And I would alugh at the thoguth of us (the Royal) with vast amounts of money and prestige, talking about how much better we did than other places with much much less.

The Royal would not be comfortable with me working half-time. Hogarth, visiting the prisons, all that would have to go. And so would judo with my son and the new writer's group my wife and I are joining.

I cringe at the thought of telling someone at the Royal about my bipolar.

And "wise": I don't know that those people generally regarded as wise rated career advancement that highly. This will show my hippie roots, but Lao Tzu and Jesus and Epicurus and so on versus those people on The Apprentice

Now I know to some of you this sounds transparent: as if I have decided something, out of fear or laziness or lack of self-confidence or whatever and am now seeking to justify my decision.

But wisdom to me sometimes means accepting unpalatable things about yourself. I am the kind of person who is going to go slowly through the training programme. My friends are going to be consultants when I am still a registrar. People I went through Uni with will be telling me what to do.

I am not focussed. I am not going to give my all, I am not going to "make any sacrifice necessary". All that "ad astra per aspera" stuff always struck me as daft. If I went to the Royal and stopped writing and stopped Hogarth and stopped judo with my son and stopped drinking merlot and eating pizza with friends I haven't seen in years like I've been doing the last few weeks (since I finally got the meds right), but I ended up a specialist in five years rather than ten, it would seem more like a diminution than a gain in stature.

My career is not my sole interest.

I think it is fear. But sometimes fear is your body's way of telling you you're about to do something stupid. And it's easy to do something stupid here.

One of the consultants here hasn't had a partner in a five years. She lives here. When she goes home and opens the fridge there's a can of baked beans and two sixpacks of beer, dead set. She fast-tracked.

Anyway, I send my CV to Lazarus Monday. It's not a smart career move, it's not fast-tracking, but all things considered, it seems wise.

Fat

Difficult problem to deal with the other day.

I was at Mauro, the youth prison, seeing kids and one of the last patients was this big seventeen year old, called Amos. He's got blond hair and blue eyes and he looks a little bit like you'd imagine Charlie Brown would look - appealing, that kind of phlegmatic but tortured look you see on big, sensitive kids. He came to see me about his weight.

Apparently in the last six or eight months he's put on fifty kilos. That's over a hundred pounds in the old language, a weight gain easily equal to the size of many of his fellow prisoners. His weight gain has not gone un-noticed by his fellow prisoners. Several of them are encouraging him to fight Ted Mulden, the other big kid in Mauro. Amos doesn't want to fight Ted Mulden, and I don't know that Ted Mulden would want to be hit by Amos, because Amos has shoulders twice as broad as mine, but it's pretty boring in Mauro, and the kids have to make their own fun.

Anyway, he came to see me about losing weight. And we came up with a plan. Diet. High intensity rapid cycling exercise. They can't have barbells and dumbells at the prison because someone is always trying to kill someone else with them, but they've got exercise bikes and so on. I told him I was unable to prescribe the slimming tablets he asked for, and that his mum was raving about, because they were basically low dose speed, (and he was in prison because of the high dose speed), but we had some pharmacological options. Cutting back on some of the medications, because I reckon and he reckons he'd feel better if he lost weight and he might not need his antidepressants or the antipsychotics he's on. I even told him I'd look into getting one of the two more widely marketed medications - the orlistat or the sibutramine. He left, as far as I can tell, feeling positive and empowered.

But I don't know. His dad is huge. His mum was huge before she started taking the low dose speed, Amos himself was fairly big before he started the high dose speed. Everyone in the family has type two diabetes and buggered joints, they are all shy. He doesn't eat fat, the food at the prison isn't that bad, but he's just always hungry, always with an empty belly. I've tried imagining what it would be like to be hungry when I get up and when I go to bed and almost every minute in between, but I can't.

I'm not excusing what he did, but you can understand how a kid in this situation might look at speed, and how someone who wanted to look better and be less shy can take megadoses of the stuff, and end up behind a wheel of a stolen car and drive it into a traffic light at three AM.

Anyway, I am going to do all I can to get this kid thinner. Diet, exercise, meditation, motivation, drugs. If there was a temple around here I could sacrifice in I'd sacrifice a chook or something, to Nibblia, Goddess of Slimming.

I don't know that it would do any good to tell him that in other days he would be a fine figure of a man, a figure of power, someone whose body evoked ideas of good fortune and wealth. Instead, he is someone behind whose back people smile.

Where five hundred years ago we had brands and bridles for sinners, nowadays we have a more enlightened system. Fat is a sin now, a sin of itself and a marker for other, equally damning indictments: Amos is self-evidently lazy. He doesn't look after himself. He lacks ambition. He doesn't "go hard", he isn't "being all he can be", he isn't "just doing it".

Anyway, diet, exercise, plus meditation (and possibly medication, if it will help). But I reckon we've got Buckley's chance. Standing behind him, shadowy and indistinct, I can almost see his father, arms like cornsacks, his broadhipped mother, his generously proportioned sisters and strongly built brothers. For two and a half billion years we've tried to get fat in times of plenty so that we can survive the famines - Amos is a victim of his ancestors' success.

The depressing thing is I fear I know what will happen. He gets out in three months. He'll still be fat. We might hardly have made a dent in it. He'll be fat and shy, with the additional burdens of time in Mauro (not a good conversation starter) and extremely poor job prospects.

And the same people will be there as were there before, with their medications that can do what mine cannot. Solve all his problems. Energise him. Blow-torch away all his fat. Light a bright white light inside his head, fire him up. He's got someone who'll give it to him cheap, "mate's rates". He might have to do an occasional favour for him later on, but nothing too harsh.

And next time it's not Mauro, which is relatively drug free, and a juvenile sentence, which does not fuck up your life for ten or twenty years. It's the big house. Things, I am told, are very different there. Steal a car, drive it high speed, an habitual offender, maybe this time kill some-one: he could be in there a while.

Anyway. I'd better get on the computer. Orlistat in juvenile populations. Sibutramine and mood disorders. We did his fasting blood sugar, that was good, that'll be some good news to motivate him with. I have to get onto the Mauro staff, see about getting a punching bag, couple of them. Write up an exercise programme.

And check the phone book for temples to Nibblia.

Drug of Choice

And it's ears and drugs night here at Florey.

A rare stretch of quiet, or what would be quiet if it were not for the constant bleeping of alarms. Our department has a new set of monitors, the things that keep an electronic eye on your pulse, blood pressure and oxygen saturation, and all the machines seem to have florid anxiety disorders. Every few hours the monitor in cubicle twelve tells me that the heart of my happily chatting woman in cubicle thirteen has ceased to beat, or that my snoring septuagenarian in cube eight has not taken a breath for the last half hour. If a patient really was at death's door each time an alarm went off, we'd have this place empty in hours.

But for some reason it's ears and drugs tonight.

Several years ago I first formed my theory that people with similar interests all know each other. Maybe they meet in hospital wards, or something. Anyway, these people all arrange to meet at the local hospital - it happens at Florey, it happened at Shipton - and so they ring up. "Hey" they say, "let's go out for a drink or something, for old time's sake. Tell you what - meet you at Florey at half past".

So you turn up for work and the first eight patients you see have foreign objects stuck up their nose, or inflammation of a part of the body that is not normally inflamed, or dizzyness. ANd for the first half of tonight, it's ears.

The first wave of attacks started around ten, and the eared people had complete control of the wating room by twelve, and had started advancing to radiology. Child with otitis media. Child with unpopped popcorn kernel in ear. Girl with ear-piercing gone wrong. Middle aged man with moth in ear (we could see it inside the ear canal, stamping its foot and scowling). Young woman with earache for a day. Young man with ear-ache for three weeks, hasn't bothered to see a doctor, hasn't taken anything for it, comes to busy emergency department in the middle of the night.

And chillingly, that last one was the one I will remember. You know those pivotal points, those moments where the direction of your life, that thing you casually imagine will go on and on in a certain direction forever, angles back. Well, I looked into this man's ear (and he was the kind of nervous man who thinks that every freckle is a melanoma, every stomache grumble cancer) and saw something odd behind his tympanic membrane.

The term "tympanic membrane" is one of those medical terms we use to conceal what we mean, another example of language designed to obfuscate rather than communicate. It means what normal people call the ear-drum, the thin skin separating the outer and middle ear. Just behind this man's ear drum was something white and mis-shapen, shaped oddly like a crouching animal, and behind the eardrum was dark with blood.

I had to call my senior in, because none of us had ever seen it before, it was just something that we had read about in books, but what it looked like was a cholesteatoma. Thi sis exceedingly bad news. It is a kind of growth that occurs behind the eardrum, and grows by dissolving away the bones of the inner ear and skull. If untreated it can grow into your brain and kill you. This is extremely rare, I don't know that dying from this happens much anymore, but this was a man who insisted on knowing the worst, who asked and asked until I told him the worst, and in this case the worst is pretty bad.

A friend came and took him away, he would be presenting to the Royal in the morning. Very sobering.

And after the ear people were repelled, there came the waves of drug people. Gazing from left to right as the clock ticks past four in the morning I can see

Fourteen year old girl who had smoked marijuana for the first time today, presenting complaint "I'm going to die".

Three drunks, including a man undergoing alcohol withdrawal. His face is a mosaic of scars and scabs. He is wearing a Jack Daniels tee shirt. He looks somehow older and less attractive than the people I see on the advertisement saying Jack Lives Here.

A thin man who took heroic amounts of intravenous speed and whose heart began to kick in his chest like a caged animal, and who fell to the ground and had a seizure. I asked his friend if the man drunk alcohol, said "Christ no, not him. He's a real health freak."

A girl on ecstasy, a drug that seems to cause people to believe that you think all their jokes are incredibly funny.

And in resus a man who took large amounts of I-don't-know-what-and-we-probably-never-will. The resus team is doing all they can, but his heart is refusing to co-operate. He is the one I feel probably got most out of what he took, whose trip, if anyone uses such an archaic hippy word nowadays, was to somewhere he wanted to go. He was a man in chronic pain, well known to the hospital staff. Like some kind of acid, the pain had eaten away at his job, then his finances, his marriage, his relationship with his children. I don't know if in the end the pain took him, or if what he did was an escape from it. But I stuck my head around the corner a few minutes ago, when the cardiac compressions were starting to get that little bit half hearted. Most people undergoing resuscitation look ugly, their faces pulled and distorted, their skin grey. But, and here's another archaic phrase, he looked at peace.

John

Caught

Back after a few days absence.

Yesterday, while lounging at home, I got a phone-call from work, and apparently I have to go to court. I worked out this makes a maximum of five upcoming court cases I am going to be involved in within the next year. Listen to this list:

A sixteen year old boy is taking the police to court because he reckons they broke his arm. I'm the one who saw him and his arm was broken, and he had been arrested. He had a spiral fracture of the humerus, the big bone of the upper arm. He reckoned the police punched him, the police reckon they had to put him in an armlock when they arrested him... this is apparently happening in a few months.

My murder case, where someone murdered my patient a few weeks after I saw her. The police reckon her partner, who was the bloke who half-strangled her and put her in the hospital is the same bloke who three weeks later strangled and punched her to death. Scheduled for November.

The other man, the Middle Eastern guy who broke into that house in the eastern suburbs and bashed those two sleeping people with a plumber's wrench, then jumped off the balcony at the prison and committed suicide. This one is still over the horizon.

The drink driving case, where the drunk guy reckons he was not drunk. I may get out of this, it's in the next month or so.

This recent one, where some woman is suing her GP because he treated her one month of back pain by giving her valium (highly addictive, doesn't work), paracetamol + codeine (addictive, treats the symptoms, not the cause), and one thirty milligram injection of morphine (a bloody big dose, causing her vomiting, confusion and a large amount of distress). All this while saying her back pain was due to stress (!) and avoiding any sensible investigation or treatment for either back pain (anti-inflammatories, anyone?) or her supposed stress. No idea when.

I have this vague idea there's another one coming up, but I have forgotten it. Since my previous times in court have been meagre (driving a girlfriend's car which turned out to be unregistered, and being arrested and charged with trespass during some anti-chicken killing protest back in the eighties) ,

Anyway, nights tomorrow.

Anything else? I've started writing fiction again. I intubated someone the other day (and this is a big thing for me, I have only done this a few times), more of this anon.

Thanks for listening, by the way.

Fixed

Two AM, just coming down from the post-evening shift buzz, and ready for tomorrow's two day seminar on "sexual choices we make". Not that 'staying home doing bugger all' was not a sexual choice I was allowed to make.

It's a weird drive home from Emerge. You leave at twelve or one and blunder out to the car-park, and the first ten minutes are normal suburban South Mordor. Then it's driving in the dark through the light industrial area: all empty garages, sheds, factories, trucks and cement mixers standing silent and still, cavernous buildings with no-one inside. The cranes and bulldozers look different in the dim light.

You know some scenes you can imagine with remarkable clarity, pictures that almost come out of your head unbidden? Often at night I get this image, just for a fragment of a second, that all the metal and the buildings are different, ore made flesh, so that the front-end loaders and forklifts become vast hands, disembodied, but real, and very capable of lifting steel and churning
soil. And instead of the flat surfaces of the warehouses there are calm, empty human faces.

If anyone else imagines - and I don't know that imagines is the right word - stuff like this I wouldn't mind hearing about it, just for interest's sake.

Anyway. Events of the last few days. Well, there's a lot I can't say, because we had a reasonably high-profile criminal case in here recently, and some of it's in the papers, and thus fairly easily identifiable. Someone I saw a few days ago is dead, a suicide, and I don't know if that's a good thing or not.

I love those old words. You can still read books where they say "His wife was a suicide", and in the older psychiatry texts people with schizophrenia are often referred to as schizophrenics, or even "the schizophrenic", whereas in our more sensitive times it is the symptoms that are schizophrenic, as if to emphasise that the person is still a person. Similar prohibitions exist for "a suicide", like "a psychotic" or "an asthmatic".

I think the rationale behind no longer publically using those terms is that describing a person by one symptom, it is seen as belittling.

But sometimes I think speaking those words was speaking a truth, maybe a truth we no longer wish to speak. If you have ever seen someone just before they die of asthma, or someone in the grips of a full depressive psychosis, or someone angry enough to kill someone, to commit homicide, it can seem for a moment that the disease is all there is. In the last few seconds it is as if the illness has seized the centre of the person and now spreads out to the periphery, invading the skin and face. It can seem like the person you knew has gone and instead there is an incarnation; asthma, or psychosis, murder, suicide become the asthmatic, the psychotic, the homicide, the suicide.

Interesting also, he says, becoming aware that this is drifting more and more towards unhealthily morbid introspection, which patients don't get named as diseases. We say Mr Williams in bed four is a psychotic, but we don't say his wife in oncology is a cancer.

Anyway. Have resolved to be less morbid in these, as well as write possibly less and better rather than more and worse. Tomorrow may be truth in advertising and periscopes for cars.

John

Attack of the Three Toed Sloth

Well, I was meant to start study today, bit of cardiovascular physiology and something on sexually transmitted diseases, and I did neither. Instead I avoided work by doing other stuff - did the washing, cleaned out the car, cleaned the bedroom, organised stuff. But no study.

Basically this is down to my sloth.

Interesting that of all of the deadly sins, sloth is the only one with an animal? The only one you can actually lay your hands on and say "here it is"? Perhaps this is because these animals were discovered to the Europeans by the Victorians, and sloth seems to have been one of their least favourite vices. And whoever named it thought "Well, I'd better have something spectacular for my next letter to the Royal Society - how about an animal named after a deadly sin? A really deadly sin. That little monkey thing, hanging upside down from a tree - call it a boneidle. A cantbearsed? A you'resomuchbetteratityoudoitI'lldoittomorrowIpromise? Howabout a sloth?"

Perhaps, of course, there are more incarnations of deadly sins lurking in some of the world's undicovered places. Were earlier Victorian explorers devoured by speckled Greeds, trampled on by Great Horned Angers, discovered in some ghastly venereal commerce with a three-toed Lust?

And that's another thing. "Venereal congress", a deliciously archaic term for sexual intercourse. I've got to use that in the medical notes one time. I could wear severe looking glasses and demand "Age of first venereal congress?" of un-nerved septuagenarians.

But why is there only venereal congress? That derives from Venus, goddess of beauty and love. Don't the other greek gods get congresses? Is there Plutonian congress, Mercurian congress? Martian congress?

Perplexing. Anyhow, have to get off to work, plus organise this new writers group, do some study and kickstart things at the gym.

See you all soon.

Matthew 26:11

For those who missed catechism this morning, that passage reads "The poor you will always have with you".

So, back from the prisons. Seeing the kids in the prisons - two prisons, one boys only, the other boys and girls, one squat and new and pale brick, the other expansive, on a high hill, bricks the colour of dried blood, both of them ringed in razor-wire - is a weird experience.

One thing that strikes you about - them - is how tiny many of them are. Your average child prisoner, and I suspect your average prisoner, is smaller than your average person. We get some very large kids, and so on, but yesterday when I write out medications for one boy (early teens) I ended up giving the dose appropriate to a five year old. Some of them the nurse is not allowed to see alone, due to the gravity of their offence, so the two of us stand shoulder to shoulder against this child who would not stand four foot tall.

It's - I don't know the word - conflicting? At one level you think these must be children. They look like children, they have the same high, piping voices, the same swagger when they're right, the same look of embarrassment and confusion when they're wrong. But they can't be children, because we've locked them up and taken them away from their parents, and because at least part of the idea of "childness" is innocence, and a need for protection. So these must be something else, something in a child's garb, wearing a child's face, but not a child. A monster perhaps, something usurping the place of a child. A changeling, a body snatcher.

The backgrounds these kids come from - ah. I can hear people logging off again. "He's saying it's all societies fault" - the backgrounds these kids come from beggar description. At the extreme, these are horror stories - mothers who hold guns to their son's heads, fathers who bugger their daughters on video and trade tapes with their friends. But most of the time it's not like that, it's less spectacular, more mundane, almost becomes run of the mill after a while - "the usual" story of amphetamines at twelve, marijuana at ten, dyslexic, ADHD, father in Mauro (a local prison), mother in Furby (a local psych ward), sexual abuse, physical abuse, emotional abuse...

I don't know. I don't know. You can't throw open the prison doors, let all the children stream out, sortof a reverse of the Pied Piper of Hamelin, because some of the things they've done have been so horrific. I suspect in the last three weeks I have started a murderer on antibiotics, checked a rapist for warts, talked about sleep patterns to someone who stabbed someone under the eye. Opening the gates of the prison can't be done.

(But you know, it would give them a chance, whereas in here they have no chance, no option to do good, only try to endure in the environment and hope that it doesn't make you into a bigger fuckup than when they sent you in here). If we beleive parents have a responsibility, then what do we expect will come out of a place where kids are locked up without their parents, and are instead incubated with criminals?

I keep getting this image from the Gospels, Christ opening the prison doors and letting the huddled captives free. And I know that story is in there because besides being a miracle story it's a story about forgiveness and redemption and giving something priceless freely, hope to the hopeless, that kind of thing... but it's an image that keeps coming back to me.

I don't know. The reason I put that "poor you will always have with you" up there is I think there's always going to be the bottom 1% of people, in terms of power and obeying the rules, and those bottom one percent are going to be put in prison. We are always going to discipline and punish. Across times and countries and cultures the crimes and the punishments vary, but I feel that whenever it happens, the kids will be the same ones.

John