The guards wake me by slamming the lock on my cell's sliding door, a noise like an aluminum stepladder abruptly collapsing. My alarm clock reads 4:17 a.m. Disoriented with sleep, I wonder if I'm still dreaming. The truth dawns incrementally: My long-awaited hospital visit must be today. I reach for the gray pants and white T-shirt folded on my foot locker. This movement's too sudden. My heart starts pounding, and I'm instantly nauseated, but this is nothing new. In fact, it's the reason I've been awakened at this unthinkable hour in the first place.
There are only so many health issues that the prison is equipped to deal with. On-site medicos did refer me to a cardiologist in what prisoners often give the fantastical appellation “the outside world.” Unfortunately, the bureaucracy's taken three and a half long, anxiety-riddled months to okay me to see one. Learning I'd been approved gave me a measure of relief, but I had no clue just when I'd be going out. To minimize the chance of escape attempts, the powers that be treat as top secret the date and time of trips beyond the facility's boundaries.
It's surreal walking across the prison yard after dark, when stark LEDs carve wedges into the night and a couple of far-off guards are the only other humans I see. The air is cool and sweet, but also slightly thick with the summer humidity familiar to Missourians. All the way at the other end of the facility waits a heavyset young guard who's been looking for me from the chain-link gate to the prison's transportation area. Once I'm close enough, I say good morning. He opens the gate, and we both pass through.
On this side of the fence is the large driveway where pale gray buses pick up prisoners for transport and drop off new ones. Today, at this hour, it's occupied only by two minivans—my ride and its security escort. We pass under a high-ceilinged carport and enter one of several numbered doors lining the transport building. Three other guards stand waiting inside, talking fantasy football. A young man in orange pants and rubber shoes sits nearby, shackled and handcuffed on the long concrete bench. No one else is in sight. It's odd to see this area so deserted. The last time I came through, the day I arrived here on one of those gray buses, it bustled with activity.
“Put your grays and ID in here,” said the oldest guard, handing me a little plastic trash bag and pointing to a folded orange article on the bench behind me. “That jumpsuit's yours.”
At this point in my prison career, the indignity of being shackled, chained around my waist, and handcuffed no longer registers. There are those who rail against every indignity they feel is visited on them by the overarching conditions of imprisonment, fighting the system at every turn, with every breath. I prefer to pick my battles. A polite request is all it takes for the guard to give me a finger's breadth of room in the shackles. Although I won't be walking far, it'll be a long enough day without steel cuffs cutting into my ankles every time I shift in my seat.
From previous experience, I expected a wait. We head to the minivans and within minutes have passed through the prison gates. It's a new vehicle. I've never seen a full-color digital speedometer before. I'm contemplating what was wrong with mechanical ones when the young man beside me asks how long I've been at this facility.
“A year and a half,” I answer him. “I did 16 years at Crossroads before that.”
“You got a lot of time?”
“Yeah, you could say that,” I say, smiling with the grim humor that's propped me up since the days when I considered myself a young man. “I've got life without.”
“Oh, damn,” he says, then falls silent for the rest of our ride to the state capital.
We travel via two-lane state highways through small redbrick Midwestern towns with businesses named Love Your Country and Dickey Bub. Between these pockets of civilization grow thick woods so hilly that the pavement cutting through them zigs and zags with the violence of an angry child's crayon scribble. My seatmate and I are tossed back and forth, and our guts rise in our torsos at the crest of each sharp rise. Never before in my adult life have I been car sick, but after 18 years of imprisonment my stomach's lost its tolerance for this kind of motion. I'm convinced that Missouri Highway 185 was paved by a sadist. Our pit stops for the guards to buy soda and lottery tickets are a much needed reprieve.
Three and a half hours later we pull up to the medical center's service entrance. Prisoners are kept out of sight of the general public as much as possible. We're each put into a wheelchair, with blankets haphazardly thrown over our wrists and ankles, and I wonder if this seemingly token gesture isn't missing the point. Wouldn't the public, seeing the hunter orange jumpsuit that unambiguously marks me as a prisoner, be reassured to know that I'm securely restrained?
Regardless, we have our Hannibal Lecter moment as the guards wheel us down out-of-the-way corridors—past the laundry, a construction area, the morgue—to the elevator, which we pile into with two guards and a prisoner from another facility.
The biggest guard pats his prodigious belly. “Guess we're gonna test the weight limit,” he quips. Cue nervous laughter.
It's an unusual dynamic, the way that nurses and other hospital staff interact with our party. They speak to the guards, exchanging pleasantries, often referring to us patients (if at all) only in the third person, as though we're incidental to all of this, and address us directly only when a consenting signature or some diagnostic question is called for. Prison's taught me to treasure meaningful conversation, so I'm hardly jealous of such exchanges. It's just interesting to see how we men in orange are personae non grata even in this setting of care.
This changes when I'm undergoing the test, thankfully. The guards unlock the belly chain to secure me by one wrist to the treadmill frame (someone's idea of hell, that). Then they stay in the room while I'm wired to the heart-monitoring equipment and put through my grueling paces. Only after my heart rate hits 178 does the treadmill begin to slow. Once the test's complete, the cardiologist and I discuss the situation.
“Your results look okay. Of course, this test doesn't rule out certain other conditions, such as coronary artery disease,” the small, affable man says. “For that they'd have to have ordered a nuclear test.”
It figures that the correct test, where my intense treadmill walk would've been accompanied by a dye injection and a body scan—the specific test needed to diagnose coronary heart disease—isn't the one that the health care provider approved. Frustrated by this waste of time, I let the guards reapply the cuffs, the shackles and the belly chain that secures the cuffs to my waist. Then I'm wheeled back to the designated waiting room. It's nearing noon, 23 hours since I was last allowed to eat, but our lunch is in brown bags in the van. I can't break my medically ordered fast until the doctors turn their reports over to the guards.
On the largest TV I've watched in years, a 20-inch LG on the waiting room wall, a movie about tortured POWs in a Japanese prison camp provides a low level of irony that no one else seems to notice. The notes take an hour and a half to arrive—a wait exacerbated by the fact that someone in the room, every three to five minutes, silently passes gas.
Past the construction area, the morgue and the laundry we roll again, out to the service entrance and the minivans. The young guard opens the hatch and retrieves our brown-bag lunches as the older one situates us in the back seat. Our escorts from the other van smoke.
“Man,” my fellow prisoner gripes, wrestling his bag into an accessible position, “how we s'posed to eat this with just one hand?”
Transport cuffs aren't like normal handcuffs, with the little links of chain. They're hinged in the middle, with a clip that slides over them, which immobilizes the wrists. You're cuffed palms-down, left arm over right, and this whole assembly is then fixed to the chain around your waist.
Eating does take some dexterity, but more important is to have your movements planned out in advance. I show the young man how to easily get into the peanut-butter-and-jelly sandwich bag one-handed, then a “headlock” technique to get his water bottle open. We eat quickly, quietly, then go back to watching the passing sights.
I see yawning pedestrians on cell phones, too many SUVs and enormous pickups, the world's smallest Walgreens, a billboard for the world's largest rocking chair and the remains of 11 animals not quick enough to evade oncoming traffic. It's all sad. It's all too much and, simultaneously, too little. I want more for the world. I want more from the world.
When the van pulls back up to the rear gates of the prison, 13 and a half hours after leaving, it's almost a relief.
Byron Case, 41, is serving a life sentence without the possibility of parole for first-degree murder at Eastern Reception, Diagnostic and Correctional Center in Missouri. He frequently publishes short stories and poems in literary journals, anthologies and on his blog www.pariahblog.com.
Editor's note: The Missouri Department of Corrections has contracted with Corizon Health to provide medical care at its facilities since 1992. Corizon, which operates in 17 states, has been the subject of hundreds of malpractice lawsuits. Corizon could not immediately be reached for comment.