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My Uncle Died the Day He Was Released From Jail. I’m Still Trying to Understand Why.

“Sudden cardiac death,” is the cause listed on my uncle Bryan’s death certificate. But it didn’t feel sudden at all — not when you factor in his underlying mental and physical health problems, years of poor prison medical care and the fact that he caught COVID-19 in his Arizona jail.

It took me four months to open the email my mom sent me with my uncle Bryan’s medical history. By the time I read through the 132 pages, divided into three carefully scanned PDF files, he had been dead almost half a year.

I wondered why it had taken me so long. There were the usual excuses — I was busy, working, things came up. I had avoided it because I knew it would be hard, emotional.

The bigger truth is I wanted Bryan’s story to be straightforward, and I was worried that what I would find in his medical records would not be. I wanted it to be a story of gross neglect on the part of the prison system, a system that had failed him his whole life. After spending years teaching in prisons and reporting on the criminal justice system, I had seen the same system fail so many other people. I wanted my memory of Bryan to remain untainted — I wanted to remember the kind letter he wrote me from prison when I graduated high school, peppered with Bible verses; the way he helped me load my grandma’s extra patio furniture into my car when I visited them my sophomore year of college; how he danced in the park on his wedding night, inaugurating a marriage that would end shortly after, but in that moment, felt beautiful and hopeful.

Of course, these memories are only part of Bryan’s story. The people who had to experience the worst parts of it — including my mother and grandmother — shielded me from the rest.

The story Bryan’s medical records tell — put together with his court records, the memories of those who knew him best, and the explanations of the county jail that held him before his death — is a more complicated one. Yes, Bryan’s case illustrates neglect in the American prison system. But more broadly, it also shows how the web of mental health, emergency medical and social services haphazardly cobbled together throughout the U.S. so often fails those who need it most. The doctors, family members, social workers and good Samaritans who try to cover the gaping holes in that web do their best, but it’s rarely enough.

Bryan died at Banner Payson Medical Center on January 29, 2021. Earlier that day, he was released from Gila County Jail in Globe, Arizona. My grandma drove with a friend the 90 minutes or so from Payson, where she lives, to Globe to pick him up. He was complaining of chest pain during the drive, and they had him lay down in the back of the car. When he didn’t feel better, they took him to urgent care, and later to the hospital.

Upon moving the patient back to his room, he lost pulses. CPR initiated immediately,” reads the doctor’s report from that day. “After several rounds of [Advanced Cardiovascular Life Support], securing airway and administering medications, the patient’s bedside ultrasound shows cardiac standstill. Time of death called at 1522. Family made aware.”

When my grandma was “made aware,” she was devastated. When I talked to her the next day, she told me Bryan had spent the car ride home from jail talking about buying a truck and trying to start his own business. This had felt hopeful, even if history suggested it wouldn’t last long.

Bryan’s cause of death is listed as natural, “sudden cardiac death due to a probable atherosclerotic heart disease.” Samples taken a few hours after he died, around 5 p.m., came back positive for COVID-19. Over the next few days, my family’s grief mixed with fear as we thought of my grandma, who had only received one dose of the COVID-19 vaccine, spending hours with Bryan before his death.

After a few long days, my grandmother’s coronavirus test came back negative. By that time, she was deep in seeking answers from the county jail. She wanted justice, and she wanted to protect others. I remember her telling me that she wanted folks to understand that those in jail were people, people with families who loved them, who didn’t deserve to die from a virus they were exposed to by institutional indifference. I, too, had been calling and emailing the Gila County Sheriff’s Office, which confirmed that in January, 15 staff members and 30 incarcerated people had tested positive for COVID-19.

Months later, in July, as I read through Bryan’s medical records, I found a strange comfort in the fact that at least he had died in a place that was familiar to him. Records document 15 visits to the emergency room at the Banner Payson Medical Center from 2015 until his death — for panic attacks and anxiety, chest and back pain, medication refills and a severe infection in his arm, to name a few.

Each doctor’s report carefully details Bryan’s underlying conditions: bipolar disorder, schizoaffective schizophrenia, panic disorder. Each visit, he told doctors he smoked more than half a pack of cigarettes a day. He always denied substance abuse and almost always denied drinking alcohol, though these affirmations would have ranged from questionable to false, depending on the day.

One incident that caught my eye took place in May 2019, when Bryan was brought to the ER by police for “clearance for incarceration.” Police had noticed that his arm was swollen with “multiple open wounds,” which the doctor who saw him seemed to think was attributed to drug use (though Bryan denied it). The doctor diagnosed him with cellulitis, a bacterial skin infection, prescribed him antibiotics and cleared him to go into police custody.

Twelve hours later, released from police custody, Bryan returned to the ER. He could not afford to fill his prescription.

“After discussion we did decide it would be best if I just filled his prescription so I called the pharmacist at Safeway to fill his clindamycin prescription and actually paid for it with my credit card,” wrote the doctor who treated him. “The patient police officer is going to Safeway to obtain that prescription and bring it back.”

Around eight hours after his second visit to the emergency room for his arm, police brought Bryan in for a third visit. He was instructed to continue his antibiotics and was cleared, once again, to be discharged into police custody.

As I read these reports, I was struck by how they each contained dual narratives. First, they told a story of emergency medicine trying to fill needs unmet by other social services. And second, they described Bryan himself — what he needed, what he wanted, how he felt, who he was. A doctor’s report from April 2019, for example, notes, “This is a pleasant 59-year-old gentleman who presents with a chief complaint of #1 cough #2 chest pain #3 right great toe pain...Patient reports that he has been walking for a long time today and that his medications recently got stolen...Patient states that God will take care of him if we can just give him water, food and refill his medications.

In a similar incident in August 2018, Bryan was admitted to the ER for anxiety, supposedly after an animal had killed his dog while hiking. “He was not injured in this altercation but comes in emotional crying,” reads the doctor’s report. “He states that if we just let him rest and give him a couple sandwiches he should be fine.

Four days before that, EMS had found him walking on the street and brought him to the emergency department, where the doctor who saw him noted: “The patient presents with back pain, lumbar pain, lower back injury and toe injury and also has been homeless walking all day long.”

In 2017, Bryan was admitted for shortness of breath and diagnosed with pneumonia. In 2015, two days after being released from jail, he visited the ER to request a medication refill, telling doctors he didn’t have an appointment with his caseworker for three days and couldn’t sleep without his meds. About a month prior, he went to the emergency room twice in one day for an anxiety attack.

There are more reports, and I read them over and over, thinking of the doctor who paid to fill his prescription and the police officer who picked it up. Of Bryan asking for a sandwich, of the characterization of him as a “pleasant gentleman,” of his faith that God would solve his problems. Of his experience of homelessness, his bouncing in and out of jail, his many underlying conditions. I fixate on the “educational materials” provided after each visit: “Anxiety reaction,” “Understanding Bipolar Disorder,” “Taking an Active Role in Your Medicines.” I’ve never read these materials, but they strike me as the most bizarre Band-Aid imaginable to compensate for the fact that the U.S. has no comprehensive system for mental health care, and essentially, no options for people like my uncle, except for a shrug and a “good luck,” and when that doesn’t work: prison.

I try to imagine alternative endings to Bryan’s story. The truth is, I don’t know exactly what he needed, or how things could have turned out different. My family — and more than anyone, my grandma — fought to help Bryan, again and again, with little support and fleeting success. I know my grandma and the people who loved Bryan did everything they could to help him. But they were fighting against broken institutions that could never give Bryan what he needed.

It’s also hard to know exactly why Bryan died. “Sudden cardiac death,” the cause listed on his death certificate, feels insufficient. The heart problems that killed him didn’t feel “sudden” at all — not when you factor in his underlying conditions, the years of insufficient health care he received while incarcerated, and that he had caught COVID-19 in jail.

Bryan’s death was complicated, as was his life. I want both his life and death to have a greater meaning. Indeed, that’s the reason I sat down to write this. But I also think it’s dangerous to lay that burden on Bryan’s shoulders, especially when, if I’m honest with myself, I barely knew him.

On the night of my uncle’s death, I wrote:

Today, I find myself looking at Bryan’s mugshot from the Pinal County Jail, taken March 14, 2020. He’s thinner than I’ve ever seen him, neck bones jutting out of skin. If you zoom in, you can see his blue eyes.

I saved the photo and its accompanying rap sheet on March 21 in a Google Drive folder I created under his name. There, I also saved 20 documents, court proceedings. Failure to appear. Theft. Disorderly conduct-fighting. Criminal damage. Harassment by communication. Marijuana possession. Threat/intimidation with injury/damage. Intentionally placing a person in fear of imminent physical danger. Indecent exposure. Criminal trespassing. DUI. Aggressive harassment. Aggravated DUI.

I scan my phone and computer for photos, documents, ways to remember him. This is all I find.

Today, buried in a psychological assessment from February 2020, taken after Bryan had been “hospitalized for his own safety after displaying behavior concerning for frank psychosis,” I found something else to remember him by.

“He identified his strengths as being a survivor, a people person, and determined,” the doctor wrote. “[Bryan’s] goal for treatment is to restart his medications.”

Those words feel improbably hopeful. They remind me of Bryan’s words on the day he died, his desire to buy a truck and start a business. I accept them at face value. I linger on them. They’re what I have.

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Mia Armstrong Mia Armstrong is a writer based in Mexico City. In addition to The Marshall Project, where she formerly interned, her work has been published in the New York Times, Slate, Longreads, Nexos and Letras Libres. She has taught writing in prisons throughout Arizona.