He could hear the football game playing on a radio outside his room, so he knew someone was there, and he knew he was dying.  He screamed and screamed as the paralysis from what he was sure was sepsis took over more and more of his body. No one answered.  Only his wits and knowledge could save him, he realized when the only thing he could move was his neck.

There was the intravenous line, he remembered, as he turned, caught, and pressed the tube between his neck and shoulder.  This, he knew, would stop the flow of fluid and set off an automatic alarm in the nursing station.  The ploy worked as a nurse came into his room, “I’m dying and calling out,” he yelled, “why didn’t you come in?” “You guys are always yelling,” she replied, “we don’t pay attention.”  He did not die that day.

This is one of the tales of prison health care written by Dr. Alan Berkman about his experiences in the federal prisons in the late 1980s. He almost lost his life again and again, not so much to the two cancers and treatments that had taken over his body, but to the incompetence and malfeasance of what passed for medical care in the jails and penitentiaries where he was confined for eight years. If they paid attention to us, he decided, they would have to acknowledge we are human beings. Doing that would undermine all the ways the prison system was set up to dehumanize and ignore the needs and demands of those it imprisoned. Above all else, the language of “security” meant they worried more about containing him than keeping him alive.

This story was only the most dramatic of the missteps and indifference that hounded Berkman’s experience of having cancer in prison. Had he had not been a white male doctor, with connections to the outside world and eventually with a New York Times column that helped bring attention to his case, he surely would have died alone. His death would come instead another 15 years later and after four more cancers, but at least then he was out of prison, surrounded by family, and able to access the best medical care available.

Those caught up in our carceral system in the face of the COVID are not as lucky, knowledgeable, or as privileged, as Dr. Berkman had been.  Despite the strenuous efforts of support groups like RAPP (Release Aging People in Prison) in New York, as well as the ACLU, the Marshall Project, and other prison organizations, aging, and vulnerable people are not being released in any number, even when they have served time for decades or up for parole, unless they are Michael Cohen, Michael Avenatti or Paul Manafort.  By the end of April, according to the Associated Press, “70 percent of tested inmates in federal prisons have coronavirus.” The Marshall Project on criminal justice counts at least 415 deaths with the highest number of positive cases per 100,000 prisoners in Tennessee, Ohio, Michigan, Kansas, and Massachusetts.  In New York State, more than 492 incarcerated people have tested positive as of May 25. Given the paucity of testing in prison, the numbers are likely much higher.

The numbers, however, do not tell us much about the lived experience. While guards have been issued N95 masks, although not everywhere, incarcerated people have not, nor are they sometimes allowed to wear masks. If you thought finding toilet paper and cleaning supplies was hard outside, those inside cannot get the most basic hygiene products while single bathrooms are shared by more than 100. Try using a sock instead of toilet paper. Medical beds are full, and testing is sporadic at best, and sick calls are being restricted. Food in the commissaries is limited.

It gets worse.  Even when placed in quarantine, spaces are shared. Or individuals are sent to solitary for weeks on end.  Since visits have been canceled, phone and email connections are circumscribed.  Legal visits cannot be scheduled, and the calls are delayed. This means it is harder and harder for community groups, lawyers, and family members to monitor what is happening behind the walls.

And the incarcerated are dying.

And when the corrections officers get sick, they carry their ills out into the community.  Even their unions have begun to protest.

It matters what happens behind prison walls. The diseases do not stay hidden: they move out into the community every time a corrections officer goes home.  Public health is only as strong as its weakest links, and prisons are just that. The only real solution is to let many of the aged and infirmed, those shown by evidence to be most likely not to re-offend, or those only imprisoned because they could not pay their bail out.  Every incarcerated person is now being left to possibly receive a death sentence. This is not what justice is about.

The governors across the county and the federal department of justice have the power to allow people out. They have resisted pleas from incarcerated people, families, public health experts, advocacy groups, and legislators that this is necessary. We need law and order based on justice and public health precepts, not vengeance.

Dr. Alan Berkman may have figured out how to get the attention of nurse while imprisoned, but he could just have easily been left to die.  We do not need to keep doing this.  Commutations and releases have to start now.

Susan M. Reverby is a historian and author of Co-Conspirator for Justice: The Revolutionary Life of Dr. Alan Berkman.

Image credit: Shutterstock.com