Severe Scratches of the Skin

The prison administration worked for many months to facilitate the transfer of one of their inmates to a prison closer to where his family lives. This doesn’t always work out, but our inmate had just received the news that he had cancer and his parents’ health was failing. The parole board approved the paperwork, and he was sent on a bus with two officers, and it took three days to arrive without incident.

Whenever this type of transfer happens, the jail will often receive a new inmate from the same facility. Around the same time our inmate was placed on the bus, Desri Stevens was being loaded into a van for the journey to our state. She arrived with a spit hood and cuffs around her waist that connected with her hands and leg irons. The van ride for the three officers was anything but pleasant. She was unruly and difficult, and finding a hotel to accommodate all three officers was challenging. It wouldn’t take long for the prison to regret the exchange, at least at first.

I was the nurse that was present when she arrived. We needed to do an intake screening in order to get her medical and mental health background. We also would get a list of medications and do an assessment. If there were any serious problems, we would refer them to the provider to address them.

Desri shuffled into the exam room, and her spit hood was removed. She was angry and tired and did not like the fact that she had been transferred to our state. She made that clear as quickly and as often as possible.

The first thing I noticed was the large gashes on her forehead that had since healed and were now scars. Additionally, she had newer scratch marks on her face, chest, and legs. I began to worry that she had been hurting herself.

I asked, “What are these scratches from?

Coming here wasn’t exactly a smooth ride,” Desri countered. “It’s not like I went to Disneyland.

Were you trying to hurt yourself on purpose?

Why would you go thinking that?

Some of these scratches are new, and some are older.

No kidding. Why don’t you go kiss my ass.

The remainder of the intake was done in a similar fashion. Each question was repeated back to me, and there was attitude, contempt, and sarcasm. The assessment went as well as possible. The cuffs could not be removed because of her behavior. She threatened to spit on me twice.

Once finished, Desri was placed on suicide watch, and that’s when her language skills became apparent. She swore, threatened, and hit the cell wall as if she were picturing my face and trying to destroy it. Her strength and strong word language were impressive.

Mental health came quickly to her cell, and several questions were asked. I was required to stay close, but I remained out of sight. Desri had no idea why she was placed on suicide watch. The social worker tried to get a clearer picture of why she had scratches on her body. Desri was only willing to share a little information, and she never wanted to see that “Stupid nurse again.”

It wasn’t like I could leave until we were finished. I told Desri that the sooner we were finished, the better for her. Finally, Desri told us that she had depression and some panic attacks. Additionally, she had a medication for high blood pressure and was borderline diabetic. I explained that we might need to do blood work or blood sugar checks. I would consult with the doctor and see if he had any orders.

The next day I had several other intakes from people coming back to the prison or being sent here for the first time. These individuals were not coming from a different state but were brought from local county jails. Once I finished, I went back to check on Desri and some of the other inmates in the section where I was working. The social worker had stopped by again, and Desir had already been seen by the medical provider. All of her medications had been reordered.

Her mood had drastically changed, and it was staggering. She had showered and gotten some sleep and greeted me kindly. This abrupt change was surprising. She had empty Styrofoam trays and had been drinking. She waved me over and looked ten years younger.

Thank you, Nurse Campbell, for all you’ve done for me.

No problem Desri. You look like you’re doing well.

I slept great last night. I talked with the social worker this morning. She thinks I’m doing good.

That is so good to hear,” I said.

She thanked me for helping her yesterday, and she hoped to be taken off of suicide watch the next day. Her scratch marks were less noticeable, and she looked healthy.

The following day was my last day on the shift for the week. I went through the same process of getting through my intakes. I headed out to see the same people as the day before. When I arrived at Desri’s cell, I was confounded that she had transformed back into the person I’d seen the first day. She had new scratches, was angry, and slammed her fist into the wall when she saw me.

Scratch marks covered her face, both arms, and her neck. Some of them were actively bleeding through the gauze placed during the night. Her voice was low and raspy, and she had aged back the ten years from the previous day or more. The charting from the middle of the night reported self-harm, anger issues, and ripping off the first two attempts to clean and dress the wounds.

Looking closer at the charting, the nurse from the night shift noted that sometime around four in the morning, she had flipped out and said that there were bugs all around the room, crawling on her and trying to burrow into her skin. She had freaked out and started pounding on the door, and when the officers arrived, they found several self-injuries. It took several minutes to subdue her, and they even had to give her a shot to calm her down. The officers or nurses saw no bugs or other things inside the cell.

I called down to and control room, and two officers were sent to her cell to help. She cuffed up without incident, but she was angry at me.

We’re going to take you to medical and clean up those wounds.

Why? The bugs will come back out of my skin when you aren’t looking.

We can try to help you with that.

No, you can’t.

Desri was moved to a bed and lay down. I opened her suicide gown and was shocked at the number of scratch marks on her chest and abdomen. Some of them were six inches in length. I began cleaning each of them and dressing them as best as possible, with her being on suicide watch.

I asked, “What exactly happened last night?

I was attacked…as I always am.

Any history of drug use?

Everyone always asks this.

And?

I haven’t used drugs in years. I only used meth a little and some marijuana.

None recently and certainly none since I came to prison.

How long have you been in prison?

Two years, and I have three more to go.” Desri was both angry and frustrated. It showed in her protective arms across her chest and in her voice.

When did you first notice these bugs on your skin?

Don’t know.

Do you see them now?

Heck no. They only come out at night. It’s like they’re sleeping during the day.

What kind of bugs do you see?

Desri shivered. “Some can be long with tons of legs. Others are like ants. They are disgusting. I don’t know why they like to live in my skin.

Twenty minutes later, I was finished addressing her wounds.

What’s going to happen to me?” asked Desri. “Are you going to stick me back into the cell so they can attack me again? Still think I want to hurt myself?

I’m going to talk with the doctor and see if we can help you.” I walked out, and it took a few minutes to find the physician. I explained to him everything I had seen since Desri arrived. He listened and began nodding part way through my explanation. He agreed to join me in medical and talk with Desri.

Stepping inside the exam room, Desri became withdrawn and began denying anything had ever happened to her. She denied any thoughts or ideas of seeing bugs.

Dr. Dewey said, “I’ve actually seen a few patients who saw bugs before. It isn’t real common, but it’s happened before.

That’s not me. I don’t know what Nurse Campbell told you, but it isn’t true. She’s trying to convince you that I’m sick in the mind. Another excuse to keep me locked up in solitary.

I don’t think so,” said Dr. Dewey.

Desri peered at me and said, “She trippin’. I’m fine.”

Hear me out. It usually happens in one of two ways. First, you hear from someone else a story about a spider or something in their cell or maybe their house. You hate how the story sounds and how it makes you feel. Many people have phobias of bugs. You then start thinking about what would happen if that occurred to you. Soon enough, you can’t stop thinking and dreaming about bugs.

Desir interrupted, “No one told me no stories.” Her face had gone pale.

The second possibility is that you see an actual spider or a bug on you. You knock it away, and it comes back over and over again. Soon, you have bugs approaching all the time, especially at night. They might come from the corners of the room or from right under your skin.

Stop!” screamed Desri. “I don’t want to talk about this.

Fine,” said Dr. Dewey. “I just want you to know there is treatment for this. We can help you.

No thanks. I want to go back to my cell…now!

I said, “I’ll stop by in a few days to check on you.

Don’t bother,” replied Desri. She was returned to her cell, and I didn’t see her for a few days.

My time off was just what I needed. Working in a prison can be difficult and draining. But I was also excited to return back. Dr. Dewey found me within ten minutes of clocking in. He had a smile on his face.

What’s going on?” I asked.

Desri Stevens finally agreed to treatment. We’ve started her on medications, and she’s been doing well the last few nights. She’s also working with mental health to get through a few things.

That’s a great thing.

He leaned closer. “It got awful the next two nights after we talked to her. The scratches were worse the first night. The second night she slammed her head into the wall.

No way.

She nearly knocked herself unconscious.

Was she really seeing bugs?

In her mind, yes. It is called Formication. It can be real to her.

What is it caused by?

Trauma, mental health, drug use, fear, or even phobia. You name it. I just hope she is willing to take her medications going forward.

Can she get rid of it?

Maybe. It’ll take a lot of therapy and dealing with things. Medications can help too.

I said, “That was one of the craziest things I’ve ever seen.

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