The police were called to a high-end outdoor mall where a female had attacked two shoppers, stripped off her clothes, and threatened to barricade herself in a lingerie store and defecate on several expensive items of clothing. Two officers arrived, discovering a scene directly out of the movie as trash cans had been heaved along the sidewalk of the store. Two crying shoppers huddled in the middle of the street. Broken window glass littered the ground, as well as items discarded from stores. The officers tried talking to the woman, to no avail, and thirty minutes later, she streaked for a back door into the alley, right into the arms of a third officer.
The officer held the woman as she tried to break free. The officer handcuffed her and forced her onto the ground as the squad car was brought around back. The women kicked and screamed as they put her in the back seat. She was utterly irrational and uncooperative. She urinated over the back seat on the way to jail. She was arrested but it was clear that something was off. Partway there, because of the woman’s behavior, they changed direction and stopped by the local hospital to get jail clearance.
At the hospital, if possible, the woman’s behavior worsened. She spat on two nurses and tried kicking the doctor. They tried to calm her down, but eventually she made it clear she wanted no treatment and insisted she was fine. She refused a urine test and drug screen. She refused to allow blood work or to talk with a social worker. Attempts were made, but she refused treatment and signed refual paperwork.
The only words she said were, “I’m Mary. And I freaking refuse everything.”
The hospital had no option but to clear her to go to jail. The officers were forced to drag her from the hospital to their car, newly cleaned, and take her to jail. She fought them every inch of the way.
Once at the jail, she refused the medical screening and intake process. She went through the booking process but declined to say whether she was safe or not. The arresting officers described what had taken place prior to coming to the jail and that, along with her behavior at the jail, she was placed on suicide watch. She was moved to medical for closer monitoring.
Over the next few days, she ate sporadically. Mental health, medical staff, officers, and even religious services attempted to talk to Mary. Not once did she say anything. Her medical cell turned into a war zone. Food, debris, bodily fluids, and toilet water were splashed and thrown throughout the room.
From there, her behavior became more bizarre. You would find her sleeping on the cold floor during the day and doing naked handstands at night. She would run at the door if you walked by as if she was going to smash into it. She would veer away. At other times, she pounded on the door for hours.
Medications to help her mental health were ordered, but she refused to take them. Patients have the right to refuse treatment, eating, and medications while in jail, and forced medications are nearly impossible to initiate.
Around day seven, something changed. It was noticeable but barely, and the staff hoped that if she’d taken a substance, it might be wearing off. That or maybe her behavior would improve on its own. Staff increased their attempts to help and talk with Mary. They tried different foods, additional fluids, and some Boost drinks. She continued not to answer questions but began singing and talking to unseen people in her cell.
On day eight, it looked like she was sitting down to eat her meal. An hour later, she vomited up everything but kept on singing and dancing. She was given a shower and tried sleeping under the warm water while seated on a shower chair.
Her cell was cleaned, and she was given a new mattress. She was moved to a different cell once she finished the shower. She didn’t wash her hair or put any soap on her body. She only sat in the warm water.
A medical assistant stopped by as she headed into her new cell to take her vitals and give her medications. Mary became upset and threatened the MA. Officers intervened, and the MA quickly left the cell and reported the incident to the charge nurse. A social worker stopped by a few hours later, but Mary only sat in the corner, hitting her head lightly on the wall.
The following morning, Mary was found lying on the ground unconsious. Thirty minutes before that, she had been sleeping in her bed and was awoken by the officer checking on her. Medical staff ran in and found that Mary’s pulse was racing, she had a temperature, and her blood sugar was in the 400’s.
There was no information that she was diabetic, but it was clear that something was wrong. An ambulance was called, and the patient was sent to the local hospital. Confusion and uncertainty ran through the jail.
Mary arrived at the hospital and was quickly assessed. Her fever was 102.9 degrees, and her pulse was 136. She was breathing, but it was shallow and quick. Her face had become ashen, and she was sweating profusely.
Doctor Ugel and Nurse Natalie helped immediately to stabilize Mary. They checked their chart and realized she had been there ten days previously but had refused treatment. They had no past medical history and knew nothing about her. The information provided by the jail was helpful, but didn’t explain what was happening.
A urine sample, chest X-ray, and blood work were sent out immediately. An IV was started, and fluids were administered. She was given Insulin to bring down her blood sugar. A cursory exam shows a few scratches, a bruise on the forehead, and other healing bruises. The bottom of her feet was calloused, dry, and cracking. The combination of fluids, Insulin, and fever treatment appeared to help calm Mary and lower her temperature. Still, she wouldn’t or couldn’t open her eyes and talk to them.
The urine came back showing no infection, but she was severely dehydrated. Her blood work showed a significant infection, some kidney problems, along with other abnormal findings.
Dr. Ugel told Nurse Natalie, “We have an infection, likely sepsis. In a diabetic, that could be life-threatening. Did you see anything that could point to a cause?”
“The scratches are healing. We checked the hair, the hands, and the bottom of the feet. Nothing was found. It couldn’t be a UTI (Urinary Tract Infection)?”
“Unlikely. Let’s do a more thorough exam. Let’s focus on the feet, as she is clearly diabetic. She might not have felt something.”
They soaked the feet, cleaned away some of the blackened skin from healing and old callouses.”
“Is this something?” said Natalie. “There looks to be something between her toes on her left foot.”
Dr Ugel hurried over. A shiny piece of glass was clearly visible as Nurse Natalie separated the big toe and the one next to it. It had cut deep into the skin, and reddish white dried drainage oozed out.”
“How is this possible?” asked Dr. Ugel. “Why would it still be there?” Removing the piece of glass took nearly ten minutes. It bled, and grasping the piece of glass was harder than he thought. Once finished, he noticed that both legs were swollen, but there was no skin redness near the foreign object. “This could explain a lot of things, but we need to do more testing.”
Nurse Natalie received an order to collect some blood. Like everything else with Mary, this was harder than it should as she was a dificult stick.
When the labs came back, Mary was found to have an infection in the blood called Sepsis. To make matters worse, the infection had also gone into the bones of her foot and partially into her ankle.
Dr Ugel explained, “This type of infection might explain some of Mary’s confusion. Having diabetes might make treatment more difficult.”
It did. It took several days to get Mary’s infection under control. She required IV antibiotics, and when they felt she was well enough, she went for surgery three separate times to clean the soft tissue, the bone, and repair the damage. Eventually though, her left foot and lower leg were amputated, and two weeks later, the three fingers on her right hand were also removed.
Mary’s condition, both physically and mentally, improved in the hospital, slowly. By the sixteenth day in the hospital, her fever and pain significantly improved. Along with the diagnosis of diabetes, Mary suffered from untreated schizophrenia, substance abuse, including alcohol, and was homeless. Dr. Ugel insisted she receive ongoing treatment and counseling, and sixty-seven days after her arrest, she was released from both jail and the hospital.
Going forward, Mary would require massive help from the government as she had no family. This would be essential for the next several years. She had a long and challenging road to recovery. She was admitted to a nursing home for treatment and stayed there for the next three months. While there, she remained on her mental health medications, and her diabetes improved. She lost thirty-seven pounds. She was given a wheelchair and learned to transfer herself. When she left the skilled nursing facility, she was in the best health she had been in years. The county social worker checked on her weekly and found a place for her to live.
Unfortunately, it didn’t last.
She was arrested three times over the next eighteen months and returned to jail in a very similar manner to the first time, at least mentally. She was often off her medications and was arrested for public intoxication, shoplifting, and missing her court date. She never stayed longer than a month, and twice, she was willing to restart her medications. Drastic improvement was seen almost immediately.
The final time Mary came to jail, she refused both mental health and medical treatment. Her charges weren’t big, but there were several attempts to get her committed for mental health services. The jail wasn’t able to restart her on her medications, and she refused every dose. It was a difficult three weeks. Unfortunately, Mary passed away eight days after leaving the jail, almost two years after her first incarceration and Sepsis infection. That time was filled with some ups and mostly downs for a woman who couldn’t get past the thoughts in her head.
