Second opinion
I TRUST that I shall not be called cynical when I mention that the first question to be answered by a doctor on examining a prisoner with abdominal pain is whether the patient is trying to get out to hospital, either as relief from the monotony of the prison regime, or because it is easier to escape from hospital than from prison. The last prisoner who gave it a go ended up with a broken leg, because he escaped from his hospital bed still wearing his socks and he slipped on our hospital's shiny stone floor. I am not sure whether he brought a case against the hospital, which after all has a duty of care towards its escaping prisoners, but I wouldn't mind betting that the thought occurred to him.
Nevertheless, I always examine very carefully prisoners who claim to have abdominal pain. After all, even notorious E-men (the prison term for escapees) are not immortal, and can suffer medical emergencies. Sod's law states that the one prisoner you don't examine properly will be the one who turns out to have something seriously wrong with him.
So when I was asked to see a young man called Aziz who was complaining of serious abdominal pain, I resolved, as I always do, to examine him properly, despite the fact that he was laughing and joking with the other prisoners, gave the thumbs-up sign to them on his way to the examination room, and continued to walk with the self-assured vulpine lope of the urban predator.
In fact, I recognised him at once as a severe case of Gold Front Tooth Syndrome. There has been a frightening epidemic of golden dentistry in our inner cities: one sees the gleam of it in every nook and cranny in the prison, mainly among youths of Jamaican and Pakistani descent, though it seems to be spreading fast among the whites. I suspect that half the crime in this country is committed not to purchase drugs, as the conventional wisdom holds, but gold front teeth.
There are, of course, several styles of gold front teeth. There is, for example, the whole row of gold teeth, which may sometimes be replacements for the originals amateurishly extracted with baseball bats. Then there is the golden rim around one, two or three teeth, and the golden edge that is to a normal tooth what an iron toe-cap is to a normal shoe.
Sufferers from Gold Front Tooth Syndrome are recidivists who see nothing wrong in what they do and are even proud of it. They are cheerful and never commit suicide, unlike other prisoners. Lack of self-esteem is the least of their problems. The girlfriends they are about to abandon are always pregnant: indeed, pregnancy is to their girlfriends what designer stubble is to certain celebrities. They walk with their legs slightly apart and their arms swinging in front of them. They have springs in the balls of their feet.
Aziz was a fulminating case: no hope for him, I am afraid (or rather, for those with whom he comes in contact 'on the out'). Otherwise, though, there was nothing wrong with him. I told him so.
'You mean I'm not going out to hospital?' he said.
'No,' I replied.
'I thought you was here to help me,' he said. 'You're just flogging me off.'
'No I'm not,' I replied. 'I wouldn't get anything for you.'
Theodore Dalrymple
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