“Maximum Insecurity”

Above all else, I suppose this blog seeks to promote transparency about what it is like to be a federal trial judge. In a recent letter, William Wright, M.D., after coming across this blog in a USA Today piece about my Hobby Lobby post, thought I might be interested in his effort at transparency. But before I get to that, a little background about Dr. Wright is in order.


William Wright, M.D. is a graduate of the University of Michigan Medical School. He practiced surgery of the ear for 30 years before attempting (unsuccessfully) to retire from medicine and spend time with his wife, an artist, and an assortment of furry friends. A private pilot, he is also the holder of three black belts and instructor certifications in Tae Kwon Do and Aikido. He is a talented digital artist fascinated by motion, energy and light. And, if all that were not enough, he is one helluva of a writer.

His book Maximum Insecurity: A Doctor in the Supermax chronicles eights years practicing general medicine at Colorado’s maximum security prison after Wright found that retirement from medicine was driving him (and possibly his wife) nuts.* The book is wonderful.

It is hysterically funny, insightful, and very human. Most of all it provides a transparent, but worldly, glimpse into the practice of medicine in a prison where the patient population consists of especially serious (and often loopy) offenders, where the prison bureaucracy strives mightily to act as dysfunctional as the screwiest of inmates, and where the physicians, assistants and nurses undertake to treat with compassion, but not judge, or burst out loud laughing at the machinations of, an odd and sometimes dangerous lot. It was “Runner Up” in the General Non Fiction category at the 2014 Hollywood Book Festival.

Keeping in mind what Wright had no reason to know when he wrote me, that is, I manage our docket of prisoner cases and thus have read a ton of complaints of inadequate medical care in prison, here are a few snippets from the book:

  • Wright explains his first few days as a prison doctor and the fact that his straight chair would not allow him to fit his legs under his desk. The solution? A new adjustable chair. Oh, no. The helpful maintenance staff cut a 2×4 into four pieces and put the four desk legs on the four shortened pieces of lumber. Desk raised four inches. Problem fixed!
  • He explains the “secret” e-mails he receives from the administration in Denver that are urgent but can never be opened because they require a unique password that he cannot get because that special password requires a second special password that he is prohibited from accessing.
  • While performing a routine check up on a murder who had killed five people in a fast-food restaurant, Wright details how the correctional staff inched forward ready for any violence as the doctor began the examination of his patient. Wright touched a stethoscope to the patient’s chest fearing that “might be like lighting a dynamite fuse.” With that, a “a sly grin” came across the man’s face “spreading his thin lips.” “You scared, ain’t you doc? You should be. I be the baddest man you ever see.”  Despite his martial arts training, Wright was scared. “What the hell was I doing here?”
  • And the drug seeking behavior. The doctor explains how one of his patients, “a chop shop entrepreneur from Fort Collins,” came to the clinic because of a complaint about pain in the heel of his foot. Trying to remember the name of the powerful painkiller “Percocet” that the inmate was seeking, but being unable to do so, Wright sees the inmate “thinking hard.” Wright wryly observes, “This is a huge red flag.” Why? Because “[w]henever an inmate is trying to think he is lying.” After the doctor suggests the name of the highly addictive pain-killer, the patient’s eyes light up in relief. The inmate-patient tells the doc he only needs a supply of Percocet for “[j]ust a few months.” Tartly, the doctor responds, “No. Use the heel pad. Have a good day.”
  • This gentle soul describes his treatment of a kid who escaped from a county jail, fell forty feet, and impaled his abdomen on a steel post. Because the nerves were impaired and needed to heal, the bowels were pulled out of the mid-section in a procedure called an ileostomy. After two years of treatment, the nerves recovered and it was time to put the bowels back where they belonged. It was only then Wright learned that as a matter of policy they “don’t reverse ileostomies.” Flabbergasted and frustrated, Wright concludes: “Maybe someone should have thought of that a couple of years ago. But I’m just the hired help.”

Near the end of the book, in a passage I liked the most (p. 240), Wright writes more broadly and warmly of his patients and his oath as a physician. He is (to put it mildly) “less sanguine” about working in a bureaucracy even though there are “stars that shine” in “supervisory roles.” “They shine against a dark background.”

He remembers taking the Hippocratic Oath at the University of Michigan, his “throat tight with emotion.” “It is a pledge to always act in the best interests of my patients.” To Wright, that was “not a quaint ritual.” He still carries “every syllable into the clinic with” him. “[T]he examination room is not the place for moral judgments.” “Even sociopaths cry in the night[,]” “[m]urders miss their children[,]” and child “molesters feel shame.”

When one of his patients remarks, “You really take this serious, don’t you, Doc[,]” Wright is almost surprised. Reflecting, the good doctor concludes: “I do. Perhaps my patient doesn’t deserve the best I can offer, but for my sake I can give no less.” (Emphasis added by Kopf.) And, that is a good place to end.


*Even with my cancer treatment and my whiny complaints, Joan, my wife, tells me that I can’t retire because, as she puts it, “I married you for life, but not for lunch.” Despite my hang-dog expression, she never smiles when she repeats this mantra. Just like the lymphoma, she is deadly damn serious. As is often the case, she is right.

6 responses

  1. Just have to echo what Dr. Wright said, and you emphasized — the way a doctor treats a patient tells me about the doctor, an nothing about the patient.

    I think that most physicians find something profound, and almost holy, in the charge to provide compassionate care to imperfect people. This requires the physician to be nice to bad people, which is good practice anyway.

    When I care for prisioners I make a point of not asking why they are incarcerated because 1. it usually does not matter and, 2.I wondet if prisioners ever tire of a mistake they made, sometimes decades ago being a large portion of their persona snd identity.

  2. The way a judge treats litigants tells me a lot about the judge. “Haughty” pretty much sums it up. A doctor takes the Hippocratic Oath, and a judge takes the Hypocritical Oath.

    If there were a just God, everyone else would treat judges the way they treat us. Wonder how they would feel if they were thrown in a mental hospital for any reason or no reason at all. Or how they would feel if they had to spend Christmas in a cold jail cell on an obviously faulty warrant that was rubber-stamped because the judge was too busy to read it.

    We all have stories. We all have grievances. And they all begin with judicial sloth. We deserve the best you can offer, but never seem to get it.

  3. JDM,

    I appreciate very much your insights. I agree that most physicians “find something profound, almost holy, in the charge to provide compassionate care to imperfect people.” I only wish I had written those words.

    All the best.


  4. Judge:
    Along those same lines, I recommend to you an excellent writer, Anthony Daniels (who writes as “Theodore Dalrymple”). Likewise as with Dr. Wright, Daniels is a prison physician, now retired. As a cultural observer Daniels is nearly peerless. You will very likely find his writing insightful, trenchant and funny. Enjoy!

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