The Mad Hatter

By Ricky Taylor

My first experience with Doctor Teitelbaum was at the Hub in the Correctional Treatment Center of the Richard J. Donovan Correctional Facility in San Diego, California. I stood in front of the wrap-around desk that contained the daily sign-in sheets for the MTAs, chatting with the officer on duty, when I heard a voice behind me. The voice was a warbled mix of falsetto and feminine baritone.

"I wish to be escorted to the Facility One Clinic. I was told to meet MTA Taylor here."

I turned to get a view of the speaker. She was a heavyset woman in her early fifties with a shocking amount of frizzy, dyed red hair, sticking crazily out from under a wide-brimmed, magenta hat. She was wearing what might have been a workout suit of a shiny material in two different shades of purple. Her shoes were yellow sneakers and she carried a large, red leather bag. Small, beady eyes peered back and forth between the officer on duty and me, through large glasses on her pale, moon-shaped face. Taken aback by the sharp disparity of her appearance among the uniformed officers and scrub-wearing medical staff, I would not have been entirely surprised if she had told me she was there to don a bright red nose and make balloon animals for the inmates. I was the MTA assigned to Facility one clinic. An MTA, or Medical Technical Assistant, was a position unique to the California Department of Corrections. It was both a medical position and a peace officer position. MTAs responded to all medical emergencies and ran the day to day of the clinics on the yard. The department would soon do away with the position, and we would be given the choice of being either nurses or correctional officers. I would later choose to become a correctional officer.

"I'm MTA Taylor," I said, "I don't believe we've met before. Can I ask what your business is at the clinic?"

She made a dramatic flourish with her left hand and raised her odd warble of a voice, affecting the style of a Shakespearian actor.

"I am Doctor Teitelbaum," she announced not only to me, but to every person in the nearby area, "I am the new Psychiatrist."

Five minutes later, I was escorting Dr. Teitelbaum across the plaza to the Facility One Clinic. We reached the Facility One gate, and the gate officer checked our identification.

"Are you new to the prison system, Dr. Teitelbaum?" I asked. I knew entering a prison yard for the first time could be an overwhelming and frightening experience.

"I am new to the prison system, Mr. Taylor, but not new to those imprisoned by mental illness." Her eyes took on a fevered, dreamy, faraway look. "I am here to help men escape their prison."

The gate officer, a black man in his late forties, looked at her, then looked questioningly at me. Talk of helping inmates escape was not something taken lightly. I assured the officer that Dr. Teitelbaum was using a euphemism.

"It's Just talk," I said. "Dr. Teitelbaum doesn't mean escape from the actual prison, but the prison of mental illness."

Dr. Teitelbaum looked wordlessly up at the officer through her large glasses. The gate officer frowned but opened the gate. He looked Dr. Teitelbaum up and down, taking in the full oddity of her attire. He grimaced and rolled his eyes.

"It's on you, Taylor," he said. "It's all on you."

We stepped onto Facility One Yard. The prison yard was a large, oval strip of land surrounded by a track a third of a mile long. Inmates wearing blue CDC uniforms walked around the track, returning to their housing units from morning chow. They walked counter clockwise in the same direction, with occasional reminders over the loudspeaker to "Keep moving on the track." Prison is nothing if not redundant. Inmates see the same colors every day; blue and gray inmate uniforms, green and khaki officer uniforms, gray prison walls. You can imagine, then, the reaction among the inmates when they saw Dr. Teitelbaum entering the yard in her purple ensemble, magenta hat, red hair, yellow sneakers and a large red bag. Inmates stopped on the track, pointing. Inmates standing in the pill line in front of the clinic stared. Some appeared hopeful, no doubt thinking, as I had earlier, that she might be some form of entertainment. Others laughed, and I heard a few jeers.

Inmates were lining up in front of the clinic for pill line. They were allowed medicine in their cells, but psychiatric medicine had to be administered at the clinic. Much of what occurs inside a prison is in reaction to lawsuits filed by inmates. The California Department of Corrections had settled or lost several lawsuits filed by inmates who suffered due to poor medical standards and nonexistent or inadequate psychiatric treatment. The courts ordered the department to remedy the problem, and the department struggled to hire physicians, psychiatrists and other medical personnel. Because of this, hiring was the priority. Anyone with a medical license could obtain a contract position working in the prison. The standards were quite low. Over the years, I have worked with fine psychiatrists and physicians. I have known and respected dedicated psychologists. I have also known the ones who, in the departments rush to fill positions, fell through the cracks of the screening process. To meet the requirements ordered by the courts, Inmates were screened for mental health related issues. This was appropriate and necessary, but it also had a tremendous impact on prisons. Suddenly, inmates were being diagnosed with bipolar, schizophrenia, psychosis and antisocial behaviors. They were placed on psychiatric medications, which required follow-up appointments with the psychiatrists. Soon, thousands of inmates were on medication, and more psychiatrists were required to meet the need for follow-up appointments. The increased numbers of psychiatrists resulted in even more inmates being placed on medication, which required even more psychiatrists and psychologists. The day Dr. Teitelbaum first walked into Facility One Clinic, the cost of psychiatric medication at Richard J. Donovan Correctional Facility had exploded to well over one and a half million dollars per month. This did not include regular, physician-prescribed medication.

Psychiatric medication can be divided into three categories: Anti-seizure medication, uppers and downers. If you pull back the curtain of psychiatric and psychological jargon, you soon realize that psychiatric medications are drugs, plain and simple. I remember a conversation with one of the contract psychiatrists. He was a in his late forties, an agreeable man without the typical airs psychiatrists are known to have. We were having lunch in the MTA office in the clinic. The inmates were locked up in their cells for count, and we were alone.

"Do you know what I do for a living, Taylor?" He asked.

I smiled at him across the desk over my lunch.

"As far as I can tell," I said, "you're a psychiatrist."

"Well, of course I'm a psychiatrist," he said," but I'm not talking about my title or license. I'm talking about what I actually do."

"Well, Doc," I said, swallowing a bite of a tuna sandwich, "I may be crazy, and you're better suited than I am to make that determination, but it seems to me you talk to inmates about their issues, then come up with a diagnosis and a treatment plan. Does that about cover it?"

"Well, that's certainly how we phrase it, but that's not the heart of it," he said. "What I really am is a licensed drug dealer."

"Do I need to get my handcuffs out?" I said. "Is this a confession?"

He grinned.

"I did say licensed, Taylor. But licensed or not, that's what I am. Have you ever really thought about what psychiatric medication is? Drugs, Taylor. That's what they are. They're uppers and downers, and I prescribe them to drug addicts in a correctional facility. If I wasn't licensed to do it, I would be sitting in a cell instead of sitting here having lunch with you."

"Now, Doc," I said. "I think you might be selling yourself short. I'm sure you're doing a lot of good. There's a big difference between what you do and what drug dealers do."

"A difference in motivation, I agree. But not in what I do. When I first started, I opened an office in the city, and advertised for clients. I wanted to help people, I really did. But you know what kind of clients I got?" I shook my head and motioned for him to continue. "People started coming into my office with memorized symptoms. I knew they were just telling me symptoms, so I would prescribe them specific medications. It was obvious. But I had a lease and bills to pay. You know what I did, Taylor? I prescribed the medications they wanted. After that, word spread, and clients kept making appointments. Over half were drug addicts wanting legal drugs." He pointed to the nearby medication cart. "That's what they are. Drugs, man, drugs."

I had experienced the effects of the medication myself about a year before, when someone handed me a bottle of liquid risperidone, a medication prescribed to treat schizophrenia and bipolar disorder. Some of the liquid had spilled and was on the side of the bottle. I touched the liquid with my bare hand. The medicine seeped through my skin and entered my bloodstream. For a good hour, I was euphoric, laughing and extremely talkative. Though the medication never touched my lips, part of my upper lip went numb. Even today, whenever I recall the incident, that part of my lip turns numb. Like the good doctor said, "Drugs, man, drugs."

The pill line was very long, reaching from the pill line window to the track about fifty yards away. Close to a thousand inmates were incarcerated on Facility One Yard, and half of them were on psychiatric medication. An MTA stood inside the medication room window, handing inmates their medication through a rectangular slot. The MTA, a balding pale-skinned man by the name of Ford, looked at Doctor Teitelbaum as she passed by. He smiled at me and shook his head. Several inmates looked at the new psychiatrist, then looked questioningly at me. I ignored the questioning looks and made my way to the clinic. I opened the clinic door and led Dr. Teitelbaum to an office in the back.

"This is your office, Dr. Teitelbaum," I said, opening the door and switching on the lights, illuminating a small office with two chairs facing each other across a wooden desk. Dr. Teitelbaum entered the office and sat heavily in the desk chair, plopping her large red bag down on the desktop. "I will bring a schedule of inmates and inmate medical charts in a little bit."

"Patients, Mr. Taylor," Dr. Teitelbaum said. "They are not just inmates. They are my patients, and I cannot wait to see them." She looked up at me through her large glasses, the faraway gleam returning to her eyes. "I assure you they have never seen the likes of me."

"Yes, Doctor. I believe that may be the case," I said. Despite her decidedly odd appearance, I fully intended to give the new psychiatrist the benefit of any doubt. Part of my philosophy was, and still is, not to judge a book by its cover. "Would you like the door closed or open?"

"Please close it," Dr. Teitelbaum said. "It is time for my calming ritual."

I nodded and exited the office, closing the door behind me. I had a busy day in front of me and had to prepare for it. Leaving Dr. Teitelbaum alone in her office, I grabbed a cup of coffee from the already brewed pot in the treatment room, sat down at the desk, and began organizing the inmate medical charts, dividing them between medical and psychiatric patients, making sure each chart had fresh doctor's notes to write new prescriptions on. I was absorbed in the ritual, when I heard Dr. Teitelbaum singing opera in what I thought might be Italian, as loud as she possibly could. I stepped out of the treatment room. MTA Ford was coming out of the medication room.

"What the heck is going on, Taylor?" He asked. I stood outside Dr. Teitelbaum's office door. The opera continued in her warbled voice. Inmates peered through the clinic windows, wondering why the pill line had stopped, hearing the Italian opera coming from inside the clinic. I shook my head and knocked softly on the office door. The Italian opera continued inside. I knocked louder.

"Dr. Teitelbaum?" I called. The opera persisted. I shrugged at MTA Ford and opened the door. Dr. Teitelbaum was sitting behind her desk. Her eyes were closed, her hands lifted above her head, moving dramatically back and forth, conducting an orchestra which only she could hear. Seeming unaware of my presence, she continued her performance, her voice straining to reach soprano levels, then falling to baritone lows, all at the top of her lungs. All I could do was wait for her to stop. For several minutes, the opera continued. Then, with one final crescendo of screeching soprano and faltering baritone, the performance came to an abrupt end. Slowly, she lowered her hands and opened her eyes, blinking in the light of the office. She stared up at me through her large glasses, acknowledging me for the first time since I entered.

"Is there something I can help you with, Mr. Taylor?" She asked.

"Well... " I said, "Uhm... What I mean is... "

"My singing, Mr. Taylor. Is that why you are here?"

"Well, yes, Doctor," I said. "It was a little surprising."

"I find opera to be calming, Mr. Taylor. It is part of my morning ritual. It lowers my stress level and prepares me for the rest of the day. Now, if you will excuse me, my routine is not yet complete."

"Will you be singing again?" I asked.

"No, Mr. Taylor," she said, "I will be meditating. Close the door, please. Let me know when the first patient arrives."

I left Dr. Teitelbaum alone in her office. MTA Ford had overheard the conversation.

"She's crazy, man," he said.

"What can we do about it?" I said.

"We need to tell somebody. I mean, she's a real mad hatter."

"I'm not in for telling," I said, a phrase used by both inmates and officers. It meant you were not a snitch. Snitches were equally hated by inmates and officers.

"This is different, Taylor. Somebody has to know."

"Let's just see how it plays out," I said. "What's it going to hurt?"

Ford agreed reluctantly and returned to the pill line. I continued to get ready for the medical and psychiatric appointments. Dr. Wong, the physician, a diminutive Asian man with thinning hair, wearing a doctor's smock over slacks and a dress shirt, arrived. He knocked on the clinic door and I opened it. He entered the clinic.

"Good morning, MTA Taylor," he said.

"Good morning, Doctor," I said.

"Is it a good morning?" He said. I opened the door to his office, letting him in. He asked me the same questions every morning.

"A fine morning, Doc." I said.

"A fine American morning?"

"Yes, Doctor," I said, "It's a fine American morning. There's coffee in the back. Want a cup?"

The doctor smiled, nodding.

"Is it American coffee?"

"It was purchased in America," I said.

"Then yes," he said. "I want an American cup of coffee."

This routine had played out five days a week for nearly a year. Doctor Wong, a transplant from Asia, who had lived much of his childhood struggling to feed himself, who somehow not only made it to the United States, but became a medical doctor, loved America with a fervency bordering on insanity. It wasn't a fine day unless it was an "American" day. He had a headache once, and I brought him a Motrin. He asked if it was "American" Motrin, taking it only after I assured him that it was.

"Good, Doc," I said. "I will bring it to you."

I returned to the treatment room to get the doctor a cup of coffee. I heard low humming coming from underneath Dr. Teitelbaum's office door. I ignored it. She said she would be meditating, which was fine with me if she did it quietly. I made Dr. Wong a cup of coffee and brought it to him, placing a schedule of inmate patients on his desk. He took the cup of coffee from me and sipped it.

"Thank you, MTA Taylor," he said. "That is a good American cup of coffee."

"You're welcome, Doc," I said.

The pill line ended about half an hour later. Inmates began arriving for their medical and psychiatric appointments. I let them in, individually checking their identification and medical ducats to the schedule, patting them down for weapons and contraband. I checked their blood pressures and told them to stand on a scale to check their weight. Afterwards, they waited together on a long, wooden bench in the clinic area. I opened Dr. Wong's desk and placed the first inmate's medical file on his desk. I opened Dr. Teitelbaum's office door to hand her the file of her first patient. She was still humming lowly to herself, her eyes closed.

"Your patients are arriving," I said, placing the file on her desk.

"Five minutes more, Mr. Taylor. I am not quite done with my calming ritual."

"Fine," I said, "let me know when you're ready."

She closed her eyes again and began humming to herself. I left her there, closing the door behind me. Ten minutes later, her office door opened. She was holding the file I had given her. She looked at the inmates who were waiting on the bench.

"Mr. Williams?" She called. A black inmate in his mid-thirties stood up. He looked at the psychiatrist, then looked at me. He raised an eyebrow.

"For real, Taylor?" He said.

"This way, Mr. Williams," Dr. Teitelbaum said.

The inmate shrugged and entered the office. Dr. Teitelbaum closed the door. I opened it again.

"Doctor" I said, "the door has to be open at least enough for me to hear what's going on. For your protection."

"That is unacceptable," Dr. Teitelbaum said. "There is a such thing as patient confidentiality."

"This is a prison," I said. I motioned toward Inmate Williams. "He is an inmate, and I can't leave you alone with him."

Her face turned a bright shade of pink, but she took her seat behind the desk.

"Very well, then," she said. She took a deep breath and let it out slowly. "Let us continue."

I exited the office, leaving the door open about a quarter of the way. More inmates were arriving for the medical and psychiatric lines, and some already seen by Dr. Wong were wanting to leave. I patted down a couple inmates to make sure they left with only what they had arrived with, and let a couple more inmates in. I entered the treatment room where MTA Ford was busy transcribing new orders from the medical charts.

"How's the Mad Hatter doing?" He asked.

"Just seeing the first inmate now. I guess we have to wait and see," I said.

It did not take long to learn how Dr. Teitelbaum was faring with the inmate. I heard Inmate Williams cussing loudly and Dr. Teitelbaum shouting in her unmistakable voice. The inmate shouted back. Dr. Teitelbaum released a hysterical scream. MTA Ford and I ran from the room, ordering the inmates in the clinic to get down. They lowered their selves to the floor. I pulled a canister of pepper spray from my duty belt and entered the office, shouting for Inmate Williams to get down. He complied, immediately leaving his chair and sitting on the office floor. Dr. Teitelbaum was standing behind her desk. Her face was red and glistening with perspiration. Her magenta hat was in her hand, and her red hair was in disarray.

"Are you alright, Doctor?" I asked.

Dr. Teitelbaum stared up at me. Her lips trembled. Her round face quivered with indignation.

"What is the meaning of this, Mr. Taylor?" She shouted. "I will not be interrupted during a therapy session!"

"You were screaming at each other," I said.

"This is therapy, Mr. Taylor," she said. Her entire body was shaking. "Do you not understand? This is therapy!"

Inmate Williams held up his hands.

"I didn't do anything to her, Taylor. I swear it, man. She's a crazy lady."

Dr. Teitelbaum twisted her hat, staring angrily down at the inmate.

"I am not a crazy lady," she shouted. "I am the psychiatrist!"

Leaving his office, Dr. Wong walked up behind me. He looked at Dr. Teitelbaum. He saw the inmate on the office floor and examined the psychiatrist, who stood, shaking visibly, clutching the magenta hat in both hands. Dr. Wong shook his head.

"This," he announced gravely, "is simply unamerican." He turned from us, entered his office and closed the door behind him.

Dr. Teitelbaum lasted a month or so longer, the need of the department to fill medical positions outweighing the need for competent providers. She never got any better, though her shouting "therapy" was ended by order of the chief psychiatrist. I was in the clinic on her last day. She was wearing her now infamous magenta hat and was attired in yellow and orange, rather than purple. We made it to the end of the shift without major incident, and I was sitting in the MTAs office. She stuck her head into my office.

"Mr. Taylor," she said, "as you probably already know, today is my last day. The establishment was just not ready for my special brand of treatment."

"I'm sorry to hear that, Doctor Teitelbaum," I said, not meaning it in the least.

"Yes, well," she said, "I am going into business for myself." She handed me a purple business card. The card read, DR. Teitelbaum, Psychiatrist extraordinaire, and included her phone number. "If you are ever in need of psychiatric care, call me." She looked at me through her glasses, that dreamy, faraway look in her beady eyes. "I am not cheap," she said, "but I am the best... "