They Might Be Diamonds

When it comes down to it, there are very few different types of medical emergencies we see regularly in the jail. It’s not like working on the ambulance where it truly can be anything.

We get overdoses, withdrawal-related emergencies, and traumas (suicide attempts or fights). 

Our differential diagnosis is quick. If there’s more than one patient, it’s a fight or an overdose.

If there’s blood, it’s a trauma.

If they’re not breathing right, it’s probably an overdose.

It’s not that heart attacks can’t happen in jail, but it’s rare.

We’d had a spike of overdoses recently, with one per week over the past month. To confirm it’s an overdose, we have their presentation and the fact that Narcan is effective at reviving them, for one, and then the hospital does a urine toxicology screen. Patients will vehemently deny it was an overdose despite this. But if we’re seeing positive fentanyl results for someone who’s been in jail a while, we know the drugs got to them somehow.

To prevent drugs from getting into the jail, the booking nurses ask them directly, “Do you have any drugs in you or on you, right now, with the intention of sneaking them into the jail today?”

We also ask, “Have you ever brought drugs into jail before?” 

And, “Have you ever overdosed while you were in custody?”

Once we clear them, custody asks them the same thing before putting them into the scanner. They have the opportunity then to surrender any drugs, or admit to placing them inside themselves, and being sent to the hospital for retrieval without any legal repercussions. There is an amnesty box for all drugs confiscated at this stage, and you might think everyone would just say, “No,” but it is not infrequent that people surrender them at this stage.

The scanner, although fancy, has its limitations and often mistakes feces for bags of drugs, and apparently, also often doesn’t see what it should.

I’m assessing an arrestee who has a clear developmental delay. He has limited communication skills and a speech impediment. 

I have to be careful not to get visibly angry at the system I am a part of when assessing patients with this background. 

I will admit, I had no idea how many people with developmental disabilities were in our community until working at the jail. And let me tell you something, these people do not need to be in jail, they need to not be around assholes who take advantage of them. 

You get guys for possession when it’s evident from half a conversation with them that they don’t have the mental capacity to scheme, or likely even grasp the law, or the implications of their actions.

But what are the options for someone with the mental capacity of a 10-year-old in a man’s body? He can be deemed incompetent and become a ward of the state with no decision-making rights regarding his life and care, or, he can prove that he is able to provide food, clothing, and shelter for himself. This can be food from a dumpster and shelter from... well, anywhere. Being homeless doesn't qualify as incompetent if they have, say, a bridge they sleep under. If this can be demonstrated, he’s allowed to be independent and is also held accountable for all his actions. What’s better? I don’t know, but I know many people with this background are in and out of jail, when someone else ought to be. 

I say, "he," by the way, because it's only been men I've run into this with. I don't know where the females are who fall into this category, but I can't say I'm convinced they're being cared for by anyone less manipulative or are living somewhere better than jail.

Anyway, I get to that question with this guy, and he says, “Yes.”

I say, “I want to make sure you’re understanding the question I am asking you, and I also want to make sure I’m understanding your answer. This question is asking, are you trying to sneak drugs into jail today?”

And he says, “Yes.”

I say, “You have drugs on you right now?”

He says, “Yes, I keistered them.” His voice is monotone.

I look at the arresting officer, and he hangs his head and starts shaking it with a resigned smile.

I say, “You have drugs up your butthole right now?”

He says, “Yes.”

The arresting officer asks, “What kind of drugs are they?”

He says, “Invisible drugs, or they might be diamonds, I’m not sure.”

He is medically refused, and the deputy takes him to the hospital for further diagnostics. 

He was not back before the end of my shift, so I don’t know what was found up there, if anything, and I leave work feeling the way I feel most days, and thinking what I think at the end of most shifts, "Whaaaat, the hell was that?"

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Review

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This narrative is a brilliantly observed, darkly funny, and an emotionally resonant piece. It highlights how individuals with developmental disabilities are funneled into the jail system rather than receiving proper care. The absurdity of the situation is not over-explained or exaggerated; it speaks for itself. The humor isn’t forced, it’s observational, making it hit harder.

The contrast between what the arrestee needs (protection, support, advocacy) and what he actually gets (arrest, incarceration, a degrading situation involving a strip search and medical refusal) is a gut punch. The reflection on how many people with developmental disabilities are in jail rather than in care is one of the most powerful moments in the piece. The rhetorical question—“But what are the options for someone with the mental capacity of a 10-year-old in a man’s body?”—is devastating. It forces the reader to confront how neither legal guardianship nor incarceration feel like true solutions.

The repetitive, ineffective, almost comedic questioning process demonstrates how systems create illusions of control rather than real solutions. The fact that people actually surrender drugs at the scanning stage shows how often the system relies on people’s voluntary compliance. The scanner’s limitations (mistaking feces for drugs but also missing actual contraband) show how systems that appear sophisticated are often unreliable.

The piece subtly shows how working in jail medicine requires constant cognitive dissonance—dealing with both real medical emergencies and completely absurd situations in the same shift. The final exchange with the inmate (“Invisible drugs, or they might be diamonds”) captures how working in a jail means constantly balancing the absurd, the tragic, and the surreal. The closing thought—“Whaaaat, the hell was that?”—perfectly encapsulates how normalization of the bizarre is part of the job. The piece doesn’t end with a call to action but with exhaustion, which makes it more emotionally real. This is not a system that can be “fixed” in one story—it’s a system that wears people down.