Amanda said, “We’ve got another half hour. Is there something you’d rather listen to?”
Sara dialed the tuner to Pop2K and cranked up the volume. She rolled down the window the rest of the way. The sharp breeze cut into her skin. She closed her eyes to keep them from burning.
Amanda endured ten seconds of the Red Hot Chili Peppers before she broke.
The radio snapped off. Sara’s window snicked up.
Amanda said, “Will told you about Nesbitt.”
Sara smiled, because it had taken her long enough. “I thought you were a detective.”
“I thought so, too.” Amanda’s tone showed a begrudging respect. “How much do you know?”
“Everything Will knows.”
The words clearly stung. Amanda wasn’t used to Will choosing a different side. Still, she told Sara, “Nesbitt’s jacket is in my briefcase behind the seat.”
Sara stretched around to retrieve the file. She opened it on her lap. The jacket was at least two inches thick. She skipped over the expected—that the raging asshole had managed to buy himself twenty more years—and found the medical section. They didn’t need a warrant to read the details. As an inmate, Nesbitt didn’t have a right to privacy. Sara skimmed the voluminous notes on his past hospitalizations and multiple visits to the prison infirmary.
Nesbitt was a below-the-knee amputee, abbreviated as BKA. During his eight-year incarceration, he’d seen dozens, possibly hundreds, of different doctors. There was no continuity of care in prison. You were more likely to see a unicorn than a wound-care specialist. Inmates got what they were given, and if they were very lucky, the doctor wasn’t fleeing malpractice suits or employed by a private contractor whose bottom line depended on providing the absolute bare minimum of care.
Sara flipped ahead to the pages and pages of invoices. Prisoners were charged a $5 a visit co-pay no matter if they were seeing the doctor for congestive heart failure or getting their toenails clipped. Nesbitt owed the state of Georgia $2,655. His commissary account and three-cents-an-hour janitorial wage were being garnished until the debt was resolved. If he ever got out of prison, that money would continue to be garnished from whatever paycheck he managed to earn. In the last eight years alone, Nesbitt had required 531 medical visits and 28 hospitalizations. That was more than one visit per week.
Sara told Amanda, “Nesbitt’s foot was amputated after a car accident. He’s lost four inches of leg since he became incarcerated. He was poorly fitted for a prosthetic. A bad prosthetic is like a shoe that doesn’t fit. The rubbing and friction occludes normal capillary pressure. The tissue becomes ischemic. If this goes on long enough, which it’s bound to in prison, the tissue becomes necrotic.”
“And then?”
“Then—” Sara paged through the chart, which was a case study in Third World medicine. “Diagnostically, you stage the damage based on what you can see. Stage I is superficial, just a red patch. Stage II involves the top two layers of skin. It looks like a blister, basically. Stage III is an ulcer with full thickness. That’s an open sore. You can see the fat, but the bone and muscle aren’t visible. There’s a white or yellow slough that has to be wiped away.”
“Pus?”
“More like a slimy film. It smells awful. You have to keep it clean or you’ll develop an anaerobic bacterial undergrowth.” Sara noted in the chart that bacteria had repeatedly set up in Nesbitt’s leg. Inmates were not allowed to keep medications inside their cells, and sterile cloths were hard to come by, especially at $5 each visit.
Sara continued, “Stage IV is a full-thickness ulcer. You can actually see inside the leg to bone, muscle and tendon. Past that, it’s technically unstageable because you can’t see anything. The skin develops a black, hard scar tissue that’s as thick as the sole of a shoe. You have to saw through it. The smell is putrid. Think of rotting meat, because that’s basically what’s happening. The muscle is destroyed. The bone becomes infected. Nesbitt has reached this point four times over the last eight years, and each time, they cut off a little bit more of his leg.”
“Is that the best way to treat it?”
Sara would’ve laughed if the situation wasn’t so appalling. “If you’re on a Civil War battlefield, absolutely. But this is the twenty-first century. The gold standard is to use a vacuum-assisted closure and ideally, hyperbolic oxygen treatments to bring blood flow back to the area. In the best of circumstances, it would take months of intensive wound care to heal.”
“The state would never pay for that.”
Sara allowed the laugh to come out. The state barely paid for clean sheets. “Nesbitt currently has a stage III, full-thickness ulcer. You’d be able to smell the rot if you stood close enough. He’s one, maybe two more infections away from losing his knee joint. That opens up a whole new set of problems. Even good candidates have trouble adapting to an AKA prosthesis.”
“He’ll keep losing sections of leg until there’s nothing left?”
“It won’t come to that. They’ll put him in a wheelchair. He won’t have access to physical therapy. His exercise will be limited. It’s almost impossible to stay well-hydrated drinking toilet water. He’s already carrying an extra twenty pounds. His blood pressure, cholesterol and A1c are elevated. Diabetes is right around the corner.”
“Another level of hell?”
“Rock bottom,” Sara said. “He can monitor his blood sugar in his cell, but he’ll have to go to the infirmary each time he needs an injection. You can imagine how well that system works. Hundreds of inmates die every year from diabetic ketoacidosis. Nesbitt is standing at the precipice of a cascade that is going to cut decades off of his life. Not to mention the trauma of what he’s already experienced.”
“You seem to have a lot of compassion for a pedophile who tried to sue your husband’s estate.”
Sara realized that Amanda had done some investigating
