I doubt people outside prison walls give a thought to what happens when one gets sick or old behind bars. Do they wonder who nurses the sick and the injured, who holds the hands of the critically ill and dying in prisons?
In Connecticut state prisons, much of that work falls to certified nursing assistants who are incarcerated themselves. I was one of them: While incarcerated at Connecticut’s maximum security prison, MacDougall-Walker, I trained, and became, a CNA. For two of my 19 years in prison, I was a caregiver inside the prison infirmary.
I was serving as a CNA during one of the worst prison health care crises in U.S. history. On March 10, 2020, Connecticut Gov. Ned Lamont signed declarations invoking both a civil preparedness emergency and a public health emergency in response to the coronavirus pandemic. Days later, the state went into lockdown.
By the early fall of 2020, with the pandemic raging, the Connecticut Department of Corrections (DOC) announced that a medical isolation unit used to care for Covid-19 positive, symptomatic people would be moved from Northern Correctional Institution to MacDougall. It became the central hub for prisoners with Covid-19 in the state. What followed was nothing short of a public health catastrophe. By the spring of 2023, nearly 12,000 prisoners contracted the disease, and 30 men had died. Of those 30, many took their last breaths in the infirmary at MacDougall-Walker. Often, the only person with them for their final moments was another incarcerated caretaker or me.
A 78-year-old man to whom I had grown close died on the morning of Sept. 9, 2021, in the infirmary at MacDougall. He was the first incarcerated man under the care of the DOC to die from Covid-19 that year. He’d been serving a 40-year sentence for the rape of a child.
Prior to working in our infirmary, I would not have even spoken to this man because of the crime that led to his imprisonment. But I soon learned that while very angry, he could also be brilliant and funny. He was not an easy person to deal with, but nonetheless I looked forward to seeing him every day.
Shortly before his death due to Covid-19 complications, he asked me to hold his hand. He’d been in prison for more than 30 years. Old, frail, blind, and bedridden, he was afraid and lonely. Turning to me for comfort, he awakened in me thoughts of the loneliness we prisoners all feel. Here was a man whom society had thrown away, a man deemed irredeemable, helping me feel and become redeemable. The warmth of my touch on his cold hands brought him comfort. My jokes and counsel brought him a little joy. When he died that night, a fellow CNA held his hand and spent the last seconds of his life with him. I secretly cried for days after he passed away. I missed him very much.
Like me, Vernal “Preacher” Davis, 58, was a prisoner CNA at MacDougall during the pandemic. Davis became both a mentor and partner to me in the infirmary. He had become a licensed CNA while imprisoned in 2015. Davis, who was released in May 2022, said the reason he became a CNA was simple: “I was always a taker in life, and I wanted to give back.”
I understand how Davis felt about being a CNA. For me, thinking back to those days in the MacDougall infirmary is still traumatizing. Just getting to work was a gauntlet of humiliation. I was supposed to start my shift at the clinic at 5 a.m. But corrections officers didn’t want to let me out of my cell until the prisoner count had been carried out. So I was up at 4:30 a.m., trying to catch the officer’s attention so he’d let me out of my cell. Most officers would refuse. They knew I had to go to work. They knew my job is important. They knew I took care of other prisoners. They just didn’t care. To them, it was just a hassle.
During each six-hour shift, Davis and I took patients’ vital signs, fed them breakfast and lunch, and bathed them. We provided triage, wound care, and rehab. We did laundry and transported patients to and from housing units, and doctor appointments, and more, for 22 men.
Among the reasons I became a CNA was to positively affect the lives of sick imprisoned men, those men who are in a prison inside a prison, as Davis would say. One of these men was held in a cell that was quite often shuttered. He is the reason I became a CNA. When I was caring for him, he had advanced dementia. Most mornings I’d find him — and his cell — covered in feces and urine.
We had a ritual. Doritos or something salty would lure him out of his cell. Davis would sit him down in a chair, covered in feces and urine, while he ate potato chips. I would get everything ready for a shower. Many mornings, working to get him into the shower meant that I’d get soaking wet, and worse. But once we got him in, it was hard to get him out.
Eighty-five percent of the time, I could handle him. It was the 15% of the time that was brutal because, though he was old, he was strong. He’d worked the fields — tobacco and sugarcane in Puerto Rico, and tobacco in Connecticut. He was a fighter, and on several occasions, he hit me. I never took it personally. I’d rather deal with him myself than leave him to the officers, who’d automatically manhandle and handcuff him.
Another CNA and I were the only people who could deal with him, and we’d be called at all hours to come calm him down and clean him. The way the officers treated him was horrible, simply horrible. If I didn’t come into work, the officer had no problem leaving him in feces all day, and unfortunately, some of my comrades had no problem with that either. Even as CNAs, we weren’t all there for the same reasons.
Whatever those reasons, we were all in it during Covid, especially my partner and I. We lived in the infirmary — not figuratively, literally. We lived there two weeks at a time, with a few days of respite in between. Often we worked 24 hours a day as Covid raged through the facility. While men were dying, we kept going. Patients still needed to be monitored, receive care, be fed, clothed, and bathed. Knees and ankles, legs, and hips needed physical therapy exercises. Wounds needed to be cleaned. It’s not an understatement to say prisoner CNAs are the backbone of the prison medical system. For this work, we earned $1.75 a day.
Some of what Davis, the other prisoner CNAs, and I witnessed was not uncommon patient mistreatment by civilian nurses and corrections officers. “I’d see nurses looking at patients, the inmates, really not caring at all. It almost made you want to give up, not on the patients but on the job,” Davis said. “But I knew I couldn’t leave them.”
Some nurses got infected by the contempt that most officers feel toward us, and developed similar attitudes themselves. There were good nurses and doctors, but many burnt out in an understaffed system where conditions were traumatizing.
Davis recalled one of his patients, a dying man in dialysis. As the man lay near death, Davis noted nurses right outside his room casually discussing their after-work plans and speaking disparagingly about the man. “I went into his room,” Davis said, “and he told me, ‘I was gonna wait for you. I’m not gonna die on their watch.’ ”
Things went from bad to worse when our medical unit became the dedicated Covid-19 facility for the entire Connecticut state prison system population, with Covid-positive men placed in what was effectively solitary confinement.
Both Davis and I contracted the disease. I fell seriously ill in my cell and was left to fend for myself until I was finally rushed to the University of Connecticut hospital burning up with a fever. The DOC never bothered to notify my family. The aunt of another incarcerated man reached out days later to my wife.
Despite the 30 deaths from Covid-19 in Connecticut prisons, the state was never held fully accountable for its alarming failures in prison health care. A federal class action lawsuit filed by the ACLU of Connecticut in April 2020 exposed the DOC for violating the 8th and 14th Amendment rights of people in their custody during Covid. The suit alleged that the state was gravely negligent for its failure to protect its incarcerated people from the spread of the disease or care for those who contracted it. In October 2020, the DOC admitted fault and settled the lawsuit, agreeing to provide the most basic standard of health care and sanitary provisions for the people in its custody.
Just a month before that agreement was made, Connecticut’s DOC commissioner praised the “incredible job” carried out by staff during the pandemic, but made no mention of the incarcerated CNAs who had risked their lives to provide the care that prison staff themselves often refused to administer. While people across the U.S. were lining up at 7 a.m. to applaud the essential workers in hospitals, prisoner caretakers at MacDougall received only the gratification of knowing they made a meaningful difference in people’s lives.
For me, being a CNA utterly transformed my life and, most importantly, my soul. Previously, I had suffered myself. But seeing and experiencing the suffering of my patients, often at the hands of those charged with their care, awakened something in me. It put me on the front lines of what I thought was a small battle but turned out to be a war — a war that, once free from prison, I would continue to fight.
For 18 years, I had prepared for my eventual release. While there’s a traumatic fragility about me, I have weathered the seasons of my life, and I am far stronger than I’ve ever been. But I still feel a sort of survivor’s guilt. The question for me is, how do I shake off 18 years of 20-hour days of confinement? It’s not like a piece of clothing I can just take off; it’s more of a tearing off of the flesh, and in that, there is trauma and sorrow.
Today, I work as an ICU clinical technician at Yale-New Haven Hospital. I’m physically free, but in some ways I feel that I’m still in prison, that I never left. My advocacy work keeps me trapped in that traumatic space, a space where I use that suffering as the catalyst to not only fuel my own transformation but also help liberate the minds, bodies, and souls of my comrades.
Everything that I learned as a CNA — empathy, compassion, service, work ethic, and even advocacy — prepared me to be recruited and hired to work in the busiest medical intensive care unit in the state. Since my release, I have held and warmed the hands of thousands of sick and dying patients and their families. My work has turned into a spiritual calling.
Abraham Santiago is an ICU clinical technician, author, policy researcher, 4-CT community engagement and advocacy fellow, and Rockwood leadership in higher education in prison fellow. Additional reporting was provided by Ellyn Santiago. This article was supported by a grant from the Ridgeway Reporting Project, managed by Solitary Watch with funding from the Jacob and Valeria Langeloth Foundation and the Vital Projects Fund.