October arrives on the outside wrapped in pink. Cereal boxes are decorated with ribbons. Football players have pink laces in their cleats. And commercials remind you gently, warmly, to schedule your mammogram, as if the hardest part of surviving breast cancer is simply remembering to make the call. I imagine it must feel like the whole world is looking out for you. But I want to tell you about the world that pink never quite reaches, because I live in it, and because some of the women I love have paid for that absence with their lives.
Let me start with Lisa Jo. She's my friend, and she has an intellectual disability, though the state doesn't always speak about her that gently. One day she sat in an exam room at the Dr. Lane Murray Unit clinic with an older male doctor. She was there for lower lumbar pain, but when he reached toward her chest to perform a routine breast exam, she slapped him. When I asked her why, she told me her mama had raised her on one rule above all others: Fight if a man tries to touch your private parts. Fight if he does anyway. In over 45 years, nobody had ever explained to Lisa Jo what a breast exam was, why a stranger’s hands might need to press against her body, or how to tell the difference between violation and medicine. So she did the only thing her mother had ever taught her to do. She protected herself the only way she knew how, against a doctor who was, in that narrow moment, actually trying to help her.
That single slap tells you everything about what’s missing in prison health care. Consent requires understanding, and understanding requires someone willing to explain — slowly and patiently — in a language a person can actually absorb. Out there, a woman with an intellectual disability might have a mother, a caseworker, or anyone else trained to walk her through what a mammogram is. In here, there are often just former nurses like me.
That's how I ended up holding Moo-Moo's hand in the waiting area at the TDCJ Christina Melton Crain Unit clinic. Moo-Moo still believes in the tooth fairy, genuinely and completely. Coincidentally, our mammograms were scheduled the same day. And when they finally walked her into the mammogram room, the machine terrified her. It's cold and presses against you in a way nothing has prepared you for. This is especially true if your understanding of the world stopped forming somewhere in childhood. At first Moo-Moo outright refused the test. The only way she would go through with it was if I could hold her hand during the procedure. But that's against the rules. Hell, just holding her hand in the waiting room was prohibited. Prison doesn’t have accommodations for women like Moo-Moo. There’s no version of this system designed to sit beside a grown woman with the understanding of a child and patiently explain why this machine needs to touch her body in order to save her life. There’s just whoever happens to love her enough to stand in the gap the state left empty.
And then there's Merri Joy Lehning. Her story breaks something in me every time I tell it. Merri was in and out of solitary confinement for 25 years at the Dr. Lane Murray Unit. And yes, she lived with the kind of mental illness that made the walls of a single cell feel like the entire world for two and a half decades. She found what she described as knots in her breasts and tried to massage them away with her own hands. She was alone, in a cell with no television. There was no nurse checking in daily and no pink ribbon campaign reaching through the door to tell her what those knots might mean. Eventually, after we complained, the nurse told her about breast cancer. I also told her about breast cancer. But Merri's mind had frozen somewhere back in the early 1990s, the decade she was arrested. At that time, few people talked publicly about breast cancer.
Merri Joy didn’t believe the knots were serious, because nothing in her frozen world had ever taught her they could be. She eventually died, and I still wonder what would have happened if she'd made it to every scheduled mammogram. If someone had reached her in a language she could understand.
Even for those of us who do get scheduled, the process itself works against you. You pack your property not knowing if you'll return to the same bunk. You endure a long, nauseating transport, handcuffed to a stranger toward a building that might as well be another planet. At the Christina Melton Crain Unit, when you finally arrive, the walls of the mammogram office are covered in photographs of decayed, untreated breast cancer. These gruesome images are meant to scare you into vigilance. But think about who’s already standing in that room. Women who have shown up and are already getting screened. Those photographs are preaching to people who already believe.
What good is a warning hung in the one place where the choir has already gathered? Those images need to be in our prison and solitary confinement building where women like Merri sit alone with fear and no context for it. They need to be wherever women with the understanding of a child are trying to make sense of their own bodies. They need someone trained to explain the process, on their level, and more than once.
So the next time you see a pink ribbon on a T-shirt or jacket, I hope you'll think just for a moment, about where that ribbon never travelled. Remember Merri, still living in the 1990s in her mind. Remember Moo-Moo, needing a hand to hold. And remember Lisa Jo, who only knew how to fight. They needed the pink ribbon to reach them too. It never did.
Kwaneta Harris is a former nurse, business owner and expat. She is now an incarcerated journalist and a 2026 Galaxy Changemaker Fellow. She also serves as a senior writer and editor for Solitary Watch and a lead adviser for The Bridge at Look2Justice. You can read more of her stories on Substack at Write or Die.
The Texas Department of Criminal Justice’s communications department did not respond to fact-checking questions regarding the process and policies around annual mammograms or the specific instances described, including the details of Lehning’s illness and death.