When I met Ralph Marcus in June 2024 at California Medical Facility, he was sitting in his wheelchair in the garden, under the shade of a gazebo. This medium security prison in Vacaville is home to a 17-bed hospice unit, the only licensed hospice program for incarcerated people in the state.
Marcus looked thin, his gray hair covered by a sweat-stained ball cap. He wore blue fingerless wheelchair gloves on each of his hands and a black flip-flop on his right foot. What remained of his left leg was covered by gray shorts.
At the time, Marcus had been incarcerated for 27 years. In 2022, he was diagnosed with spindle cell sarcoma, a rare bone cancer. After an injury, spindle cell production is typically a helpful part of the body’s healing process. However, once the injury is healed, if spindle cells continue to divide uncontrollably, a mass or tumor develops.
Marcus told me he spent months trying to get medical staff to look at his swollen and swelling leg, filing healthcare request forms and speaking directly to nurses and doctors. He was dismissed and misdiagnosed, he alleged. In response to his complaints, they gave him compression socks.
Our last conversation took place over the phone, three months before he died. Through intense bouts of coughing, he informed me that his left lung had shut down and that the right one would do the same soon. He told me he had arranged to have all of his files sent to me after his death, which added up to hundreds of pages of records and notes relating to his case and his time in prison.
Below is a transcript of our last conversation, lightly edited for clarity and chronology. Marcus died before he could review the final draft.
During the pandemic, when I was at Mule Creek State Prison, I injured my left shin. This was in late September 2021, and we couldn’t just go to the clinic because of COVID. The nurse came out and looked at my leg and said, “It’s just inflammation. Don’t worry about it. It’ll be OK.” My entire left foot and toes were swollen and red.
I kept trying to go to the prison clinic, but [the medical staff] wouldn’t do anything about it. A few times, they didn’t even let me lift my pant leg up. They kept saying that they’d send me out to off-site medical to get it checked.
One of the things I learned [during this process] was you don’t have a doctor-patient relationship when you’re in prison. They rotate the doctors constantly, making a relationship all but impossible.
While I waited to see a doctor, my entire leg swelled up — from my foot, up my ankle, my calf, my knee, all the way up to my thigh.
In July 2022, I finally got to see an off-site doctor through telemedicine. At the prison clinic, an MRI was performed on my leg.
At the end of that August, I was transferred to Highland Hospital in Oakland. They examined me and did biopsies to determine if I had cancer.
Later, doctors told me they were very sorry to tell me that I had spindle cell sarcoma — and that it was not curable. They said if I had gotten to them when it was in my foot, I would have been OK. It’s very aggressive, I remember them saying. A rare form of cancer.
‘The Next Step to My Death’
When I first went to the hospital, the doctor who examined me said, “I’m going to need you to come back for surgery.” But for a long while, I didn’t go back. I couldn’t follow up with anyone.
I’d see a prison doctor and tell them. One even asked, “Well, why didn’t you go back?” And I said, “I don’t know. I’m not supposed to be the one to arrange that.” Then they would send me back to the hospital, and it would start all over again. I’d be scheduled to go out to the hospital, but then I’d never actually get to go.
One time, I got to the hospital, but the doctor wasn’t there. Just the assistants saw me. When I got back to the prison, all they saw was that I went to the hospital. It looked like a successful visit.
Fortunately, it wasn’t always like that. Throughout this ordeal, I’ve been off-site 178 times.
Lucas Thornblade, from the University of California, San Francisco, was a very good doctor. He tried to save my life by amputating my leg. But it was the next step to my death.
Right after they amputated, the officers escorting me back to the room were kind of teasing me. When they saw [what was left of] my leg on the table, they said it was gross.
I stayed at the hospital for a short time, about a week. Then I was sent to California Health Care Facility in Stockton.
It’s been downhill ever since. Not long after I got back to the medical facility, the doctors called me back, and they said something to the effect of, “Marcus, we need to do a biopsy. … It looks like it’s possible some of the cells got through.”
And then they did three biopsies on my stump. They came back, and a doctor [from U.C. San Francisco] said, “Marcus, unfortunately, some of the cancer cells did get through, and you are definitely going to pass away very soon.”
Very up front — I appreciated that.
The End
I’m calling you from the garden. I can hardly sit down. I look like a monster, like another “Elephant Man.”
After the surgery, they wanted to give me a bunch of codeine. But the codeine makes it where you can’t use the toilet, and it dries the inside of your mouth so bad. The doctor here gave me this pear and told me to take a bite out of it while I’m trying to talk.
Living with this…I can’t describe how it feels right now. Just this morning, the spindle cell broke through into my stomach. It woke me up, and it basically made a little bit of a mess. I had to clean it up. I knew it was going to happen sooner or later. It basically deforms you to the point of death.
I remember I was sitting out here in the garden when the doctor came out to visit. She saw me and said, “Marcus, you need to find something to do to get your mind off of this cancer.”
So I started making a birdhouse. And I made it in a way that’s going to stay for a long, long time.
Carla Canning is Prison Journalism Project’s associate editor. Prior to PJP, she was a Tow audience engagement fellow at The Marshall Project and worked on the Life Inside section. Carla holds a master’s degree in engagement journalism from the Craig Newmark Graduate School of Journalism, where she created a website guide for people visiting loved ones incarcerated in New York State prisons.
A California Department of Corrections and Rehabilitation’s information officer stated that, due to medical privacy laws, they could not disclose the details of Marcus’ on- or off-site medical treatments. They also stated that California Correctional Health Care Services assigns every patient a specific primary care provider. Although a patient could be seen by different providers than the one assigned, all providers have access to the same notes in their records systems.
In response to a question about Mule Creek State Prison’s clinic operations during the COVID-19 pandemic, they stated that “there were no statewide directives that prevented patients who were not quarantined or under isolation from visiting a clinic.”
