AMSA PremedFest 
University of Florida, 
Gainesville, FL
April 11-12, 2015

The Orchard’s Opposite

Prison medicine reveals humanity, redemption

The New Physician April 2010

prisonerI am not surprised the discomfort is there. In my apprehension, I haven’t considered that there also exists here a profound sense of compassion, trust and caring.

My best friend from elementary school is in prison. The digital grapevine connected me back to high-school friends, and I learned where Greg was and how long he was going to be there: 30 years. Occasionally, I think about what happened to him, how he could have drifted so far from hockey in parking lots, ice fishing with his mother on Lake Hopatcong, and playing with his retriever puppy after school. I’m curious about what Greg’s life is like now in prison and, more practically, about how he’s managing his cystic fibrosis.

The correctional medical facility I’m rotating through as a medical student is the state prison system’s flagship hospital. It houses thousands of inmates, has thousands of employees, and functions on an annual budget of more than $100 million. It’s a giant place, old and imposing, with windows only as wide as my palm and paint peeling off the walls in enormous sheets. The outside walls of the edifice remind me of the cracked mud of a dry lakebed: lonely, arid, almost toxic, with a long, stagnant history. I drive the winding driveway, through an apple orchard, toward the parking lot. There are hundreds of apple trees, aligned in perfectly long rows, packed with tiny, young leaves this time of year. Who decided to plant an orchard by this prison for the patients in this hospital? Perhaps no one knew what to do with the vast fields that surround the prison. I park, don my short white coat, and walk toward the prison hospital.

Living within its walls are people who have been convicted of many sordid crimes: murderers, rapists, robbers, drug users and sellers, kidnappers and gang members. Most of them are in this facility because they have a chronic medical condition that requires continuous medical management, like Greg’s.

Today, I am visiting the prison as a medical student, intent on learning from this experience. And, for the time that I will be here, the patients will be my patients. My patients. I feel discomfort with this thought; it’s in my hands and my knees. I can feel it in my throat. It’s partly fear, partly anxiety; mostly, it’s the unknown. I’d been to a prison before, but never as a health care provider. I’d never taken a history, nor done a physical exam, nor tried to gain the trust of a patient in a state penitentiary. I am not surprised the discomfort is there. In my apprehension, I haven’t considered that there also exists here a profound sense of compassion, trust and caring.

I meet my preceptor, Dr. Green, in her office. She’s much younger than I’d expected, and she is passionate about prison medicine. I forget how apprehensive I’d been just two minutes earlier. Dr. Green tells me of challenges her patients face in prison: drug abuse, drug-seeking behaviors like cheeking and smuggling, sexual abuse, and feelings of solitude, exclusion and despair that many patients experience. She speaks passionately about her sense of service and of doctoring: She is here to take care of everyone, no matter their history or story. She is as committed to her profession as any doctor I’ve met.

We walk together down the long green-tiled corridors of the prison, escorted by a corrections officer, passing countless men in orange jumpsuits and countless rows of cell blocks. Eventually, we arrive at the hospice unit, where those who are sentenced to prison beyond their lifespan can die peacefully, free of pain and in the company of those who care for them. It was one of the first of its kind in the nation. Now, multiple correctional medical facilities across the country have hospice programs.

The unit is in a minimum-security zone, on the other side of the hospital from the main entrance. It overlooks the apple orchard. This is where I will be for part of this rotation.

The cacophony of the prison fades behind us as we enter the sun-filled hospice ward. A man with tattoos creeping up the edges of his neck and muscles bursting from under his orange jumpsuit sits with another breathing his last breaths. Beyond them, a bald, wasted inmate leans back in his wheelchair and laughs while playing cards. Another young, healthy-looking man helps an old, weak inmate to the bathroom. Both patients and hospice volunteers are men who have been sentenced to life in prison.

Morris, the 63-year-old volunteer, has spent his morning with an inmate who is dying of pancreatic cancer. The hospice patient is lying in a bed, cachectic, jaundiced, on a morphine drip, asleep. He looks peaceful, neither struggling to breathe nor in pain. Morris finishes reading a chapter of The Secret Garden, and we sit to talk.

“Here,” he tells me, “I spend three days a week helping people die. Only thing is that I have a different perspective.” When I ask him why he does this, he responds: “It’s rehab for me. I’ve been to all the group sessions and to all the counselors. I read a lot of books. I’ve read the Bible dozens of times. None of that has worked. This is what helps me rehabilitate.” There is some irony in the path Morris’ life has taken: from maliciously causing death to benevolently facilitating it. “There is power in caring for someone who cannot give back to you,” he explains.

My first day of the rotation finishes with writing notes, following up on medication orders, and calling for psychiatry consultations for a few of our patients.

I think of my childhood friend Greg as I walk out of the giant, imposing edifice. He is my age, within 10 years of the median life expectancy of patients with CF. Living in a prison increases his risk factors for respiratory infections and lowers his life expectancy. He must know that his years are numbered and that he will likely die in prison. I wonder if he is afraid of being far from people who care about him. Today, I saw comfort in the dying process. Will Greg have this? I saw the power that exists in caring for someone who cannot give back to you. If Greg were a hospice volunteer, would reconciliation with his past actions be easier?

The transformations occurring in this facility bewilder me. Physicians with strong wills and passions provide care to patients whom many in society choose to ignore. And the men, simultaneously criminals and patients who have spent a lifetime in this place for crimes they committed a lifetime ago, reconcile their actions with the help of the hospice patients. I don’t think many of the hospice volunteers have forgiven themselves for what they’ve done in the past. At least the inmates I spoke with haven’t. Rather, this hospice program allows for its inmate volunteers to give back to others who cannot return the kindness, care for others, and prove to themselves that they are good people. They see benevolence in themselves and attempt to create a more caring world within the prison.

On my way out of the prison that my patients cannot leave, the apple orchard straddles the driveway for a half-mile. I now realize that someone else had felt the humanity here and was inspired to bring a little more humanness to the place.

Daniel Stein is a third-year at the University of California, Davis, School of Medicine. Pseudonyms were used in this story to protect privacy of inmates and caregivers.