Practicing medicine in other worlds

Short White Coat is a blog written by second-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

Medical students spilled out of the classroom in which 23-year-fugitive and ex-convict Katherine Ann Power spoke last week about medical care behind bars.

Power -- who drove the getaway car during a 1970 bank robbery that resulted in the death of Boston police officer Walter Schroeder -- shared insights from her six years as an inmate of Framingham Women's Prison: tales I expected to hear, about little sympathy for the sick and the need for control trumping access to medicine, and others that surprised me in their positivity.

Prison came with some relative perks, she told us. For many of the women, this was their first opportunity to spend time taking care of themselves, a sad testament to their previous lives. Regular attendance at exercise classes shaved days off their sentences, providing tidy incentives for Power and her fellow inmates to stay fit.

Granted, Powers was afforded a lot of special privileges as a high-profile convict, including biweekly therapist sessions (more than she had pre-incarceration) and prescriptions filled at government expense. She said she used her position to argue for better conditions, making sure to pick her battles. One of them was adding vegetables to the prison menu.

Still, she described a widespread though slow move towards a rehabilitation (rather than punishment) model for prisons, one which favors readying inmates for the outside world once they’re set free. It’s a promising sign, and Power chose her audience (of future medical providers) wisely in sharing these stories.

As we train to deliver the highest standards of care, we’ve had more than one recent reminder of settings outside our academic medicine bubble where this just isn’t the norm.

The previous week, Dr. David Steinbruner, an ER doctor in the U.S. Army, told us about his experiences in Iraq. He showed us CNN footage of the daily struggle to adequately treat both soldiers and locals rushed to the safe confines of his combat hospital. In this blood-soaked world where bedside ethics take place in real-time, you save your patients’ lives with what you have and what you think will work, he told us. Clinical trials are an unafforded luxury for some of the quick fix treatments he’s tried (usually with success). (For another inside look at a combat hospital in Iraq, see this Globe story on the 399th Combat Support Hospital, a Massachusetts-based Army Reserve unit.)

It must take thick skin to practice medicine in these worlds.