Dr. Rachel Bedard

You aren't allowed to walk on the island.

It's sort of a fortress unto itself that the Department of Correction for New York City runs.

And it is a complex of multiple jails that are all on this island, a bunch of different buildings.

The buildings house people sort of in different special populations.

There's one for women, there's one for people who are sicker, there are ones for specialized mental health units.

And depending on the kind of medicine you practice, your day can look very different.

So

For the first few years that I worked there, I would basically print a list of everybody in the system who was older than 65.

And I would go sort of try to find those people where they were and call them down to a clinic in that building.

There's no freedom of movement in the New York City jail system, which means that every time a guy moves from one place to another, he has to be accompanied by an officer.

Like somebody has to come pick him up and unlock a door and take him out and bring him to you.

So things move very slowly.

Like it's like being in the airport all the time, right?

Yeah.

emergency room.

It's an incredibly sort of congested system that requires a huge amount of excess human contact.

It's hard to have real privacy during clinical encounters because you're not actually sort of behind a truly closed door ever for safety reasons.

But you can imagine that there's like a tension there with being able to provide

care to people who are ambivalent about revealing themselves in that kind of environment, right?

And so it is a clinical dynamic that's very much constrained by the security concerns of the system.