The Cook County Jail is a massive 96-acre compound nestled on the south side of the city of Chicago, although you wouldn’t know it was there unless you were looking for it. Like most jails, Cook County is embedded into the neighborhood that many of its inmates inhabit. Mexican flags hang over the shops along the street. A Popeyes sits across the street, somewhat strategically, awaiting those wanting to taste their first meal of freedom. Opposite the jail sits the courthouse, with colossal columns and Latin phrases etched into the stone. The words “veritas” and “libertas,” Latin for “truth” and “freedom,” tower ironically over the entrance to the jail. It was through these doors that I spent my first elective of residency.

I have always had a passion for health equity. In graduate school, I would pore over maps from the Centers for Disease Control outlining disease burden across the country, fascinated and appalled at how these maps were near copies of the outlines of poverty. I worked in government, research, and as many outlets as I could find to wrap my head around how our country could be so fraught with injustice. I ended up going to medical school to inch myself closer to the problem, to be able to work one-on-one with patients, so that I could apply my public health knowledge to the individual patient. That is how I found myself, in the middle of my intern year, at Cook County Jail.

After weaving my way through the series of leaky underground tunnels, I would arrive at my assigned block for the day. As a resident, I spent time in different medical sectors of the jail, but I often chose to spend the day in the maximum-security block. Initially, the idea of providing medical care in this type of setting was extremely intimidating. I was on edge as I interviewed patients with my preceptor. As much as I tried to ignore it, I focused on their jumpsuits, handcuffs, and numbers next to their name indicating the number of days they had spent in jail.

But slowly, things began to change for me. As time passed, I became accustomed to the beige walls, beige suits, and pieces of metal. I no longer had to try to ignore the atmosphere; it became just another piece of the daily routine. I listened as patients came to me with the same complaints that I heard in the community: shortness of breath, knee pain, and the management of diabetes. As I shed my unease, I nestled into my role as a physician caring for patients. Free from distractions of cell phones, interruptions, and time slots, I became engrossed in the care I was providing and grounded in humanity.

Throughout my time, I would often hear inmates talk about their life “in the world.” They would say things like “In the world, I have a heart problem” or “In the world, I wear an ankle boot.” This was how I would unearth their medical problems: through small glimpses into their life “in the world.” Sometimes these statements would reach outside the realm of medicine. “In the world, I have two daughters,” one patient told me. “In the world, I work as a custodian, I really hope I don’t lose my job,” another said. It was as if their lives in the world, outside the walls of the jail, were a completely suspended and parallel reality. That what happened on the inside was not their real life, it was just life outside the world.

During the last week of my rotation, I was invited to participate in the art session inside the maximum-security block. I traded in my pens and stethoscope for a few art supplies— four paint brushes and four containers of paint—so that we could keep track of the items at all times. Walking into the courtyard, I felt that sense of unease return. I was locked inside, surrounded by maximum-security inmates, armed with only a paintbrush.

Looking up to the cinderblock wall on my right, I saw the reason for the paintbrushes. Decorating the wall was an image of a phoenix, half painted in, rising above the Chicago skyline. The men had slowly been filling it in, week by week.

Moving out into the center of the block, I was greeted by men who I had treated all week. They welcomed me as I handed out the art supplies. Given the limited quantity, the paint time was limited to four minutes each so that everyone could get a chance to paint. Halfway into the session, a man that I had seen in clinic came up to me. “We want you to paint some of our mural,” he said as he held out a brush. I walked over to the mural and began to fill in the wing of the phoenix along the wall of the jail.

I have struggled to find my place in medicine. I am often too engrossed in the larger picture of policy and inequity, and I wonder how this will fit into everyday medical practice. But inside the jail, I found the greatest joy in medicine. Every day I would leave the outside world in order to come in. There, I felt that I had made the most intimate human connection. Practicing medicine means helping people to achieve health, and that requires being able to meet others in their time of greatest need. During my first year in medical practice, I learned that I had to leave the world in order to find my place in it. I will be forever grateful that I did.

 

Caitlin Farrell, DO, MPH, is a family medicine resident at Northwestern University. She received her medical degree from the University of New England College of Osteopathic Medicine and her MPH from Boston University. She enjoys writing on topics including health policy, healthcare inequity, and medical humanities. Although she is still in training, she hopes to eventually combine her passions for health policy and medical practice in order to improve the system of medicine. She currently lives in Chicago with her French bulldog, Lucy.