Memoir: I gave up my private medical practice to treat the addicts and thieves in a women’s prison

When I opened my North York private practice in 1976, I harboured all sorts of idealistic notions about what it meant to be a doctor. I’d be a respected professional. I’d solve difficult medical mysteries, like a Hippocratic Poirot. And, of course, I’d be helping people.

Fifteen years later, I was becoming disillusioned with medicine. My patients were increasingly demanding—for prescriptions, for referrals, for my time. Even when my appointment book was full, some patients would hassle my secretary until she was in tears, insisting they see me that day. I never had enough time with each patient and took home piles of paperwork every night. I felt like a clerk working the return counter at Canadian Tire.

A colleague of mine had been working as a physician for the provincial Ministry of Correctional Services, and they happened to be seeking another part-time doctor to look after young female offenders at the Vanier Correctional Institute in Brampton. I started seeing patients there two days a week in the fall of 1990.

The Vanier—which was combined with the Maplehurst Correctional Complex in 2003—is a medium- and maximum-security provincial prison, with sentences that range from a few days to two years. I steeled myself for the worst: I expected a dangerous, squalid penal colony. It turned out to be much more benign. The campus comprised a cluster of units scattered across a green meadow. At the centre was a large administrative building where I held my clinic. It was less like the prison on Oz than an old elementary school, with terrazzo floors, painted cinderblocks and long corridors.

Adjusting to my new patients was a profound shock. Every day, guards would bring a parade of juvenile offenders, all under the age of 18, to my office. I’d perform full physical exams on each new admission as well as on any inmates who had medical complaints. A pair of guards patrolled my exam room at all times, trained to listen to the tone of the conversation to ensure each situation was under control.

The kids I treated were different from any I’d encountered at my office. I’d see young women with undiagnosed mental health issues—ADHD, bipolar disorder, depression—who had been self-medicating with alcohol, cocaine and Valium. A good number of them had been victims of sexual molestation. I never looked at their charges—there wasn’t enough time—but I knew from our conversations that many were incarcerated for petty thefts and robberies, often committed to support their addictions. Sometimes they seemed feral, as if they’d grown up with no parenting at all. (Many of them had.)

At one point, I began working with adult offenders and stopped seeing youths. By then, I looked forward to my clinics. Whereas my private practice left me dissatisfied, my correctional work energized me. Sometimes as a family doctor, you feel like you’re healing the well. Here, there was work to be done. My prison patients, plagued with dire medical and psychiatric conditions, weren’t getting the care they needed in the community.

Many inmates had used harder drugs like heroin and crystal meth, sometimes during pregnancy. Some would choose to terminate the pregnancy, while others would hold out hope that Children’s Aid wouldn’t take the baby away. I was counselling patients, treating addictions and diagnosing disorders. After years of coasting, I was finally putting my medical training to use in an urgent way.

I was also beginning to connect with my patients again. They were grateful to learn about why they might have a mood disorder, or how their menstrual cycle works—stuff that no one had bothered to tell them before. For the most part, they appreciated what I was trying to do for them, and we developed mutual respect.

Many of the women move in and out of the system for decades. I’ve observed women I treated as young offenders return time after time—a handful of them are in their late 30s now, and I’m even treating some of their kids.

Once, a patient overheard me talking about an upcoming holiday dinner and suggested I try cooking my turkey breast-side down, so the meat would catch the roasting juices. A couple of years later, when she returned to the jail for a new sentence and I saw her again, she asked how the turkey had worked out.

In July 2006, I closed my practice and devoted myself to my correctional job. I’ve never been happier. The best days are when I hear that someone has been able to get out of the system. Just a few weeks ago, I ran into a former inmate I’d treated for a serious medical condition while she was at Vanier. It took a few years, but she’d cleaned up her act and was now working and living happily downtown. She stopped me on the street and gave me a hug.

Laurie Middlestadt is a Toronto physician.

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