Walled in

Karen Gedney drove up to the Northern Nevada Correctional Center, a compound of gray buildings, chain-link fences and guard towers in Carson City. Her heart pounded. Her mouth went dry. She summoned her courage and walked across the parking lot to the gatehouse. She announced that she was there to start her new job as prison doctor. Several years earlier, she’d accepted a full scholarship to med school in return for a four-year appointment in an underserved area.

But there was nothing on the gate officer’s clipboard to confirm that he should have been expecting her.

“Why the hell don’t they tell me anything?” he muttered. His question would turn out to be a reasonable summary of one of the main themes of Gedney’s next few years.

The new doctor struggled to find her bearings during her first weeks and months treating prisoners. Her staff was comprised of a nurse who showed no warmth to anyone, a physician’s assistant who seemed immune to Gedney’s authority, and a competent, cooperative x-ray technician who turned out to be one of the few people willing to answer the doctor’s questions directly. Gedney soon learned that he was an inmate.

The prison’s medical director was on leave, and no one seemed to want to say where he was or when he might return. When he did return, he was wheelchair-ridden, disoriented and weakened by cancer. The medical director soon died, leaving Gedney in charge—with a list of questions: How do the politics work here? Why do some higher-ups seem to resent my presence? Who can I trust?

When her four-year commitment was up, she considered her other options and decided that being a prison doctor was her calling. She stayed until she retired in 2016.

“All through those years, I had been telling people little stories, and people would go, ’Oh my god, you should write a book,’” Gedney said during a recent interview in a coffeehouse. So, she kept a journal. Now, she’s self-published her memoir, 30 Years Behind Bars—Trials of a Prison Doctor.

Humble beginnings

Gedney, who retired in 2016, has the build of an athlete—she’s a skier and hiker—dresses like a model, and accessorizes like an art collector. She speaks with a knowing tone, a deep, genuine warmth, and, after decades in Northern Nevada, a mostly intact East Coast accent.

She grew up in the town of Saugerties, New York, in the Catskill Mountains, not far from Woodstock. She likes to joke that she was born with a wooden spoon in her mouth—as opposed to the silver spoon that signifies a privileged childhood.

“My mother was a German immigrant, coming in after the second World War to the United States with a seventh-grade education and nothing else,” Gedney said. “My father was a product of a Dutch sea captain and an illegitimate German countess. He had a miserable upbringing and, at 17, joined the Merchant Marines and experienced the world.”

Gedney further described her mother, who is now in her late 80s: “She’s very, very tough. It’s very much that German mindset—’You fall out of a tree and break your leg? Who cares? Get up and go back to work.’ And I didn’t know any different, because we were so isolated.”

As a child, Gedney had poor vision, and the problem went undiagnosed. She could not see clearly something that was more than an arm’s length away.

“So, what did I do?” she said. “I read books.” Her fourth-grade teacher assigned a book report. She doesn’t remember which book she reported on, but she remembers having been entranced.

“I couldn’t really see people,” she said. But, reading a book, she could pick up everything that was going on. At around age 9, she became a voracious reader and discovered the work of Frank G. Slaughter, a prolific and best-selling novelist who was also a physician.

“It was all about doctors who were, in historical times, taking care of people, where they were protecting against abuses of power,” Gedney recalled. “And they had romance and intrigue and danger.” Slaughter’s books also talked about current medical research and technology.

“I decided when I was 9 years old I was going to have to be a doctor—solely based on books,” Gedney said. “And I decided that was the sort of life I wanted, where it was danger, intrigue, adventure, protecting people, and then finding all these neat things out about science. And then I never changed.”

Settling in

In 2018, about a third of practicing doctors are women, according to data from the Henry. J Kaiser Family Foundation. And in 2017, women made up slightly over 50 percent of med school applicants in the U.S., according to a report from the Association of American Medical Colleges. In the 1970s, when Gedney started med school, the percentage of female doctors was closer to 15—and had only risen that high recently.

“Fortunately for me, I liked to study,” she said. “And when I graduated high school, I had a number of scholarships.” She graduated Phi Beta Kappa from Clark University in Massachusetts, which now calls itself a “private research university,” and which Gedney called “sort of a pre-med-type university.” Despite the honors, she did not get into med school on the first try.

“It was very difficult to get into med school, especially if you’re a female and you absolutely don’t know anybody to give you a recommendation in the medical world,” she said. “I did some master’s work, became a bacteriology supervisor, and then applied the next year.” She was admitted to the University of Cincinnati College of Medicine.

“And then, the best thing happened,” Gedney said. “I got the National Health Service Corps scholarship. They paid my medical school for four years. Even back in 1980, that was a hundred-thousand-dollar scholarship. And they gave me room, board, books and medical school. And that’s where I made the agreement.”

She didn’t know at the time exactly what she was agreeing to. After med school in Cincinnati, she was required to do a three-year residency in order to become a full-fledged physician, which she did at the University of Nevada, Reno.

After the residency, she was offered two choices—the Northern Nevada Correctional Center or Cabrini-Green, a public housing complex in Chicago.

“I had interviewed there, and, the day before, they killed a woman right on the doorstep of the place,” she recalled. “And I thought, maybe I’ll be safer in the prison.” Plus, her husband was pleased that they wouldn’t have to relocate.

Throughout the book’s first chapters, as Gedney was getting the hang of her role as prison doctor, she treated several fresh injuries. In one example, a “cho-mo” arrived in her office, beaten by fellow inmates with a sock filled with combination locks. In another, a prisoner had been on the ground in handcuffs and leg restraints, angry and yelling threats. Guards had brought in a dog. They’d lost control over the dog, and it had bitten the prisoner in the leg.

Gedney treated each inmate who came to the infirmary not as an offender of one kind of another, but as a patient whose ailments it was her job to help heal. She treated murderers and white supremacists, and she asked herself, “Instead of hating and fearing these groups, wouldn’t it make more sense to try to understand why they had chosen to live their life in that way?”

That position sometimes put her at odds with the custody officers.

“It’s always the suspicion,” Gedney said during the interview. “They always looked at me like, ’Why do you give ’em good care?’ which was hard to deal with, where, in the outside world I would be recognized as a compassionate doctor, who went more than the mile. And in prison, no, I was like a target.”

She could see the custody officers’ point of view, though. If one of them showed compassion for an inmate, they’d be branded an “inmate lover,” and their authority would suffer, which could lead to more violence.

“They have a world where they have to sit hours and hours sort of waiting for something bad to happen,” Gedney said of custody officers. She summarized the findings of an article she read recently: “Correctional officers have the highest rates of PTSD, depression and suicide, per capita, of any profession.”

A lifelong calling

Back in 1973, a Texas prisoner named J.W. Gamble was unloading bales of cotton from a truck as part of a work assignment. A bale fell on him, injuring his back. He was not treated promptly. The incident led to a 1976 Supreme Court case, Estelle v. Gamble, which established that inmates have a right to health care.

A similar suit, Taylor v. Wolf, led Nevada’s then-governor Richard Bryan to petition the federal government for two prison doctors, who would be installed in 1980. Gedney was one of them. The other was a woman she calls “Marla,” in the book, who worked at the maximum security prison nearby.

One day—after an inmate who was an IV drug user died and two others came in with hepatitis B, possibly from sharing needles—Gedney wondered about patient confidentiality. In the outside world, and according to her medical training, confidentiality was paramount. In the prison, was she obligated to report the drug use? She couldn’t find an answer, so she called Marla to discuss the issue. Their conversation that day reveals worlds about the situations and decisions they each contended with:

“Marla, how’s the weather at Max today?”
She laughed. She knew I wasn’t talking about the temperature, seeing as the two prisons were only a few miles apart. “Well, it’s a lot cooler here today than yesterday, when a couple of inmates went at it at the weight pile.”
“Anyone really hurt?”
“Nah. Fortunately, the officers didn’t hit anybody when they fired off warning shots. So how are you doing over at your place?”
“Surviving,” I said. But for how much longer? “Marla, did anyone over there talk to you about the subject of medical confidentiality and how the prison looks at it?”
“Hmph, I bet they think about it differently than we do. But as far as I’m concerned, I’m the doctor and that license means more to me than any job. If they don’t like it, I expect they can take it up with the Feds who put us here.” She laughed. “I’d love to see them do that.”
“So you don’t feel any pressure to break confidentiality because we’re in a prison instead of a clinic?”
“The only reason we’re both sitting in prison right now is that they’re under that big lawsuit. You know, I saw the inmate in that suit for pneumonia last week. He’s this skinny schizophrenic with scary eyes. When I looked at his X-ray and other films done on him in the past, you wouldn’t believe the amount of buckshot in his body. He’s probably carrying around a half-pound of lead in him. Rudy told me that when he acted up in the past—before they had any provider to give him an anti-psychotic—the officers would just shoot him in order to control him.”
I didn’t like lawsuits, but I knew that sometimes it was the only way something could be brought to attention that needed to be done. The lawsuit against the prison had enabled the system to be given two federal doctors for four years: myself and Marla.
“Yeah, I heard about that lawsuit. Taking care of the mentally ill, especially violent paranoid schizophrenics, would be difficult for a mental institution with a psychiatrist, let alone a prison with no real doctors. I never knew there were so many mentally ill patients in prison. For some reason I thought they would be in mental institutions.”
“Wake up, honey! When Reagan was president, he gutted those mental health clinics and asylums. Why do you think we have so many more homeless people now?”
“I knew about that, but seeing it up close is different. It’s not only the mentally ill, it’s all the addicts. I don’t see how sticking a guy in a cage and making his life miserable is going to address the things that caused him to be an addict in the first place.”
Maybe I was being made to feel that I was not wanted because I really wasn’t. Maybe the prison administration did not want things to change.

Gedney’s stories of injured prisoners and political chess from early in the book are just the tip of the iceberg. Things get even more intense from there, and her long career is also punctuated with moments of humor and hope. The story remains a page-turner throughout.

Reading it, it’s easy to wonder, over and over, how she dealt with the pressures of prison and kept returning to work day after day. She has three answers.

One is the support of her husband, Clifton Maclin. Gedney’s joke for him is that he was born with a platinum spoon in his mouth. He’s an African American man who’d grown up privileged, and who’d seen atrocities and was almost killed in the Vietnam War. After work—he was a financial adviser—over dinner or a foot rub, Maclin would patiently listen and sometimes advise when Gedney wanted to discuss a problem or decision she faced. Maclin also soon became a respected speaker and teacher at the prison.

“Without a spouse like Clifton, it’d be very hard,” she said.

Another thing that shaped her views on prison work early on was what Gedney called “naivete.” Looking back, she speaks now as if it were largely as a blessing. “I wasn’t familiar with prisons,” she said. “There are some people who go into a prison with all these preconceived notions. Like, these are horrible people. They are bad people. They’re scum. They should be punished. When I went in, I didn’t have that. I sort of lacked that judgmental gene.” If a smoker had advanced lung disease, for example, she said she was unlikely to admonish him for smoking and more likely to probe into what drove his addiction.

Yet another source of strength was her mother’s stories from World War II. When prison staffers would say, “I’m just following orders,” she’d think of the destruction that a “just following orders” mindset had led to during that war. She wrote in the book that she’d concluded, “To not think … to not question … to not wonder if something could be done in a better way… it scared me.”

“Over the last 30 or 40 years, the prison has swung back and forth on the pendulum of repressive to rehabilitative, depending on the prison directors and the wardens,” she said. “I lived through, I think eight or nine different prison directors and eight or nine different wardens.” Near the end of director Greg Cox’s tenure, in 2015, Gedney decided it was time to retire, which she did in 2016.

Shortly before her retirement, James Dzurenda was hired as director of prisons. Dzurenda has implemented reforms that swing toward rehabilitation. In February 2017, Nevada’s ACLU’s told the Nevada Independent that it was “cautiously optimistic” about Dzurenda’s policies. In August 2017, the civil liberties organization was dissatisfied with the prison’s new policy on transgender inmates.

After retiring, Gedney got to work on her book.

“What I wanted to do was write a book to share the inside of the prison from the eyes of someone who is a healer—not a guard, not an inmate,” she said. Her book was published in February. Now, she’s working on marketing it and scheduling talks and presentations.

As to her prediction for the near future of prison policies, she said, “It takes a long time to change a culture.”