Approaching the Mohawk-Walsh Medium Security Prison, images from prison movies come to mind: the high walls, the barbed wire, and the impenetrable, dead quality. Signs direct me to continue around the drive to the Walsh Medical Facility. The walls and wire disappear, and I park in an ordinary parking lot. Two men are working outside, mowing the green grass edging the sidewalk. A few uniformed men stand near the door, chatting, apparently watching the gardeners. They greet me with smiles and send me inside to the desk where I explain the reason for my appointment. Shortly a young woman appears and escorts me back through a doorway. While I wait for Kathie Krstovich, the Deputy Superintendent, I comment how lovely and bright the offices are, and she extols the virtues of Walsh.

Kathie, a slightly graying, no-nonsense person, arrives. She describes the overall structure of Mohawk-Walsh. Walsh, the medical part of the prison, is a Regional Medical Facility, adjoining and part of the state prison for men. This means that men from prisons all over this part of New York State come to Walsh for medical attention; everything from a consultation with a skin doctor to long-term skilled nursing care. Kathie suggests we tour the facility, a recently remodeled hospital building. We go through a passage where I show my ID, then out into the air. She greets and talks to everyone we pass, men in hospital gowns in all stages of illness, men in wheelchairs, men walking, men lying on mobile beds, glassy-eyed. Her kindness, even now in memory, is touching. One patient refers to some recent improvement, saying: “It’s all due to you.”

Many of the rooms are brightly lit by sunshine. A few men sit quietly in a walled, sunlit patio. We enter a large reception-type room and interrupt a classroom situation. Perhaps 20 men in hospital gowns attentively focus on a presentation at the “blackboard.” I am introduced to the instructor, a volunteer from the AIDS in Prison Project. I am aware of a very weak person lying nearly-prone in his wheelchair near the door.

The tour continues, with Kathie speaking to guards as we pass, fielding complaints and gossip with the utmost skill. We go outside again, passing a few ambulatory patients with Kathie making encouraging remarks to them. Next we look in on the cafeteria where I hear that 1000 men are fed in record time. The cafeteria is bright and clean and could be in an upscale elementary school. I have to remind myself that this is actually a place where men are imprisoned for crimes against either society or other people like themselves.
At some point I adroitly realize that Kathie must have been a nurse, and she relates some of her background a nurse in a community hospital, then a prison nurse, promotions, then prison administration, then the opportunity to develop the Walsh facility.

Next we pass the newly-built rooms intended for the hospice ward with isolation booths in their corners where highly-contagious patients will be housed. These rooms will be used once staffing is in place, although already about 70 men a year die at Walsh. They look like state-of-the-art hospital rooms, but I know I wouldn‰t want to die in one of them.
As we walk across the green playing fields, Kathie describes her correctional approach. These men are criminals; “They didn’t get here by stealing hubcaps.” But their punishment is being here; they don‰t need to be punished further. She lists the sports and other activities available to men here classes, law library brought to the bedside, seasonal picnics run by outside volunteers. ‹It keeps them occupied. That way they don’t hurt each other, or us. I find myself in awe of her combination of hard-headed practicality and compassion. This lady, I think, does not fall prey to idiot compassion!

I learn that the men incarcerated here live in barracks, 60 to a dormatory, with one guard to a dorm. How can this be? Kathie informs me that it is because of the high quality of New York Correctional Officers.
Back in her office, Kathie tells me more. The facility is accredited by the American Correctional Association. There is an out-patient clinic, and an ambulatory clinic daily; 46 patients in long term care, 21 in ‹hospiceŠ care. There is a pre- and post- hospitalization unit, depending on needs.

We talk about the proposal for inmate volunteers in the hospice. Kathie doesn‰t know what the legalities are and is cautious, thinking of possible abuse of helpless patients Ö from extortion to stealing candy boxes to revenge by a previous enemy. Because it is a regional facility, moreover, Walsh has rich resources, and perhaps doesn‰t so much need inmate volunteers to care for the dying. She names the personnel available to patients: MDs, RNs, two hospice nurses, LPNs, nurses aides, buddies and tutors, volunteers from the community, Chaplains, counsellors, outside groups like the AIDS in Prison Project, peer groups which, she says, ebb and flow. Patients at Walsh, and staff, also have a lot of contact with the families of the men.

We get to some of the thorny issues, questions raised by the prisoners‰ advocates. Are dying patients shipped off to local hospitals at the last minute to avoid legal actions because they die in prison? Is palliative care available? Are there legal services for the terminally ill? What about resuscitation? In each case, these issues were resolved years ago here in a manner hospice would hope for. Kathie, in fact, implemented for the Department of Correctional Services the health portion of the Medical Parole legislation. In addition, the alarm went out from here warning of the extent of the AIDS epidemic in prisons. Kathie has established a problem-solving group for inmates. They are required to come with an agenda to a group composed of inmates, counsellor, security, and Kathie.
Regarding the structural issue of conflict between the correctional and medical staff, often rumored in journals, we have an interesting exchange. “Do you have any suggestions for working with wardens?” I ask. “I am a warden!” she replies. Then she tells me that she developed lesson plans for a joint orientation for security and medical personnel that involves their working together. Now, when a problem arises they already have the process of working together intact. Kathie emphasizes that New York State DOCS is a para-military organization and that the medical staff has to cooperate. For example, when several trips outside the prison are planned for a given day, and security calls her with concerns for what they can safely cover, she would request the doctor to review appointments and cancel an inmate‰s non-emergency appointment until another day.

I tell Kathie about the National Prison Hospice Association, which I am representing. NPHA wants to ensure that guidelines for adequate hospice care are established, disseminated, and followed. She agrees to participate in that effort if approval is granted from her bosses.
After some personal exhange, I leave. I remember Kathie talking of their grief one morning, finding a young man dead even though they knew he would die soon. I walk outside into the sunshine where the gardeners are gardening, bent over. Chills are running up my body, and I am happy; something good is happening in the the middle of the New York prison system, the largest in the U.S., something sane and true. The nurse-warden had a lot to do with it, but she said she is no renegade in the system. I‰m hoping the work, these practices, will spread.

Months later a friend asks me about the visit to the Rome penitentiary. In the midst of remembered images of plants and sunlight, sweeping lawns and an enlightened nurse-warden, I am standing in a large waiting-room. Guards in a locked ante-room are searching a prisoner before allowing him to enter. Men, visitors from nearby prisons, sit on benches all around the reception room. They watch us, childllike, while they await appointments with a doctor. Suddenly, as if on cue, each man takes out a paper bag lunch and, like a school child, begins to eat. I understand with a shock what it means to lose one‰s independence, to become, in a sense, infantalized by a system punishing them for their wrong actions.

I also remember that the sickest men in this pleasant place will not be leaving here but dying here, and that the rapidly increasing numbers of dying prisoners all over the country are less fortunate than these; they may die without relief from pain, without contact with family; they may die alone.