I went to medical school in a prison town. At first the Kingston prisons seemed to me like the sugar refineries or steel plants of other cities, simply the main local industry. One of them—a gray, neoclassical, walled compound—was near the campus, on the lake. Another, across from the Value Village, resembled a small castle with red spires; some locals called it Disneyland North. There were four other major institutions outside the city, much less visible from the road.

Some students joked about them. These tended to be young white men who, if they ever did find themselves in jail, would likely soon be freed through family connections, or a judge who saw himself reflected in their faces, their manner, or their home address. It was new for me to be around classmates like that—ones who might play a round of golf with the dean or department head, hired housekeepers, and shopped at thrift stores only satirically, at Halloween. In their company, the feminist and anti-corporate perspectives that I’d come to take for granted as a campus activist at the University of Western Ontario were considered amusing, though amusement was only the waxy coating over a compressed sense of entitlement; if I pushed through, I knew there would be contempt, and even fury.

When it came to prisons, however, I had nothing to say; my life at the turn of the millennium had afforded me that ignorance. While my parents had modest incomes, they also had graduate degrees. The racisms I’d encountered were particular to being perceived as mixed race, or South Asian, or Arabic. They were not anti-Black or anti-Indigenous, and therefore did not place me at exponentially higher risk of imprisonment. I saw the prisons as ominous boxes, self-contained and arbitrarily situated in our area. Their relationship to the community remained obscure.

Then, during the first month of classes, I volunteered for an after-school arts program at a local public school. I worked with first-graders who had been identified in evasive professional language as at risk. One afternoon, around a low, rectangular table strewn with pipe cleaners and popsicle sticks, one grim little girl in pigtails told me that her father was a trucker and gone all the time. Immediately, three or four other children claimed the same.

I brought up this coincidence with their teacher afterwards, and she clarified that the fathers were incarcerated. Although I can’t recall what the teacher looked like, in my memory she struck that common tone in which the initiated speak to relative outsiders about prisons—or perhaps in which we respond to any privileged innocence—with a degree of pleasure at its erasure. In return, I made an effort to hide my dismay. And what do we do that for? I mean assimilate terrible facts by pretending not to feel.

My privilege had classist and racist foundations, and somehow caused me to underestimate the love in the lives of imprisoned people. I had pictured men—the downtown prison was a men’s institution—without relations, and failed to consider that their partners and children and mothers would move to live near them, for the sake of whatever contact was allowed. It was a subtraction I had made from their humanity. If my own father or brothers were long-term prisoners, I too would try to make visits affordable and practical. My privilege was that this circumstance seemed unimaginable. I stood nearer, in other words, to the fraternity men of my class than I had realized.

My sense of immunity would soon undergo an adjustment. I started medical school in 21, and September 11 was our second day of classes. During an early break, a fellow student appeared at the lectern and said she had just read at the library’s computer terminal that America was under attack. Our class stirred in disbelief and confusion, but the next professor took the stage without comment, and the title of his PowerPoint presentation appeared on the screen: Blood. I listened for a few minutes, saw that the material was familiar, and left to get the news. During the months and years after that, as an anti-terrorist infrastructure was taking shape to target people with olive skin and Islamic names, I would learn to worry for my brothers and their possible incarceration. I would finally grasp that, for many, prison gates were only a crooked official or bureaucratic error away.

Back in that public school classroom, however, the aches of those six-year-olds were a revelation. Afterwards, whenever I passed the prison, I could almost see their love and longing and anger for their fathers, tethered and drifting from the razor-wired walls like threads of spider silk.

The next impression the prisons made on me was an indirect but gruesome one. As part of our medical training, we were each required to shadow a paramedic team for one shift. I told my friend and classmate I had spent a quiet evening eating doughnuts and watching comedies at the station, and responding to a single call from a woman with back pain. The paramedics were relaxed as she limped from her house to the ambulance; she was a regular, they said. Then I asked my friend about his experience.

He was usually wryly funny. He explained that his team had been called to the downtown prison after a suicide. They had to cut a hanging man down. His voice was both incredulous and already imbued with a determined acceptance, as if he took it as his duty to withstand what he had witnessed.

Then came the clinical years.

“I have lunch at twelve,” a tall, thin patient in the infectious disease clinic told me. He repeated this several times as I persisted in a thorough assessment.

“You’re meeting someone for lunch?” I asked.

“No,” he said, looking at me with scorn, “I’m in prison.”

The placid man in the waiting room—his partner or friend, I had assumed—must have been a guard.

The term “minimum security” occurred to me. The question of what he had done. Never ask them: that was the only instruction I ever heard from a professor regarding prisoner patients.

As hospital admissions, prisoners were marked with a middle initial of “X” on our lists. I suppose this was to alert health-care workers to potential complications: the impossibility of a neurological exam on a person in shackles or the need to allow a guard into the imaging room. The prisoner in-patients were people twice institutionalized. I wondered if the hospital was a respite for them.

One night, I was called to a ward room with two uniformed guards at its doors. There were four patients inside—three in the usual half-curtained beds, and one man on a gurney in the aisle. I had his chart in my hands. Restraints locked his wrists and ankles to the rails, and were impossible to reconcile with his condition; he was emaciated, fevered, and trembling. We were approximately the same age. His diagnoses were pneumonia, diabetes, and HIV/AIDS, and I could see from his bloodwork that he was critically ill.

“I’m all right,” he kept telling me in a small voice fractured with pain, “I think it’s just a cold.” He had big, dark eyes. I told myself that he had probably been violent—and that he would trick me too if required, easily and remorselessly, in a habitual fight for survival. I did that, I now see, because of the vulnerability I perceived in him. It made me want to stay and hold his hand, but I knew that doing so would cost me, in some unwritten sense, as a medical student; we were supposed to be tougher than that.

The next prisoner I remember was a bearded, red-haired man lying handcuffed to a gurney in a hallway, awaiting surgery. It was another incongruous picture. Pre-operative patients already seem disarmed: they lack their usual clothing, or their eyesight, or the sense of remove from their own mortality. The man’s restraints, in this context, implied that the threat he posed was immense.

There was also the strange sequence of procedures that had been or would be done to his body: immobilization by chains, and then by anaesthesia; cutting and cauterizing; leaks of blood. Their meanings blurred, and the rituals of surgery could suddenly be perceived as punitive, or even as a curing of whatever was amiss in him, the ablation of the will to harm.

These mental images of corrective procedures now strike me as central to the incarceration system’s own unsettled question: should inmates be punished or rehabilitated? Isolation is already inherently painful to our nature. Past that punishing aspect, doing time is not a blank, suspended existence, and the condition of people released from prisons depends on the substance of their days, months, and years of incarceration.

The doctor at one of the clinics I rotated through also worked inside the prisons. When I asked about his experience he told me how disastrous it was that prisoners could not clean their needles for drug use. He had advocated for bleach buckets on the range, the common area directly outside the cells, but those were deemed too dangerous. He described a horrific economy, in which some prisoners would swallow their prescribed medications under supervision, then make themselves vomit to sell the pills. The money might be for food, phone calls, or contraband. He seemed to speak with an extinguished kindness, in a sandpaper voice.

I think of the efforts made by doctors, or teachers, or other institutional workers, to not feel too much. If the purpose of prisons was truly rehabilitation, that numbing practice might have no place. The buildings would be architecturally overhauled, their interiors no longer resembling cages. Instead of infrequent and opaque reports of an inmate death, a riot, or a drone ferrying contraband over a wall, we would hear regularly from incarcerated people themselves. They would receive a dignified rate of pay for their labour.

Contemporary prisons are supposed to have classrooms and libraries and culturally oriented anger management programs, measures intended to lead to the release of benign and skilled individuals. But what I’ve observed of people on day parole, on statutory release, or in resumed lives of relative freedom, is that living in prison has left signs of trauma: scars, restlessness, a vigilant scanning of the periphery. Correctional officers, too, are affected by the institutions; a recent Canadian study found that more than a third suffer from work-related PTSD. When human exchanges are fraught with threat, mistrust or abuse, no one involved is immune.

Kingston’s historic downtown prison closed in 213, and three years later it reopened for tourism. I went on a bright day one May, a decade after I had left both the hospital and medicine itself. I wanted to know what was inside the walls that I had passed by hundreds of times.

Two young students guided our group through the family visiting rooms, where microphones were embedded in the small, metal tables, and past the domed, central space with its tiered ranges, inside the metal workshops, and along a row of open cells. Under the dome was a panoptical guard station, a geometric structure of steel and bullet-proof glass. There were framed pictures on the wall. One photograph from the 197s showed the inmates relaxed and crowded along the fenced galleries, listening to a live concert.

At each stop, retired Kingston Penitentiary officers told us the history of what we were viewing. Some seemed to offer a straightforward perspective. One former guard with a booming voice recalled the period when officer weapons were stored beneath the guard post: “Having the armoury here was wonderful. We could get anything we needed. Pistols, guns, gas, batons, shields.” A stern woman described doing cell checks: “We looked for a live, breathing body.”

Other narrators used forms of doublespeak that I couldn’t quite decipher. A gaunt man with a mustache said smilingly, “When we got the security cameras in, the prisoners really liked that.” The undesirables, others said, or the definition of reasonable force. The tour was strictly timed and surveilled; whenever I lingered at a stop to ask questions, one of the students would return and rush me through the tight and labyrinthine hallways after the group.

I thought of Charles Dickens’s description of the place in 1842. He was travelling through eastern America and Canada, making stops in Boston, Toronto, and Niagara Falls. Of Kingston, he wrote: “There is an admirable jail here, well and wisely governed, and excellently regulated, in every respect.” At the time, some inmates were children under the age of ten, routinely whipped for breaking rules that included not speaking or giggling.

What felt cumulative, during our tour of the now dormant building, was the effect of endless cold, hard surfaces—metal, limestone, and concrete—ubiquitous in the floors, the walls, the bars, the railings, the seats, the tables, the bunks. Everything was made to withstand force or to be hosed down, but people had lived there—breathing bodies—and I saw no means for them to be even fleetingly at ease. The punishment or rehabilitation question seemed settled in the furnishings themselves.

There was, even as we walked the extensive outdoor grounds, a sense of suffocation rising in me. Where were the former prisoners’ voices? In the segregation unit, where a residual atmosphere of suffering remained unmistakable, I saw a skilled drawing of an Indigenous Medicine Wheel, along with axes, a feather, and a grieving woman’s face, still on the cinderblock wall of a cell.

We were not supposed to ask, at the hospital, what a prisoner had done because the answer could affect our duty to provide impartial care. This is a beautiful principle in medicine: the idea that every wound deserves the same quality of attention, no matter who bears it. But what we were more implicitly taught not to pursue is the question of where the injury began. With a famine; a slave ship; a broken treaty; with the Sixties Scoop.

Some months after the tour, I was at a community meeting that involved a sharing circle. One of those present was a muscular white man with a tense demeanour. In the circle, he volunteered that he had done what he called the worst thing possible, and had served his time. He was frustrated that many people—potential employers, friends, or lovers—still saw him as a criminal. “What about forgiveness?” he asked.

He sat beside me, and we were without the separations that institutions impose—without the white coat and the orange jumpsuit, the scripted roles of authority and compliance. He spoke with a volatile impatience. Ideologically, I wanted to agree with his perspective, to erase the weight of his past, but instinctively, I wanted only to be less near him, and to not mention that I had a daughter. The fault wasn’t mine or his, but collective; my sense, bodily and trusted, was that whatever had happened to him in the name of justice and rehabilitation had not worked. I don’t believe prisons enclose or remediate physically violent behaviour. They are a stopover in its circuits, where pain and trauma are amplified.

Activist movements for prison reform or abolition are more prominent now than they were when I was a student, but perhaps what requires reform first is our definition of what constitutes violence. At the after-school arts program, many of the children gathered around that glue-stained crafting table—who aren’t children now, who probably have children of their own—were chronically hungry, and to be six years old and hungry in a city of stocked stores, among gleaming billboard images of restaurant meals, is violence; to be a mother with only a few dollars of grocery money per day is violence; for a child to name their hunger to the wrong adult and lose their family is violence.

That genocide is violence goes without saying; its brutal aftermath marks communities for generations. Living with a pervasive cultural image of yourself as inferior is also violence, and when the police and courts base their work on that image, the system becomes an entrapment.

In relation to those forms of violence, most of us accord ourselves a false sense of blamelessness. We don’t determine rates for social assistance programs; we don’t refuse to fund water filtration systems for Indigenous communities; we don’t fasten the handcuffs to the stretcher. Our own violence takes the form of silent, continuous consent; it lives in us, a negative space with armoured walls.

After the prison tour, I remembered another way that the prisons had come up during our first week of med school: the downtown penitentiary was rumoured to house Paul Bernardo, a serial rapist who also murdered three girls. My cohort was the same generation as his teenage victims, and it was natural that we would discuss him—but now I also see the implications of us naming only that inmate, one who was monstrous, and undoubtedly guilty, and could never be safely released. Very few such people exist, but it was convenient to consider him the representative prisoner, because it absolved us of asking who else was in there and what their stories might be. Viewed in the slanted sunlight that makes threads visible—gleaming filaments strung between razor wires and walls—these stories are ones in which we are all complicit. Those hard and unforgiving surfaces are ours.