Ever wondered what it's like to work as a cardiologist in a federal prison?

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The archetype of prison life is rugged: rolls of barbed wire, concrete floors, cold steel and brawls—lots of them. But what about the inmates who are limited to hospital rooms? What about those who have to be hooked up to machines to keep breathing, or have fluid drained from their lungs every day to stay alive?

In October’s issue of JAMA: Cardiology, Ersilia M. DeFilippis, MD, details in a short essay her own experiences working on a heath care team in a care level 4 prison—one built for inmates who need near-constant monitoring.

Keeping up with a heart-healthy lifestyle within the walls of a federal prison isn’t easy, for patients or their doctors, DeFilippis wrote, recounting her experiences with one patient who struggled with advanced heart failure. To check his pulse, she had to maneuver around shackles. He was prescribed a heart healthy diet, but the salty, red meat snacks available at commissary are, as DeFilippis wrote, “excellent triggers for a heart failure exacerbation.”

According to the essay, inmates within the Federal Bureau of Prisons are more likely to have hypertension, hyperlipidemia, diabetes and obesity, as well as noncardiac chronic conditions like HIV, hepatitis C and asthma.

DeFilippis’ team delivered the best care they could, she wrote, but resources were limited.

Read more about her experiences here: