More Americans are dying behind bars than ever before. At one correctional facility, volunteer death-doulas offer care and comfort to their fellow prisoners.
It’s six p.m. on a summer Wednesday, and Billy Canady Jr., 47, is beginning his shift as a hospice volunteer. His patient, Carl Stevens, is dying of cancer. A mermaid looks down on the bed where Stevens is sleeping, part of an ocean-themed mural that sports his sentimental touch: photos of Stevens’ children and grandchildren by the bed. Canady taps the elderly man lightly on his shoulder to let him know he’s there.
“He just looked up, and it’s like you get this sense that he knows he’s safe,” says Canady, who is fourteen years into an eighteen-year sentence. It’s looks like this that make his volunteer work worth it, he says.
Canady has been looking after Stevens (whose name has been changed here because he did not agree to be interviewed for this piece) for a little over two weeks. At this point, caring for him means sitting by the bed to keep him company because Stevens is still largely self-sufficient. They have a few things in common: both love German shepherds and value family. And, most importantly, both are inmates at Osborn Correctional Institution, a medium-security prison in northern Connecticut.
The mantra of hospice is “death with dignity.” It is a comfort-oriented approach to death in which quality of life is deemed as important as the number of days the patient has left. Pain management is a priority, and unlike the sterile anonymity of a hospital, hospice patients die at home or in a place that feels like home, surrounded by family. Hospice care is meant to address not just the physical needs of the dying, but their mental and emotional needs as well.
Osborn’s hospice may not be as cozy as a living room, but it is a definite step up from a cell or the general medical ward down the hall. Many inmates don’t have family who are willing or able to spend their last weeks, or days, with them. So in addition to medical duties, the inmate volunteers serve as a stand-in family.
Osborn is among a relatively small number of U.S. prisons that have a hospice program. The most recent count, conducted ten years ago, found only 65 out of 1,800 correctional facilities had hospice programs. Able-bodied inmates play a key role in the prison model of hospice: They volunteer as part-time companions to the patients, and part-time assistants to staff nurses. They spend time talking with their patients, reading to them, and just being there for them. And if the patients need help, the volunteers feed, bathe, and take them to the bathroom.
There is no shortage of elderly inmates in need of hospice care, largely thanks to bloated sentences during the “tough-on-crime” ’80s and ’90s. In fact, they make up the fastest growing population in prisons today: In 2014, the most recent year for which data is available, the highest number of inmates on record died behind bars, with about 3,500 in state prison and about 450 in federal. Inmate volunteers provide free labor and save the prisons money, but proponents of prison hospice say that its greatest benefits are social rather than economic. For the patients, hospice offers them the prospect of a more humane death by allowing them to spend their final days with round-the-clock care by peers. And for the workers, the experience of caretaking can be profound. Plus, academics who study this type of program say that this goodwill is spread beyond prison medical wards.
After an inmate embraces the role of caretaker for his patients, “then it becomes more about their relationship to other people … their community,” says Kristin Cloyes, a professor of nursing at the University of Utah who has studied the prison hospice program at the maximum-security Louisiana State Penitentiary, also known as Angola. “They’ve actually transformed the culture,” she says. Cloyes speculates that the hospice program at Angola was a key factor in the dramatic decline in violence Angola has seen in the past three decades.
Jamey Boudreaux, executive director for the non-profit Louisiana and Mississippi Hospice and Palliative Care Organization (LMHPCO), has been visiting Angola to observe the hospice program since its early days in the late ’90s. He also recognized the cultural shift Cloyes cited. The hospice program created a “new emphasis on dignity of one person — no one dies alone,” he says. “The administration saw that when you start respecting human dignity, the violence dropped.”
Since the program started at Osborn ten years ago, the hospice has seen 37 patients. (This doesn’t represent all of the inmates who have died here over those years, as some chose to die in the medical ward alone or with a staff nurse, explained Colette Morin, a nurse at Osborn and the coordinator of the hospice program. Others are hesitant about signing the “Do Not Resuscitate” order — only offered when a patient is entering their last six months of life — required to enter hospice care. This is a barrier to some inmates, Morin says, who think, “If I’m signing into this program, I’m signing up to die.”)
Canady is one of twenty inmates currently trained to be an inmate volunteer. Over the past six years, he has guided fifteen patients to a peaceful death.
Morin describes the 45-hour hospice training, which covers practical skills as well as emotional, as a process that allows guarded men to break out of their hardened shells. It is important that trainees learn to be more in tune with their own emotions, so that they can be present for their patients. An early assignment is to write a letter of apology to their victims and read it to the group.
“The transformation, I feel, starts there, but it carries on to the rest of their life in prison,” Morin says.
But the intimate interaction — clothing, bathing, assisting in the bathroom, and so on — between inmates in hospice goes against standard prison code and concerns some correctional administrators, according to a 2002 survey of fourteen state and federal prison officials carried out by the GRACE Project, a now-defunct effort to increase the understanding of prison end-of-life programs. Putting able-bodied inmates in charge of weak ones also raised eyebrows because of the potential for victimization. It is concerns like this, perhaps, that explain why prison hospice is not more widespread.
At Osborn, staff is very selective about who they allow to be in the program. One of the longest serving volunteers at Osborn was put on probation, Morin says, because of a contraband infraction — unauthorized sneakers.
Canady was first introduced to hospice work while on temporary leave from prison to visit his dying grandmother in 2010. Hospice workers were caring for her at that point, and he was moved by their efforts. When he returned to Osborn, he decided to give the prison’s hospice program a try.
Alongside Narcotics Anonymous, which helped him kick his addiction to crack cocaine, Canady counts hospice work as among the most rehabilitative experiences that he has had in prison. “I can just be me, and be proud of the person who I am, the person who my mother and father wanted me to be,” he says.
Canady’s father, Billy Sr., is a Vietnam veteran and a retired school aide. His mother, Belva, worked on the production floor at a local factory in Waterbury, Connecticut, an industrial town about an hour and a half south of Osborn, making small screws. Of their three sons and one foster daughter, Billy Jr. is the only one who has been incarcerated. The parents describe Canady as a happy-go-lucky kid who fell in with the wrong crowd.
“Everyone out here speaks highly of him,” Billy Sr. says, “They’re surprised that he’s still incarcerated.”
Canady describes his wrongdoings as a spiral of addiction, and stealing to fuel his addiction, starting when he was in high school. Things got out of control, he says, when at 22, his best friend died after a fight with an armed neighbor. “I heard two shots,” he says, and “72 minutes later he died.” At that point, he says, he just stopped caring.
His addiction took hold of his life. He stole from his parents, and eventually — armed with a gun and knife, which he brandished but never used, he says — from a local gas station and two cab drivers. It was those robberies that landed him where he is today.
“Like they say in recovery, when you get desperate, you’ll go to extremes to get what you want,” he says.
Under different circumstances Canady doesn’t think he and Stevens would have crossed paths. Stevens was a journalist who lived in a rich part of Hartford, whereas Canady grew up in industrial Waterbury, and was “running the streets,” in his words, at a young age. Yet there he was, sitting by the man’s bed during his most vulnerable hours, caring for him as he neared the end of his life. Canady loved listening to Stevens’ travel stories — he visited New Mexico each year to meet his best friend, a place Canady had only seen pictures of — and never grew tired of hearing about his children and grandchildren.
Their transgressions brought them to Osborn, and hospice bound them together. About a month after Stevens entered hospice at the age of 73, dementia started to kick in. One afternoon, a staff nurse found him wandering the hallway talking to his daughter, who wasn’t there. She called Canady.
When he sat down by the bed, Stevens told him that he “finally made it to the office,” but became riled by an imagined deadline. Canady, playing the sympathetic editor, reassured him: “We’ve got plenty of time to get this done.”
Eleven days later, Canady packed Stevens’ bag, and helped him shower and change into a state-issued outfit for release: elastic-waist denim pants and a grey sweatshirt. He is only Canady’s second patient to have been granted medical parole.
“I told him he was going home,” Canady says. “I held his hand and told him how much I love him, and God bless him and stuff like that. I thanked him for allowing me to work with him and sit with him. He smiled and he squeezed my hand to let me know that he heard me.”
Stevens died a few days later. Reflecting on their relationship, Canady says: “He told me I was a good person. You don’t get that too much in here.”
This fall, Canady started his bachelor’s degree in human services at Osborn through a federally funded Pell Grant program. He’d like to do some sort of social service work when he’s released in four years, and wants to continue being a hospice volunteer. He realizes that his options will be limited because of his criminal record — most places are very careful with who they allow to work with elderly patients. But, he says, “I definitely want to stay connected however I can.”
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“What we thought was interesting was that [becoming an inmate volunteer] went beyond personal transformation,” says Cloyes, who co-wrote a series of studies on the program at Angola. According to Cloyes and her co-authors, the work of caretaking creates a set of shared values among volunteers, a social contract that is distinct from mainstream prison cultural norms: ‘“real men’ who want to care for others and elevate themselves, their prison family, and the community,” the authors write in a recent article. These shared values create a culture among caretakers, one that is passed on from experienced volunteers to newbies.
Experienced and novice volunteers came together this Valentine’s Day, when roughly forty family members of inmates and a handful of prison administrators gathered in Osborn’s visiting room to celebrate the graduation of eleven new caretakers. They had been selected through a rigorous application process and completed the 45 hours of training. The graduates and a few senior volunteers, all wearing beige prison uniforms, sat on metal chairs with chipped white paint as the guests filed in. Three tables adorned by silver and blue plastic tablecloths lined one side of the room, topped with two large grocery-store-bought sheet cakes, a tub of single serving milks, and a large canister of coffee and Styrofoam cups for the post-ceremony celebration.
Following opening remarks by Morin, and a Christian prayer by a visiting reverend, Canady stepped to the podium to address the crowd. This was the first time he was the senior volunteer speaker. His mother and father sat in the middle of the room. Billy Sr. rested his elbows on the table, clutching his hands. Belva looked at her son intently.
Canady thanked everyone for being there. “Six years ago I decided to do something different with my life in prison,” he said. “I remember my father always used to ask me: ‘When are you going to grow up?’ That’s what I’m doing, I’m doing something I’m proud of,” he said, his voice cracking. Belva, too, wiped away tears. He told the graduating volunteers not to let the stigma that they won’t amount to anything dictate their lives, and to take this as an opportunity to step in that direction, as he did.
“I no longer have to walk these halls like a prisoner,” he says, “I can walk them like a man.”
Story by Maura Ewing
Illustration by Jeremy Leung