Prison Hospices Offer a Haven of Mercy

Juan Robles thinks there are two men within him.

The first one, easily enraged, is racked by violent impulses, swayed by his companions. That’s how, eight years ago, he landed in the penitentiary for armed robbery.

The second Robles bleeds with empathy. He has a gift for easing others’ pain; he responds intensely to the influence of peers. That’s why he volunteers inside the prison hospice--for the shattering, redemptive work of helping ailing inmates as they die.

The transformation of Robles is just one consequence of a surge in prison hospices, a trend slowly altering the culture of U.S. prisons. Devoted to physical and emotional comfort for the dying, hospice units may actually touch whole prison populations; according to some wardens, violence apparently diminishes when a prison starts a hospice.

Prison hospices are multiplying because of a national push for longer prison sentences, coupled with epidemics such as AIDS. With the prison population roughly triple what it was in 1990, dying naturally while behind bars is now common.

Last year, about 3,000 U.S. inmates died in custody--50% more than just the year before. Today, a population defined by its divorce from other humans is facing, in large numbers, the one experience all people share. To keep up with the needs of the dying, 12 states, including Texas and California, currently have prison hospices.

In any prison, the hush and humanity of a good hospice contrasts bluntly with the institution around it. But the idea of tranquil death takes on special irony in Texas, which executes more inmates than any other state. Last month, officials even flew an inmate from a hospital intensive care ward, where he’d been placed after trying suicide, back to death row to execute him on time. Although their roots are practical, hospices have had some unforeseen effects. Inmates surprise wardens by competing for hospice volunteer jobs. Once-suspicious victims’ advocates now support hospices. And some prisoners’ advocates denounce them.

Anecdotal Evidence of Drops in Violence

Most unexpected of all, several wardens have cited anecdotal evidence that violence drops markedly when a prison hospice opens. The ripple effects don’t much surprise Juan Robles, though. At 33, he says his real self came alive only one year ago, while he was tending to the dying.

Tall, dark-eyed and gentle-spoken, Robles is easy to imagine as a hapless soul imprisoned by some trick of fate. He’s not.

He was born in McAllen into a strict Seventh-day Adventist family. In his 20s, he worked diligently at a factory. He also was possessed by a sudden, volcanic temper, drank wildly and “turned into a totally different person” around his friends after work.

In their presence, he committed an armed robbery at 25. He was sentenced to 15 years. In prison, he says, his aggressive behavior continued--until about a year ago, when a race riot prompted reassignment of all Latino inmates to different prisons. Robles, who is Mexican American, found himself at the Michael Unit in East Texas, notorious at the time for discipline problems of its own. But by the time he arrived, a pilot hospice had been installed, and to Robles it seemed a prayer had been answered.

“I’ve always been interested in the nursing field, in hospitals and nursing homes,” he says. “I always prayed I could do hospital work.”

He applied for a volunteer job, went through the training and began a regimen of two 12-hour shifts, twice weekly. The demanding job is purely voluntary.

The facility is one of five state or federal prison hospices in Texas, where 150,000 people are incarcerated. California’s one hospice is in Vacaville, and 12 additional states are considering starting them.

Near capacity with 19 patients, the Michael Unit hospice looks like a low-tech hospital wing. In its green concrete-block halls, the institutional odors of prison give way to the faintly different, slightly kinder smells of an infirmary.

Robles, rotating with other volunteers, bathes, soothes, feeds and comforts inmates whose prognosis is six months or less to live. Patients receive pain medication but no emergency action to resuscitate them. Family members can visit often.

But it’s in the nature of prison hospices, says supervisor Joyce Miller, that the most intense support comes from other inmates.

“In hospice we treat the mind, body and soul,” Miller says. “These guys get real close to the guys here. Usually when you take a prisoner in, there’s already some strings cut [from their loved ones]. Sometimes our hospice aides become the family of the person who’s dying.”

‘I’m Afraid That I’ll Die Alone’

And maybe only other inmates understand the dread of dying behind bars, surrounded by other inmates, remote from those who once knew them best. “I’ve lost a lot--my wife, my child--since I came here,” Robles says. “I put myself in [patients’] place, and I’m afraid that I’ll die alone.”

At the Michael Unit, a maximum security prison in a dusty margin of the East Texas woods, the 3,200 inmates are noticeably calmer in the nearly two years since the hospice started, Warden Larry Johns says. He thinks the hospice’s nurturing climate helps first the patients, then the volunteers and finally the whole prison. “The philosophy changes in the setting itself,” Johns muses. “The inmates change. It changes how we look at them.”

“There’s certainly no empirical data, but you will find a majority of wardens saying it makes sense from a security basis,” adds Elizabeth Craig, president of the Colorado-based National Prison Hospice Assn. Historically, the deaths of inmates have prompted violence, minor arson and vandalism, all of which may diminish when a prison has a hospice. Inmates often believe that companions who die in prison infirmaries are mistreated, even killed, Craig says.

But not all hospices, Craig stresses, are as comfortable as the Michael Unit, where each patient has a private room and relative freedom of movement through the area.

Ray Hill, a former inmate who is now a prison reform activist and Houston radio show host, has no use for the prison hospice system, even at its best. Hospices, Hill says, only detract from inmates’ slim chances of actual parole to die at home. And, he adds, they obscure severe problems, such as under-treatment of epidemic levels of hepatitis C.

“There is a general callousness and lack of concern about providing adequate health care to a population they perceive to be disposable,” Hill says of Texas’ political leadership. “People who die in prison hospices die earlier than they would if they were in free-world care. And they die less gentle deaths.”

But, hospice activists rejoin, long sentences simply reflect the public mood--a mood not likely to change soon.

Meanwhile, victims’ rights advocate Dianne Clements has no objection to the hospice system, as long as inmates don’t leave prison a moment earlier than scheduled.

“If we can provide them an environment in which they die with dignity . . . that’s a good thing,” says Clements, president of Houston-based Justice for All. “Certainly juries and our Texas Legislature and victims’ families understand that longer sentences equate to inmates dying in prison.”

Fifty-six-year-old James Purkey, convicted of armed sexual assault, has known for some time he would die in prison.

The throat cancer that forces him to sip liquids constantly from a plastic cup has taken him into the last days of his life, but the skinny, animated man can still walk stiffly about his cell, thumb the hot rod magazines beneath his bed and hug his equally skinny mother, Helen, as she ends her daily visit. He’s just grateful, Purkey says, that he lived long enough to die in prison decently.

Lawsuits Sparked Texas Prison Reforms

Three years ago, most inmates in the Texas system would have died inside their cells. Orderlies with painkillers may or may not have surfaced regularly; a chaplain showed up occasionally. Most further attention depended on whether an inmate was well liked.

But Purkey, behind bars for almost 37 years, remembers when things were much, much worse--before lawsuits in the 1980s launched vast, systemic Texas prison reforms.

“I’ve accepted. I’ve accepted,” he says of his impending death. “See, you have no idea how this system used to be, how horrible.

“I remember sitting with a friend till he could no longer drink his coffee or put on his clothes. Till the pain was so bad he wanted to kill himself or wanted you to do it. We had no mercy program whatsoever. They’d put you in another unit, put you in a room and then you died. A trusty would come in with rubber gloves and rubber boots and hose you down to wash you.”

In the hospice, Purkey asserts fervently, “nobody is in pain. Nobody.”

But, says Robles, inmates he’s cared for still face the fear and psychic pain of dying--often terribly compounded by their circumstances. In his white prison scrubs, a small cross dangling from his neck, Robles has more than once comforted inmates anguished at the dead relationships and distant families they leave behind.

Often too, dying inmates brood on questions of judgment. Their failures. Their crimes.

“My patients are always ready to talk. . . . They want to talk about crimes in their free lives. Crimes for which they weren’t punished,” Robles says. “I think they want to get it off their chest.”

He listens attentively. Sometimes he buckles.

Of all the patients he’s seen, Robles identifies most closely with the Latino immigrants in hospice, the ones who can’t speak English. The son of Mexican immigrants, he knows Spanish-speaking patients sometimes shrink from making requests of English speakers.

Rodolfo Fernandez Fonseca, who died this year, was his best friend in the prison. A drug dealer who died of AIDS, Fonseca did not go easily.

“He was so aware,” says Robles. “I’ve never seen so much emotional fear. It was so sad for me, not to be able to help.” Finally, he talked to a therapist--one of the support systems that the hospice team provides--to overcome his grief.

Yet even that experience, Robles says, had a meaning it might not have for somebody outside a prison.

“Working in a hospice has meant that my emotions are alive in me,” he says slowly. “I think we all have compassion, but we don’t cultivate it. I think this is the real me now.”