Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

What follows are three first-person narratives from the perspectives of a hospice inmate volunteer and two members of security at the Louisiana State Penitentiary Hospice Program, recipient of this year's Circle of Life Award.

• Room Number Six by James West

• Personal Reflection on the Louisiana State Penitentiary Hospice Program by Colonel Sam Smith
• Security's Role in Hospice Care—A Personal Reflection
  by Colonel Darren Bordelon

Room Number Six

James West

[Citation: West, J. Room Number Six. Innovations in End-of-Life Care, 2000;2(3), www.edc.org/lastacts]

On January 7, 1997, with tears streaming freely down my face, I stood over his cardboard casket being lowered into a pauper's vault in the unfrequented prison cemetery. I unclasped my fist while letting slide from it a crucifix, a token of our friendship he had given to me. As I stood transfixed on this cross lying upon his casket, vivid memories raced through my mind. Logan and I had been doing time together, housed in the same living area for several years. We slept in beds next to each other, and over the years established a concrete friendship behind these razorwire fences. Through his stories told late at night, I had lived on the bayou, encompassed in the Cajun culture; worked an oil rig in the Gulf of Mexico; set traps for, caught and eaten crawfish. I sensed Logan's Southern pride when he spoke of his kids, his family, their traditions. We watched each other's backs, as they say in prison, until the day they diagnosed him with lung cancer.

Logan, whose nickname was "Bones," went through surgery in which they removed one of his lungs. Thereafter, he was reassigned to Room Number Six on the ward, Nursing Unit II. Those assigned to the treatment areas back then lived there and died there, essentially alone.

For one prisoner to visit another prisoner, it almost took an act of Congress. Security was strict. On those occasions when I could find a ranking security officer compassionate enough to allow me to visit, I would go see my friend. His face would light up when I entered the room. As our tradition was, we would sit and tell each other stories, laughing along the way. For at least a year, I would spend a few hours with him every couple of weeks. With each visit, his condition—but never his spirit—regressed. Little did I know he was preparing to die.

The day before he died, Bones asked that I be there for him to the end. He said, "I told my family that I did not want to be buried in Gueydon, Louisiana, among lots of strangers. I would prefer to be buried here where all my friends are." I reassured him that I would be there until the end.

Bones died alone in Room Number Six on January 5, 1997. When word got to me a few hours later in my dormitory, I wept uncontrollably, engulfed by the feeling in my heart that I had failed my friend. He died alone! As my tears drop into his grave, I ask Bones to forgive me for not being there with him as I had promised. Security refused to allow me to visit that morning!

August 28, 1999, in Room Number Six: I'm a hospice volunteer sitting vigil with another friend dying of cancer, when the correlation with Room Number Six strikes me. I swallow hard to fight back my emotions. Ernest Davis' friendship had begun in a similar way to that of Bones'. I befriended and lived with him in the same dormitory. His death, I vowed, would be different!

A month earlier, Ernest and I were sitting on his hospital bed, when he pointed to the hospice literature lying upon his bedside table. His throat cancer had already claimed his voice, but I could comprehend most of what he communicated. The fear in his eyes told the story. He was visibly struggling with the doctor's diagnosis, magnified by the thought of dying alone in prison. To older prisoners, the treatment center was "The Place of No Return." I took his hand in mine and promised him I would be with him from then on. I explained the hospice philosophy to Ernest, then invited him to accept hospice care so that I could literally love him to death. I'll never forget asking him if he knew how to spell hospice. He rolled his eyes at me, and with his hoarse whisper he spelled, "H-O-S-P-I-C-E." I smiled and said, "That's correct, but we spell it a little differently; we spell it L-O-V-E!" He nodded. Eventually, he accepted hospice and we set upon a daily journey, hand in hand.

Sitting at Ernest's bedside, I look at his niece, asleep in a chair. She has spent the night here in this room with us both. For twenty years, she grew up visiting her uncle in prison. Now due to our hospice visitation policy, she was allowed to sit vigil with us also. Holding Ernest's hand, I close my eyes, thinking of what it was like before, periodically visiting with Bones, and what it is like today. Never again, due to our hospice program, will another man unnecessarily die alone in Room Number Six.

Personal Reflection on the Louisiana State Penitentiary Hospice Program

Colonel Sam Smith

Chief of Security, Main Prison East Yard

[Citation: Smith, S. Personal Reflection on the Louisiana State Penitentiary Hospice Program. Innovations in End-of-Life Care, 2000;2(3), www.edc.org/lastacts]

The hospice program has allowed me an opportunity to view my job as a security officer from a completely new and different perspective. After twenty years in corrections, I had seen men stoop to extremely low levels to bring discomfort, displeasure, and disgrace to others. However, I was taught and believed that "there is a little good in the worst man." Needless to say, this belief has been tested over the years.

When the hospice program came along, I was in a position that allowed me to assist without interfering with the development of the program. I was asked if I could or would assist with the movement of inmates attending training to become hospice volunteers. This seemed strange to me, because inmates seldom give up their free time to volunteer to do anything. However, we conducted protection checks and removed other small obstacles to maintaining security while allowing inmates to go from their housing units to the training, and later to work as volunteers in the prison hospice in the medical dormitory. This was accomplished by utilizing the same security guidelines that we normally used, and it enabled the program to become a reality.

Once the program was up and running, when the first patient died, we saw that Angola truly had a hospice program. In the aftermath of this experience, we understood that a once terrible prisoner had been transformed into a lonely, needy patient. Nurses and volunteers cried. Everyone had done his or her job. Doctors and nurses had provided the medical care that they were trained to give. Inmate hospice volunteers had provided love, comfort, and companionship to one of their own.

I've observed a man rubbing a patient's painful arm, shoulder, or leg. I've observed dying patients hold their assigned volunteers' hands as they slip off to a faraway land. All of this has allowed inmates to show compassion that has never been shown before. People bonding together for a common positive cause is unusual in our society. It is refreshing to know that the hospice program provides an opportunity for the different elements within the prison to work together for the overall success of the program. Standards and expectations are high. Everyone has helped to police potential problems because they believe, "We have worked too hard to lose the hospice program."

Inmates are the heart and soul of this program. It is truly for them. One of the greatest known fears of inmates is to die alone in prison. This program tremendously lessened the probability of that happening. It guarantees that you will have a family with you when you go. It gives an inmate the emotional strength to get ready to go.

At 6'5" and 265 pounds, my physical size represents the stereotype of the correctional officer. I've worked hard to control my disposition so that I wouldn't be the stereotypical model. Over the past couple of years, I've developed a strong inner sense that tells me I'm a better person because I was involved as men struggled to find themselves and their true identities. I've observed true miracles in men who were counted out, but recovered, and walk around today.

Hospice is one of the most positive programs in the prison. I supervise most of the inmate organizations, clubs and religious groups that offer self-help and/or improvement programs for the inmate population. The hospice program sets the standard for these types of programs.

Security's Role in Hospice Care—A Personal Reflection

Colonel Darren Bordelon

Assistant Chief of Security, Camp D

[Citation: Bordelon, D. Security's Role in Hospice Care—A Personal Reflection. Innovations in End-of-Life Care, 2000;2(3), www.edc.org/lastacts]

In 1997, I was asked what I thought about setting up a hospice program in the prison here at Angola. I had heard Warden Burl Cain talk about this program. He said he had seen a story about hospice in the newspaper and felt that we needed a program like this and wanted to implement one at Angola. The idea was to use inmate volunteers to sit with dying inmates.

At first, I had my doubts about the program. Being a security officer with more than twenty years experience, the first thing I thought was that the inmate volunteers would take advantage of sick and weak inmates. I was also worried about the inmate volunteers moving around the nursing units and whether they would have enemies. I felt like it would just be more work for security.

To set up the hospice, it took about a year of planning, writing policies and procedures, and research by Carol Evans, a hospice social worker from New Orleans, and staff at this facility. Despite my initial doubts, I knew from the beginning that I wanted to be involved in everything dealing with the hospice program. Working as a team with classification, we screened all of the inmates who applied to become hospice volunteers. We were looking for inmates who had good conduct records and who showed care and concern about others, rather than worrying just about themselves.

In 1998 the hospice program took off, and I watched it closely to see how the inmates would interact. I was surprised to see that the program showed such a positive impact on the inmates and also on security. It helped the security staff to see the inmates as human beings and forced the security staff and medical staff to work together.

In the first couple of days of the program, we established a schedule for both the volunteers and the inmate visitors that outlined how many people could come [to the medical unit where the hospice beds are located], at what times, and how long they could stay. Each hospice patient was assigned six volunteers and allowed ten inmate visitors a month. The inmates could visit for two hours at a time and could not come more than three days a week.

Both the inmate visitor and the volunteer schedules are flexible, and nursing staff and the security supervisor work together to expand visitation as they see fit. It helps that the interdisciplinary hospice team members respect the security personnel, see maintaining security as our first priority, and work together professionally.

The hospice program at Angola has worked well and is still growing. Through team effort, the program seems to be getting more organized as time goes by. Security officers have seen that the program does not violate prison rules and that from a disciplinary standpoint, the inmates are treated alike. Security, physicians, classification, chaplains, mental health staff, volunteers, and nursing staff working as a team made this program work and brought these people closer. This experience has shown us that utilizing inmate volunteers is a "must" for a successful prison hospice.