Resurrecting a Prison Doula Program
We’re sitting in a large circle on the stage below the altar in the Presbyterian Chapel of the California Men’s Colony (CMC) prison. The light is dropping and the air cooling quickly, which we can feel through the open side door. There are 23 prisoners, Kris Kington-Barker, Executive Director of Hospice of San Luis Obispo (Hospice SLO) and myself. The emotion is powerful. The men have just finished an exercise in pairs discussing the legacies of their lives as they take turns being the doula and then the dying patient. It is the evening of a second, long day of working together, nearing 8:00 pm.
In the exercise, the men had spread out across the chapel in pairs. I could see the emotion: both pain and tenderness—the occasional, tentative hand on a shoulder, as a partner struggled with what they were saying and feeling. Touching openly like this between men is not part of the prison culture, and it’s frowned on by the correction officers that oversee their lives. Breaking through this unwritten code of behavior is risky, it makes them vulnerable. It’s much more usual for men here to be aggressive and predatory toward each other. That’s why what has been happening in this chapel over the first two of three days of learning to be doulas is that much more special.
The men are now talking about the experience of the exercise, how real it felt, how hard it was to be both the dying person and the doula—which they call here a Supportive Care Services (SCS) Volunteer. One man says: “I knew it was an exercise, but it felt so real to think I was dying. I’m young and I’ve never really thought about dying, not even when I was out there doing things that could have gotten me killed very easily.”
The experience of facing dying has been hard for many of the men as they play the role of the dying prisoner. Eighty percent of them have life sentences and may very likely die in the prison hospital that they hope to serve in as doulas.
Most of these men seem to have found some measure of acceptance with the sentences they are living out, recognizing that they deserve the hard life of prison for all the pain and suffering they caused their families and their victims’ families. They have signed up for the SCS program to do as much as they can to make amends for their crimes and to do something they can feel proud of.
This is the second time INELDA has partnered with Hospice SLO to train inmates at the California Men’s Colony to serve fellow inmates when they are dying. The first time we were here in 2017, the prison hospital had to be closed to install a new sprinkler system. That work was finally completed in the fall of 2018 and the hospital has reopened. During the hiatus, dying patients were shipped out to other prison hospitals in California. The SCS program fell apart during the long hospital closure. Some of the original group of men that trained for the program were released during that time, some were transferred to other prisons, others were involved in violations that prevented their continuance in the program.
For a time, it seemed that the administration of the prison would let the program die. But due to the tenacity of Dr. Denise Taylor, the original champion of a hospice program at CMC, a Chaplain Mark Williams and Kris Kington-Barker, the SCS program was resurrected. INELDA was invited to return and help train a new crop of volunteers. Of the 23 men in this training, nine of them had been part of the 2017 training, which focused mostly on grief, since the hospital was closing down. That training gave the men some tools to help their fellow inmates deal with the death of men they cared about who died in another prison hospital.
During the present three days of training we taught the men the model of care that serves as the foundation for INELDA’s approach to doula work. On the first day, we presented an overview of the model and then focused on deep active listening. The men did an exercise in which they responded to the kind of statements they might hear from a dying inmate. They struggled with some of the same issues as people in our public trainings: the desire to change how the dying inmate was feeling, the urge to fix things, and the anxiety about having the right words to say. “I just sat there wondering if I would ever know what to say,” said one inmate. “But then I remembered about giving the question back to them and figured that way I can’t make it worse.”
On the second day, we discussed how the volunteers would work with each other in teams, so they could provide care around the clock when an inmate is actively dying. Then we moved on to concentrate on exploring meaning and legacy work, which led to the deep sharing in the exercise talked about above.
At the end of the second day, the atmosphere in the chapel was intense but reflective. As they left to go back to their cells, each and every man shook Kris and my hand thanking us for coming. Kris and I both were touched by this show of appreciation and gratitude. The next morning, we were greeted in the same way: by shaking our hands, as they took their seats for another day of learning.
We started our last day together with a period of open discussion and questions about how the program would work. While the details are still being worked out, the group of 23 men will be divided into three teams of between six and eight men, depending on how many of them stay in the program after the training. All of these men went through a careful vetting process and individual interviews, but a few may still be dropped from the program or feel they are not ready for the work after experiencing the training. Nonetheless, there is a heightened sense of comradery among the men, some of whom had not known each other very well before the training. The population at the prison is around 3,500 men.
Before we dive into new subjects, we show the men a film called Prison Terminal, directed by Edgar Barens, which was nominated for an Academy Award in 2014 as a Documentary Short Subject film. Kris had ordered it specifically for the training. It depicted the last days of an inmate, Jack Hall, in a hospice program in an Iowa maximum security prison. The film showed a group of inmate volunteers taking care of Jack with an amazing degree of kindness and compassion. They massaged his back when he had been lying on it for a long time. They washed and shaved him when he couldn’t do that for himself. At one point the primary inmate volunteer, a black man, leaned down to kiss Jack on the cheek and tell him he loved him. Jack, responded in kind, even though he had once been a racist.
“You’ve been teaching us that the work is always about them, not about us,” said one of the inmates as we discussed the film. “That’s how that guy was with Jack. But I can see how hard that is. When we did that exercise yesterday about legacy, I just wanted to make things better when he (his partner in the exercise) talked about being afraid of getting punished on the other side.”
When Jack died the state required that he be fingerprinted. The nurse who was there at the time made a point of washing the ink off his fingers, saying: “They come in here with ink on their fingers, but I make sure they leave with all the ink washed away.” That moment of tenderness, granting Jack a measure of dignity even in death, touched and inspired all of us.
After some further discussion on the film, we turned to a presentation on signs and symptoms of active dying and imminent death. It is odd to see a number of these men appear uncomfortable in hearing about the way a body deteriorates and then breaks down in the last days and hours. Many of these men had committed murder, but never really thought about what happens physically as someone dies.
From signs and symptoms, we moved on to teaching and practicing guided imagery. Only a few of the men had any idea what guided imagery was all about. They had experienced it as a meditation technique. But none of them had ever guided another person. When they broke again into pairs to try it out, they found that it wasn’t as hard as they had feared. “I lost my words,” said one inmate. “So, I just stayed silent for a while hoping that he (his partner) would go wherever he needed to. Then I started repeating some of the same stuff over again and threw in some things that just occurred to me, even though he hadn’t said it when we talked (beforehand). When we were done he said those extra things were just what he had been seeing.”
We finished out the day by talking about the importance of allowing their grief when a patient they were serving died. And, talking about self-care to avoid burning out. The last sharing was by one of the men who had been part of a much earlier incarnation of this program and was also part of the 2017 training. “This work is going to change you,” he told his fellow inmates. “You’ll know how precious each moment is, even here in these walls. And, you’ll learn how meaningful it is to give to another without expecting anything in return.”