'm lookin' funny in my eyes,
And I believe I'm fixin' to die,
Believe I'm fixin' to die.
I'm lookin' funny in my eyes--
I've tried so hard to come home to die.
"Fixin' to Die"
Bukka White,
Parchman Prison Farm, 1938

Glen Herbert is spending the last day of his life in the infirmary at the Louisiana State Penitentiary at Angola. His family won't make it to the prison before he dies, but he has two friends, Michael Singletary and Claude Donald, sitting by his bedside. They lean close, holding Glen's hands, feeding him fruit from a can, listening to whatever he might have to say in his last hours. Occasionally they gently ask a question. ãHey buddy, how are you doing? Are you all right? You're not hurting anywhere are you? Glen lets them know he's OK. His light blue eyes seem focused on a point in the distance, but heâs still present. Later that day, at 1:47 in the afternoon, Glen passed away.

Three days earlier, Glen Herbert had been well enough to walk over to the glass-enclosed meeting room off the ward and peer in. He could see a bunch of guys, inmates from different ãoutcampsä on the prison grounds, sitting in a circle with two women he didnât know. They had been there all morning, and Glen wanted to know what they were doing. Claude, an inmate orderly on the ward, told him that they were in a training session to become volunteers for a new program starting up at Angola, a hospice program for terminally ill and dying inmates. Claude later said that Glen was impressed, that he thought it was a good idea. Unfortunately, Glen Herbert died too early to reap the benefits of the hospice that would open in January 1998.

The Louisiana State Penitentiary (LSP) at Angola is the size of a small town, stretching from the east bank of the Mississippi River into the Tunica Hills 60 miles north of Baton Rouge. Most of the penitentiary's 18,000 acres are farmland, broken up by five separate compounds, called 'Camps,' that house Angola's 5200 inmates. Angola's own brochure gives the following account of its demographics: Of Louisiana State Penitentiary's inmates, 85% are violent offenders. Fifty percent (50%) of the inmate population are serving a life sentence and will never be released from the prison. For the majority of Angola's residents, the world has shrunk permanently to a 26-square-mile swath of rural Louisiana flatland.

"We have to make it work for one another."

From its earliest days as a brutal prison work farm known for routinely working its inmates to death, Angola's history has been consistently troubled. As recently as 1991, Federal District Judge Frank Polozola lifted a two-year "state of emergency" classification from Angola, ending another soiled era this one marked by administrative corruption and rampant suicide among the inmates. In the six years since, the atmosphere at the huge maximum security prison has slowly changed, due in part to the willingness of two successive wardens to take unorthodox approaches to their jobs.

Angola, which holds the dubious distinction of housing more inmates serving natural life sentences than any other institution in the country 3,876 at this writing is where most of Louisiana's violent offenders end up, and odds are they won't be leaving, ever. Approximately 75% of Angola's inmates, including a huge percentage of the inmates who entered the prison after 1979, can expect to grow old and die there. And at Angola, the only prospect more dreaded than dying in prison is being buried there, at Point Lookout Cemetery, condemned to a permanent separation from the outside world.

Last year, Angola's current warden, Burl Cain, was approached by members of the Lifers Association and the HIV/AIDS Peer Education Team, concerned about the increase in number of inmate deaths due to natural causes. At the same time, news of the inmates' interest in hospice education reached staff members at University Hospital Community Hospice (UHCH), a department of the Medical Center of Louisiana, in New Orleans. Carol Evans, BCSW, called Warden Cain to offer UHCH's help. Cain's long-standing concerns about the growing elderly and ill populations at Angola led him to take one further step: he suggested a full-fledged hospice within Angola's R.J. Barrow Treatment Center. Enthusiastic about a program geared toward comfort-oriented end-of-life care within the Louisiana prison system, Carol offered to spearhead the collaboration and began to guide the inmates and administration through the process of starting hospice at LSP.

It took Carol a year to formulate and implement a training program for the hospice and to help draft its policy and procedures. Inmate volunteers, medical staff, and security personnel at the Treatment Center attended seminars with titles such as "Communicating with the Dying", "Care and Comfort Measures", and "The Psychosocial Dynamics of Death and Dying". Other sessions were devoted to managing personal stress and working through the bereavement process with the family (including the inmate surrogate family). All three groups received instruction on the hospice philosophy, as well as more specialized training in their respective duties. Throughout the training, the aim was to help LSP create a hospice program in accordance with standards established by the National Hospice Organization. Carol felt that it was important to give the corrections staff ample time to think about the material and assimilate the ideas of hospice before the first patient was admitted to the program. "The staff really has it now," she said recently. "They know how to think like hospice staff; they have had enough time to process what they have learned and experienced. It takes a long time to understand hospice, to think like a hospice person.ä

One week into the training period, word of the new program reached every outcamp at Angola, even those at the far perimeter, some twenty miles away from the Treatment Center. Inmates relaxing in the open recreation area were now used to seeing the inmate volunteers and their hospice instructors bustling out of training sessions every day at six p.m., notebook, clipboards, and the hulking hundred-page Hospice of Louisiana State Penitentiary Inmate Volunteer Manual under their arms. Something serious was definitely going on, and the inmates were asking questions. After a week, five or six prisoners a day were requesting to become part of the training.

After a security screening, the "inmate leaders" who would make up the vanguard group of hospice volunteers on the program were carefully selected by six of the most trusted and influential inmates in the prison community, including Wilbert Rideau, the editor of the Angola's award-winning magazine The Angolite. The twenty-five inmates represent a cross-section of the prisonâs complex population: there are Muslims, Catholics, and Baptists, and representatives from some of Angola's most active clubs, includng the Lifers Association and the Human Relations Club (which supports indigent inmates). Through these volunteers, a powerful message efficiently filtered out to the larger prison population, that the administration was finally addressing an issue that had been discussed among Angolaâs inmate activists for years.

"What will happen to me in years to come if I don't get parole or a pardon?" Believe me, that's what a lot of these guys are thinking," says Charles Bouie, a 34-year-old lifer who was one of the first to suggest bringing a hospice worker to Angola. "Nobody wants to die alone, but thatâs how it's been at Angola; a guy would be cut off from his friends, from his routine. I had a friend die up here five months ago, Morris Green, and I was able to get a call-out to come see him, but there was another friend who desperately wanted to come but couldn't. Morris was on his last legs, and he was saying, "Tell him to come see me, tell him to come see me." But the guy couldn't get the call-out approved. With the hospice, there'll be a program in place so that we'll be able to be here and provide some care and comfort to our friends. From what I heard in my dormitory last night, everybody's pretty excited.

How to handle the growing numbers of inmates dying in America's prisons and jails has become a leading issue in corrections in this country. Since 1983, deaths in prisons nationwide increased an astonishing 550%, according to a recently published report by the U.S. Bureau of Justice Statistics. Last year, nearly three times as many inmates died at Angola as made parole, a figure that also held true for the two previous years a first in the history of Louisiana. In 1995, state and federal prisons were housing approximately 72,000 inmates over the age of 55. Is keeping "longtermers" in prison until they die the best alternative for them? And if they are going to stay in prison , what approach should be taken toward their care? One recent correctional trend seems to favor the building of geriatric prisons, an extremely expensive alternative. A stroke victim, for example, could be released to his family and monitored with an electronic ankle bracelet for a cost of $3200 a year. In more humane terms, if a sick or elderly Angola inmate is transferred to the new geriatric facility in northern Louisiana (at Fort Wade), what will the psychological and emotional effects be if he is separated from familiar surroundings and friends after ten, twenty, or even thirty years at Angola?

Finally, on January 14, the first patient was admitted to the Angola hospice program. His family, including his inmate family, was briefed about what they could expect in the coming months and how they would participate in the patient's care. Relaxed visitation rules now applied so that friends could visit in the Treatment Center more frequently than usual. The day after the patient was admitted, the first interdisciplinary hospice team meeting was held, with input from UHCH via teleconference call. After the meeting, Carol was heartened to realize that the Angola team was now thinking in terms of the goals and principles of hospice care.

Prison hospice is one means of sending a positive message to those who have the unfortunate prospect of breathing their last breaths behind bars. In the sometimes dehumanizing environment of prison, the message of hospice, which recognizes and affirms a person's basic humanity at the time of death, is especially pertinent, and especially needed.

"Do you want to know why Louisiana has the second highest incarceration rate in this country?" booms Warden Cain one day over lunch." Our sentences are too long, our sentences are too tough! You're doing more time for every crime than you do in most any other state. The problem with Louisiana? We don't ever let 'em go. Once you break the law, you don't get another chance. If it were up to me I'd say let's not keep dying old men in prison. They're too old to pull an armed robbery or be a ski-mask rapist. They ought to do about twenty years on most any serious crime and when they turn about fifty years old when those two come together on a graph they pretty well should have a good shot at going free."
--from an interview with Anne Seidlitz