The California Medical Facility in Vacaville is the major treatment center for ill and/or dying inmates in the state prison system. In the mid-1980s many inmates were dying of AIDS, often dying alone in their cells. This barely-noticed crisis inspired Nancy Jaicks Alexander and Robert Evans Alexander, FAIA (dec.), working with Father Patrick Leslie (then the Catholic chaplain) to establish the first hospice in an American prison.
A unique aspect of this seventeen-bed hospice is that the hospice volunteers, of which there are forty, are all fellow inmates. Many of the volunteers are serving life sentences for murder with no possibility of parole. They receive weekly ongoing training in hospice care. When a patient is close to death, volunteers sit around the clock in eight-hour vigils so that no man will die alone. The principal fatal diseases at this time are lung cancer, cirrhosis of the liver, and HIV/AIDS.
Students in LA 256: Healing Gardens and Restorative Landscapes, taught by Clare Cooper Marcus, took on the challenge of creating a garden for this hospice. This class was not a studio; rather it was principally a seminar with reading, lectures, discussion, and experiential exercises. The garden design was in lieu of a term paper, and the students had just two weeks to produce their proposals along with suggested budgets. Preliminary designs were reviewed after one week by Associate Professor Louise Mozingo, and landscape architect Vince Healy who, as a student at Harvard, had written his MLA thesis on hospice gardens.
The Dog Run
As a first step, Nancy, Chaplain Keith Knauf (current director of hospice volunteers), and I met with some of the hospice volunteers to solicit their ideas. They talked about the current 35×12-feet outdoor space of the hospice – a concrete slab completely caged-in with chain link – which the staff calls a patio and the inmates term “The Dog Run.” They were enthusiastic about the idea of expanding it and creating a garden.
I asked them what they thought would be important in such a garden. “The sight and sound of water,” said one man. “I grew up near the Southern California coast and the sound of water is really important to me…” “Lots of color,” offered another. “The hospice wing is pretty cheery.” And another suggested, “Things to eat! We have some cherry tomatoes and peppers in the Dog Run. People really like that.”
I asked what might be some of the objections which the administrative or custody (“security”) staff could raise and among the responses was, “It would have to have a roof like the Dog Run so we couldn’t climb out and escape.” Additionally, I was told that, “Chain link would have to be anchored all round in concrete so a person couldn’t tunnel out.” Another informed me, “They wouldn’t allow anything that could be broken apart and used as a weapon.”
As enthusiastic as they were, the inmate-volunteers were well aware that the biggest impediment would be the cost. “But we could do some of the work ourselves,” volunteered one man, “I have a degree in civil engineering from Sacramento State. I could build a fountain.” Another, who had worked in construction, said he could build planter boxes. “We could get local nurseries to donate plants.” “Inmates in the horticulture and landscaping program could raise plants and take on the maintenance,” was the inspired suggestion of another man. The most surprising idea came from a grey-haired, stocky man. “Twice a year we hold food sales. We sell pizza and donuts – stuff like that. We make over $6,000 each time. We could give that money for the garden.”
No Trees Allowed
The prison authorities agreed, after appropriate security checks, to permit the students to tour the prison and measure and photograph the proposed garden site. For all of us it was quite an emotional experience: none of us had been in a prison before, most had never visited a hospice.
Like most prisons, the environment of the California Medical Facility at Vacaville is grim. The building is a quarter mile long and houses 3,300 inmates, of whom 550 are diagnosed with HIV. Within the prison there is no color and little sound beyond men shuffling along the corridor to a clinic appointment, guards calling out to inmates to stand against the wall as visitors pass, and the clanging echoes of security gates opening and closing.
Cell blocks open off a wide concrete corridor like the teeth of a comb. Between the cell blocks are areas of open space, some used for exercise and weight training, others filled with dead grass and inaccessible. On one side of the prison are sports fields used at designated times for running, baseball, basketball, and socializing. Here, some of the inmates feed seagulls with food left over from their lunch. There is no shade; there are no trees. In July 2006, outdoor temperatures reached 108°. A lone tree in a courtyard next to the chapel was once climbed by a patient from the psychiatric unit trying to escape. The tree was cut down and the courtyard permanently closed.
The one bright spot in the whole facility is an area for vocational training in horticulture comprising a garden, greenhouse, lath house, and compost bins. Perhaps the most touching experience in our whole prison tour was entering the shady verdure of the lath house and meeting a slim, white-haired man with deep blue eyes wearing a neat blue work shirt. “Please come in – come in! My name is Richard; just – Richard…” He proudly showed us his domain – gravel paths winding between ferns and tropical plants, each neatly labeled with its Latin and English names. “This was nothing when I came here two years ago – all overgrown, no labels. And I didn’t know anything about plants! Now I have my California State Certificate in Horticulture.” Unfortunately this little oasis in the prison is a quarter mile from the hospice wing and security restrictions do not permit inmate-patients being brought here to enjoy the plants and the garden.
As the students measured and photographed the potential site of a garden for the hospice (under the watchful eyes of guards in a nearby tower), we all become aware of the limitations that would have to be dealt with: a large steel storage container that could not be moved, a driveway for delivery vehicles that could not be transgressed, a security restriction that said, “No trees,” and the requirement that the whole site must be surrounded and “roofed” with chain link fence. Nevertheless, the students saw the potential to create a healing oasis in this otherwise grim environment.
The Most Creative People in California
The last class meeting comprised a return visit to the prison, and formal presentations by the three student teams to prison officials, including the chief medical officer for HIV treatment services, the associate warden, a lieutenant from the custody division, and the director of hospice volunteers. Unfortunately, the inmate-volunteers themselves were not permitted to attend.
Prison officials were impressed with the quality and sensitivity of the designs, as well as the goal of reducing costs by proposing drought tolerant plants and solar panels. The students took note of the requirement that every square inch of the garden should be visible when a guard steps out of the hospice into the open space. They also responded to suggestions from lectures and reading that a hospice garden needs places where a person alone, or a patient and a visitor, can find some privacy; places where a family group might sit comfortably with a chaplain or counselor; raised beds where a patient in a wheelchair might pick tomatoes or water strawberries; opportunities to visually “escape” by viewing the hills beyond the double chain-link and electric fence which surround the entire prison. The prison authorities were also pleased to note that student-teams recognized the potential for horticulture trainees to raise cuttings and annuals and plant up beds in the hospice gardens, thus linking these two elements of the prison population.
All the designs recognized the essentials of a healing or restorative landscape in a healthcare environment, whether in a hospice, a hospital, or a nursing home: seasonal color, intricacy of texture, the sight and sound of water, close in and distant views, plants that move with the slightest breeze, flowers to attract wildlife (the restrictions of the chain link fence would restrict this to hummingbirds and butterflies). The goal is to create a rich, sensory milieu since empirical evidence shows that “nature distraction” has the affect of reducing stress, lowering blood pressure, and reducing the heart rate.
A few design elements were vetoed by the head of security. We had urged the students to propose quick-growing vines that could withstand the summer temperatures of 100°-plus in Vacaville and that would soften the effect of the required chain-link “cage” around and over the garden. Too late, we discovered that prison security goes the rounds, shaking every piece of chain-link three times a day in case they are being filed through prior to an escape attempt. The one team who proposed a split bamboo fence inside, and separate from, the chain link got the green light. Irrigation systems, proposed by two teams, were also vetoed in case inmates dug them up and “re-used” the metal couplings. A final surprise veto came for four lemon trees in large pots. At first we thought it was for the pots; we had been told to avoid anything that could be broken and used as a weapon. But it was for the lemon trees. “They’ll take the fruit and make it into alcohol. There are stills in the prison. We don’t know where they are. They’ll use anything – raisins from the cafeteria, fruit brought in by visitors.” On recounting this to colleague Randy Hester, he remarked, “It sounds like some of the most creative people in California are in prison!”
An Island of Compassion
At the end of the presentations, prison officials were very enthusiastic about creating the garden and were, I think, totally persuaded as to its potential psychological benefits for staff, inmate-patients, inmate-volunteers, and visitors. They were delighted that we could leave copies of all the designs with them, to use in any way they wanted. The problem of actually creating a garden, as always, is money. The prison system budget is hugely over-stretched; crowding has resulted in indoor gymnasia and recreational facilities being converted into dormitories. “We cannot use taxpayers’ money to make a garden,” we were told by Dr. Bick. “But five years ago, they told me I couldn’t have a new clinic, and this year it opened. We’ll create that garden somehow, however long it takes!”
Nancy refers to the hospice that she helped to create as “an island of compassion in a sea of violence, fear, and paranoia.” We are hopeful that the garden, when it is created, will become a restorative oasis for those who are dying, for the medical staff, and for the inmate-volunteers who care for their peers.