Sebastopol woman works to dignify death for San Quentin prison’s ailing inmates

Sandy Fish co-founded the Humane Prison Hospice Project with the goal of training incarcerated people to provide each other end-of-life care.|

Sandy Fish’s life journey has been complicated, meandering and at times chaotic. But death is at the center of almost every turn.

That might seem implausible at first glance: At 66, she has long hair so blond it’s almost white, framing a smiling, roseate face. She wears dirty Chuck Taylors on her feet and her hands fly everywhere as she speaks.

She is full of vitality.

But death is always with her. It is her life’s work.

“I think about death everyday,” she said, grin unfaltering.

She sat at the wooden picnic table outside the one-room Sebastopol house she rents, which she calls her hut. The road leading from downtown was dappled with yellow sunlight penetrating the foliage overhead. Her hut sits among others on a property up a hill, surrounded by gardens and woods.

“Death makes me appreciate life and how precious every moment is,” she said. “It brings everything. It tends to make me want to feel everything.”

Fish has dedicated the past several decades to easing death — to increasing access to death with dignity for the most vulnerable people. A grandmother and recent transplant to Sonoma County from Mill Valley, she co-founded the Humane Prison Hospice Project in 2016, an initiative to train incarcerated people in San Quentin State Prison in end-of-life caregiving.

The goal of the project is to give people in San Quentin, and eventually all California prisons, the tools to care for each other as they die of terminal illness and old age.

The project is one of the first such hospice training programs in the state, and the only one with aims to expand statewide.

While the project has been slowed by the pandemic, which shut some programs indefinitely in San Quentin, the underlying problem Fish and her co-organizers grapple with continues to worsen: Hundreds of people are dying of old age and related ailments in California prisons every year.

Incarcerated populations are getting older due to war on drugs-era policies and punitive sentencing laws in the past several decades. Nearly a quarter of the state’s 125,472 people in custody were over age 50 in June 2019, the most recent year for which data from the California Department of Corrections and Rehabilitation is available. And the average age within prisons has steadily increased every year.

People who are incarcerated on life sentences in San Quentin have few options for where and how they’ll take their last breaths:

They may die in the prison infirmary, alone.

If lucky, they may fill one of 17 dedicated palliative beds at California Medical Facility, a prison hospital in Vacaville, one of the only prisons out of the state’s 32 that has hospice services.

They may be brought to a hospital in the outside community, where they are chained to a bed and guarded until they die.

Or they die in their prison cell, with their cellmate sent to grieve afterward in isolation while the circumstances are investigated for any foul play — standard protocol in the case of an inmate death.

In most scenarios, people behind bars die without loved ones and without palliative care. Although reform advocates have pushed for compassionate release for people in prison near the end of their lives, Fish said that isn’t always what those people prefer. Approval for compassionate release takes too long for people on their deathbed. And often, their only home is their cellblock — their only family after decades of incarceration their fellow inmates.

Fish credits two early experiences for starting her on her path toward the Humane Prison Hospice Project.

She was born in Valley Forge outside Philadelphia and at 27 landed a role as an actress playing the younger version of the protagonist in “Getting Out,” a play about a woman returning home from prison.

Years later, she was by her best friend’s bedside when she died from cancer. She witnessed firsthand the healing power of supporting someone when their heart beat for the last time.

“After holding her hand, whenever someone needed a caregiver, I was there,” Fish said.

Prison hospice work was an inevitable destination for her, she said, even if it wasn’t immediate. She had her daughter, relocated to Marin County after meeting a man and then left him. Other love interests brought her to Oregon, Washington, D.C., Kenya, Istanbul and elsewhere. She worked odd day jobs while trying to sustain a career in acting and volunteered with her free time — as a census worker, a cat sitter, a camp counselor, and a volunteer in an orphanage for children with AIDS, because she “wanted to be around dying.”

In 2008, after she had returned to the Bay Area, she became formally trained in volunteer hospice care. It was around this time that Fish met Michael Satris, who founded the Prison Law Office providing legal services to people incarcerated at San Quentin.

“I was so close to thinking about death, so I asked, ‘So how are they dying in San Quentin?’" she recounted.

“Badly,” he answered.

That bothered her profoundly. It still does.

“I can’t stand it. It kills me that they are dying in cells, in cells that are so small we won’t let dogs be kept in them,” she said, her voice choked by tears.

So, armed with her hospice training and a fierce drive to spur change, Fish made it her mission to help bring dignity to death behind bars. She joined forces with the Brother’s Keepers, a crisis and suicide prevention peer support group launched in 2005 by people incarcerated in San Quentin. She also met and teamed up with Ladybird Morgan, a Bay Area registered nurse, clinical social worker and educator. In 2016, the Humane Prison Hospice Project was officially founded.

She had originally hoped to provide the bedside support for dying prisoners. But she soon learned how important it is that the men care for each other. They need to have someone by their side “who gets it,” she said. And, more practically, many of them were already doing end-of-life caregiving, supporting and cleaning and feeding their dying cellmates, without education or direction. With the introduction of the project, Morgan and Fish would travel to San Quentin and provide weekly training in volunteer hospice care.

The program has the potential to be transformative, she said.

“I feel very, very strongly that something so profoundly wrong is happening in our community. That their last breath is affecting all of us. And it is,” Fish said.

Fish said those outside prison might think the impacts of death in custody don’t touch all of us, because we can’t see them or we ignore what happens within prison walls. Just like COVID-19 in prison affects all public health, the toll of inhumane deaths can be felt by people, families and communities on the outside.

“And when you have them cared for, the ripple effect of that goodness comes into our community,” Fish said.

The caregiving is healing for everyone involved, she said: the ailing inmates, the men providing care, the prison staff witnessing it, volunteers coming in, outside communities and families of those caring and dying, and potentially even criminal justice policymakers.

New faces have joined the effort, like Marvin Mutch, one of the founders of Brother’s Keepers who was incarcerated for 41 years before he was released in 2016. They have trained one cohort of men and had begun another when COVID-19 hit.

While training has been suspended for more than a year, Fish is hopeful they will get back into San Quentin soon. Bureaucratic red tape makes it impossible to know when.

Fish now wears many hats in the project, including historian, communications specialist, researcher and coordinator. She “got the party started” and is now the “fire” pushing it forward, she said.

She remains committed to the cause because she feels like she has no other choice.

“That last breath is so important,” she said. “I would drop it like a hot rock if it didn’t bother me so much.”

You can reach Staff Writer Emily Wilder at 707-521-5337 or On Twitter @vv1lder.

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