A Promise Made of Coffee and Cake, Kept Inside a Prison Where Women Go to Die

Editor’s Note: This story deals with death, dementia, and the end-of-life conditions faced by women in prison.

Two women died. Their deaths bookend a moral universe.

The first death was a breath, released among loved ones.

Tosha’s grandmother was brought home for hospice. For four days she lay in her own bed, the air thick with sage and sweetgrass, the scent rising in a slow spiral meant to carry a soul. The women of the family placed red cloth in her hands. Their voices, low and steady, wove old songs into the quiet. On her bedside table, there was a cup of morning coffee.

“It was the biggest gift I could possibly give to her for everything she had done for me in my life,” Tosha says.

The second death was a scream, trapped in a concrete box.

Ms. Peterson lived with Alzheimer’s and had lost her grip on place and meaning. The prison around her blurred; all she had left was a small cell and rules she couldn’t hold in her mind. When guards came close, she reacted like anyone terrified and disoriented - a jolt, a swing - and those moments were marked as violations. Violations led to isolation. In the final stretch, she was confined to the medical unit. Her screams rolled through the hallway.

“You could feel her terror,” Tosha says. “She didn’t know where she was or what was being done to her.”

In between those two deaths - one held gently, the other swallowed by fear - is the work that now anchors Tosha’s life.

She is waiting for clearance at this very moment. One more training. Final volunteer paperwork. Soon, she will walk back into the Washington Corrections Center for Women. Not as inmate number XXXXX. As the woman bringing Death Cafes into prison.

The Long Walk Out - and the Unlikely Road Back In

Nine years ago, Tosha walked out of that same prison after serving a nine-year sentence. The distance between that woman and the one preparing to walk back in spans an entire geography of becoming: an Associate Degree in Addiction Counseling, a BA in Human Development, a Master’s in Prevention Science, doctoral work underway. She is now an Outreach Coordinator for Washington State University’s College of Medicine, supporting tribal nations. A mother of two children, ages three and seven.

Her path bent unexpectedly during her undergraduate years. A blank slot in her schedule became a course on death and dying. A professor assigned a “lossography,” asking students to map their first loss and their deepest one. The stories were shared anonymously.

“It was so impactful,” she says. “Seeing how people understand grief and loss.”

She didn’t realize it at the time, but that class was the start of something bigger than she would ever imagine. It planted the first seeds of what would eventually grow to shape her work.

Her Indigenous identity still roots her to date. When she walks back through those prison gates, she carries two versions of herself: the woman who lived through incarceration and the researcher who now examines it.

“I bring my wholeness,” she says. “I bring my realness. I am one of them - the only difference is that I made it home.”

A Silent Epidemic Behind Bars

The scale of death in American prisons is a silent epidemic.

According to the UCLA Law Behind Bars Data Project, more than 15,000 people died in US prisons from 2022 to 2024. That works out to over 5,000 deaths a year - nearly twice what the annual totals were twenty years ago.

But numbers flatten what is lived.

“There is not a single institution in the United States that has a living unit for women with chronic illnesses or at end-of-life,” Tosha says.

In some places, advocates are trying to close the gap. The Humane Prison Hospice Project has begun going into several women’s prisons in California to offer hospice and palliative care services. Other facilities contract with outside hospice providers, bringing nurses and counselors into the prison to see women wherever they happen to be housed - general population, medical, or segregation.

But these efforts are scattered, not systemic. They are add-ons, not foundations.

“There are programs coming in,” Tosha says, “but no one has a designated living unit that provides those wraparound supports for women who are dying.”

The consequences are brutally simple. A woman receives a diagnosis at an outside facility. Unless she is actively dying, she returns to general population, a mix of ages and custody levels. Her caregivers become correctional officers with no training in dementia care, pain management, or end of life support.

“Most individuals are not diagnosed until late stages because we do not have preventative healthcare inside prisons,” Tosha explains. “People become confused. They are treated in inhumane ways because staff do not know how to interact with them.”

At the Washington Corrections Center for Women, there is at least an acknowledgment of aging. The prison has created a unit for elders. On paper, it is a step forward. In reality, it can house only about a third of the women who could benefit from it.

The HOPE Team steps into that gap, offering respite support, sitting with elders, helping with basic daily tasks. But even there, the core problem remains: none of the prison staff assigned to the unit has formal training in hospice or palliative care. The correctional officers who control the doors and the daily routines are not trained in those disciplines either.

In Washington State, about 150 women currently need end-of-life care. The system offers five medical beds. Beyond that, support is a patchwork of outside contractors, overworked staff, and incarcerated women caring for one another in spaces never designed for dying.

Many people think of compassionate release as a kind of escape hatch. In practice, it’s anything but. The process is tangled, slow, and built with hurdles: proof of steady family support, evidence of community ties, and a disciplinary record with no recent marks.

Ms. Peterson never stood a chance of meeting those requirements. Her dementia caused her to misinterpret orders and react defensively. Each reaction became an infraction. The illness itself disqualified her from mercy.

“They will not send somebody home if they show any violent tendencies,” Tosha says. “Even if the cause is dementia.”

Even those who qualify often die before paperwork reaches a decision maker.

One friend of Tosha’s finally received a compassionate release. “She was basically released to a hospital because she was that close to end of life,” Tosha recalls. “She died free, but she could have come home a lot sooner.”

Bringing Death to the Forefront in a Place That Avoids It

The prison administration asked if they could rename it. “Death Cafe sounds too ominous,” they said.

Tosha refused. “The point is to bring death to the forefront,” she says. “If we cannot think about our own death, we definitely are not thinking about what death looks like for people who are incarcerated.”

The idea is simple. A space to speak openly about mortality. No agenda. Just conversation. Often with cake.

The Order of the Good Death funded her project. She will bring coffee, pastries, and conversation cards, adapted for the reality inside.

• If you were to die while in prison, what would you want to happen to your body?

• If your cellmates could decorate your room for a memorial, what would you want ii tot look like?

• What would you want for your last meal?

“Death anxiety is high inside,” Tosha says. “Especially for people with long sentences. They know there is a real possibility they will die in prison.”

The work goes beyond conversation. It touches the most fundamental question of autonomy: who gets to make decisions about your body when you cannot speak?

“When you go inside, your advanced directive no longer holds up,” she explains. “You no longer have bodily autonomy.”

She tells the story of a woman taken to an outside hospital. The provider asked if she wanted to be resuscitated. She said no. A guard intervened.

“Actually, no,” he told the provider. “You will resuscitate her.”

For Tosha, this is one of the deepest violations.

“The only thing worse than dying in isolation like Ms. Peterson is being kept alive in a coma for years in a prison. Your body - wasting away while you are kept artificially alive against your will.”

Advanced care planning is a way to reclaim a sliver of personhood inside a system built to erase it.

When Suffering Is Met With Silence

There is another story from Tosha’s time inside. A woman in minimum security began begging for help, convinced something was terribly wrong in her body. She pleaded with the correctional officer, who had no medical training, to declare a medical emergency.

She denied her. Twice.

She died in her bunk, surrounded by forty-five women who watched, helpless.

“She was basically told that her life was not worth it,” Tosha says. “And we witnessed that. And by extension, we were told our lives were not worth it either.”

When women expressed grief or outrage, they were ordered to stop talking. They were sent back to their rooms. No grief counseling. No rituals. No gathering. Nothing.

The rules are explicit. No hugging for comfort. No shared meals to honour someone’s life. Holding someone as they cry can earn an infraction. An unauthorized memorial is labeled “inciting a riot.”

Ask where the system pushes back hardest and Tosha gives one word: security.

A healthcare provider requests a thicker mattress for a woman with brittle bones. Security risk.
A nurse shows compassion to a dying patient. Boundary violation. Security risk.

“We have to revisit what security means,” Tosha says. “If people are not being harmed, is security really at risk?”

Where Indigenous Knowledge and Western Science Meet

In Tosha’s workspace, peer reviewed journals sit beside sage bundles. A master’s certificate hangs near a woven medicine wheel. Her work lives at an intersection academia rarely permits: Indigenous Ways of Knowing meeting Western Prevention Science.

“People want to separate those things,” she says. “Spirituality in one box. Data in another. But for my ancestors, they were never separate.”

She shows a memory bundle: a small cloth pouch containing a photograph, a letter, a stone, and a braid of sweetgrass. In academic language, it is an intervention that strengthens social connection and reduces anticipatory grief. In her culture, it is a way to keep ancestors close.

“Both things are true,” she says.

The prison system often creates grief and then denies the right to express it. A woman’s mother dies but she cannot attend the funeral. Her child is placed in foster care but she cannot call. These are disenfranchised losses.

When Tosha’s father died, she honoured him fully. Wild rose water was prepared. His pictures were covered with red cloth for a year. A medicine man played the flute. His body was wrapped in a tribal star quilt.

“He was not a spiritual man,” she says. “But honouring him allowed his spirit to heal, and it allowed me to grieve.”

This is the same principle she brings to her work with incarcerated women: grief is real, and honouring it is a form of care.

A Quiet Rebellion Led by Women Inside

The most subversive act inside the prison began not with Tosha, but with the women themselves.

The HOPE Team, co-founded by a formerly incarcerated woman L. Elizabeth Shatswell, trains younger inmates to care for aging and dying elders. They offer what the system does not: presence, consistency, tenderness.

“We are a collective society inside,” Tosha explains. “We form pseudo families. Bonds based on care, not just biology.”

Her doctoral work supports the program with evidence. She conducts talking circles, gathering testimony from dying women, caregivers, and staff.

Dying women receive dignity. Younger women gain purpose and skills they can carry home.

“Many women inside have lost connection with their mothers or grandmothers,” she says. “Caregiving is inherent in us.”

The vision extends further. An elder unit connected to the baby unit, where incarcerated mothers live with their young children. Research shows benefits for all three generations. Even at the end-of-life, people feel valued.

“People at end-of-life often feel like they have no purpose,” Tosha says. “We want them to know they are valued. Their life has value. Their death has value.”

A Global Reckoning Begins to Stir

Last month, Tosha carried the stories of her grandmother and Ms. Peterson to Istanbul, where she co-presented at the International Corrections and Prisons Association Conference 2025 with L. Elizabeth Shatswell and KeWee Roselle .

What she encountered in Istanbul echoed a much bigger problem. The world is aging faster than its systems can adjust. For the first time, people over 60 are on track to outnumber children. In the US, that shift is already showing up behind bars - within a few years, roughly a third of the prison population will be older adults.

Yet of the roughly 1,600 prisons in the United States of America, Tosha estimates that perhaps ten have specialized programs for dementia, hospice, or palliative care.

“Maybe ten facilities,” she says. “In the entire country.”

Organizations like the Humane Prison Hospice Project are trying to fill the gap, but the need dwarfs the effort.

The global audience asked questions that cut to the heart of American punishment. Why withhold comfort from the dying. What purpose does suffering serve?

Awareness is rising. The ICPA’s next journal issue will focus entirely on dying behind bars.

“But awareness is not care,” Tosha says. “And care is urgently needed.”

A Vision of Dignity, Tenderness and the Bare Minimum

“Close your eyes,” Tosha says.

Think of a woman in her seventies. She’s tired, her health slipping, but - she isn’t behind bars. She’s in a room with a window that lets the outside in - it hugs her. Her daughter is there, hand in hers. A spiritual leader comes to see her. Music she loves plays low in the background.

“The most important part,” Tosha says, “is that she knows her life mattered. And her death matters too.”

That longing for acknowledgment is what led Tosha and KeWee Roselle to hold the Sacred Echoes Mass Memorial in July 2025. The gathering honoured 142 women who died in the Washington women’s prison or shortly after release, and two whose whereabouts remain unknown. The lodge where it was held sat beneath tall evergreens. The Black Rose Collective donated long-stem roses, each tagged with a woman’s name, lining the pathway like a living corridor of witness. A hand-painted sign read: Let their light guide us all. For many who attended, it was the first time these women’s names had been spoken aloud together - the first time their deaths received a ceremony, a community or even the smallest gesture of public remembrance.

This vision seems simple. In American prisons, it is radical.

“I am not asking for luxury,” she says. “I am asking for the bare minimum of decency. That someone dying be treated with tenderness.”

Tosha is an abolitionist. She believes mass incarceration must end. But she is also a harm reductionist who understands the urgency of the present moment.

“People are dying every day inside these institutions,” she says. “We cannot wait for the entire system to be rebuilt. We have to make what is inhumane more humane.”

Her plan begins in Washington State, then expands. A pilot program. A model. Free curricula and toolkits any facility can adopt.

“We want people inside to know we have not forgotten them,” she says. “That they are loved. That they deserve this.”

Together with Elizabeth Shatswell and KeWee Roselle, she is co-founding the Kindred Light Initiative, a nonprofit dedicated to supporting dignified end of life care in prisons.

The Promise She’s Still Keeping

Tosha protects herself through connection. Smudging ceremonies. Meditation. Time with her children, who are the why behind all of this.

“When you advocate for the most marginalized, you advocate for everyone,” she says. “I am doing this for my children, and for their generation.”

There are days she is told to rest. Days she must say no to requests. But she is not alone. There is Elizabeth. KeWee. A network of formerly incarcerated advocates. Researchers. Chaplains. People who read these stories and carry the work forward.

“When we share this, it lightens the load,” she says. “We are not in it alone.”

She is still waiting for the final clearance. When it arrives, she will gather what she needs: Death Cafe cards, coffee, pastries, memory bundles, sage.

The gates will open. She will walk back in.

She will keep her promise to the women who never made it home. Women like Ms. Peterson, whose screams still echo in her memory. Women who deserved to die with dignity rather than fear.

In a system designed to deny humanity, Tosha is bringing it back. One conversation at a time. One memory bundle at a time. One moment of witnessed grief at a time.

“I am keeping my promise,” she says.

And she will.