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02 November 2006

ONE MUST COMPARE the influence and stature of Cicely Saunders, who died on Thursday of last week, aged 87, to that of Florence Nightingale: two great Anglican women who transformed the care of the sick and dying.

While Florence of the Crimea revolutionised the nursing of the acutely sick in military and civil hospitals, Cicely Saunders brought about an equal revolution in the care of the chronically and terminally ill, and thus created the worldwide hospice movement.

Both women were awkward misfits in their early lives. Both underwent a conversion and became devout Anglicans. Both spent years studying for their chosen profession, and accumulated wide specialist knowledge in their determination to turn natural compassion into highly effective organisations to achieve the relief of suffering.

Born a hundred years apart, the difference was in professional qualifications. Florence Nightingale largely educated herself with her obsessive study of Blue Books and hospital conditions. Cicely Saunders qualified first as a nurse, then as a hospital almoner, and finally, in her late 30s, as a doctor, so that she would have both the knowledge and authority to pursue her research into the relief of pain in the terminally ill, and eventually to found St Christopher’s Hospice, Sydenham, which was to become the model for hundreds of hospices both in the UK and overseas.

She was born in 1918 into an affluent suburban home in north London. Her father, senior partner with the estate agents John D. Wood, was an ebullient man whose temperament was in direct contrast to that of his wife. She was a snob about her social position, but totally unable to cope with husband, family or housekeeping, and would retire to her room for days at a time. Although Cicely found her father stimulating company, and an aunt came to the domestic rescue, Cicely was for the most part unhappy at school and unhappy at home.

With the help of a crammer she got into Oxford, but was relieved when the outbreak of war gave her the excuse to leave and take up nursing, and win a place in the Nightingale Training School attached to St Thomas’s Hospital. The training was rigorous, but suddenly she was in the right place and appreciated, and happy for the first time in her life. But her height gave her a vulnerable back, and the latter part of her training was hampered by continual back ache and sick leave. She qualified triumphantly, only to be told she must never nurse again.

She decided on a career as a hospital almoner, and returned to Oxford to work for a degree and diploma in social sciences,  doing much of her work lying on her back. She completed two years’ work in one year, and qualified with distinction. She then, with relief, turned to the practical part of her training at St Thomas’s, glad to be back working with patients where she felt her real vocation lay.

It was at this time that she had the traumatic task of helping her parents separate for the sanity of both of them, and persuading her mother to leave the family home. She also experienced a dramatic conversion into the Evangelical stream of the Church, and became an enthusiastic member of All Souls’, Langham Place. Just as importantly, she fell in love with a dying man who became instrumental in shaping her future career.

He was a Polish Jew, and the whole of their love affair was conducted in a hospital ward over the few weeks until he died. Their conversations were of love, of God, and increasingly about the care of the dying. David Tasma had cancer, and was often in great pain. But in the hospitals of the 1940s, the dying were regarded as medical failures, and the doctors gave up on them. Pain relief was given only when the pain was already unbearable. There was no understanding of holistic care, physical, mental and spiritual, or that pain relief should be continuous to enable people to live their last days conscious and aware, without fear, and surrounded by love.

Cicely 7428

Receiving a Lambeth Doctorate: with Archbishop Coggan in 1977

Cicely now knew that her vocation was to work with the dying; and David Tasma left her £500 towards the home for the dying he knew she would some day build. Though her day job was still as an almoner, she began to work in the evenings at St Luke’s home for the dying in Bayswater, where she saw a staff caring both for the mental and physical distress of the patients, and the regular use of analgesics to keep pain under control. She knew she must do more. A surgeon friend told her the only way she could have the influence she wanted was to qualify as a doctor. “Go and read medicine,” he said. “It is the doctors who desert the dying.”

At the age of 33, having done no previous science, she crammed her way through an MB at St Thomas’s. She went on through all the stages of medical training to qualify six years later, and won a research scholarship to be the only Fellow researching pain in the terminally ill.

Her research led her to St Joseph’s, the hospice run by Roman Catholic sisters in Hackney. A third of the patients there were dying of cancer. Only three of the nuns were qualified nurses; the rest of the carers were young Irish girls. There was no resident doctor. The care for the patients was loving, but the staff did not have the professional skills to manage acute pain and the distressing symptoms of nausea and breathlessness. So, when Cicely Saunders went to work there three days a week, her skill and tact led to immense improvements in patient comfort. Chief among them was the regular giving of new analgesic drugs, where possible by mouth, which kept pain under control without the patient’s becoming comatose.

All who worked with her remarked on her extraordinary effect on patients, her immediate intimacy, the way she could calm and reassure them. It was true also of the patients’ families, as she came more and more to see that they were partners in the care of the patient, and they also needed care. She was not always quite as tactful with the people she worked with. Demanding of herself, she could also be demanding of her colleagues.

It was during her daily Bible-reading in the summer of 1959 that a verse from Psalm 37, “Commit thy way unto the Lord; trust also in him; and he shall bring it to pass,” convinced her it was time to realise her dream of building her own hospice for the dying. She outlined a plan for a 100-bed home, independent of the National Health Service, and over the next few years, with the help of Bishop Evered Lunt, then of Stepney, gradually convinced a whole series of authorities and influential people of the need for special care for terminal and chronically ill patients.

From the beginning, she knew it must be a religious as much as a medical foundation, not only because she herself was so deeply motivated by her faith, which by this time had broadened into mainstream Anglicanism, but because anyone nursing the dying day after day needed some sort of religious faith and belief in the afterlife to be able to cope. The chapel would be central to the building.

Land was found and bought in Sydenham, and gradually the money was promised and given. In the midst of all this, Cicely fell in love with another dying Pole, an affair as passionate and profound as that with David Tasma, and when he died she was shattered almost to the point of not being able to carry on; but she did. Building St Christopher’s Hospice was as fraught with complications as most such undertakings, but in June 1967 the first patients began to move in.

Two years later, with great difficulty, I persuaded her to let me visit St Christopher’s and interview her. It was a very odd interview because she would not let me identify her (we settled for a coy “Dr C”) or the hospice, despite the fact she still needed to raise £27,000. She said she did not want prospective patients to assume that to be admitted to St Christopher’s meant an automatic death sentence; but I suspect it was also her innate shyness.

I found the place beautiful, basic hospital furnishings augmented by richly coloured curtains, masses of plants and flowers, huge windows. There was a wing of bed-sitting-rooms for the very frail, and small wards for those with painful illnesses. Work was beginning with patients in their own homes, and bereaved families received aftercare as long as they needed it.

The hospice had an average of one death a day, but it felt like a place of life, of warmth and caring, with a genuine family atmosphere. Families could visit at any time, except Mondays, to give them a guilt-free day off, and the staff, in bright uniforms, were clearly committed to their work of loving care. They did not have to be Christians, but they were expected to join in ward prayers, and prayers of committal round the dying.

St Christopher’s rapidly became a centre of teaching and research, convincing all those of the medical profession prepared to listen that patients for whom there was no hope of cure still deserved the very best medical care available. The hospice movement spread with astonishing speed, partly funded by the National Health Service, but still dependent on fund-raising and voluntary work.

Shortly after my visit, Dr Saunders met and fell in love with yet another Pole, a painter, and married him. This did not affect her professional life. Until she was 60 she continued to work on the wards, experimenting with new drugs and techniques, and after she retired she continued teaching her skills, lecturing and broadcasting. Always she argued against euthanasia, insisting that every life could be lived with dignity to the end, and no one need die in pain or distress if properly cared for.

In 1981, she was awarded the Templeton Foundation Prize. Made a DBE in 1980, she was awarded the Order of Merit in 1989; and in 1984 her biography by Shirley du Boulay was published. But her real reward and memorial are the millions of people who have been able to go on living their lives to the very end, and have died in peace.

Dame Cicely’s funeral will be held privately. Details of any memorial service will be announced later.

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