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
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.
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
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
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.