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Recollection: ‘You matter because you are you’

02 November 2006

Dr Robert Twycross spoke at Dame Cicely Saunders’s memorial service in Westminster Abbey on 8 March. He said, in part:

DAME Cicely Saunders [ Obituary, Gazette, 22 July 2005] said: "You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die."

She was a qualified doctor, I a medical student, when I first met her at a Student Christian Movement conference. It was truly a fateful meeting, because it determined the direction of my medical career. I owe her a great debt of gratitude for what she did for me then, for later appointing me as Research Fellow in Therapeutics, and for her continued support ever since.

Cicely said: "I did not found hospice; hospice found me." But the obituaries were unanimous: Cicely Saunders was the founder of the modern hospice movement, of palliative care.

It is said that she was an awkward misfit at school. However, as a student nurse at St Thomas’ Hospital, she was the popular girl, and was very happy. She felt she’d "come home". But, even so, she had to fight a natural shyness, and her student ward reports were not all good.

But that was long ago. More recently, one visitor described her surprise on meeting Cicely: "I expected someone gentle, and was struck by her dynamism and force of character. This was clearly someone who had battled." And on hearing that someone had observed a look of love and steel in her picture in the National Portrait Gallery, Cicely is reputed to have said: "Love and steel: how kind. Anyone doing hospice work will need plenty of both."

Cicely certainly possessed both. How else could she have coped as a student nurse with chronic back pain? Coped with the need to start all over again as a social-work student? Coped with the need to go to medical school, because only as a doctor would she be listened to by doctors?

Then, in the early 1960s, she suffered a series of bruising bereavements. Cicely was definitely "a wounded physician", who was thus enabled to sympathise with and support the patients and families who came under her care.

The opening of St Christopher’s Hospice in 1967 was a major milestone in Cicely’s life. It was almost 20 years after she had first decided to build a special home for people with terminal illness. People like David Tasma, a dying Polish émigré, who in 1948 had left Cicely £500 so that "I can be a window in your Home."

To describe the difference St Christopher’s Hospice has made, and continues to make, to thousands of patients and families, let me quote from a letter written in 1972 by a grateful relative: "St Christopher’s is not just a building, but a way of living — an attitude towards people, their life and their death. . . It did seem very remarkable that the vision of one person, who had responded to a need, could be caught and sustained by so many others, so that the vision became a reality and the reality perpetuates itself creatively."

Cicely was a tireless ambassador for the cause, and others joined her in the task. It was greatly helped in the 1980s when the World Health Organisation introduced its Cancer Control Programme, which emphasised both pain relief and palliative care.

Cicely was an inspiring teacher. Her teaching model of "total pain" took people, almost without effort, from a narrow physical outlook to a holistic approach in which the unit of care is the family. Cicely disparaged "tender loving care"; she championed "efficient loving care", in which attention to detail is the constant watchword.

In the 1960s, Cicely prepared a four-page handout for her lectures. Now, as befits a full-blown medical speciality, the handout has been superseded by the 1244 pages of the multi-author Oxford Textbook of Palliative Medicine, and by numerous other books. But the core message remains the same: "You matter because you are you."

I wonder how many have read Cicely’s autobiography — a slender volume, Watch with Me, containing five reflective articles written and delivered over a span of 40 years. The last, "Consider Him", is dated 2003. In little over ten pages, Cicely recounts the salient points on her pilgrimage through life, and tells again the constant inspiration of her faith. She quotes a favourite theologian: "The crucified Jesus is the only accurate picture of God that the world has ever seen, and the hands that hold us in existence are pierced with unimaginable nails."

Indeed, it is clear from her writings and diaries that her faith was possibly the major force in her life, which sustained her through thick and thin: a major source of her resilience and dedication.

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