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Cicely Saunders: A life and legacy, by David Clark

30 November 2018

Nick Goulding learns more about a complex and influential life

THIS year has marked the centenary of several landmark events: among them, the Armistice on 11 November, and, on 6 February the Representation of the People Act that gave women the vote for the first time. Less well known is that Dame Cicely Saunders, a founder of the modern hospice movement and a pioneer in palliative-care medicine, was born on 22 June 1918.

In view of her huge impact on modern medicine, it is disappointing that I could not find her name on a single list of top 100 British women which was published to celebrate women’s suffrage.

David Clark’s book is a timely correction for such oversight. His comprehensive work is a significant addition to a sparse biographic literature on Dame Cicely. The only other significant biography was that of Shirley du Boulay, first published in 1984 and last updated in 2007.

Professor Clark is an internationally recognised figure in the area of end-of-life care, and this latest contribution reflects 20 years of researching his subject’s life and curating her papers. He interviewed Dame Cicely on many occasions between 1994 and her death in 2005. Their rapport is obvious from the nature of the anecdotes and quotes which populate the volume.

Readers are immediately struck by the painstaking and thorough research that has gone into this book. It is a meticulous work of academic distinction. For example, scholars of palliative-care medicine will appreciate the description and analysis of Dame Cicely’s concept of “total pain”, and her transformative holistic approach to pain management. There is a wealth of information on her influence internationally in the development of protocols for pain management in terminal cancer. Her legacy in that area of medicine remains to this day.

Her vision was more than merely easing pain in the end stages of life, and Clark emphasises her quest to integrate the medical, psychosocial, and spiritual dimensions of palliative care. His research is backed up by footnotes, helpfully organised at the end of each chapter. To have put all 1013 references at the end of the book would have been overwhelming.

The latter part of the book focuses on St Christopher’s Hospice, in Sydenham, London. This was Dame Cicely’s baby. It is her lasting memorial. Clark records its development in fine detail from conception through establishment to maturation. He gives equal weight to the highs and lows, the successes and failures.

The author cleverly weaves the hospice narrative together with the personal portrayal of a complex, enigmatic individual who had an overarching passion for care of patients, families, and staff. Dame Cicely had a tireless and unquenchable compassion for the dying; an idiosyncratic style of managing people; and occasionally unorthodox relationships with patients.

In the final chapter, Professor Clark really begins to get under the skin of his subject. The high detail of previous chapters gives way to a more absorbing style. This more personal and emotive conclusion gives a tantalising glimpse into Dame Cicely’s soul. There is definitely more to emerge from the life of this intriguing woman.

The Revd Professor Nick Goulding is Professor of Pharmacology and Medical Education at Barts and the London School of Medicine and Dentistry.

Cicely Saunders: A life and legacy
David Clark
OUP £28.99
Church Times Bookshop £26.10

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