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Dame Cecily Saunders

The the mother of modern hospice care passes on.

12:00 AM, Jul 19, 2005 • By WESLEY J. SMITH
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RALPH NADER once mused to me about what a terrible thing it was that Jack Kevorkian was (at the time) the world's most famous doctor. He was right. That distinct honor should have belonged to Dame Cecily Saunders, the founder of the modern hospice movement who died last week at age 87 in London at St Christopher's, the hospice she founded in 1967.

Dame Cicely, as she was known affectionately in England, was a nurse and devout Anglican who was working as a medical social worker in a London hospital in the years immediately following World War II. She met a Jewish immigrant, named David Tasma, who had escaped the Warsaw ghetto, only to lie dying in a London hospital at the age of 40. Tasma was alone in the world and Saunders made a special point to visit with him every day. Their friendship changed our world.

As Saunders and Tasma spoke of his impending death, she began to comprehend "what he needed--and what all of the other dying patients and their families needed." Saunders had an epiphany. She told me, "I realized that we needed not only better pain control but better overall care. People needed the space to be themselves. I coined the term 'total pain,' from my understanding that dying people have physical, spiritual, psychological, and social pain that must be treated. I have been working on that ever since."

Saunders work was a "personal calling, underpinned by a powerful religious commitment," wrote David Clark, an English medical school professor of palliative care and Saunders's biographer, to whom she has entrusted the organization of her archives. So strong was Saunders's faith in what she perceived as her divine calling, she began volunteering as a nurse at homes for the dying after work. Urged on by her deep desire to help dying people, she went to medical school at the age of 33, this at a time when there were few women doctors.

Saunders focused her medical practice on helping dying people and alleviating pain. She obtained a fellowship in palliative research and began work in a hospice run by nuns, where pain control was unevenly applied, a nearly universal problem at the time, causing much unnecessary misery. Saunders conceived of putting patients on a regular pain control schedule, which, in her words, "was like waving a wand over the situation."

Believing firmly that "the St. Christopher's project [was] divinely guided and inspired," she became an activist, energetically raising money for the new project, and in the process, raising the consciousness of the medical establishment. Saunders' initial idea was for St. Christopher's hospice to be a "sequestered religious community solely concerned with caring for the dying." But the idea soon expanded from a strictly religious vision into a broader secular application, in Clark's words, a "full-blown medical project acting in the world."

SAUNDERS SUCCEEDED beyond even her own wildest hopes. St. Christopher's opened in a London suburb in 1967 and jump-started the modern hospice movement. "We started in-home care in 1969," Saunders said, "the majority of our work is out in the community." Saunders soon exported hospice to North America. In 1971, she sent one of her team doctors to New Haven, Connecticut, to help found the first modern hospice in the United States, from whence it spread nationwide.

AS I PONDER Dame Cicely's life, I reflect upon the death of my father in 1984. Dad fought the good fight against colon cancer for about two years until the day he was sitting on a hospital bed contemplating a bile drainage bag doctors inserted to prevent jaundice caused by tumor blocking his bile duct. Dad looked at the bag taped to his inner thigh. He sighed deeply and his shoulders sagged and he looked up at me with an expression I had never seen before. That was it, I knew. Dad had made a momentous decision: his fight to stay alive was over.

As a society, we too often make dying a shameful thing, something unnatural to be hidden away in a dark corner. Mom and I were determined that wouldn't happen to Dad, that just because he was dying that did not mean his life was over. We shifted emphasis from cure and life prolongation, to comfort, dignity, and peace. That meant hospice, which then was still a relatively novel concept.