Cicely Saunders

British health worker Cicely Saunders (born 1918) began her medical career as a nurse then turned to social work and finally, at the age of 39, earned a medical degree. Her work with terminally ill patients led her to found St. Christopher's Hospice in North London, England, in the 1960s. St. Christopher's is largely regarded as the model for the modern hospice movement, which emphasizes a holistic approach to caring for the dying. In early 2005 Saunders continued to work with St. Christopher's as well as lecture and publish on issues related to the care of the terminally ill. Her tireless work was recognized in 2001 with the Conrad N. Hilton Humanitarian Prize, which carried with it a one million dollar gift to St. Christopher's.

Early Life

Saunders was born in London on June 22, 1918, the first of three children born into the wealthy family of Gordon Saunders, who worked in real estate, and his wife Chrissie. She first attended day school and then, at the age of ten, her parents sent her to Southlands, a boarding school in Seaford where her aunt served as matron. At the age of 14, her parents sent her to Roedean, a fashionable boarding school near Brighton. Having found it difficult to make friends her entire life due to painful shyness, Saunders found the transition especially difficult. "I didn't like Roedean and, in a sense, I was an outsider there, which was good for me in that being unpopular when you are young gives you a feeling for others who feel they don't quite belong," Saunders told Cherie Booth in an interview published in the London Daily Telegraph in 2002. Saunders' discomfort was heightened by increasing troubles in her parents' long–stormy marriage. Gordon and Chrissie eventually separated in the late 1940s.

Saunders had hoped to attend Oxford University upon graduating from Roedean, but she failed her entrance exam. Also turned down by Lady Margaret Hall and Somerville and waitlisted at Newnham College, Cambridge, she attended tutoring courses in London and was eventually accepted at St. Anne's College, Oxford. She initially set out to study politics, philosophy, and economics, but changed her path after the onset of World War II. Uneasy remaining in school while war raged around her, Saunders left St. Anne's to train as a Red Cross war nurse at the Nightingale Training School.

Continued in Medical Field

Saunders served her probationary rotations at several London mental hospitals and then worked on the medical, surgical, children's, and gynecological wards at Park Prewett hospital. She also assisted in the hospital's theater and kitchen. She recalled the work as stressful in Shirley de Boulay's 1984 biography, Cicely Saunders: Founder of the Modern Hospice Movement. "I didn't know anything about children and I was in charge and I had somebody who knew even less than I did as my number two and night sister wasn't pediatric trained and two or three babies died and it was really wearing," Saunders once remarked. Saunders remained committed to her work, however, but soon had to leave the field due to back problems, which had plagued her for much of her life.

Saunders then returned to St. Anne's, where she studied to be an almoner, which is similar to a medical social worker. She trained at the Royal Cancer Hospital and in September 1947 she joined the staff of St. Thomas's Hospital's Northcote Trust, which specialized in cancer patients, as an assistant almoner. Soon after arriving at St. Thomas's, Saunders met David Tasma, a cancer patient from Poland with whom she fell in love. Saunders and Tasma's entire relationship was conducted in the confines of the hospital, with Saunders caring for him as he approached his inevitable death. Her experiences with Tasma and several other patients with whom she developed close friendships convinced Saunders of the need for better–rounded care for the terminally ill. Care for the dying should address not only the medical concerns of patients, but also their emotional and spiritual needs, Saunders believed. Tasma left her 500 pounds to create a place dedicated to her concept, and Saunders began exploring new concepts of holistic care for the terminally ill. "David's influence on my life was enormous," Saunders told Cherie Booth in the Daily Telegraph. "He was very poetic and when he died he left me pounds 500 and said: 'I will be a window into your home,' meaning the hospice. It took me 19 years to build a home around the window, but the core principles of our approach were borne out of my conversations with him as he was dying."

Became Doctor, Founded Hospice

While Saunders resolved to continue her work with the dying, her concept of hospice care developed slowly. She first attended St. Thomas's medical school, qualifying as a doctor in 1957. She then entered the pharmacology department at St. Mary's Paddington as a research fellow, where she pursued her interests in alleviating the pain of the terminally ill. During this time she promoted the practice of the regular administration of drugs to those in constant pain, as opposed to the provision of medication primarily when requested by patients, which was standard practice at the time. Saunders developed the theory that addiction to such strong medications as morphine stemmed not from their regular administration but from patients' constant need to ask for them, which reminded them of their dependence. Regular administration of such medications enabled the patient to receive lower doses as well, allowing them to remain alert and again, minimizing the risk of dependency. This approach to pain management became a fundamental basis of hospice care.

In 1959, Saunders began writing documents outlining her concepts for the modern hospice. In a paper titled "The Need," Saunders contrasted standard medical approaches to the terminally ill with her vision, as quoted by de Bourlay: "Some are admitted to their treatment hospitals as emergencies. Many find this a great solace, but a busy general ward is rarely the right place for them. Others die in Nursing Homes, and while it is impossible to make generalizations, it is safe to say that many do not have anything approaching the care they need. Often their suffering is intensified by isolation and loneliness. There are a number of institutions founded to care for these patients exclusively, and they offer two things above all—love and care, stemming in most cases from the strong sense of vocation of the staff."

A second paper, "The Scheme," outlines a plan for a 100–bed home for cancer patients and those suffering from other terminal illnesses. A devout Christian, Saunders incorporated opportunities for spiritual reflection into her plan, including a chapel, staff theologians, and prayer time. Yet she remained adamant that religion not be forced on anyone. "Considering how little used many patients are to paying attention to religion, it is necessary that they should be approached with tact and gentleness and that they should suffer from no surfeit of food to which they are unaccustomed." In addition to emphasizing the importance of pain control, "The Scheme" also highlighted such concepts as light–filled rooms, ease of transporting patients from room to room, dayrooms with comfortable chairs and fires, and an overall home–like atmosphere. Saunders underscored that the environment would be intended to comfort not only the patients but their visiting families, as well.

St. Christopher's Opens

Once her plan had been outlined, Saunders began raising funds for its physical manifestation, St. Christopher's Hospice. By this time, she was working at St. Joseph's Hospital, and there she fell in love with another Polish patient, Antoni Michniewicz. Again, the relationship occurred entirely within the hospital, and Michniewicz's death gave Saunders a greater sense of empathy with the families who would be served by St. Christopher's. "I missed him quite dreadfully afterwards, but it gave me a terrific head of steam to do the work, as I understood very deeply what it was like to be losing someone," Saunders told Booth. "I felt I had a right to say to families that I understood how they were feeling." After Michniewicz's death, Saunders met yet another Pole, Marian Bohusz–Szyszko, after purchasing one of his paintings for the chapel at St. Christopher's. The two became life–long companions, living together for 17 years before marrying in 1980. Bohusz–Szyszko died in 1995 at St. Christopher's after a decade–long illness through which Saunders nursed him.

St. Christopher's opened in 1967, a place that served, in her words as quoted by de Boulay, as "a hospital and a home." Today, the facility, and Saunders' underlying concepts, are regarded as the models for the modern hospice movement, which has gained favor worldwide. In 2001, Saunders and St. Christopher's were awarded the Conrad N. Hilton Humanitarian Prize, which carried with it a one million dollar gift to St. Christopher's. "This award recognizes how science and humanity need to go together and that is what hospices are about," Saunders remarked upon receiving the award, as quoted in London's Times newspaper in August 2001. In early 2005 Saunders continued to run St. Christopher's and also continued to advocate for increased funding for hospices and hospitals. Saunders noted to Booth that she had no idea how far–reaching her work would become. "I didn't set out to change the world; I set out to do something about pain," she said. "It wasn't long before I realized that pain wasn't only physical, but it was psychological and spiritual. . . . Hospice has spread because it taps into family values and offers a simple, basic way of dealing with pain and other symptoms."

Books

De Boulay, Shirley, Cicely Saunders: Founder of the Modern Hospice Movement, Hodder and Stoughton, 1984.

Periodicals

Daily Mail (London), February 26, 2000.

Daily Telegraph (London), September 5, 2002.

Times (London), August 16, 2001.