Wald, Florence (1917—)

American dean of Yale School of Nursing who played a key role in launching the hospice movement in the United States in the early 1970s . Name variations: Florence S. Wald. Born Florence Schorske in New York City on April 19, 1917; daughter of Theodore Alexander Schorske and Gertrude (Goldschimdt) Schorske; graduated from Mt. Holyoke College, 1938; Yale University, M.A. in nursing, 1941; married Henry J. Wald; children: Joel David Wald; Shari Johanna Wald .

Established the first hospice in the United States, the Connecticut Hospice, in Branford (1974); numerous honors include being inducted into the National Women's Hall of Fame (1998).

Modern medical technology prides itself on its many strategies of keeping death at bay, but while the ability to prolong life is often welcome, there are times the situation of the terminally ill patient is stripped of its human dimension to become little more than a series of technical decisions in which the individual and family are excluded from active participation. In recent decades, the profound issues raised by dying and death have been restored to the center of medical care as a result of the hospice movement. The modern movement was founded by Dr. Cicely Saunders , who established St. Christopher's Hospice in London in 1967. In the United States, it was primarily because of the efforts of Florence Wald that the hospice movement became a significant part of the spectrum of health care for the terminally ill.

Born in New York City in 1917, Florence Wald graduated from Mt. Holyoke College in 1938, going on to Yale University, where she was awarded a master's degree in nursing in 1941. For a year after leaving Yale, in 1941–42, she worked as a staff nurse at the Children's Hospital in Boston. She then moved to Manhattan, where she was employed for a year with the Henry Street Visiting Nurse Service. This was followed over the next 15 years by various positions in the New York area, including a period when Wald worked as a research assistant in the cornea research laboratory of the New York City Eye Bank. She also served briefly in the final stages of World War II in the nursing branch of the Women's Army Corps, leaving the service with the rank of second lieutenant.

By 1957, Florence Wald's varied experiences led to her being appointed to the faculty of the Yale University School of Nursing as director of that institution's mental health and psychiatric nursing program. Within a year of starting her work at Yale, Wald was appointed acting dean of the nursing school. The next year, 1959, the appointment became a permanent one, and she would remain dean until 1967.

In 1963, Wald's career and life were transformed when she met a remarkable woman. While touring the United States to inform medical professionals of her successes with the hospice concept, Cicely Saunders stopped for several days at the Yale University Medical Center. Saunders made "an indelible impression" on Wald and most of the other faculty and students with whom she came in contact. Saunders' approach to patients suffering from terminal cancer, which was broadly based on her many years' experiences as a nurse, almoner and physician, emphasized aggressive measures to ease the pain of the illness. Once this was achieved, Saunders argued persuasively, patients and families could get on with the business of attending to precious relationships in the closing chapters of life.

From the outset, Saunders' "vision of patient and family in the foreground and medical treatment in the background and her conviction that listening was an essential act" took hold of Florence Wald. She saw the great value of these ideas for patients with terminal illnesses and their families and determined to transplant them to the United States. But she was also a realist, and because of her experiences as a dean of one of the leading nursing schools in the United States harbored few illusions as to how difficult it would be to change the thinking of a deeply conservative medical profession, as well as to revamp curriculums, develop new services, and change long-accepted practices. In her favor was the zeitgeist of the 1960s, which was a time of profound changes and challenges to old ideas and institutions. Massive protests against the Vietnam war, the search for happiness through radical experimentation in lifestyles, and attacks on orthodoxies of all stripes characterized the entire decade. In the medical profession, intellectual and institutional ferment began seriously to challenge a health-care hierarchy in which male physicians had long reigned as virtual demigods. The women's movement inspired new ideas and attitudes among nurses. All of these changes made it easier for Wald to organize the solid foundations of a coalition that would eventually bring about the successful implementation of the hospice concept in the United States.

By 1966, Wald was able to organize 30 medical professionals at Yale in a workshop with activities that included a visit by Cicely Saunders. Some of the individuals who came from beyond the Yale campus included Elisabeth Kübler-Ross , who was then teaching at the University of Chicago, and Colin Murray Parkes of the University of London. By 1969, Wald had been able to secure Saunders as the mentor of what was now a permanent group determined to create the first hospice in the United States. After a month's internship spent working directly with Saunders at St. Christopher's Hospice in London, Wald returned to Yale to continue her planning activities with her interdisciplinary team, whose core members included Dr. Morris Wessel and Dr. Ira Goldenberg and, as director of religious ministry, Reverend Edward Dobihal. Other key members of Wald's group included nurse Katherine L. Klaus and Catholic priests Don McNeil and Robert Canney, as well as Lutheran pastor Fred Auman.

For several years, from 1969 through 1971, the team led by Wald gathered data and compared ideas in order to have a solid foundation on which to transform their dream of America's first hospice from an abstraction to a reality. As they began to plan a hospice that would serve the greater New Haven area, volunteers clamored to help with the fund raising, publicity, office chores, and, eventually, inpatient care. "The surge and interest were unstoppable," said Wald. Her husband Henry J. Wald, a health-facility planner, also became involved in the project, and in 1974, having been incorporated as an independent, not-for-profit institution, the Connecticut Hospice in Branford began providing home care. In 1980, the Connecticut Hospice added an inpatient facility.

Wald's work as a medical pioneer has earned her many honors, including induction into the National Women's Hall of Fame in 1998. Still active in her 70s and 80s, she spent countless hours as an advocate of the creation of hospice units in America's too-numerous prisons. In a 1999 interview, she argued persuasively for hospice care for the terminally ill, describing it as "the end piece of how to care for patients from birth on. It is a patient-family-based approach to health care that belongs in the community with natural childbirth, school-based health care, mental health care, and adult care." In a remarkable career rich in achievements, Florence Wald played a crucial role in "taking what was essentially a hidden scene, death, an unknown, and making it a reality. We are showing people that there are meaningful ways to cope with this very difficult situation."

sources:

Blau, Eleanor. "Ministry to the Dying, a Heartfelt Turn in Theology," in The New York Times. December 30, 1972, pp. 23, 26.

Brockman, Elin Schoen, and Dianne Hales. "Women Who Make a Difference," in Family Circle. Vol. 103, no. 8. June 5, 1990, pp. 15–17.

Corless, Inge B., and Zelda Foster, eds. The Hospice Heritage: Celebrating our Future. NY: Haworth Press, 1999 (The Hospice Journal, Vol. 14, no. 3–4).

Fellman, Bruce. "Dimensions of Dying," in Yale Alumni Magazine. Vol. 58, no. 1. October 1994, pp. 54–57.

"Florence Wald Inducted into the Connecticut Women's Hall of Fame," in Connecticut Nursing News. Vol. 72, no. 2. June–August 1999, p. 2.

Friedrich, M.J. "Hospice Care in the United States: A Conversation With Florence Wald," in JAMA: The Journal of the American Medical Association. Vol. 281, no. 18. May 12, 1999, pp. 1683–1685.

Siebold, Cathy. The Hospice Movement: Easing Death's Pains. Toronto: Maxwell Macmillan Canada, 1992.

Wald, Florence S. "The Emergence of Hospice Care in the United States," in Howard M. Spiro, et al., eds., Facing Death: Where Culture, Religion, and Medicine Meet. New Haven, CT: Yale University Press, 1996, pp. 81–89.

——. "A Nursing Perspective on Patient Care," in Lillian G. Kutscher, et al., eds., Hospice U.S.A. NY: Columbia University Press, 1983, pp. 139–143.

related media:

Flattery, Kevin. "The Hospice Movement in America" (video), Kansas City, MO: University of Missouri-Kansas City, School of Medicine-Hospice Care of Mid-America, 1984.

John Haag , Associate Professor of History, University of Georgia, Athens, Georgia