Tributes to Dame Cicely Saunders
She was an inspiration to thousands, indeed to hundreds of nurses, doctors, and other health professionals in Britain and elsewhere
A tribute to Dame Cicely – Dr Robert Twycross
Cicely Mary Strode Saunders 1918-2005
‘I did not found hospice; hospice found me.’
I first met Cicely in 1963 in Bristol at a Student Christian Movement Conference. I was still a medical student; she was a qualified doctor in her mid 40s. It was truly a ‘fate-full’ meeting because it determined the direction of my future professional life. Things would have been very different for me if I’d never met Cicely. I therefore owe her a great debt of gratitude for what she did for me in 1963, and ever since. A small part of repaying her is the opportunity to honour her in your presence here today.
But no matter what she said, the obituaries were unanimous: Cicely Saunders was the Founder of the modern hospice (or palliative care) movement:
‘She transformed the way we look at death and dying.’
‘She transformed the care and treatment of the terminally ill.’
By her attitude, she conveyed a message to those she cared for:
‘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.’
Cicely the person
So what was Cicely like as a person? One obituary stated that she was an awkward misfit in her early life – meaning, I think, during her senior school years. However, by the time she started training at St Thomas’ Hospital, she was perceived very differently by her fellow student nurses. Her biographer writes:
‘Cicely was happy – marvellously happy. For the first time she was the popular girl, the one whose opinion was sought, who had friends, who was successful. She slotted into nursing… like a book finding its right place on the shelf. Over 40 years later she still glows with warmth as she remembers the feeling that she had ‘come home’… but, even so, her training was not all plain sailing. She had to fight a natural shyness and her ward reports are conflicting.’
Much more recently, one visiting professional described her surprise when she first met Cicely:
‘I had somehow expected someone gentle, and was struck by her dynamism and force of character. This was clearly someone who had battled.’
And when someone observed a look of love and steel in Cicely’s picture in the National Portrait Gallery, Cicely herself is reputed to have said:
‘Love and steel, how kind. Anyone doing hospice work will need plenty of both.’
And certainly Cicely possessed both love and steel – compassion and determination.
How else could she have struggled to reverse her initial rejection by Oxford University? Coped as a student nurse with the limitations imposed by chronic back pain? Coped with the need to start all over again as a Social Work student? How else could she have 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, Cicely suffered a series of bruising bereavements. First Antoni Michniewicz – the second Polish émigré in her life, then Mrs G – a very special patient with whom she had a mutually supportive friendship over many years – and then her father. Cicely was very much ‘a wounded physician’, and was thus enabled more readily to empathise with and support the patients and families who came under her care.
St Christopher’s Hospice
The opening of St Christopher’s Hospice in 1967 was a major milestone in Cicely’s life, and was achieved with the help of a growing band of influential supporters, many of whom subsequently became members of the Hospice Council or the more informal Foundation group.
It was almost 20 years after her initial decision 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 by a grateful relative in 1972:
Dear Dr Saunders
I would like to write to you and attempt to express something of the gratitude and admiration that I feel for St. Christopher’s. In saying this I realise that St Christopher’s is not just a building, but a way of living – an attitude towards people, their life and their death – that is so remarkable. During those weeks which I spent with my father, and with you, 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… The men and women at the Reception desk all greet you as if you belong and are welcome, the cleaners smile and look as if they enjoy playing their part in the scheme… The Nursing staff have all the qualities that nurses are supposed to have and something extra as well. I don’t quite know what it is – perhaps it’s a dimension of personality which is free to flow out when a nurse is trusted to motivate from within and is not oppressed by bossy hierarchies.
So how did this affect my father who was brought into the Hospice too ill and too weak to be much aware of his surroundings?… He benefited because St Christopher’s is a happy place in spite of its sadness (perhaps joy is a more appropriate word because you can’t experience joy without sadness). So those daily visits was marked by a feeling of serenity and calm as well as with humour and laughter, for which one is so grateful… And I think I came to know my father better during those visits, as a man and not just my father!
I have written more than I intended, but please accept it all as an attempt to say ‘thank you’ for so much that has been good.’
Cicely the professional
Cicely realised that it was necessary to combine patient care with teaching, advocacy, administration and research. And so she was soon appointing additional staff to share the load:
- patient care: Mary Baines, and later Tom West
- home care: Barbara McNulty
- staff support and bereavement support: Colin Murray Parkes
- advocacy in high places: Albertine Winner, and later Gill Ford
- research: Ron Weldon, and later me.
Although Cicely was a tireless ambassador for the cause, others joined her in the task: ·
Eric Wilkes, Ronnie Fisher, the National Society for Cancer Relief (now Macmillan Cancer Relief), Thelma Bates, Derek Doyle, Prue Clench
International: Florence Wald, and later Balfour Mount, followed by many others.
The cause was greatly helped in the 1980s when the World Health Organisation adopted its Comprehensive Cancer Control Programme, which emphasised the need for both pain relief and palliative care.
Cicely was a gifted and inspirational teacher. She captured her audience’s imagination and intellect with stories of actual patients, illustrated by slides. Her teaching model of ‘total pain’ took people, almost without effort, from a narrow physical outlook to a holistic approach, in which concern for the physical aspects of suffering was supplemented by and integrated with concern for psychological, social and spiritual aspects. The unit of care became the family.
But this was clearly anchored in a scientific approach to the use of analgesics, other symptom relief drugs, and non-drug measures. In an article in the British Medical Journal 10 years ago, entitled A personal therapeutic journey, Cicely mentioned a handout she prepared to accompany her lectures: Drugs most commonly used at St Joseph’s and St Christopher’s Hospice. It was 4 pages and covered 2 sides of folded foolscap. It was later updated and expanded by Mary Baines, and remained a key handout for many years.
Now, the handout has been superseded by the 1244 pages of the Oxford Textbook of Palliative Medicine, and numerous other books – such as befits a full-blown medical specialty. But whether just 4 pages or 1244, the need for a thorough holistic evaluation of the patient remains essential. Cicely disparaged ‘tender loving care’; she championed ‘efficient loving care’ in which attention to detail is the constant watchword.
Many of us have read Shirley du Boulay’s biography of Cicely. I wonder how many have read Cicely’s autobiography?
It is a slender volume entitled Watch with me, and contains 5 reflective articles written and delivered over a span of 40 years. The last talk, Consider Him, is dated 2003. In little over 10 pages, Cicely recounts the salient points on her pilgrimage through life, and tells again the constant inspiration of her faith. She quotes from a book by one of her favourite theologians:
‘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’.
She believed that, and I believe that. And, although she never paraded her Christian beliefs ‘on her sleeve’, she truly followed the Way of Jesus. Indeed, it is clear from her writings, and from her diaries, that her faith was a major, possibly the major, force in her life which sustained her through thick and thin. To ignore this would be to ignore a major source of her resilience and dedication. Cicely’s personal watchword must surely have been: ‘I am loved, therefore I am.’
Charisma versus routinization
It has been said that history alternates between charisma and routinization. In this context, charisma refers to the ability of exceptional individuals to act as a catalyst for social change, and acknowledges the impact of personality in bringing about radical innovation in institutions and established beliefs. In relation to the evolution of hospice and palliative care, Cicely Saunders was without question the initial charismatic influence.
The question for us today is: Is palliative care in danger of moving from the creative and disruptive influence of charisma to the cosy ambience of routinization? I hope not.
Palliative care services, even in Britain, generally have not yet reached their full holistic potential. But movements tend to become monuments. So the best tribute we can give to Cicely is to make sure that hospice, that palliative care, remains a movement with momentum, and maintains an ongoing creative tension between charisma and routinization.
So, in summary:
Cicely was a friend, colleague, mentor, teacher or carer to hundreds, indeed to thousands.
She was an inspiration to thousands, indeed to hundreds of thousands of nurses, doctors, and other health professionals in Britain and elsewhere.
Cicely didn’t just talk the talk,
She walked the walk.
She stayed the course, and in doing so she changed the world,
And is changing it still.
Although physically she has left us, her vision lives on.
To honour Cicely, we too must not just talk the talk,
But, like her, we must walk the walk,
And stay the course, and continue the task of changing the world.
Fear of death is instinctive,
So the task is unending.
For each new generation, the same battles to fight and to win.
So may it please God to allow Cicely’s mantle to fall on us collectively as we honour her as the founder of the modern hospice, as the founder of palliative care – and also as the one who was found by hospice.
A tribute to Dame Cicely – Dr Sam Klagsbrun MD
Individuals do matter! The bible is filled with examples of the power of individual people. Look at the impact Moses, Jeremiah, Job and Jesus had on the world they lived in and on untold generations thereafter. Where does such power come from?
There are two sources. The first is the power of personal example and the second is the power of teachings. Moses was both a leader by virtue of setting a personal example as well as by being a teacher. So was Jesus. I do not exaggerate when I say that it is precisely in that mode that I think of Dame Cicely – both as an outstanding leader and as a superb teacher!
Our biblical ancestors did not start out planning to become leaders at the beginning of their journey. Moses certainly was not looking for that job – indeed, he argued vehemently against taking it on. Over time, he became a leader. Leaders become leaders because of the gradual accumulation of experiences in the positions they are in, which in turn begin to shape the impact of their leadership. The growing image of the leader captures the attention of an every-increasing audience, which gives leadership its power.
Thirty-five years ago when I first met Dame Cicely, she was already at that time making quite a mark. I was in awe of what she had created – not only at St Christopher’s, but indeed of her influence, which was spreading throughout the world. What I saw in action on my first of 35 annual consultation visits was enormously powerful, precisely because of its utter simplicity! On my first day at St Christopher’s, years ago, I followed Dr Saunders on Rounds, going to the bedside, watching her pull up a chair and sit so that she would be at eye level with the patient, rather than standing and looking down at the patient. I watched her smiling, reaching for the patient’s hand, inquiring about the patient’s feelings and symptoms, asking about family visits… taking time and sometimes simply sitting quietly at the bedside without even saying anything. I had literally never seen anyone in all my years of practice behave quite this way and take so much time with each and every patient. Here was a great teacher, teaching by personal example.
The lasting power of Dame Cicely’s teachings had a lot to do with the uniqueness of her lectures. Dame Cicely’s always let the patients do the teaching. Every lecture was based on slide presentations filled with the faces of the patients, each telling their own stories. Dr Cicely Saunders taught that it’s the individual person that counts. It’s the paying of attention to the individual’s needs, symptoms, fears and pain, which matters. Teaching abstract theories and principles never have the power of the impact compared to that of the personal story. It’s the translation of a particular person’s needs into a broad system which explains the enormous power of Dame Cicely’s impact on the world of medicine. I remember many years ago, inspired by my St Christopher’s experience, launching a floating hospice team at St Luke’s hospital in New York City, together with Rev Carlton Sweetser of blessed memory, a chaplain who had spent much time at St Christopher’s. We went to the bedside of dying patients – wherever they were in the hospital. One day finishing rounds at the bedside of a particular patient who was in a semi-private room, as we were leaving, his room-mate in the neighbouring bed yanked open the dividing curtain and yelled out at us, “Damm-it do you have to die around here to get this kind of attention?”.
Cicely Saunders has left her mark in the medical world way beyond the world of hospice care. Because of St Christopher’s and Dame Cicely, the field of palliative care has been born. We live today in an era of enormous technological and scientific advances. However, all to often, it’s the entire patient who’s forgotten behind the newest symptoms, which are the centre of attention, rather than the patient.
It is most fitting to offer in our memorial for Dr Cicely Saunders her own words;
“I have tried to sum up the demands of this work… in the words ‘Watch with me.’ Our most important foundation for St Christopher’s is the hope that in watching, we should learn not only how to free patients from pain and distress, how to understand them and never let them down… but also how to be silent, how to listen and how to just be there.”
Dame Cicely – who we remember today – has taught us and shown us how to put the whole patient, the entire person back on centre stage – to the enormous benefit of all patients, families, and the entire field of medicine. We are deeply grateful and thankful! May her memory be for a blessing.
The Road to Gethsemane – a reading from the Service
from The Stature of Waiting, 1982
William Hubert Vanstone (1923-1999)
When a Christian believer is going through any distressing or disquieting experience, it can be a source of comfort and encouragement to him to remember that the Lord Jesus ‘knows all about it’ – that He Himself went through the very same experience. So it may be that the thought of the handing over of Jesus – of His transition from action to passion can be of practical help to people who must face, or have already faced, a similar transition in their own lives. We have already stressed that the word ‘passion’ does not mean, exclusively or even primarily, ‘pain’ : it means dependence, exposure, waiting, being no longer in control of one’s own situation, being the object of what is done. So the passion of Jesus ‘connects’ not simply or even primarily with the human experience of pain : it connects with every experience of passing, suddenly or gradually into a more dependent phase or area of life-with going into hospital, with retiring or losing one’s job or having to wait upon the actions of other people and other factors beyond one’s control. If the thought of the passion of Jesus is helpful at all, then it may be helpful not only to the person who is bearing the ‘cross’ of pain but also to the person who feels that he is ‘on the sidelines’, that he has become useless or ineffective, that he is no longer making his mark in the world or his contribution to it. ‘To be handed over’ in ways such as these is particularly disquieting to a person who, by habit or temperament, has been exceptionally active and energetic or a notable achiever; and such a person may well find comfort in the thought that a similar pattern appears in the life of Jesus – that He also passed from activity and work and achievement into a final phase of waiting and dependence and passion.