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.

Saunders, Cicely

The name of Cicely Saunders is synonymous with one of the major social innovations of the twentieth century: the modern hospice movement. Saunders was born in England on June 22, 1918, the first of three children of Gordon and Chrissie Saunders. She enjoyed the material comforts of a successful middle-class family, and at the age of fourteen was sent to Roedean, one of the country's exclusive boarding schools for girls. In 1938 she went to Oxford University to read politics, philosophy, and economics, but interrupted her studies two years later to become a student nurse at the Nightingale Training School of London's St. Thomas's Hospital. When a back injury forced her to leave nursing, she returned to Oxford and qualified in 1944 with a diploma in public and social administration. She then commenced training as a hospital almoner, or medical social worker.

In a large London hospital Saunders became involved in the care of a patient who was ill and dying far away from his own home. His name was David Tasma, and he had come to London as a refugee from Poland's Warsaw ghetto. In the short time that they knew each other, he proved an inspiration to Saunders, and their professional relationship turned into a deep friendship. One day he said to her, "I want only what is in your mind and in your heart." This combination of emotion and intellect proved to be a guiding theme in her subsequent work. The two discussed an idea that it might be possible to create more homelike places where people could end their lives. When Tasma died, on February 25, 1948, he left Saunders with a gift of £500 and the following encouragement: "Let me be a window in your home."

Saunders determined immediately to learn more about the care of the terminally ill. First she worked as a volunteer in St. Luke's, a home for the dying in Bayswater, London. Then she made the momentous decision to study medicine, starting in 1952 and qualifying at the age of thirty-eight. She began to see her work with dying people as a form of religious calling or vocation.

In 1958 she took up a position as Research Fellow at St. Mary's School of Medicine, conducting work at St Joseph's Hospice in Hackney, in the East End of London. Here she laid down the basic principles of modern hospice care. She developed a systematic approach to pain control in terminally ill patients; she gave attention to their social, emotional, and spiritual needs; and she began teaching what she knew to other people. Her concept of "total pain" provided a revolutionary way of conceptualizing the complexity of patients' suffering. In response to medicine's despairing rejection of the dying patient—"There is nothing more we can do"—she offered a positive, imaginative alternative that sought to ensure pain relief, maintain dignity, and enhance the remaining period of available life, however short.

Soon Saunders made plans to build her own modern hospice. To signify that it would care for people on their last journey in life, it was given the name St. Christopher's, referring to the patron saint of travelers. She gathered a group of supporters who helped to work out the plan in detail, and she traveled to the United States and other countries to promote and refine her ideas. There were huge barriers to be overcome, including the low priority assigned to the care of the dying in the British National Health Service, a lack of research, no specialized education in the field, and social indifference to matters of care at the end of life. Yet, after eight years of fund-raising, planning, and promoting the idea, Saunders saw St. Christopher's Hospice open to its first patients in 1967. As she often remarked afterwards, "It took me nineteen years to build the home round the window." Along the way she had marshaled help from major charitable donors, from senior figures in the establishment, and from a growing body of clinicians and lay people committed to the development of this work.

For the next eighteen years Saunders was the medical director of the hospice she had created. She quickly expanded its services to include home care; she promoted research into pain control and into the efficacy of the program; and she developed a center for specialist education. During this time she authored some eighty-five publications, some of which appeared in several languages. Constant media attention made the hospice well known throughout the world. Her work was acclaimed internationally, and she received many prizes and honors from numerous countries, including the Lambeth Doctorate of Medicine (1977); the Gold Medal in Therapeutics of the Worshipful Society of Apothecaries, London (1979); the Templeton Prize for outstanding contributions in the field of religion (1981); and entry into the Order of Merit, the highest honor within the British system (1989). St. Christopher's received thousands of visitors each year and became a beacon of inspiration for others who came to study, develop clinical skills, and conduct research.

In 1985 Saunders retired from full-time work at the hospice but remained active in her writing, teaching, and support for developments in hospice and palliative care. Both her private and professional life continued to be matters of public interest. She became the subject of a biography and of television documentaries and press interviews. In 1980 she married the Polish artist Marian Bohusz-Sysko, whom she had first met in 1963. She continued to travel and give lectures and presentations, especially after her husband died in 1995; her work remained a source of inspiration to those endeavoring to develop palliative care around the world. Her eightieth birthday was celebrated in 1998 with a conference in her honor at the Royal College of Physicians, London. In 2000 she retired from the position of chairman at St. Christopher's Hospice to take on the role of president/founder and to assist in the development of a new palliative care institute that will bear her name.

See also: Hospice around the World; Hospice in Historical Perspective; Hospice Option; Pain and Pain Management

Bibliography

Clark, David. "'Total pain,' Disciplinary Power and the Body in the Work of Cicely Saunders, 1958–67." Social Science and Medicine 49, no. 6 (1999):727–736.

Clark, David. "Originating a Movement: Cicely Saunders and the Development of St. Christopher's Hospice, 1957–67." Mortality 3, no. 1 (1998):43–63.

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

DAVID CLARK