Cicely Saunders photo by John Biewen

A Revolution in Dying

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Cicely Saunders

She sits for an interview in the basement of St. Christopher's Hospice, the world's first modern hospice, which she founded in London in 1967. Dr. Cicely Saunders somehow gives the impression of being tall, even though she's a modest 5-foot-4. Perhaps it's the strong, crisp voice combined with an unyielding air of confidence.

"My story in this field goes right back to 1948 when I was a social worker...meeting a young Polish Jew who had an inoperable cancer," Saunders says. "I became very fond of him."

In fact, Saunders and her patient, David Tasma, fell in love. She was 29 then, an Oxford graduate, former nurse, and a devout Christian. She was moved by Tasma's deep anguish. Not just the pain from his tumor. He was also sad and alone.

"I remember him saying, 'I'm just a rude sort of fellow.' He told me how he'd been brought up in the Warsaw ghetto, and his grandfather had been a rabbi, but in a way he left it all behind." Tasma felt "that he was just not an important person," Saunders says.

She visited Tasma about 25 times over the last two months of his life. In the course of those conversations, she says, she found her life's mission: to ease all kinds of pain at the end of life - pain not only physical but also emotional, psychological, and spiritual. But how? And was she really the person for the job?

The first step in Saunders' explorations was to volunteer at something called St. Joseph's Hospice in London - not quite a hospice in the modern sense but a small religious home for the dying.

"They had no drug charts, no patients' notes, no ward reports," Saunders recalls. "They had tender loving care by some Irish Roman Catholic nuns with Irish nursing auxiliaries. They were lovely."

The patients at St. Joseph's were seen as beyond medical help. For that very reason, the nuns could ignore prevailing scruples about pain control.

"There I saw the regular giving of oral morphine for the first time and realized that here was the answer to the control of constant pain. The constant control that I'd never seen in the hospital, because people were having pain first, they were earning their morphine by having pain. This was a very different scene."

Saunders learned to administer morphine before pain gripped the patient, not after, to stay ahead of the pain rather than chasing it. She wanted to take such practices beyond the religious home, to more dying patients in a professional, medical setting.

First, she says, she got some advice from a surgeon friend. Before setting out, in effect, to launch a new branch of medicine, the friend told Saunders that she'd better become a doctor first.

"'It's the doctors who desert the dying,' Saunders recalls her friend saying, 'and there's so much more to be learnt about pain. And you'll only be frustrated if you don't do it properly, and they won't listen to you.'"

Saunders agreed. At age 33, she became a medical student. When she got her medical degree in 1957, she became the first modern doctor to devote her career to dying patients.

It would take her another ten years to open the world's first modern hospice.

Next - Florence Wald