St. Christopher's photo by John Biewen

A Revolution in Dying

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St. Christopher's

St. Christopher's Hospice is now a $15-million-a-year institution, the size of a small hospital, with 48 beds, gardens, aromatherapy and a library.

"One of the important things to say about St. Christopher's is that what you're seeing here is just the building," says Executive Director Barbara Monroe, a lively woman with short, dark hair and a ready laugh. "And I say that really quite with some emphasis because hospices are not buildings, they're philosophies."

Most of St. Christopher's' 500-plus patients get care in their homes. A small army of 900 volunteers do much of the work. St. Christopher's is still a leader in research on pain medication and bereavement. It's also a worldwide training center for those who care for the dying.

"One of the things that we're very committed to in our education programs is supporting the developing world," Monroe says. "So this year we had staff in Russia and Poland for training courses. And we've had people here from Africa, Latvia, Russia, India, Swaziland, Vietnam."

From its beginnings, St. Christopher's set an example for North America, too. Florence Wald worked here before founding Connecticut Hospice in 1974.

So did Dr. Balfour Mount, a cancer surgeon from Montreal who became another key figure in the hospice movement. He came across Saunders's name in 1973 while reading On Death and Dying by Kübler-Ross. He picked up the phone and called Saunders in London, explained who he was and that he was interested in learning more about St. Christopher's.

"And she said, 'I know you,' Mount recalls. "'You want to come to London with your wife, see a few plays, then come over to St. Christopher's, have a quick walk around and have a look and then go home. Well, I won't have it. You be prepared to come over, roll your sleeves up and get to work for a full week, and I'll have you.'"

Mount made the trip, without his wife.

"I was deeply impressed. ... That's where I wanted to die, first of all."

Two years later, in 1975, Mount founded the world's first hospital-based hospice (he called it a palliative care unit) at the Royal Victoria Hospital in Montreal.

Starting in the mid-1970s, hospice programs sprouted by the dozens, then the hundreds. In 1982, Congress passed a landmark law requiring Medicare to pay for hospice, placing it in the mainstream of American medicine. Today, some 3,200 hospice programs serve about 900,000 patients a year in the United States.

"And there are now, what is it, 8,000 programs in over a hundred countries around the world that have grown from the experience of St. Christopher's Hospice, London, period," says Mount. "And the work of Cicely Saunders."

Cicely Saunders still comes to her office at St. Christopher's most days, even though she's in her mid-eighties and there's already a big bronze bust of her in the lobby. The bust she blames on a donor.

"He gave us a very good donation here but rather on condition that I had my head done by this chap and that it was put in reception. And I said, 'Well, it can't go in reception 'til I'm dead,' but I was overruled."

Next - Body, Mind, Spirit