Personal interviews make the latest biography of Dame Cicely Saunders a rich, fascinating read

Categories: Care, Must Read, and Opinion.

Hospice UK’s Grants Coordinator Matthew Bodley reviews Cicely Saunders: A life and legacy, the new book about the founder of the modern hospice movement by Professor of Medical Sociology and Vice President of Hospice UK David Clark OBE.

Cicely Saunders reflecting on her own life, stated “I did not found hospice; hospice found me”.  Professor David Clark explores the nature of this encounter and the consequences of its legacy for the hospice and palliative care movement in this new biography of Cicely Saunders.

David Clark writes in the prologue of this book of his growing realisation, while documenting the history of the hospice and palliative care movement, that the story of its evolution was inextricably bound up with the life story of Cicely Saunders. He relates how he approached Saunders with an idea of capturing for posterity and exploring in more depth elements of her story through a series of personal interviews.

It is these recorded interviews which provide a rich seam of material for this fascinating biography of Saunders, published in this centenary year of her birth. Clark also draws on her archives, which as the sociologist Yasmin Gunaratnam puts it, include “dreams, promises and windows”.

Saunders emerges as a deeply reflective person. Obliged as a war time staff nurse to fall in with the indifference among the medical profession to their dying patients, she felt “helpless”, but “there was no alternative”. Whilst working a full day as an almoner at St Thomas’s Hospital, she spent the evenings as a volunteer nurse at St Luke’s Home for the dying (a proto-hospice) in Bayswater, in order to test her vocation: “I really went there to see whether I was right in that slot”, she recalled, “and they said that I slotted in straight way”.

Thereafter, she viewed the realisation of hospice care as a matter of personal calling. She embraced this calling with an unbounded optimism: “we can relieve suffering if we put our minds to it”.

In Saunders’ vision the sphere of hospice care went beyond the alleviation of physical pain through careful administration of drugs – “constant pain needs constant control” – enabling patients to stay alert, with no hint of addiction or toleration. She saw it also a matter of helping produce a “climate in which the patient can find their own meanings”; addressing what today we would refer to as psycho-social pain.

Her vision was underpinned by two central principles, dying pain exists in relation to others and in community; and dying patients may continue to grow “in patience and courage right up to their last moments”.

You are acutely aware, from reading Clark’s book, of the enormous energy, effort and skill Saunders poured into propelling hospice care into the public arena. While she uses her consummate skills of advocacy and persuasion to win support from Trusts and Foundations, she shows no hesitation in mobilising the “candid expression of her opinions” to champion her cause and challenge established boundaries, protocols and norms. I am particularly taken by the description of Saunders as a “detail terrier for whom no issue was too small” and the account of her skilful use of the Copeland-Chatterson punch card sorting system to collate and index the case notes of her patients.

“You matter because you are. You matter to the last moment of your life, and we will do all we can to help you not only to die peacefully, but also to live until you die”. These words of Saunders, which are frequently quoted on hospice websites and grant application forms, have been adopted as a rallying cry for the hospice movement and eloquently sum up her vision.

In spite of its adoption as the movement’s mission statement, you feel a slight uneasiness as you read of the zeal with which Saunders threw herself into living out her vision; sharing the discomfort of the Reverend Mother from St Joseph’s Hospice at witnessing the overfamiliarity of a doctor with her patients. For Saunders, however, it was crucial to the work that she was undertaking that she be real and unguarded with her patients. David Tasma, the first Polish émigré in her life with which she formed a close relationship, demanded of her “I only want what is in your mind and in your heart”. Another patient foundational for her thinking was Barbara Galton (Mrs G), with whom she had a mutually supportive relationship for many years.

In the early 1960s, Saunders suffered a series of bruising bereavements; first the death of her close friend Antoni Michniewicz, another Polish émigré, then in the following January Mrs G, and her father the following June. She was plunged into what she described in her recorded interviews as “the very dark hole of grief”. You sense from her own accounts of this episode that she plummeted to great depths.

Although deeply affected by this experience, Saunders remained undaunted. The fervour with which she embraced the care for the dying had been renewed by an “authenticity of having been there”. “There is a real creativity in bereavement”, she reflected afterwards, “the power of powerlessness is something that you can go on learning about endlessly”.

Cicely Saunders: A life and legacy is out now on Oxford University Press

Leave a Reply

Your email address will not be published. Required fields are marked *