Angel to the Dying

The founder of the modern hospice movement, Cicely Saunders, has made it possible for thousands to die with dignity.

The visitor to Saint Christopher’s Hospice, situated in a shady suburb in south London, first notices its unlikeness to a typical hospital. Rooms are filled with furniture purchased from a department store, not an institutional catalogue. Front windows frame a view of a park manicured in fine English tradition; rear windows overlook a flower garden and goldfish pond. Signs of life are everywhere: the staff gathers around a bedside singing “Happy Birthday,” artwork hangs from every blank wall space, and a patient’s cocker spaniel is carried in for a visit.

Despite the homeyness, a cloud hangs over Saint Christopher’s, for the building is, in essence, a place where people come to die. Forty percent of its patients die within their first week.

Since opening Saint Christopher’s in 1967, Cicely Saunders—now Dame Cicely, after being so honored by Queen Elizabeth II—has made it possible for 15,000 people to die in the way they choose, without high-tech intervention and artificial postponements. The design of her 62-bed hospice incorporates everything she has learned about care for the dying. “Every person deserves a good death,” says Dame Cicely, and she devotes her boundless energy to providing that right for her patients.

Saunders rules her hospice not as Dame but as Queen, and her visits to the wards resemble royal visits to the colonies. Her physical presence itself is daunting: she is six-feet tall, and has the no-nonsense demeanor of a schoolmarm. She treats the patients with kindness and calls all the nurses by name, but woe to the staff member who slacks off, or who speaks up against her pet projects.

Saunders has spent her life fighting battles—against a skeptical medical profession and skeptical religious authorities, against a picky National Health Service and a cramping fund-raising budget—and has emerged from these battles triumphant, accustomed to the role of leader and not follower.

Saunders once said, “I’ll spend the first 100,000 years of the next life apologizing for the toes I stepped on in this one.” But Saint Christopher’s has learned to accommodate her sometimes imperious style nicely. Key staff tend to stay long-term, despite the emotional strain. And everyone agrees that Saunders has no peer when it comes to relating to patients. In minutes, her superb listening skills can gain her an intimacy with them usually reserved for old friends.

Dame Cicely’s influence has spread far beyond the grounds of Saint Christopher’s. The unique alchemy she has wrought from the two elements of faith and medicine has helped transform the Western approach to death and made the word hospice a commonplace in the English language. No one would have expected such accomplishments from a woman who spent her first four decades trying to figure out what to do with her life.

As an adolescent, Cicely thought of herself as an ugly duckling. Tall and gawky, she poured herself into pursuits of the mind, and she spent most of the time feeling lonely. Her studies lacked focus; at Oxford, she studied politics, philosophy, and economics. At the onset of World War II, ignoring nearly everyone’s advice, she left Oxford to study nursing in a course founded by Florence Nightingale.

Cicely’s university years proved decisive in two ways. First, she became a Christian there. After reading such notables as C. S. Lewis, William Temple, and Dorothy L. Sayers, she joined Lewis’s Socratic Society and met a group of evangelical Christians. On a summer retreat at a seaside village in Cornwall, she became a bubbly, enthusiastic convert, and soon afterward joined John Stott’s congregation in London. The second decisive act, leaving Oxford, set her life firmly on a medical track.

Nursing school was conducted in wartime conditions whose privations sometimes rivaled those at the front. Students slept in unheated barracks and met in unheated classrooms. “We would get up early to break the layer of ice that had formed over the water jugs we then used for our baths,” Saunders remembers. “And during air-raid blackouts, we performed ward rounds in the dark.” After four years of rigorous training, she was fully certified as a nurse, but along with her degree she got the strong recommendation to look for another, less physically demanding line of work. A series of physical ailments, especially a bad back, had caught up with her. In 1944 she found herself back at Oxford studying to become an “almoner,” a patient advocate much like an American medical social worker.

Finally, at age 29, Cicely took her first real job, as an almoner in a ward that specialized in cancer patients. One of her first patients was a refugee, a Polish Jew named David Tasma. She could not help breaking the rules about maintaining professional distance. She discussed religious faith with David, repeated the psalms she knew by heart, and stayed by his bedside until he died. Indeed, Cicely Saunders, the nurse, almoner, and evangelical Christian, fell in love with this dying, agnostic Jew. When David finally died, only she and his employer accompanied his coffin to the Jewish cemetery.

David’s death put yet another twist in Cicely’s circuitous career. She had seen close up how poorly modern medicine handled death. For the sake of a patient with a chance of recovery, a hospital would go to any lengths. But a patient without hope was an embarrassment, a shameful emblem of medicine’s failures. Doctors tended to avoid terminally ill patients, or spoke to them in platitudes and half-truths. In busy, crowded modern hospitals, terminal patients died very much alone.

By breaking the rules, Cicely had eased the process of death for David Tasma. He did not die alone, and neither did another Pole named Antoni a few years later. Strangely, Cicely fell in love with him, too. From David and Antoni she learned the fathomless depths of grief and the peculiar vantage point of the dying patient no nursing school could teach. She began to sense an inner tug, a vocation to spend her life among the terminally ill.

When she confided her thoughts to a trusted physician friend, his advice was blunt, “Go study medicine. It’s the doctors who desert the dying.” It made little sense for a woman already trained in two careers to start over in a third, but that was Cicely Saunders’s decision. At the age of 33, having never studied science, she enrolled in medical school, the oldest in her class by far and one of very few women. “She’ll be 90 before she qualifies,” she overheard one 18-year-old classmate whisper.

In medical school, the pattern of her zigzag life started to become clearer. Her Christian faith strengthened: she met every day for prayers at lunchtime, invited outside speakers to address fellow students, and even volunteered as a counselor in a Billy Graham crusade. Medical training, too, served her goal of working with the dying: an old family friend hired her as a research fellow to study pain in the terminally ill.

Saunders qualified as a doctor in 1957, at nearly 39 years of age. Two years later, while reading the devotional book Daily Light, she came across the familiar verse from Psalm 37, “Commit thy way unto the Lord; trust also in him; and he shall bring it to pass.” It struck her with the force of special revelation. It was time to act on her call.

After a full day of meditation in a chapel, she emerged to write up a prospectus on what had been taking shape in her mind for many years. She divided her thoughts into “The Need” and “The Scheme.” With that paper the modern hospice movement was born.

All who know her report that Dame Cicely has mellowed in the past few years. They credit not so much her advancing age—she is now 72—as they do Marian Bohusz-Szysko, “the third great Pole in my life.” This one she married, in 1980, after a 17-year courtship. She has since nursed him through five life-threatening illnesses and claims to be happier now than ever in her life. Caring for Marian has also brought Saint Christopher’s back into the center of Dame Cicely’s life. For a while she had been traveling the world as an outspoken opponent of euthanasia, and an enthusiastic ambassador for hospice.

The hospice movement had its genesis in Saunders’s original vision, as much a religious as a medical vision. At Saint Christopher’s, faith radiates everywhere—from the chapel that stretches half the length of the first floor, from the religious artwork hanging on the walls, and from the many staff members who have Christian convictions. Yet, from the beginning, Saunders determined to found her hospice movement on principles broad enough to attract people from a variety of faith perspectives, or none. “We suspected she wanted to produce death-bed conversions,” comments one British psychiatrist. “How wrong we were.”

“Years ago,” Saunders recalls, “I was asked the question at Yale, ‘Can hospice only be done with a Christian foundation?’ I remember thinking, ‘If I say yes, I will close doors and narrow the vision, when what I want to do is open doors.’ ” Saunders reckons that about half of modern hospices have a religious base.

That she has indeed opened doors is seen in the proliferation of the hospice movement. Saint Christopher’s has become a mother institution that trains nurses, doctors, and many others in the burgeoning field of “palliative medicine.” When it hosts an international conference, hospice representatives come from as many as 40 countries, including Turkey, Iceland, and Zimbabwe. In the United States, nearly 2,000 hospice programs have sprung up. (Many U.S. programs, following another model pioneered by Saint Christopher’s, rely on home visitation.)

As Cicely Saunders sees it, the community of the dying both receives and gives back benefits. Dying people need the comfort and strength of the church. But the church needs the community of the dying as well: to summon up eternal issues, to teach us to listen, to give ways of serving Christ by serving others in his name. “My own hospice vision,” she says, “is of a God who does not prevent the hard things that happen in this free and dangerous world but who instead shares them with us all.”

The hospice movement resurrects a theme from the Middle Ages, when the church counted care for the dying as one of the seven cardinal virtues, when saints would pen books on the “Art of Holy Dying” and talk about death as an act of completion and faith. “In one sense, every death is an outrage,” says Dame Cicely, who has seen many. “But surely some are better than others. Has a patient been reconciled with family members? With God or his or her own inner values? Is he or she surrounded by caring people? Suffering is only intolerable when nobody cares. We try to offer our patients safe conduct.”

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