For the doctors and nurses at the south London hospice it had been a wrenching weekend. Twelve patients had died between Friday and Sunday nights, and by Monday morning death’s wide swath had left the staff physically and emotionally exhausted. It was time for a tall, somewhat stout, white-haired woman to provide the reassurance of her presence: standing in a stairwell, in the path of grief-bruised nurses and doctors, greeting each with a jovial smile and concerned questions: “How was your weekend?” “Are you exhausted?” “Are you coping?” If there is one thing that Cicely Saunders knows about, it is coping. This much-honored 70-year-old physician, who eight years ago was made a Dame of the British Empire by Queen Elizabeth, has devoted much of her life to caring for the dying, and in doing so has changed the way of death for millions of people. Dame Cicely is England’s modern-day Florence Nightingale. She has made herself death’s interlocutor, bargaining away the pain and isolation in return for peace and acceptance. She has done this as much through the strength of a very forthright — some say autocratic — character as through good medicine. “Her spirit is not to be complacent,” says Dr. Samuel Klagsbrun, professor of psychiatry at Columbia University who has known Dame Cicely for more than two decades. “Even at this age she stirs the pot and challenges people.” In 1967, inspired by a gift from a dying patient and armed with an indomitable determination, Dame Cicely opened St. Christopher’s, the world’s first modern hospice. In doing so, she changed the impersonal, technocratic approach to death that since World War II has become endemic in overwhelmed Western hospitals. No heroic efforts were made to prolong life. There was no operating theater; no temperatures were taken or pulses recorded. Instead of specialists mumbling into charts, there were doctors sitting at bedsides holding patients’ trembling hands. When death came, it was not with the accompaniment of IV drips and respirators but with tranquil normality. Above all, through the skillful and unobtrusive administering of drugs, there was control of the agonizing pain that is often bound to terminal cancer. “What I did,” says Dame Cicely, “was to allow patients to speak for themselves, to suggest what we ought to do to give them safe conduct.” Earlier this month, she welcomed the Queen to St. Christopher’s to help celebrate the hospice’s 21 years as the mother ship of a worldwide movement that has become known simply as “hospice.” Increasingly people are choosing the death with dignity pioneered at St. Christopher’s, either in inpatient facilities or, more often, at home through hospice-administered visiting programs. Hospice care is available in developing countries, such as India and Thailand, and in the Communist world . But no country has embraced the concept as widely as the U.S., which has 1,679 hospice programs. Last year 172,000 Americans, some 90% of them suffering from cancer, chose hospice care for their final days. AIDS sufferers are also finding that the hospice’s sympathetic aura can ease them through the last days of their debilitating illness.
