‘Can’t you give me something, Nurse – another injection? I can’t stand much more.’
Ward sister would say something like:
‘Not just yet, dear, it’s too soon after the last dose. Try to hang on till the night nurses come on duty. Then you can have an injection for the night.’
In speechless agony she would nod, her eyes frantic with fear and suffering, then say: ‘I’ll try, Sister, I’ll try. How long must I wait?’
‘Only another couple of hours, dear. I tell you what; I can give you a couple of codeine. That will ease things until you have your injection.’
The ward sister was not being stupid or callous; this was no better and no worse than the norm. It was accepted practice.
When I was a ward sister in 1963, at the Marie Curie Hospital in Hampstead, this would never occur. We gave analgesics, four hourly, day and night, and every dose was different, tailored to individual needs and the patient’s level of pain. Dr Saunders’ studies had been so successful, and her teaching disseminated so widely, that uncontrolled pain had become a memory.
Dr Saunders did not rest on her laurels, however. Great souls never do; there is always more to be accomplished. She felt that her calling was to create a hospice that would be a working/ teaching model for the medical profession. This imaginative approach would not only ensure pain relief and meticulous nursing, but also maintain a patient’s self-respect and dignity, enhancing the remaining period of that person’s life, however short it might be.
A hospice for the dying was unknown and unacceptable to the decision-makers of the National Health Service in the 1960s and they would not support it, so private money had to be found. Fundraising was a massive task. Millions had to be raised, a building site found and purchased, architects instructed and planning permission obtained. Dr Saunders had many helpers and admirers, people who were also aware of the neglect of the dying, and who were inspired by her visionary outlook and inexhaustible energy. Money was raised, obstacles overcome, and in 1967, nearly thirty years after the young nurse first heard her calling, St Christopher’s Hospice was opened in Sydenham, Kent.
Planning, building, fundraising – that was the easy part. Even research into the control of pain was easy, compared with the next part – the need to change medical and social attitudes to death.
The primary objective of the hospice movement was, and still is, to show to the world that death need not be a time of suffering, but a time in which to achieve fulfilment. This does not mean a grand ending to a brilliant life; it encompasses the quiet, unsung lives of millions of ordinary people who have lived simply, within a small circle, doing their best and achieving great things in small ways. My mother-in-law was such a person. She had done nothing spectacular in her life, but she was a good woman and, in human understanding, she was one of the wisest people I have known.
She died in her daughter’s arms, quietly and peacefully, as she had lived. This is what I mean by the fulfilment of life.
The hospice movement strives to achieve this, working towards the mental, physical, spiritual and emotional well-being of each patient as he or she approaches the end.
Meticulous, skilled nursing is the most important part of the care of the dying, and the nurse becomes a central figure in the patient’s life. Dr Saunders knew this – had she not been a nurse herself? Most nurses are by nature kind and compassionate, but they need special training, and Cicely Saunders’ series of six articles on the Care of the Dying in the Nursing Times (1959–61) were seminal in the development of the profession and it has been found that those who specialise in palliative care usually find it so rewarding that they do not want to return to mainstream medicine.
Death is a family affair – or should be –just as a new birth involves the whole family. But dying at home often needs professional help, and this was another part of Dr Saunders’ vision – to maximise home visiting. St Christopher’s Hospice trained nurses to work in the community and, today, practically every hospice in the country has its own specialised nurses working in people’s homes so that a dying patient does not have to go into a hospital or even a hospice. In addition, we have, in the UK, over three thousand Macmillan Nurses who have had five years of training and who work exclusively with cancer patients and those who wish to die at home. This work is mostly funded by charity donations. The National Health Service provides about twenty per cent of the total cost.
Dr Saunders’ achievement was truly staggering. ‘The Care of the Dying’ is a fairly common phrase now, and most people do not realise that it is a relatively recent branch of medicine, with its own specialist training, research and disciplines. Today. around two hundred and fifty Hospices for the Care of the Dying exist all over the country, and this does not include specialist palliative care units in most general hospitals. It has become an international movement – over one hundred countries now have their own hospice care, and look to the teaching of Cicely Saunders as to how they should be run.
Dame Cicely Saunders died of cancer in 2005 at the age of eighty-seven, in St Christopher’s Hospice.
It is interesting to compare the lives of Cicely Saunders and Elisabeth Kubler-Ross. They were about the same age - Cicely the elder by eight years - and they died within a year of each other. They both had war experience, when death was all around. With no known contact between each other, they both saw the needs and suffering of dying patients in English and American hospitals in the post-war era. They both identified the cause as the widespread denial of death by the medical professions and society at large. The work undertaken by both of them was groundbreaking. It is one of those fascinating instances where two people with brilliant, insightful minds identify the same problem at the same time and work towards different but complementary solutions. Cicely started the hospice movement in 1967 when St Christopher’s Hospice was opened. Elisabeth published On Death and Dying in 1969. The contribution they made to medicine and to society was immeasurable.
1957
DR CONRAD HYEM
In 1957 I worked in Poplar, East London, with an order of nursing nuns and was required to visit a Mr Hyem, who lived in one of the tenements known as Canada Buildings. They were densely populated and regarded as slums.
I climbed the stone stairs, went along the balcony to his flat, and was taken aback by a small brass plate on the door stating: ‘Dr Conrad Hyem, Doctor of Philosophy and Psychology’. The day book had called him ‘Mr Hyem’, so I assumed the ‘Doctor’ was the wit of some Cockney joker, to amuse himself and his mates. I raised my hand towards the knocker, but at that second the beautiful soaring tones of a violin sounded from within. I stood outside the door, holding my breath, staring unbelievingly at the door. A woman called out:
‘Go on. It’s only the Doc. ’E’s lovely, ’e is. ’E gives us all a toon. Jus’ knock. ’E’ll soon stop.’
I shook my head and put my fingers to my lips, breathing ‘ssshhh’, and leaned closer to the door. The music was beautiful, full-bodied and rich, filled with that plaintive yearning which of all instruments the violin can achieve to perfection.