In the Midst of Life

the Catholic Order of the Irish Sisters of Charity at St Joseph’s Hospice for the Dying in Hackney, London. She worked with them as a volunteer, whilst continuing her paid work as an almoner.
    At St Joseph’s she saw that, as a patient drew near to the terminalstage of an illness, far from there being ‘nothing more we can do,’ there was a great deal more to be done: bring comfort in relaxed surroundings, look after the physical, emotional and spiritual well-being of the patient, give medical care if possible, but if not, meticulous nursing in the last stages of life. However, she saw that the nuns were just as hampered as hospital nurses in giving pain relief for cancer patients, because the medical staff had control of drugs.
    During the next six years her vision developed and she realised that the medical profession must change, not just in its attitude to pain relief, but also in the wider context of recognising the needs of a dying patient as an essential part of the physician’s work. What an awesome task for a young girl in her twenties – to change the medical profession! She was ‘only’ a nurse and a social worker. What could she do? A calling from God is always hard and demanding, but it can never be resisted, whatever the cost to the individual.
    None of us lives or works in isolation, and Cicely was constantly talking to like-minded people; what emerged was the advice that she should train to be a doctor. She did not have the scientific background required, but intensive study got her up to standard, and, at the age of thirty-two, she was accepted by St Thomas’s Medical School in London. Six years later, in 1952, she qualified. She was nearly forty, and had travelled a long road from student nurse to qualified doctor. But a longer, more difficult road lay ahead.
    Cicely Saunders was the first doctor to devote her entire professional career to the care of the dying. Many have since followed, inspired by her example and teaching. Her inspiration is with us still, and widening all the time in the hospice movement that she created, and that became international in scope.
    As a newly qualified doctor she was determined that her first task must be research into the control of pain. The medical director and the nuns of St Joseph’s Hospice gave her the facilities to test her theory that pain in cancer could be fully controlled by the regular, four-hourly use of analgesics. The idea was revolutionary at the time and, by the 1960s, she had proved, beyond a shadow ofdoubt, that drugs given in this way did not create zombie-like drug addicts, that the dose did not have to be increased to maintain effectiveness, in fact it could sometimes be decreased, and that patients became calm, comfortable and, in every way, happier because the pain had gone.
    Sixty years ago, only about four per cent of cancer patients survived; today, around forty-eight per cent can be cured. Pain is nearly always part of the disease, and we take it for granted that pain can be controlled. But it took a nurse-turned-doctor to prove the fact – and point the way for others to follow.
    I remember so clearly a woman I nursed at the Royal Berkshire Hospital in 1953. She had a sarcoma, an aggressive type of cancer. The seat of the cancer was probably in her ovaries, but it had spread to her bones and she was in the orthopaedic ward because one of her legs was broken. It was altogether the wrong ward for her, because most orthopaedic patients are relatively young and feel quite well, but this lady was dying. Whilst they hobbled around on their crutches she lay in bed, unable to move. One could see that she was trying to hide the pain, but every so often sweat would break out on her forehead and she would bite the sheets and grip her hands so tight the knuckles became white. Through clenched teeth she would articulate in a strangled voice:
    ‘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