In the Midst of Life

was not being stupid or callous; this was no better and no worse than the norm. It was acceptedpractice.
    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 haveknown.
    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