Book: Selected letters, 1959-1999
Author: Cicely Saunders
Price: (Oxford University Press, ?39.95)
When Dame Cicely Saunders talks about death it is as if she had died many times herself, without ill effect. Her tone is of a well-travelled person, comfortable with her subject, who can tell us what to pack, what to say and how to prepare for another country.
She is an old-fashioned missionary. Her founding of St Christopher's hospice in 1967 was an act of faith in God-and in herself. She is now credited with launching the modern hospice movement. But she has never been a swaggering Christian. After starting to read PPE at Oxford, she left to train as a nurse and medical social worker before deciding there was a need for improved pain relief-and spiritual help-for the dying. She retrained as a doctor and it was through her pioneering research with cancer patients in the early 1960s (she showed how narcotics could be used without adverse effect) that the medical profession began to take heed.
There were two reasons for visiting her this year: her selected letters (1959-1999), have just been published by OUP, and she has given her name to a research foundation which will extend her work into end-of-life care. The Dame Cicely Saunders Foundation will be the only international institution devoted to such research. She declares that "cancer patients fare pretty well," but there is less knowledge about how to relieve those suffering from other diseases. Those who are not cancer patients are now known, she says wryly, as "the disadvantaged dying."
There is nothing disadvantaged about Saunders herself. She is a splendid 84 year old, with mutiny in her eyes. She was the daughter of a Hertfordshire estate agent and, although her grandmother died when Cicely was eight, her disappearance was never discussed. It was, in the 1920s and 1930s, unseemly to talk about death. It was the war that brought her face to face with it. She was nursing men with TB and septic wounds with no pain relief: "We had nothing to offer but ourselves and meticulous nursing." She learned that "yourself is the best thing you can offer."
Saunders speaks in the kind of homilies you can imagine a Victorian child sewing onto a sampler, but her words are bracing. "Love is stronger than death," she says, and the hospice movement grew out of both. When Saunders was a medical social worker, she met David Tasma. He was a 40-year-old survivor of the Warsaw ghetto who was dying of cancer at St Thomas's hospital. He knew no one in London-she was his only visitor and had to break the news to him that he was dying. A passionate friendship developed; she was a Christian, he was an agnostic Jew. She began to conceive of a hospice that would better meet the needs of dying patients, in the process bridging religious differences, a "community of the unlike." Tasma left her ?500 to set up the first hospice, St Christopher's in Sydenham.
Her letters part company from this fairy tale. They remind the reader that it is difficult to start anything from scratch. Saunders observes, "One must not be disheartened by the number of people who say, 'What a splendid idea' and also, 'I'm quite sure you will get what you want,' but who will not actually do anything about it themselves."
One of the questions she worries about in the letters is how to plait the secular and the religious within the hospice movement. She told me that she has since discovered that people who have "no religious language" may find that "care itself can be spiritual, improving their self-worth and giving a value beyond themselves." But what, I wonder, can you say to someone who is dying? Isn't saying "goodbye" impossible? She does not agree. "I think it is important to say 'Thank you' and 'I'm sorry' and 'I love you' and 'Goodbye'..." (though not all at once, presumably).
She knows that the hospice movement has its adversaries. She and Ludovic Kennedy, president of the Voluntary Euthanasia society, "tangle," she says carefully. And, on the subject of Diane Pretty, she is less than Christian: "She was a very controlling lady. She could have died sooner, but she insisted on treatment for chest infections. I don't dispute that there will always be people like that but a law would undermine a majority of vulnerable people who don't want to make-or be forced to make-that decision."
Curiously, in her letters, when Saunders refers to her own bereavements, she writes in a curbed way, as if to express her grief were an indulgence. She told me that when her husband, Marian Bohusz-Szyszko, a Polish artist (all her romances were with Poles) was dying, it was "a dialogue in silence" that prevailed (an exception to prove her rule?). "Love doesn't always need words," she says. Then, at last, her husband unexpectedly told her: "I am completely happy. I have done what I have had to do in my life and now I am ready to die." She produced his words again, in her Sydenham sitting room, as if flaunting a jewel.
