1. Nicoll, Leslie H. PhD, MBA, RN

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This year marks the 35th anniversary of St. Christopher's Hospice in London, England. Founded in 1967, St. Christopher's is widely regarded as the first teaching and research hospice. Dame Cicely Saunders established the hospice after years of pressure, persuasion, and persistence. She is described as the "founder" of the modern hospice movement, although Dame Saunders notes that a patient she cared for early in her career in many ways deserves that title.


By all accounts, Dame Saunders is a remarkable woman. Born in London in 1918, she began studying philosophy, politics and economics at Oxford University in 1938. With the outbreak of World War II, she left Oxford to begin studying nursing at St. Thomas's Hospital. Chronic back problems forced her to leave nursing; she returned to Oxford, completed a "war degree," and in 1947 became a "lady almoner" (now known as a medical social worker) at St. Thomas's.


Shortly after finishing her studies, she met a 40-year-old man named David Tasma, a Polish refugee from the Warsaw ghetto who was dying of inoperable colon cancer. In describing her conversations with Tasma, Saunders recalls:


I went to see him, and then I followed him and visited him about 25 times during the 2 months that he was dying in a very busy surgical ward. And he was David Tasma, and he is really the founder of the modern Hospice movement.


When David died, having quietly come back to the faith of his fathers, but not seen a rabbi or anything, he made me his executor and left me this legacy. He said, "I'll be a window in your home" and it turned out to be 500 pounds. So that's why we have a commitment from the beginning to openness, openness to the world, openness of course to patients and their families, but openness among ourselves. I didn't realize all of that to begin with, I just had the rather symbolic picture of a window.


But two other things he said, or one he said and one I knew about him, were equally important, sort of pillars of Hospice. The first was, "I only want what is in your mind and in your heart." He wanted me to say something to comfort him and I was repeating Psalms, which I knew by heart; and then I said, "Well, shall I read something to you?" and that's how he used that phrase. But thinking about it afterwards, I realized or began to realize that it could mean everything we could offer of the mind, and that would mean research and constant inquiry and constant learning and increase in understanding, but it had to be given with the friendship of the heart. *


After Tasma's death, Dr Saunders volunteered for several years at St. Luke's hospital where, for the first time, she saw dying cancer patients being treated adequately for the pain of terminal illness. At another doctor's urging, she studied medicine to learn more about pain management and to gain credibility for her ideas about caring for the terminally ill. And finally, in 1967, 19 years after David Tasma's death, Dame Saunders, now a physician, opened St. Christopher's hospice in London and "built a home around the window."


In the early 1970s, she came to the United States to lecture on hospice and the practices at St. Christopher's. Her visit sparked the beginning of the American hospice movement. The first hospice began in New Haven, Connecticut, in 1974 as a massive community effort. Today, there are 3500 hospices in the United States serving more patients per year than all the rest of the world. As many as 100,000 volunteers contribute more than 5 million hours of support services and bedside care to this nation's hospices. In England, St. Christopher's still serves as a teaching and research facility dedicated to the physical, emotional and spiritual care of the dying. Dame Saunders serves as President, and at 84 years young, still goes in to work everyday.


So as 2002 draws to a close, reflect on the death of one young man and the persistence of one woman to create a better world for dying patients, that is, what we have come to know as hospice.



*From the Oral History Project of the John C. Liebeskind History of Pain Collection, UCLA Louise M. Darling Biomedical Library. Interviewed by John C. Liebeskind, August 11, 1993, in Dame Cicely's office in London, UK. Manuscript collection no. 127.33 [Context Link]


Plan now to attend the Fourth Annual Clinical Conference on Hospice and Palliative Care


April 9-12, 2003


Adams Mark Hotel


Denver, Colorado


Watch the Web site for updates.