(3 of 4)
Saunders did not invent the hospice. The Greeks probably originated the concept of a place to go to die before 1000 B.C. It has its modern roots in a home for the dying opened in Dublin in the late 19th century by an associate of Florence Nightingale's. Not long after, the Sisters of Charity opened a similar home in London. It was largely at that home, in the 1950s and 1960s, that Dame Cicely developed her ideas for a modern hospice that would bring physical and spiritual peace in the face of death. The end of life "can turn out to be the most important part," says she.
One powerful reason why that is true at St. Christopher's is the system of pain control developed by Dame Cicely and others. The hospice only admits patients with terminal cancer or amyotrophic lateral sclerosis, ALS, the motor-neuron illness commonly known in the U.S. as Lou Gehrig's disease. Fully 60% of new arrivals suffer from pain that has been consuming them, sometimes for weeks. With a combination of morphine and other drugs, such as tranquilizers, administered every four hours, the pain is quickly eliminated for most patients. But other components of pain are, in their way, equally agonizing. "I would put at the top of the list just anxiety and fear," says Dame Cicely. "It's very frightening to be very ill and feel you are losing control."
The nurturing begins the moment the ambulance arrives with a new patient. Madeleine Duffield, the matron (nursing director), is at the door with a warm bed covered with a colorful afghan. Questions like "Doctor, am I going to die?" are answered honestly. "Deception is not as creative as truth," says Saunders firmly. "We do best in life if we look at it with clear eyes, and I * think that applies to coming up to death as well."
It is not hard to find patients at St. Christopher's who will complain about the lack of honesty when they were in the hospital. Or of the suffering because medication was only given when the pain became too enormous to bear. Or of the indignities forced on the dying. "I saw a man die full of wires and plugs and little bleeping things," says Cancer Patient Ted Hughes, 56. "He was treated like an embarrassment and put in a side room with curtains around his bed." By comparison, says Patient Phyllis Sadler, 87, "I am looked after with such love and kindness here." So well does St. Christopher's revivify its new patients, physically, mentally and spiritually, that 15% of them are soon well enough to return home, even though they seemed only days from death when they arrived. At home they are looked after by the hospice's team of five visiting nurses and a doctor on 24-hour call. Even after a patient dies, St. Christopher's offers bereavement counseling to relatives.