Cicely Saunders was a great writer of letters. Indefatigable in her correspondence, she was equally happy dashing off the briefest of newsy notes, or setting out several pages of detailed text, full of insight and reflection. My acquaintance with her letters, built up over many years, was invaluable to me as I was writing her biography, published in June this year to mark the centenary of her birth. As the centenary year closes, I was looking for a seasonal missive to share on the blog. I came up with this one, written in the year of her 80th birthday, 1998.
By the late 1990s, Cicely had adopted the increasingly popular genre of the Christmas Letter to be sent to a wide range of friends and colleagues all around the world, and gathering up the highlights of the previous twelve months. Looking out the letter from 20 years ago, I was surprised and delighted to see I had been given a personal mention. A classic of its form, Cicely’s Christmas Letter sets out a year of breath-taking activity, challenge and resilience.
London, December 1998
Christmas greetings to you all and may the next year be good for you. Please forgive another general letter but as I always enjoy those I receive from friends, I continue to do the same myself.
I am writing this as I think of beginning work again following a few weeks off after a knee replacement. I have appreciated excellent care with a few days in a local private hospital and two weeks in St Christopher’s. The excellent surgical nursing in the former was impressive though my time there was marred by my difficulty in taking strong analgesics. Having spent much of my life encouraging people to take them without fear of tolerance or addiction, I find no amount of anti-nausea drugs have any effect on me. It was good to go to the Annual General Meeting in the Hospice in a wheelchair from the ward to give the Chairman’s Report with real “inside” knowledge. We have to be grateful for all the hard and sensitive work that goes on day and night in the wards (and out in Home Care) while we plan expansion to tackle unmet need and all the resources that are needed for this. I was also glad to learn that I was considered “down to earth” and not too daunting to care for! I did not, of course, try to find out anything about the other patients but could not help seeing two families come into peace in the room next to mine, nor fail to appreciate the immense demands this made on the staff and their understanding and patience.
I am putting off my second knee until the summer as I have three trips booked before then. These will be for lectures and meetings in Germany, Norway and the USA (where I hope to catch up with some longstanding friends as well as lecture). People I met in the 1960s have become very special and as they, too, have been involved in hospice development, we have watched growth and learned together in our very different settings. The Professor of Sociology who is working on the history of the Hospice Movement and who has all my extensive archives at the moment, has traced how much happened in the ten years before St Christopher’s finally opened in 1967. We all learned most from listening to patients (I was making tape recordings with them as early as 1961) but Professor Clark has drawn the story of innumerable contacts from my voluminous correspondence of that time. St Christopher’s was a pioneer but once again I am aware of the truth “What have you that you did not receive”.
1998 included several trips: an Ethics Conference in the Netherlands which I attended together with my long term Personal Assistant, Christine Kearney, revealed how palliative care can begin to develop in spite of the acceptance of euthanasia but also how much that can be avoided by the skills in listening and care we have been learning and trying to spread. German speaking Switzerland was next and revealed how little had even begun in our field but also that there was some keen interest.
Australia was another destination and was again a special trip. Our director of Patient and Family Services accompanied me and we had three luxurious, if cold, days in the enormous Government House in Melbourne before going on to Sydney to take part in the International Work Group on Death, Dying and Bereavement. Eighty of us from around the world worked in small groups to produce papers on different topics. Once again, many old friends from the first meeting of the Working Group, which took place in 1974, joined to make it a stimulating time – if a little taxing on my knees and back.
At home I have a splendid support system and still get into the Hospice for prayers at 8.45am each morning and spend the day in my office seeing staff, writing, some teaching and a number of meetings both within the hospice and externally.
Of course, the most exciting times for me this year were the celebrations for my 80th birthday. A full Hospice chapel for Thanksgiving, followed by a tea party in the grounds of the Hospice for staff, family and friends was a wonderful occasion. This was followed by a conference attended by over 200 at the Royal College of Physicians on “Advancing Palliative Care” which was graced by the presence of our Patron, HRH Princess Alexandra (a well kept secret – I had not expected this at all). I was also honoured by a luncheon at the Richmond home of the Princess the week previously and she had not given a hint of her attendance at the Conference.
My family keep well and busy, my Polish granddaughter has her doctorate and my step-daughter in San Francisco calls me nearly every week. Last year, I forgot to tell you of a visit in Los Angeles with a friend with whom I shared a flat in 1946 and all the catching up we did. We did not seem to have changed very much.
Altogether I am very lucky to be so busy still but find the morning of quiet all the more important and chapel is still in its central place. We have to meet the endlessly varied spiritual needs of our patients as well as all the practical needs of the end of life and the final letting go. This is wonderfully demanding and rewarding work and we have to strive all the time to support the whole Hospice community.
The 1998 Christmas Letter is characteristically Cicely. It begins and ends with hospice. In between we see her own health problems revealed and are given the fascinating insight that one of the world’s great proponents of opioid analgesia had an intolerance to morphine. It shows us the determined Cicely, never missing the Annual General Meeting of St Christopher’s, even if it meant attending in a wheelchair. For me it brought back the memory of speaking at her 80th birthday celebratory conference in the Royal College of Physicians, London. There are stories of her international travels and a special mention of her beloved IWG, in which she was so revered. We read about tea parties, family occasions and royal connections. We get fascinating glimpses of her daily routines and the profound importance of religious faith and practice within them.
In her 80th year, Cicely’s situation can be captured in a beautiful phrase from a poem by Anne Ridler, whose work she loved so much. For as the 1998 Christmas Letter shows, the life of Cicely Saunders had now become an exacting joy.