Cicely Saunders’ Life and a Legacy – a personal view

I very much enjoyed reading David Clark’s biography of Cicely Saunders. It is eminently readable despite being published by an academic press and should appeal to all professionals who work with the dying and a wider public wanting to find out more about this complex, driven and inspirational woman.

On a personal note there were many resonances. I was a GP for 31 years and my medical career was book-ended by the death of my mother from breast cancer when I was 15 in the early 1970s and the death of my father from pancreatic cancer after I retired in 2016. My parents,  born in 1914 and 1917 respectively, were exact contemporaries of Cicely Saunders.

In the early 1970s I was not told either of my mother’s initial diagnosis or her mastectomy and her terminal illness was not revealed to me until the day she died (although of course I knew she was very ill – but curiously never questioned it). I do not know what she was told. Interestingly she chose to ‘hold on’ until I had completed all my O levels before she died (a point alluded to in the book). She suffered debilitating bone pain and spinal collapse and I remember collecting her Nepenthe mixture from Boots. (In Mount Vernon Hospital when she was admitted for respite,  this was referred to as “Jungle Juice”). She also received palliative radiotherapy at the Middlesex which gave her considerable relief. She had fantastic personal care from her GP and there was an extensive network of neighbours and friends who supported her at home in her last few months whilst I was at school and my father was at work. On one occasion one of the hospital nurses even came over in her spare time to cook a meal for us. In our last conversation on the day before she died in Edgware General Hospital and presumably inspired by the care she had been given, she expressed her wish that I should become a doctor – which turned out to be great career advice.

During my career, treatment of patients with cancer changed immensely and again mirrors the changes that Cicely Saunders and others inspired. When I started as a surgical houseman (with no training in breaking bad news) it was my job to tell the relatives (not the patient!) the results of the ‘open and close’ laparotomies then carried out to confirm the diagnosis of untreatable cancer. Over time I have had the privilege to look after patients and their families coming to terms with dying. In a similar way to Cicely Saunders, by listening, I learned much from them including the ‘trick’ of using denial as a coping strategy whilst being fully aware of the reality (mentioned in the book). I too have had difficult conversations with patients about administering euthanasia.

My father’s death was completely different. He was aware from the start of his diagnosis and prognosis and his consultant discouraged him quite reasonably from having heroic surgical or chemotherapy treatment. It allowed us all extended time to talk with him and has provided me with an archive of written down reminiscences. It is interesting that despite the debilitating effect of his illness he had little pain and only received one dose of parenteral morphine throughout his illness.

Having worked in a small practice I recognise the advantages of choosing team members from those you know and trust and found it difficult to recruit when faced by more ‘egalitarian’ selection methods. I can identify with Cicely Saunders’s selection processes here!

I also recognise the onset of ‘founder syndrome’, which David Clark refers to, in myself . I came to a point in my career where I felt it was wise to retire rather than to carry on whilst feeling disillusion and a nostalgia for an idyllic past that could never return,  and in truth may never have existed!.

Over my career I have worked closely with doctors with evangelical religious convictions and have always found this hard to square with my own scientific approach. Having said that I continue to have great respect for them and the care they offered their patients. I also find it puzzling that doctors like Cicely Saunders have had to cite divine instruction for their actions when human compassion would be an adequate and commendable reason.

Finally, it was a great pleasure to attend the book launch at St Christopher’s Hospice and hear from those whose worked with Dame Cicely first hand. This brought the scope of her work and career into perspective for me.


Tony Hirst is a retired GP, living in Lancashire

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