La influencia de Cicely Saunders en los profesionales de cuidados paliativos (Dr Carlos Centeno on the influence of Cicely Saunders)

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Dr Carlos Centeno Cortés

Carlos Centeno remembers his first meeting with Cicely Saunders in her famous collection The Management of Terminal Malignant Disease. He describes the influence of that book  in his decision to become a palliative care doctor and the later influence of another meeting in another of Cicely´s books: Watch with Me. This reflection illustrates the influences she has had, the continued importance of her legacy, and the lessons she still has to offer to tomorrow’s doctors.

In order to increase the international reach of our project, we ask our guest bloggers if they are willing to write in their native language. This post is in Spanish and is followed by a summary in English.

Era 1990 y curioseando libros de oncología en la Universidad de Valladolid, cayó en mis manos un libro con un título que se me antojaba curioso: “Cuidado en la enfermedad maligna terminal”. Estaba escrito por Cicely Saunders en 1980 y lo publicaba la Editorial Salvat. Vaya puntería, pensé yo, poner la palabra “maligna” en un título me resultaba casi morboso en español. Era evidente que no parecía una traducción feliz, pero el hecho fue que las letras grandes en portada y el reclamo “maligno”, ayudaron a que sus páginas iniciaran una revolución en mis ilusiones de médico recién titulado. En ese libro, conocí a Colin Murray Parkes, Robert Twycross, Mary Baines, y a muchos otros. De ahí salté a bucear en la historia de la autora y leí, no recuerdo de donde llegaron, algunos documentos del St. Cristopher’s Hospice en fotocopias y los retazos de una historia del movimiento Hospice que ya entonces se me quedo grabada. Conocí poco después a dos de los pioneros españoles de la medicina paliativa; Jaime Sanz y Juan Manuel Núñez Olarte, y decidí emprender un estudio que mostrara cómo el abordaje de cuidados paliativos superaba el cuidado oncológico tradicional. Mis notas sobre Saunders se convirtieron en el primer capítulo de la Tesis Doctoral. Al terminar ese estudio yo quería ser médico de cuidados paliativos.

Veinticinco años después, mi querido amigo David Clark me regaló la primera edición de “Watch with me” (Velad conmigo), una pequeña monografía con cinco conferencias de Cicely Saunders y me propuse que el libro llegara a difundirse en una edición española. La tarea de revisar la traducción se convirtió en mi feliz re-encuentro con Saunders y en una profundización insospechada en mi vida profesional de médico de un equipo de medicina paliativa. Hoy, enseñando en la facultad de medicina, compruebo cada año como los futuros médicos encuentran en las páginas de este libro y en la vida de Saunders, inspiración para ser mejores médicos, para dar lo mejor de si mismos junto al paciente, sea cual fuere la especialidad que elijan.

Dentro de unas pocas semanas, reuniremos en la Universidad de Navarra a un selecto grupo internacional de personas que de un modo u otro,  han profundizado en la vida y obra de Saunders: David Clark, Martina Holder-Franz, Isabel Galriça Neto y Enric Benito. Apenas se abrió el plazo, un aluvión de peticiones nos han llevado a aumentar el aforo previsto. Y es que Cicely Saunders sigue teniendo mucho que decir a todos los profesionales, sobre la enfermedad maligna terminal y sobre la buena medicina al final de la vida y y en cualquiera de sus etapas.

Carlos Centeno, 1 de octubre de 2015

It was 1990, and browsing oncology books in the University of Valladolid, I found a book which title caught my interest: Management of Terminal Malignant Disease (Cuidado en la enfermedad maligna terminal). It was written by Cicely Saunders in 1980 and published by the publishing company Editorial Salvat. “What a title!”, I thought the use of the term ‘malignant’ (‘maligno’ in Spanish) was pretty morbid in our context. It was obvious that it did not seem a ‘happy translation’, but the fact is that the big font and the use of this word ‘malignant’ started a revolution inside me, a recently graduated physician.

I met Colin Murray Parkes, Robert Twycross, Mary Baines, and many others. From that moment on, I began to absorb myself in the figure of Cicely Saunders herself, and read – I do not know where exactly- some photocopies from St. Cristopher’s Hospice and some snippets of a story that became engraved in my mind. Afterwards, I met two of the palliative medicine pioneers in Spain; Jaime Sanz and Juan Manuel Núñez Olarte, and decided to begin a study to demonstrate how the palliative care approach significantly improved traditional oncological care. My notes on Cicely Saunders became the first chapter of my Doctoral Thesis. Once I finished that study, I was devoted to becoming a palliative care doctor.

Twenty-five years later, my dear friend David Clark gave me the first edition of Watch with me as a present – a little monograph including five of Cicely Saunders’ letters. I proposed that I produce and disseminate a Spanish version of it. The task of revising the translation was a lovely reunion with Saunders and an unexpected step forward in my professional life as a palliative medicine physician. Today, teaching at the Faculty of Medicine, I can see every year how the future doctors still find in this book´s pages and in Cicely´s life, an inspiration to be better doctors, to be the best possible professionals towards their patients, whatever specialty they may choose.

On 17 October 2015 a Symposium on Cicely Saunders´ life and work will be held at the Hospital San Juan de Dios in Pamplona, with the support of a select group of international experts: David Clark, Martina Holder-Franz, Isabel Galriça Neto and Enric Benito.

Shortly after the Symposium was announced, the huge amount of applications made us reconsider and expand the capacity. It seems as if Cicely Saunders still has much to say to all professionals: on terminal malignant disease and on the ‘good’ medicine at the end of life, and at any of life’s stages.

Carlos Centeno, 1st October 2015

Dr. Carlos Centeno is Director of the Palliative Medicine Unit in the Hospital Clinic of the University of Navarra, professor of Palliative Medicine at the Faculty of Medicine and main researcher of the ATLANTES Research Programme (Institute for Culture and Society, University of Navarra). He combines interests in clinical research issues such as symptom management, with public health issues in such as national development, medical education, and social awareness.  His team work closely with the Glasgow End of Life Studies Group, whose founder Professor David Clark is a visiting Professor at ATLANTES.

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