"Palliative care should be a right, not a privilege."Manuel SerranoPalliative care is a manifestation of humanity".Cicely Saunders was born in Barnet, England, in 1918. She worked as a nurse for some years until severe back pain prevented her from continuing her profession. She later graduated as a Social Worker, which allowed her to be - as she always wished - in contact with the patient.
While doing this work in a London hospital, she met, in 1947, someone who would change the direction of her life as well as the pattern of her thinking. She wrote: "However, I did not know what was expected of me until July 1947, when I met David Tasma, a Jew from Warsaw who was suffering from advanced cancer. After his discharge from the hospital, I followed him in outpatient practice, because I knew that being alone and living on rent, he was likely to have problems. In January 1948 he was admitted to another hospital and for the next two months I was practically his constant and only visitor."
Cicely Saunders and David Tasma
They formed a very close relationship, with a deep and intimate knowledge. Cicely Saunders captured it this way: "We talked about his short forty years of life, about his lost faith and his feeling that he had done nothing for the world to remember him by. We talked many times about a Home that perhaps I could found that would respond to the needs of symptom control and personal recognition at the end of life".
The patient was far from his family and culture, in an anonymous environment, and this fostered a climate of desire and love for the person who was concerned about his "pending" issues to be resolved in his life a few months away from death. They talked and imagined an ideal place very different from the hospital where he was admitted. Their patient felt the need for more symptom control, even though he was not in acute pain, but what he needed most was to clarify himself, to know who he really was before he died.
The deadly disease was separating them at the same time that love was growing. David Tasma, terminally ill, understood, thanks to that love, who he was and who Cicely Saunders could become. He saw all her concerns and compassion for the pain of others that she harbored in her heart and head. A relationship that went beyond caregiver and patient: they fell in love, well aware that their love story was a matter of months.
When Tasma was transferred to another hospital, she continued to visit him daily. Death could not be a problem for them: He in his forties, bedridden, she a little younger, was happy in her profession. The backdrop of this story is the ward of an anonymous hospital. This was not and is not good medical practice - in the sixties of the last century in England it was not even considered good practice for a doctor to talk to a patient. Many friends warned Cicely Saunders that she was overstepping the boundary of what a professional relationship should be.
The "hospice movement
He was a man who died and left nothing in this world "apparently", because he was a key figure in the "hospice movement" that she envisioned and promoted: the patient needs physical but also social, emotional, psychological and spiritual care. David Tasma left a great legacy to humanity by giving encouragement to what would become the "hospice movement", which would later be named palliative care.
He bequeathed her 500 pounds to found an institution where she could die in better circumstances: "I will be a window in your home". In deep conversations, he would tell her that he would have left her what little money he had to build what they had dreamed of together (at that time it was a castle in the air).
Cicely was told that Tasma told the charge nurse on the floor, "I have made peace with the God of my parents." She died a few days later. Cicely and her boss were the only attendees at her funeral, and they recited the Psalm 91: "With his feathers he will cover you, and under his wings you will be safe."
"It took me 19 years to build the Home around the window," he wrote. David's window is part of the main reception area at St. Christopher's Hospice and is a wonderful heirloom that sends a message around the world. It was founded in London and, those few pounds he gave her, were the first bricks to build the first window. Cicely envisioned this home for the dying as a place where the sick would receive the best possible care. Cicely always saw in that window a symbol: that of a place open to whatever challenges the future might bring, as well as a place where she could care for all who wanted it. It was the first center that exclusively cared for terminally ill patients with palliative care. At the same time, St. Christopher's became a training center and the point from which the "hospice movement" spread.
Cicely Saunders, pioneer in palliative care
The challenge of being open, symbolized by the window, and the blending of all the diligence of the mind along with the vulnerability of the heart, were the principles upon which hospice and palliative care were founded, and I believe they still are today.
"I only want what is in your heart and head." This precious phrase that Tasma said to him is the foundation of palliative care: to put on the same scale all the compassion towards the patient that one is capable of at the same time as professionalism based on science and study.
The last months of life can be a fantastic time for the patient and family. Saunders pioneered the transcendent look at the patient with as much professionalism as possible. The essence of medicine is, after all, just that: a suffering person and an incurable disease, but the person is there. The compassion of the heart and the intellect merge to improve the patient's life. Because "you are you until the last day of your life," said Cicely Saunders.
