Hello, I'm Kirsty Young and this is a podcast from the Desert Island Discs archive. For rights reasons, we've had to shorten the music. The programme was originally broadcast in 1994 and the presenter was Sue Lawley. My castaway this week is a doctor whose purpose in life is the care of the dying. An estate agent she went to Rodine in Oxford, trained as a nurse and later as a doctor. When she was 29, she fell in love with a young patient dying of cancer. He left her a legacy of 500 pounds with the message that he wanted to be a window in her home. A home she would open.

To help the dying. She realized that the process of dying was a neglected area of medicine and starting with that bequest raised enough money for a new kind of hospice. Two decades later in 1967 she opened St. Christopher's in Sydenham, South London. Today there are 190 similar hospices throughout the country, all of them caring for the dying along the lines of her teaching. She is Dame Cicely Saunders. What's the essence of that teaching Dame Cicely? How do your hospices as it were differ from those that you worked in as a girl? I think the most important thing is to get across to people that this is an important part of their lives. That you can sum up what you've been, you can reconcile yourself with some of the situations that you may be unhappy with.

With. In fact, there may be a lot to do. You needn't necessarily be sure that you're reaching the end of your life, but somewhere within yourself will be that knowledge. And I think Is about living until you die and it may be much longer and hopefully very much better than you ever expected and of course most that time will probably be in your own home with people coming out to visit you because hospice doesn't only mean bricks and water it means attitudes and skills which are now spreading very widely but it's also to do with the use of drugs, pain-killing drugs really isn't it? Well yes I mean I wanted to do something about the control of pain because quite obviously the pain particularly at the end of a life when

Was not very well addressed and had scarcely been researched at all. And the doctor I was working for said, Go and read medicine. It's the doctors who desert the dying and there's so much more to be learnt about pain and you'll only be frustrated if you don't do it properly and they won't listen to you. And of course he was right. So you offer obviously total understanding of pain control, you offer dignity, you offer support, are coming to terms with your life before your death is really. Yes, I think what we learned very early on when I was working together with the sisters at St. Joseph's developing this was that pain is not only physical, it is psychological, it's family pain, and it's spiritual pain as well, and it's seeing a whole person. The whole need and the whole possibility. It must nevertheless for you, by the very nature

of your work, your patients come and they go, you go on and you've been there for a very long time dealing constantly with death. It must, has it not been a very gloomy business? Well, of course, I'm not by the bedside much now, but I did have a check from a patient in one of the wards just before Christmas. And so I went to her bed. In one of our wards just to say thank you and she was the most lovely person in her 90s Salvation Army who was full of life and expectancy And meeting somebody like that, at their most mature and very ready for whatever was going to happen in the mystery ahead, that's not depressing. That is very enlightening and Rewarding. Well now we commit you here to a kind of living death really because we

Rob, you of all company and creature comforts and we cast you away on a desert island, do you find anything at all inviting about that idea? I'm not really a survivor on my own very well. I am a people person. But on the other hand, I have had times of solitude, particularly in the country. And perhaps you'll allow me a few birds to look at. To listen to indeed. Music to listen to as well, what's your first record? Well I'm choosing Chopin because we're going to be talking later about my Polish connections. It also has been one of the records to which I have worked. I like to work with music when I'm writing and trying to think what to do for the next article.

- Part of the first movement of Chopin's piano concerto. Number one played by Christian Zimmerman with the Concertgebouw Orchestra of Amsterdam. Chopin, who was a Pole, and Polish men have played a very important part in your life, haven't they, Dame Cicely? Well, they have, but they've all been very different. Shall we start with the first one? Who is the one I mentioned in the introduction? David Tashma, whom you nursed when he was dying of cancer. Well, actually I didn't know him when I was a nurse. I knew him when I was a social worker. You would have been what, in your late 20s? Yes, I was about 28. Yes, but tell me about him. What had he done for a living? Who was he? He'd come from the Warsaw ghetto, but he had left the country.

Poland some while before the war even, I think. He was just working as a waiter in London and he was a very interesting person, very gentle. He was only 40 and he felt that he hadn't done anything with his life. That he wouldn't have, as it were, left a ripple on the pool when he went. We talked together of somewhere that could have been more helpful to him perhaps in the very busy surgical ward where he was, excellent though his ward sister was. And the idea of somewhere came together as we were talking and that was when he used that expression. I'll be a window in your home and left us the commitment to openness. Openness to people, openness to the world and indeed openness to each other. But you'd fallen in love with him? I was very fond of him. In fact, yes, I did love David.

And I remember one day when I was talking to him, he suddenly said, Can't you say something to comfort me? And I said the 23rd song, which I knew by heart, and then he said, Go on. Else. And I said, well, shall I read to you? And he said, No, I want only what's in your mind and in your heart. And that's another of the founding principles of hospice, everything of the mind, everything we could bring of research and understanding, but with the friendship of the heart. But you saw him in some way, didn't you, as a sign from God, if you like, of what you ought to do with your life. Three years or so before, having been searching for meaning for quite a long time, I'm one people where things suddenly click and I felt as if I'd been turned round and then instead of battling my way against the wind it was behind me and I really

I really believed and I had a lot to learn and I also wanted to find what was the right thing to do and three years later, having just waited and got on with the work, I knew. But you hadn't had any deeply held religious beliefs as a child, had you? No, we weren't that kind of family, but I had a very good godmother who was very important to me all the way through. And she gave me all the right books and stayed quietly in the background. You've been sent to Rodine to school and you've been terribly miserable. I hated it. I was lonely, I was unpopular, I just didn't fit in. I did gradually by the end and ended up head of the house, but I hated being away from At home I wasn't very happy either. In fact I was difficult. I'm not suggesting it was anybody else's fault. I think it was my own. But did you feel pretty unloved? Oh yes.

Than a lot of people do in their adolescence, don't they? - But I suppose what all that means is you knew what it was like to be on your own, to be an outsider, to be-- And that was really important. It gave me a feeling for people who don't feel very well about their own self-worth. - Let's have a record number two. I go back to the music that I heard at home and we did have very good times as well as the bad times. And I know that I'm not going to be able to do that. Choosing pull ropes and swing low, sweet chariot. ♪ Wingo, sweet chariot ♪

Paul Robeson and Swinglow Sweet Chariot. Did you always think as a girl Dame Cicely that you'd like to be a nurse? I don't remember it but when somebody was looking back on my old school proposal for some reason, and they found that the headmistors felt that I had and that my family didn't want me to, but I'd obviously repressed it had disappeared. Because you went up to Oxford to read people. Yes, I did. I was thinking of being a secretary to a politician or something like that. Could you think that was parental pressure then, dissuaded you from nursing?

Certainly my father was very keen for me to go to university which he hadn't been able to do himself. And then... When came the war though, when you were up at Oxford, and then you really felt you should nurse? Yes, I decided after one term of wartime this was no place for a girl, and I then was able to persuade the family, so I waited to get into St Thomas's to train, rather than to go off and be a VAD. But it was much later, wasn't it, that you decided to be a doctor? Yes, because towards the end of my nursing training, my back, which hadn't been very good, finally packed up, and the obvious thing to do was to go back to Oxford, finish quickly a war degree, and manage to... Get back into public health or something like that because by that time I longed to get back into hospital because I loved it. The moment I started nursing all the old unhappiness went away and I felt like a book that had been put into the right place on the shelf. But then this very brave decision to train as a

Doctor because you had no scientific qualifications whatsoever. I mean it was a huge hurdle to decide to leap, wasn't it? Well, it was starting physics at the age of 33. I bet. And you went on to study pain control. You worked at St. Joseph's Hospice. Were you to meet the second pole to have a profound influence on your life? And I'll ask you about him in just a moment, but let's pause there for record number three. Well, we're going to... Go to the time when I was back at Oxford singing in the Bach Choir because I'd been singing in choirs all my life and Listening to Kathleen Ferrier and I would like one of the arias of her singing even though it's an old record Nobody else did. See the Saviour's outstretched hands, He would draw us to His death.

singing the aria 'See the Saviour's Outstretched Hands' from Bach's St Matthew Passion. It's 1960 at St. Joseph's hospice that you met Anthony Mcnaveitch. Again, he was a patient and he was dying. Who formed with him a relationship which you've described as the hardest, the most peaceful, the most inhibited, and the most liberating experience I've ever had. Well, he was in a six bed bay and I was just his doctor for months. And suddenly he said something which made me realise that he was... Fond of me and I remember him asking me was he going to die.

The only person I think in all my life, without asking back another question or talking around it I've just said yes. And he said long and I said no, not long. And he said, was it hard for you to tell me that? And so I said, well, yes, it was. And he said, thank you. It's hard to be told, but it's hard to be told. Hard to tell to. And I think that shows the sort of person he was. And out of that encounter, we had a month in which we were never alone. We were always in the ward. And yet we somehow managed to communicate at an Really very, very deep level. How did you do that? I mean, you must have been, for a start, concerned about the ethics of it, I mean, the doctor falling in love with the patient.

You don't actually get into bed with them. But you held hands. Yes, he kissed my hand and we kissed once. But once was enough. And I think what was important is that the end of that month, there was nothing that we'd said that we regretted and there was nothing that we might have said which we hadn't. It was very happy and yet it was absolutely devastating. When he'd gone. I should say it must you must have been desolate. Well I didn't have any memories you see we didn't have a past. So so often in bereavement you can go back and unpick and get the good things out of the memories and forgive the things where you got And we regretted and when you were angry with them, we didn't have any of that. So I had to grow up in my bereavement, which I suppose was why it turned into such a very creative thing, because it was in a sense the

Power behind all the work that went into finding the money and building St. Christopher's, finally building the home round David's window. His death, Antony's death, was the spur, was it? Well, no, I already knew that was what I was going to do, but I didn't know how. But are you suggesting that- You got your creative energy, as it were, out of your bereavement. I think an awful lot of it, yes I do. And I think that does happen with people. I think I'm unusual in that. - That you find something else to replace what you've lost, in a sense. - Yeah, and you're saying thank you. And you're wanting other people to have, in a sense, the feeling of he was important, which I think both Anthony and David gained from our loving each other. Next record. This is something that I used to play over and over again. I used to play over and over again.

Again when I was trying to come out of feeling very sad and it's a Schubert song of them say which has the most accompaniment which one almost wants to dance to. ♪ That least not too long ago ♪

Schubert's Auf dem Zeh, sung by Dietrich Fischer-Diesgau. How much of a fight was it then to get St. Christopher's? Was built because it was built seven years after Anthony died I think. We opened seven years after. It was a day by day business and I was working at... Joseph's a lot of the time and so in a way the patients of Joseph's were my fundraisers and from time to time I was able to take possible fund givers around St. Joseph's and Would charm him because I involved them all and they would be praying like beavers for me.

So it was all built on donations, was it? Yes, yes. A lot from grant giving trust because I couldn't really do a sort of public appeal because I don't think people would have known what I was talking about. Because this was going to be the first ever research and teaching hospice with home care, bereavement, follow up and other things built in, which the earlier hospices which there weren't very many anyway, hadn't really integrated into what they were doing. The idea of actually getting down and seeing how you can really make symptom control much more scientific, as well as at the same time looking at the whole spiritual, social, emotional side and bringing the two together. But I've always thought that a hospice, frankly, was somewhere where people went ultimately to die. But you say no people go to the hospital. Home again. Oh yes indeed. Some hospices have a very high discharge rate and ours is quite high and some...

People come in and out. And we have a number of people, of course, coming up to our day centre about 20 years ago. Are there every day of which most of those will be coming up from home and some of them will be with us for quite a long time. But what people are really looking for I presume at root is reassurance. They want to be heard. To tell them it'll be alright? They don't necessarily realise how near the end they are. You don't have to know that you're near the end of your life to come into a hospice. I mean, the commitment may be, we can do something about your pain, or we can do something about your breathlessness, Be, then most people do know within themselves, and on the whole, sharing is better than deception if you're going to be able to fight the right battle, as it were. But if they're facing the truth, the truth that death is at hand. They must be asking you those...

Mental and unanswerable questions. What is life about and what does death mean? How do you answer those? Entirely on the relationship between the person they ask, and may very often be a nurse, not necessarily the chaplain, maybe a doctor, the relationship that that person has already with the patient and the sort of exchange because Truth is much more in a relationship than just in words and there are many times when you have to say I don't know Better that than a platitude. Oh, yes platitudes don't work, but to be able to to just share, perhaps not say anything, because quite often all that somebody wants is for you to just stay there, to appreciate that what they're facing is very hard. And we don't want to smooth everything over and say everybody is cheerful in a hospice, but we do want to

things are real and reality, when you come to terms with it, has an extraordinary amount of joy hidden there. We're going back to the time when I was a houseman and back into the St. Thomas's And once or twice we had the enormous honour of being conducted by Vaughan Williams himself. And choosing the lark ascending.

Part of Vaughan Williams' The Lark Ascending, played by Barry Griffiths with the Royal Philharmonic Orchestra conducted by Andre Previn. Well now Dame Cicely Saunders you must tell me about the third pole in your life and how you met him. Now his name is, and you might have to help me here, Marianne Bocuszyszko. Very well. But it was his work, not him, that you first came across, I think back in '63. Well, I was still really grieving for Anthony and I was driving back... From the public library and I saw a picture through a window of a gallery and I stopped and went... In and it was the last half hour of a one-man show and I went round thinking I absolutely got to have one of these because I discovered also it was a...

Who came from the same city as Anthony and it was about the same age actually. I couldn't afford the big picture I'd seen in the window, but because I wanted another one of Christ stilling the storm so badly, the gallery let me have it half price. And I went back home thinking, what have I done? I'd never bought a picture before in my life. Anyway, I went back to the gallery and I got his address and I wrote and thanked him for having painted such a picture and said, I hoped we'd be able to afford one of the bigger ones me open the hospice and he wrote back and said it was the most important thing that had happened in his life and invited me to his students' exhibition and that's how we met. So if you're going to fall in love with an artist, it's rather special to fall in love with his art first.

But he wasn't free at the time, he was married, wasn't he? No, his wife was in Poland. He'd been taken prisoner of war in 1939 and his wife had never come out. And he'd stayed out as really a political refugee. And we had a... Relationship, meeting as friends for a long time. Nearly 14 years ago, but I had known him, now I've known him for nearly 30 years. But so you were in your 60s when you eventually got married? Oh yes, we were very old, but that didn't make any difference to it being a very exciting thing and a final sort of coming home to love. It also says something you'd always, had you always wanted to be married? Yes I had. I had not found it easy not to be married but every time I thought about it I would then think of a particular patient or somebody that well if I had been I wouldn't have met them. So it worked out. There's an anthology put...

By Cruz, a four bereaved people with the title 'All in the end is harvest' and I think I would say that was true. Now he's 18 years you're seeing him. Yes, he's nearly 93 now. So it's presumably now he who gets the greatest benefit from your caring abilities. Yes, I spend a lot of time looking after him. But he's a very nice person to look after. Maddening sometimes, like all people. - And this record's for him, I think. Is for him because he is pretty deaf and he really does find it difficult to listen to music, although he'll watch it on television, but he will listen to Beethoven's 7th Symphony. Because it's full of rhythm and sand and it gets through hip to his deafness.

Part of the third movement of Beethoven's Symphony Number Seven, played by the Vienna Philharmonic, conducted by Karl Böhm. You must have been asked on many occasions, Dame Cicely, to help someone who's dying. That's the euphemism, the usual euphemism for euthanasia, for offering that final lethal injection. What do you say, or what have you said in the past when people have asked you that? First of all, it isn't many occasions.

It is in a way surprising how people change or how few people actually think of it, although more do now than did earlier on in my career. But the whole problem of people who want to have their life ended may be insoluble for that particular person. I don't disagree, I don't dispute that there are some people who feel there is no other way for them but that. But the real problem is, I think, a social one, that if that was made possible by law, then it would pull the rug from under a whole lot of vulnerable people.

Them not just a right to die but a duty. I'm nothing now but a burden and I ought to opt out and although that might be very subconscious I think it would get through and I'm afraid the changed attitude of society over the whole area of abortion doesn't make us feel very happy that safeguards and so on would keep things to the very limited area which people often talking about. What about in the case of a degenerative disease such as motor neurone where someone is losing control of his or her physical functions and where they begin to suffer lawful indignities? Haven't such people a right to ask while they're still fully physically functioning that they be given a way out when... Eventually they need it. I still come back to, I don't think you can have that without undermining a very important

Value in society, the value of dependent people. And we have looked after two to three hundred patients with motor neurone disease in Saint Christopher's in the years that we've been able to do that.

It's very few who have gone on saying they would like something because they have found with Independence there can be a surprising independence and an independence of spirit With most patients there is something to discover. I'm not saying it's true for everybody, but I do think that the way To look at these patients is always as a very individual person and to give them the feeling that they matter to you and that their Miseries matter too, and that you're prepared to listen to them do what you can to support and That's what we can offer. I think law is a very blunt instrument in a very complex and difficult situation and Lawmakers can make terrible mistakes which are then very

difficult to unpick. Record number seven. We're going to something quite different, back to my singing again, and this is, St. Christopher's had a choir, and we even joined with another choir and sang Haydn's Creation in Norwich Cathedral. And so we're going to choose something out of the creation, The Heavens Are Telling the God. ♪ The word of his words ♪

The City of Birmingham Symphony Orchestra and Chorus and The Heavens Are Telling the Glory of God from Haydn's Creation. What about, may I ask you, about your own death? I know that

Sure, would want death to be as speedy and as painless as possible, but I understand that wouldn't be your choice at all. I would like to have time. I think one needs time to say thank you. One needs time to say I'm sorry. And one needs time to sort out something of yourself and what really matters until perhaps you can finally reach the place where, as it were, you can say, well, I'm me and it's all right. And of course, I would be facing death as a Christian with the belief that I won't travel that journey alone. And although it is into mystery, it is a mystery

But we wouldn't ever want to impose that feeling upon our own patients unless they came forward and asked for us. When David died I had the strong, strong feeling that he had come in his own way to the right place for him and that freedom of the spirit was another of the things that he left us as the principles of hospice. Last record. Well, I'm choosing something from John Rutter's Requiem, the last number of all, because I think it gives the peace which I do believe.

The many, many people that I've known over the years have finally reached for themselves. For they last, for they last, for they never last, from the last. For they last, for they never last, from the last.

- Looks I turner from John Rutter's Requiem, sung by Donna Deem with the City of London's Sinfonia conducted by John Rutter. If you could only take one of those records, Dame Cicely. To take my husband's that they'd given and blast it out loud on your island. That's right. What about your book? The Oxford Dictionary of quotations. Because that will give you so many things to go on thinking about. And your luxury. I write bad poetry in times of stress, so can I have lots of paper and pens or pencils? And you'll write your poetry and play your Beethoven and hope to be rescued? Oh yes, I'm not a survivor. I wouldn't do anything about trying to get away. Dame Cicely Saunders, thank you very much indeed for letting me be with you.

Us here your desert island discs. Thank you I've enjoyed it. To a podcast from the Desert Island Discs archive. For more podcasts, please visit bbc.co.uk/radio.