Palliative Care: The old and the new

By Carlos Chan (c2020). Photo credit: Cicely Saunders Archive.  The second window from the right has an inscription underneath it which reads:
I will be a window in your Home,” the promise of David Tasma of Warsaw who died 25 February 1948 and who made the first gift to St. Christopher’s.

During my time in England, I spent a day at St. Christopher’s Hospice in London. They have a day program for healthcare professionals to come visit and learn about the history of palliative care, to tour the hospice itself and see the wards, and to talk about the future of palliative care and some possible challenges. I found myself in an odd group of visitors – two individuals who fundraise for the hospices across the UK, a director for another hospice, and a clinical psychologist from Japan on leave to study English. I was the only medical ‘professional’ in the visiting group that day.

St. Christopher’s Hospice was the birth of modern-day palliative care, started and built by Dame Cicely Saunders (a nurse, physician, and researcher) in London and her efforts were assisted by Dr. Mary Baines, who went to medical school with Dame Saunders herself. I was privileged enough to hear about the history of St. Christopher’s Hospice from Dr. Baines as she told stories of Dame Saunders and how the hospice movement came to be. In fact, I learned that the term ‘palliative care’ was coined by Dr. Balfour Mount, a urologic-cancer surgeon from Montreal (I am not very proud to admit that I had to have a British physician teach me Canadian medical history, but there it is). In fact, it seemed that the term ‘palliative’ was coined because hospice meant something else in French (I think it could be translated into ‘mouroir’, which would literally mean deathtrap, a pretty negative word. Now do note that this is hearsay, as I have not been able to independently verify online this as the reason for the invention of the term ‘palliative’, as suggested by Dr. Baines).

At the beginning of the presentation, as the only medical professional visitor that day, Dr. Baines singled me out for a question to begin her history lecture: What did physicians do for patients before the era of cures? As I was working my way through The Emperor of All Maladies and learning about the morbid history of radical surgery in the attempted cure of cancer, I somewhat facetiously told her that before cures were a part of the physician’s arsenal, surgeons merely cut out more and more in attempts to cure. Her response to my cheekiness was memorable – I can hardly imagine what she was like as an active and practicing physician. She shut that down very quickly and prompted me again and again for a real and more intelligent answer. Unfortunately, I was unable to provide her with the right answer (as you can see, I am not only killing it in my medical studies in Canada, but across the pond as well). It turns out that the answer was simple: before physicians could provide cures, they treated symptoms and provided comfort to patients and families. Simple. Which sounds suspiciously like… modern palliative care.

Dr. Baines’ point was that palliative care is not a new thing – it has been around as long as the physician’s profession has existed. Before cures were part of the arsenal of a physician’s black bag, symptom management and providing comfort were the only things that a physician was able to provide. It was a bit of a personal shock when I heard her answer – how could I have missed such an obvious thing? However, as the presentation went on, it seems like this was a struggle for most modern-day physicians to understand – Dr. Baines herself mentioned that she had to personally wrestle with the idea prior to joining Dame Cicely Saunders in founding the palliative care movement. It seems that this is a difficult concept for many new physicians to accept, given that most of us were born in an era where curative treatment is the expectation and anything less was a failure of the physician and modern medicine. After all, why did we choose to become doctors if not to cure our patients? However, the more I think about it, the more it makes sense that providing symptom management and comfort to patients remain at the core of what we do. My MF-4 tutorial had a ‘funny’ saying: “If you can treat it, then treat it.” However, what happens when we can’t treat it? That doesn’t mean we stop doctoring our patients. It just means that we reach into our black bag for other tools. I like to think back on Dr. Baines’ question as a good reminder that palliative care is not a new notion – and that it is for every single physician, regardless of their specialty or training, as it remains the core of what we are as a profession – both historically and as we continue onwards into the future.


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