Keynote Address by Sandol Milliken Stoddard

September 12, 2006

I am honored, and I thank you. And I also give thanks for the good work you have been doing, and I call to mind those who have led the way for us all, especially my dear friends and mentors, the late Cicely Saunders of St. Christopher’s Hospice in London, and Dr. Bill Lamers in this country – long may he live. I must also mention your own Stephen Connor, whose book Hospice: Practices, Pitfalls and Promise is such a necessary treasure – a copy should be in every hospice – and Ira Byock, who has written so gracefully about death and dying, and so movingly about his experience as a hospice physician. It is no coincidence that all of these fine hospice leaders have actually done the demanding, hands-on work of the heart that Cicely called “hard medicine with a human face.” I could not have written about hospice as I did unless I had been invited to work at St. Christopher’s.In fact, it was one of the happiest days of my life when I had a long-awaited letter from Dame Cicely that said, “We have decided that you will do.”

My thoughts go back often to another happy day in 1977 in Marin County, California, when I was sitting in a plain, bare little room approximately 8 by 12, with one desk, two chairs and a telephone hanging on the wall. That was Hospice of Marin, right at the beginning – Dr. Lamers was behind the desk and I was interviewing him, because this was the first American hospice west of New York. Marin’s hospice by now is large and famous; but at the time, it consisted only of one doctor and one nurse – both unpaid volunteers – and they were doing beautiful hospice work, one patient and family at a time. These are some of your gallant forbears and I hope you will remember them on difficult days, and take courage. The numbers are very different now, but in the end it is not the numbers that will count; it is the care that you provide to one patient, one family at a time, and the spirit of that care that will both define and support you. And I hope that you will never, ever think of hospice as just another health-care delivery system. It is so much more than that.

In that same bare little room in California there was a box on the floor, and Bill reached into the box one day and handed me a book that set my imagination afire. It was called “The Medical Work of the Hospitaller Knights of St. John of Jerusalem.” These valiant souls, the hospitaller knights, are another significant part of your heritage. Their monastic order was founded a thousand years ago to care for the ill, the wounded, the dying, and especially the dying poor, at various hospitals and hospices in the Middle East. Dying was seen as a sacred journey then, and the knights responded to that vision, putting their own lives on the line for it, in a time of great violence and brutality. The records of their organizations refer to patients as “Our Lords the Sick” and direct that they be humbly served. Patients received remarkably good medical care, and the aristocratic knights ate plain food while the patients were given the best of meat, fresh vegetables and bread on silver plates, and wine in silver goblets. I wondered what happened to all that silver?  Well, Napoleon stole it and melted it down to finance his disastrous attacks on Egypt. Syria and Palestine. So I guess the bad old days were not so different from our own.

I’m afraid they’re not going to let me talk to you all morning – which I would love to do – so I will close after just a few thoughts about my hopes for hospice today. Elisabeth Kubler-Ross once said that hospice was the finest organization for change in this country – that was 35 years ago – and I agreed. Those were the heady days of rebellion against the “Establishment” and rejection of traditional hierarchies in favor of more democratic methods and humanitarian ideals. Hospice in this country took a particularly American turn, in that it did not depend upon the formal inpatient unit as in England, but launched itself instead as a community concern. Hospice set an example then about the wonders people can do when they band together and work for the common good. With patient and family at the center of the circular hospice flow-chart, an unusual kind of bonding took place in the hospice community as a whole; hospice teams were uniquely egalitarian in that members all looked after one another; and with the dying patient often serving as teacher, they developed creative new pathways to efficiency and excellence of performance. My main concern for hospice now is that all this may be forgotten; it is so easy to slide back into the old familiar lock-step patterns of competition, power-seeking, and militaristic bureaucracy. Please, don’t let that happen on your watch.

And please, never forget that although your patients die, healing is what hospice is about – healing of individuals, of families, healing of society. Healing, as we all know, is not only a physical phenomenon. By attending and supporting human life at its most vulnerable, by reaching out to comfort those who suffer, and by treating one another with sensitivity and respect, we ourselves are healed; because this way of being brings joy and satisfaction, and because it lifts us all to a spiritual realm where we become servants to the mystery of life itself.