When Florence Wald, American granddaughter of German immigrants, filed into the Fitkin amphitheatre of Yale University for a lecture in 1963 she was a middle-aged nurse, albeit one of the most senior nurses in the US. She was dean of Yale's School of Nursing, already 46, but what she heard that day changed her life and, through her, the lives of countless Americans.
The lecturer was British nurse and physician Cicely (later Dame Cicely) Saunders, who described to a rapt audience of student nurses her plans to set up a "hospice" in London that would give terminally ill patients not only medical but also emotional and spiritual comfort in the last months of their lives. It was a revolutionary, holistic approach, treating the dying patient as an individual human being rather than a condition or a collection of symptoms. To Florence Wald, Saunders' words crystallised her own concerns: too much power had been left in the hands of doctors – their focus was on medical technology, on cure rather than care – and the needs and rights of dying patients had been neglected. Wald believed what was needed was a "coalition" of doctors, nurses, patients and their families.
For Wald, the Saunders lecture was "so powerful. To me, it was like opening a door where there had been a wall. She blew me away". Four years after that lecture, Saunders opened the world's first modern hospice – St Christopher's Hospice in Sydenham, south-east London – aimed at minimising the pain of cancer and other terminal-illness sufferers, and preparing them and their loved ones for death. Wald gave up her coveted position as nursing dean at the mighty Yale and visited London in the summer of 1968 to serve as a lowly intern at St Christopher's. "Only bring your shoes," Saunders told her in a letter. "We'll give you a uniform. We are quite hard work!"
While Saunders is considered to be the "mother of the modern hospice", Wald, widely known as "Eppie" to her colleagues, is credited with spreading the hospice message to the US and beyond. The women remained close friends and confidantes until the last days of Saunders' life in 2005, when the latter described her own suffering, and spiritual strength, in regular calls and letters. That was despite the fact that Saunders was strongly Christian, Wald a "secular humanist".
After her spell at St Christopher's, Wald returned to the US and founded the first modern American hospice, the Connecticut Hospice, in 1974. She first visited the terminally ill in hospitals or in their own homes. Then, in 1980, she opened a 44-bed in-patient facility, which became a model for the current 3,200 hospices around the US. These treat about 900,000 patients a year, covered by the Medicare national health scheme. Wald's husband Henry gave up his job as an engineering consultant to back her financially, morally and with concrete ideas as to how a hospice could work. Their son and daughter turned the project into a family affair.