Number of words: 540

Yet a third voice of dissent arose in oncology in the 1980s, although this voice had skirted the peripheries of cancer for several centuries. As trial after trial of chemotherapy and surgery failed to chisel down the mortality rate for advanced cancers, a generation of surgeons and chemotherapists, unable to cure patients, began to learn (or relearn) the art of caring for patients.

It was a fitful and uncomfortable lesson. Palliative care, the branch of medicine that focuses on symptom relief and comfort, had been perceived as the antimatter of cancer therapy, the negative to its positive, an admission of failure to its rhetoric of success. The word palliate comes from the Latin palliare, “to cloak”—and providing pain relief was perceived as cloaking the essence of the illness, smothering symptoms rather than attacking disease. Writing about pain relief, a Boston surgeon thus reasoned in the 1950s: “If there is persistent pain which cannot be relieved by direct surgical attack on the pathological lesion itself . . ., relief can be obtained only by surgical interruption of sensory pathways.” The only alternative to surgery was more surgery—fire to fight fire. Pain-relieving opiate drugs such as morphine or fentanyl were deliberately denied. “If surgery is withheld,” the writer continued, “the sufferer is doomed to opiate addiction, physical deterioration or even suicide”—an ironic consideration, since Halsted himself, while devising his theory of radical surgery, had swiveled between his twin addictions to cocaine and morphine.

The movement to restore sanity and sanctity to the end-of-life care of cancer patients emerged, predictably, not from cure-obsessed America but from Europe. Its founder was Cecily Saunders, a former nurse who had retrained as a physician in England. In the late 1940s, Saunders had tended to a Jewish refugee from Warsaw dying of cancer in London. The man had left Saunders his life savings— £500—with a desire to be “a window in [her] home.” As Saunders entered and explored the forsaken cancer wards of London’s East End in the fifties, she began to decipher that cryptic request in a more visceral sense: she encountered terminally ill patients denied dignity, pain relief, and often even basic medical care—their lives confined, sometimes literally, to rooms without windows. These “hopeless” cases, Saunders found, had become the pariahs of oncology, unable to find any place in its rhetoric of battle and victory, and thus pushed, like useless, wounded soldiers, out of sight and mind.

Saunders responded to this by inventing, or rather resurrecting, a counterdiscipline—palliative medicine. (She avoided the phrase palliative care because care, she wrote, “is a soft word” that would never win respectability in the medical world.) If oncologists could not bring themselves to provide care for their terminally ill patients, she would leverage other specialists—psychiatrists, anesthesiologists, geriatricians, physical therapists, and neurologists—to help patients die painlessly and gracefully. And she would physically remove the dying from the oncology wards: in 1967, she created a hospice in London to care specifically for the terminally ill and dying, evocatively naming it St. Christopher’s—not after the patron saint of death, but after the patron saint of travelers.

Excerpted from pages 224-225 of ‘The Emperor of All Maladies: A biography of Cancer’ by Siddharth Mukherjee