Hospice founder leaves legacy

Florence Wald NUR ’41 GRD ’56 devoted her life to death. Even until her own passing this month at the age of 91, Wald worked tirelessly to make the process of dying dignified and comfortable for countless terminally ill patients.

In fact, the former dean of the School of Nursing died while receiving the kind of end-of-life care she herself introduced to the American medical system earlier in her career.

Wald, who passed away Nov. 8 of natural causes, started the hospice movement in the United States and devoted her life to its cause — to improve terminally ill patients’ quality of life. Hospice care prepares for death individuals who have an estimated six months or fewer to live and who have exhausted curative measures. Thirty-eight years after Wald opened the country’s first hospice, there are over 3,200 such programs in the country, which together serve over 900,000 patients annually.

More than a half-century ago, as a young nurse, Wald witnessed a woman with advanced ovarian cancer who was put through numerous rounds of chemotherapy, even after it was clear the treatment was not improving her condition or her quality of life. Watching the nurses crying in the hallways because the doctors neither would — nor could — do anything but continue to treat her, Wald was convinced that the ethos of treatment for treatment’s sake was not a valid option for the terminally ill.

“We are taking what was essentially a hidden scene: death, an unknown,” Wald once wrote about hospice care, “and making it a reality.”

As dean from 1959 to 1966, Wald revamped the nursing education at Yale to emphasize the importance of involving patients and their families in decisions on treatment and end-of-life care and is credited with bringing more rigor to the school’s curriculum.

Though Wald had a quiet demeanor, the current dean of the Nursing School, Margaret Grey, said that her steely determination to change the way end-of-life-care was delivered gave her a strong voice.

“At YSN we will miss her presence, but her legacy will live long in the faculty, staff and students who learned from her,” Grey said.

At her induction into the National Women’s Hall of Fame in 1998, Wald told The Associated Press that she had found it was difficult for nurses and doctors to give up on treatment even when they saw a patient’s suffering increasing and condition worsening despite — or even as a result of — treatment.

“There are times when the symptoms can’t be controlled,” Wald said, “and the physician and nurses and others need to meet that patient and let the patient decide for themselves what they want.”

Wald always knew she wanted to be a nurse, but her unique interest in the treatment of the terminally ill did not come to a head until 1963, when she attended a lecture by British physician Dame Cicely Saunders. Saunders spoke on her plans to open the world’s first hospice in Sydenham, England, and about her research on caring for the terminally ill.

For Wald, who disagreed with the prevailing practice of performing procedure after procedure despite the fact that neither the patient’s condition nor their quality of life was improving, Saunders’ emphasis on keeping dying patients as comfortable and as alert as possible struck a chord.

“In those days, terminally ill patients went through hell, and the family was never involved,” Wald said in 1998. “No one accepted that life cannot go on ad infinitum.”

Inspired, Wald resigned from the deanship in 1966 to focus her efforts on learning more about Saunders’ initiative. After interning at St. Christopher’s, the hospice Saunders founded, Wald opened her own hospice unit in 1971 in the nearby shoreline town of Branford, Conn., providing in-home care. Three years later, along with a Yale Medical Center chaplain and two pediatricians, she established the country’s first in-patient hospice center, the 44-bed Connecticut Hospice in Branford.

The publication Yale Nursing Matters last week described the Connecticut Hospice as “a model for hospice care in the United States and abroad,” adding that Wald “changed the perception of care for the dying in this country.”

At the time of her death, Wald was working on adapting a system she had spearheaded in correctional facilities to fit Connecticut’s system of veterans’ homes. Since its inception in 2000, the program has trained more than 150 prison inmates to provide hospice care for fellow inmates who are terminally ill.

Wald told The New York Times in 1998 that individuals outside of the penitentiary system could not understand that inmates had not been taught how to take care of their health. She emphasized not only that hospice care is beneficial for terminally ill inmates, but also that the process of caring for the terminally ill rehabilitates inmates at a low cost to the state, as it gives meaning and purpose to their lives.

“Our mother was passionate that all people should be treated as important,” Wald’s son, Joel Wald, told the A.P. shortly after his mother’s death. “We’re very fortunate to have had a mother who touched so many lives.”

In addition to hospice care, Wald also believed that physician-assisted suicide should be an option for patients who feel that either the physical or psychological effects of their conditions were too much to bear.

Wald’s funeral service took place at Battell Chapel on Nov 12. Her friends, family and past and present coworkers filled the chapel to mourn her death and celebrate her life. In addition to the six individuals slated to speak, ten more went up and spoke to Wald’s kindness, compassion and commitment to enabling all individuals to meet death with dignity and respect.

Wald graduated from Mount Holyoke College in 1938 and received her masters of nursing from the School of Nursing in 1941. After working as a nurse during World War II, she received a master’s degree in mental health nursing from Yale in 1956. Wald also received three honorary doctorates: an honorary Doctor of Law from the University of Bridgeport in 1967, an honorary Doctor of Humane Letter from Mt. Holyoke College in 1978 and an honorary Doctor of Medical Sciences from Yale in 1995.

Among her numerous awards and honors, Wald was a member of the Connecticut Hall of Fame and the American Nurses’ Association Hall of Fame. She was also named an American Academy of Nursing “Living Legend,” received the Founder’s Award of the American Hospice Association, and the School of Nursing Distinguished Alumna/us Award.

Wald was preceded in death by her husband, Henry. She is survived by a brother, Carl, a Pulitzer prize-winning historian, a daughter Shari, who is also a nurse and hospice care provider; a son, Joel; and five grandchildren.

Comments

  • Anonymous

    Hello -
    I am a documentary maker and hospice volunteer in Atlanta, Georgia.
    I've produced a short documentary about end-of- life decision making, palliative care, caregiving and hospice.

    It's called 203 Days.
    You can view it in its entirety at the following University of Connecticut website along with a study guide.
    http://fitsweb.uchc.edu/Days/days.html
    It is an unflinching look at the day-to-day interactions between patient and caregiver, in this case an 89 year old woman who is living with her daughter.

    203 Days won the First Place 2007 Film Award from the National Hospice and Palliative Care Organization (NHPCO).

    If you'd like more information please go to my website
    http://bbarash.com/bb_203days.htm

    I hope this film is helpful to people who want to know more about some of the most common experiences for caregiver and patient at this difficult time.

    Sincerely,
    Bailey Barash