Dr Robert Twycross

Here, Robert’s wife Deirdre reflects on those early days: the research that underpinned his practice, the challenges of establishing a new service in Oxford, and the patients and colleagues who left a lasting mark.

“When I look back and ask myself why Robert did what he did, the answer is very simple. For him it was always about pain relief and symptom control. If someone is in pain, nothing else matters. You cannot enjoy anything, you cannot think of anything else.

Robert went to St Christopher’s Hospice to research whether morphine could relieve pain as effectively as diamorphine, but without the same fears around addiction. At the time there was real anxiety about using strong opioids. Robert wanted to examine the evidence properly, and he did. His research showed that morphine could provide effective pain control and was also cheaper and more widely available – which meant better treatment for patients around the world.

Robert began work at Sobell House on 1 August 1976, only a few months after the hospice opened. The early days were very hard – only 12 beds were open because there was not enough money to staff the rest. For years he covered almost everything himself, often on call every other weekend.

He refused to teach medical students at first. He said he couldn’t teach until he had written the science of palliative care. So he wrote it. He produced a practical book for junior doctors, which eventually developed into the Palliative Care Formulary.

It was always important to him that clinical practice be grounded in clear evidence. One of the most significant changes he helped introduce was the idea that pain relief should be adjusted to each patient’s needs rather than restricted to fixed doses at rigid intervals. It sounds obvious now, but at the time it was revolutionary.

We also met extraordinary people from around the world. Doctors and nurses came to train or attend courses, and many stayed in our home. The common thread among people who work in palliative care is strength and kindness. One patient who marked us deeply was Jane Zorza, aged 25, who was the daughter of Victor and Rosemary Zorza. Jane arrived at Sobell House in terrible pain and stayed only nine days. Robert became completely absorbed in trying to control her symptoms. After her death, her father wrote A Way to Die and became a passionate advocate for hospice care around the world.

Fundraising in those days was difficult. People didn’t easily donate to what they saw as a ‘house of death’. But the team believed deeply in what they were doing. If you could relieve someone’s pain, you gave them back the possibility of living fully, even at the end of life.

When I think about those years, what I remember most are the patients who were no longer in pain. If pain is controlled, people can focus on the people they love, on conversations, on meaning. That was always Robert’s goal.”

In memory of Dr Robert Twycross (1941-2024)