Architecture: A monument to cancer care

A cancer victim's legacy is helping build new centres that support patients facing the terrors of the Big C. By Nonie Niesewand
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The Independent Culture
Maggie Keswick Jencks wrote a blueprint for holistic healing and the built environment as she lay in London's Royal Marsden hospital before she died. This is her introduction: "A diagnosis of cancer hits you like a punch in the stomach. Other diseases may be just as life-threatening, but most patients know nothing about them. Everyone, however, knows that cancer means pain, horrible treatments and - though it's no longer quite the unmentionable Big C of 25 years ago - early death."

View from the Front Line is an account of the quest that Maggie and her husband Charles Jencks, the architecture critic and author, made so that other cancer patients would be better informed about their chances of survival, and to improve their quality of life. Her observations on the failure of NHS hospitals to provide care, as opposed to cure, constitute a blueprint for the way architects can help. She really did believe buildings can affect people.

She put her own money into building the first Maggie's Cancer Caring Centre with the architect Richard Murphy, near the Edinburgh Western General hospital in 1996; it opened 12 months after her death. Neither hospice nor hospital, the day centre is for people to find a bit of space, and find out more about self-help. Any service offered there will be approved by the professional advisory board and it will be complementary to orthodox medical treatment. Empowerment is what Maggie Jencks called it.

Now the second Maggie's Centre, designed by her old friend Frank Gehry, will turn Dundee into a sort of Lourdes. Architectural pilgrims will come to see Gehry's first building in Britain, but the messages it sends out to every hospital about the need for a decent environment to confront illness are a major draw.

Dr Alastair Munro, an oncologist at Dundee's Ninewells, says 9,000 to 10,000 patients are treated for cancer at the university hospital each year - yet there are only 3.5 doctors for them. "Cancer is the process of the loss of control of cell division. If we can kill the cell, the patient gets better. But this leaves a vacuum. A space needs to be filled... Architecture is about space that needs to be filled. Buildings can be therapeutic.

"We can't address the pastoral problems. We're Third World in the treatment of cancer patients. Sure, Dundee has one of the best concentrations of people doing the basic biology of the disease. But we don't take account of the patient. To be honest, we have been too close to a cure, and have forgotten about the care. There is an urgent need for more centres like this to help in getting advice and keeping up spirits."

At 48, Maggie Keswick Jencks underwent a mastectomy. Five years later the cancer had spread to her liver, bone and marrow. When she asked: "How long have I got?" she got the reply: "Two to three months on average." She was then told: "I'm so sorry, dear, but could we move you to the corridor? We have so many patients waiting."

"Waiting could finish you off" is a title tucked into her exploration of the right diet, exercise, meditation, therapy, and support for family and friends in a comfortable, calm environment. The NHS is obsessed with cutting waiting time, but "waiting time in itself is not bad," she observes. It is the circumstances in which you have to wait that count.

She gives a check list of what increases anxiety while diminishing the confidence of the patient. Overhead light, often harsh neon; interior spaces with no views of trees or the sky outside; miserable seating against the walls in a corridor, partitioned toilets without a proper door in a frame; no hand basin in each private lavatory to wipe away tears; no mirror for getting ready to face the world outside again, no herbal tea or coffee, no books for those who want to learn about their disease; no TV or video that could show information tapes or, just as important, comedies. In Anatomy of an Illness Norman Cousins observes that laughter is not only an escape, it also relaxes the patient, leading to less pain and better sleep.

With very little money this could change in NHS hospitals. The NHS Trust wants to site Maggie's Centres close to oncology wards at all major UK cancer treatment hospitals. But how to fund them? The Maggie's Centre is an Edinburgh charity to which she left money. The Dundee project is built through the generosity of Anne Gloag, founder of Stagecoach - helped by Frank Gehry waiving his fees. Charles Jencks is already worrying about cutting the corners of Frank's design to save money. "Quantity surveyors will tell you corners are expensive. But Frank is good at low budgets: this has got to be a challenge for him. It's the water he swims in."

Following major surgery in January this year, Jim Clapperton learnt that he had an inoperable pancreatic cancer. His wife discovered a pamphlet for the Maggie's Centre and took it home. As Jim descended into what he describes as a "spiral of despair and complete hopelessness" his wife drove him to the Centre. They were taken aback by the bright, colourful, airy and modern appearance of the building and the welcome they were given. The centre has support groups, private counselling, access to the Internet to provide updated global information, a library, a rest-room, and a kitchen for nutritional advice. Four months later, Jim Clapperton still has fortnightly appointments for relaxation which he finds "extremely beneficial". Now he and his wife are off to Alaska to see the whales.

The Frank Gehry building stands in an ancient woodland on the brow of a hill overlooking the river Tay. It is a small work and Gehry has shown great sensitivity and attention to detail. The scale model on view at the Soane Museum, as part of the current case study on Gehry, shows small block planning - the model will be transferred to the Dundee Contemporary Arts gallery when the show closes on 19 June.

Just 150 yards away from Maggie's new centre is a bridge, also designed by Gehry, across a shallow man-made lake on the site, important because it is a boggy area and the bridge across the water to the Ninewells oncology wards for treatment carries both a physical and emotional need.

Keeping mind and body on the same track is important. Fred Stephens is the local project architect. A sheaf of drawings accompanying the model shows how Gehry begins with a drawing of such force that it spins around the page like a cosmic Big Bang. The next stage is the model, simplistic in appearance but deadly accurate in ascribing function to the cluster of small boxes, "really understandable to me who can't follow plans and elevations", says Laura Lee, director of Maggie's Centre in Edinburgh.

The final stage is wrapping these functional forms into a collage with a membrane. At Bilbao's Guggenheim it was curvaceous, tensile titanium. Who knows how this building will end up? Only Frank Gehry. What you see at this stage is not necessarily what you will get. A series of imploding bricks and blocks is designed to show us simply that he tackled the function of the brief.

Planned on a domestic scale, at 200 square metres, it has an entrance with a coat and brolly space; a sitting-room extension with information and library area, video access, an outside view, and a hearth. There may be a fish tank - Maggie Keswick liked them. The kitchen has a table for 12 and a central island for cooking demos, as diet is important.

There's a larger relaxation room for 12 lying down, two smaller counselling rooms with a fire, and two small soundproofed therapy rooms. Lavatories have wash basins and mirrors and no gaps under the doors. There is a small space to lie down, and a garden, as well as parking for visitors.

The brief to Frank Gehry must have pained him a little. He was her best friend, after all. "We want the building to make you feel - as Maggie made you feel when you had spent time with her - more buoyant, more optimistic, that life was more interesting than it seemed before. Ambitious, but possible?"

The Taj Mahal is the famous love story written in marble. Time and tourists have picked away over four centuries at the lapis lazuli but the spirit remains. But it still is a tomb. Meanwhile, another love story is being written in Dundee by Charles Jencks, in the name of his late wife.