When Maggie Keswick Jencks died from cancer in July 1995, plans for the conversion of a former stable at Edinburgh's Western General hospital lay on the bed with her. Drawn up by the Scottish architect Richard Murphy, these were designs for the first of the Maggie's Centres that opened in November 1996. The third of these innovative and inspiring cancer daycare centres - the second was completed last autumn at the Western Infirmary, Glasgow - is to be opened this Friday by Sir Bob Geldof in the grounds of Ninewells hospital, Dundee, overlooking the Firth of Tay.
Sir Bob is not the only celebrity linked to the latest Maggie's Centre. The Dundee building is the first in Britain by Frank Gehry, Toronto-born architect of the much-admired Guggenheim Museum, Bilbao, and the razzle-dazzle Walt Disney Concert Hall due to open in Los Angeles next month.
Patrons of Maggie's Centres include Gehry, the sculptor Sir Eduardo Paolozzi, author JK Rowling, and television presenters Jon Snow and Kirsty Wark. Maggie's husband was Charles Jencks, the distinguished American-born architectural historian and writer; they met while Maggie was studying at the Architectural Association in London. Both were close friends of Gehry and of the architects who have been commissioned to design seven more Maggie's Centres in Scotland and England, including Richard Rogers (Charing Cross hospital, London), Zaha Hadid (Royal Victoria hospital, Kirkcaldy) and Daniel Libeskind (Addenbrookes hospital, Cambridge).
Architecture mattered to Maggie. She loved it as she loved her husband, her teenage children, John and Lily, the Scottish landscape and what she defined as the "cosmic" gardens of ancient China. She was raised and educated in China, Scotland and England. Her thoroughly researched and beautifully written book, The Chinese Garden, first published in 1978, is now in its third edition. At 47, Maggie was diagnosed with breast cancer. Like many people, she found hospitals disturbing, not least because of their design. All those harsh, fluorescent-lit corridors and waiting rooms that would make even Britain's shameless privatised railways blush. Maggie wanted to confront not just the disease gnawing away at her body - what could she learn from it, what therapies were available, what sort of diet should she adopt, what sort of exercise regime - but what appeared to be the lack of truly caring cancer care clinics in Britain.
In 1993, after a mastectomy and a five-year remission, Maggie was diagnosed with cancer of the bone, bone marrow and liver. "How long have we got?", she asked a local consultant, thinking of her family. "The average is three to four months", he replied, adding: "I'm so sorry, dear, but could we move you to the corridor? We have so many patients waiting."
"No patient," wrote Maggie in her warm and inspiring booklet, A View from the Front Line (1995; revised 2003), written for fellow cancer patients, "should be asked, no matter how kindly and how overworked the hospital staff, to sit in a corridor without further inquiry, immediately after hearing they have an estimated three to four months to live.
"Most hospital environments say to the patient, in effect: "How you feel is unimportant. You are not of value. Fit in with us, not us with you." Maggie travelled to Los Angeles with Charles to see for herself the pioneering cancer care work practised at the Wellness Foundation in Santa Monica. What she learned was that there was no one "right way" to cure or to care for cancer patients, much less to help those who dedicate so much of their lives to looking after them.
"Medical treatment," says Laura Lee, former oncology nurse and chief executive of Maggie's Centres, "is only part of the solution if you are affected by cancer. What is crucially important to well-being, as Maggie learned, is your attitude to that treatment and the confidence that you can carry on with your life. This might sound pretty obvious, yet where can you find somewhere to go and talk, to learn and have people to listen to you and care for you? Almost nowhere. That's why Maggie came up with the idea of Maggie's Centres before she died: beautiful, relaxed daycare centres - homely, clubby, friendly and in the best new buildings by some of the world's most imaginative architects. Instead of having to travel to rather frightening hospitals, cancer patients and those caring for them can come to us."
And who could be frightened by a Frank Gehry building? Cartoon-like, they can make the most distressed visitor smile. The Dundee building waves hello to visitors with its funny crinkle-crankle roof echoing the rippling Tay behind and below it. Inside, it is warm and chummy, with a dash of Hollywood in the glamorous Busby Berkeley stair that whirls up from the ground floor.
Maggie, for all her informed discussion of medicines and therapies, and no matter how hard the going, remembered to laugh, smile and enjoy life as best she could. If she was going to die prematurely, she wanted, she said, to die well. She found the idea of going on a sugar-free and fatless diet, for example, something of a joke. "Had someone told me to follow such a diet, I would have been appalled. (Life with such miserable meals! You must be joking!) I am not a natural vegetarian. I adore meat - roast lamb for Sunday lunch is my idea of caviar with trumpets; roast beef with yorkshire pudding makes my heart sing. I love dripping, brains, and kidneys, liver and bacon, pork crackling, sausages, croissants, unpasteurised brie, mayonnaise, French sauces, double cream, sponge cakes and black gingercake lathered with butter," she said.
She learned, though, so much about cancer (including what to eat, and ways to care for carers and sufferers), that her Maggie's Centres had very nearly got off the drawing board by the time she died. The centres, says Laura Lee, "turn around three key concerns: relaxation and stress reduction, emotional support, and information. A part of what makes them so different from existing hospital departments is that people are free to drop in any time, free of charge, between 9am and 5pm without having to make appointments, although, of course, this helps. We're friendly, and even funny, and we don't turn people away. We don't boss patients about or their friends and families. What we're not, though, is an alternative therapy treatment centre working completely outside conventional medicine. We're an independent charity working alongside NHS hospitals."
The big question, of course, is do Maggie's Centres work? They are certainly popular. In 2001, the Edinburgh centre received 11,500 visitors. Half had booked, half had walked in; 63% were women, 37% men; 58% were patients, 42% carers; 44% were concerned with breast cancer and its treatment. The first external review of Maggie's Centres was conducted by Professor Leslie Walker, a pyscho-oncologist working in the field of pyscho-social support at the Institute of Rehabilitation, University of Hull, and Bill Duncan, emeritus professor of radiation oncology at Edinburgh University and chairman of Maggie's Centres professional advisory board.
Of all the many positive things they had to say, Duncan underlined the "skilled listening at the heart of the centre's programmes." Maggie recognised that very many of us are frightened of hospitals, partly because we feel ourselves to be unheard, passive victims in their care, and partly because of the buildings they occupy with their abattoir-meets-call-centre-on-a-bad-and-bloody-night interiors. And hard-pressed, poorly paid reception staff unable even to say "hello", much less listen to new patients by the end of long shifts.
Maggie's Centres cost between £700,000 and £1m to build, and between £175,00 and £225,000 a year to run. "With very little effort and money," wrote Maggie, "hospitals could be saying to their patients 'Welcome! And don't worry. We are here to reassure you, and your treatment will be good and helpful to you.'" And, in a building designed to lift, not to sink the spirit. "Above all," said Maggie, "what matters is not to lose the joy of life living in the fear of dying."
