IAPC pays heartfelt tribute to Dr. Robert Twycross: India’s ‘Teacher of Palliative Care’

It was in Nobember 1999, I first met Sir Robert Twycross. He was the principal faculty for the foundation course, my first formal training in Palliative Care. His passion towards Palliative Care was palpable in each of his sessions. I was spellbound by his lectures and teaching methodologies. He was a regular faculty for the Palliative Care sessions in Calicut, Kerala when we had only foundation courses as the formal training programs.

His unflagging fervor towards Palliative Care always inspired me. He continued to support us with his book – Introduction to Palliative Care (IPC) to be published as the Indian economy edition to facilitate the Palliative Care training in India. We never felt he was an overseas faculty, when he stood with during the clinical discussions and home visits. It is a indeed a loss not only for the Palliative Care fraternity, but to the mankind. He was the epitome of compassion in healthcare and passion in mentoring. We miss you, but are sure that your teachings will guide us in raising the bar of Palliative Care education in India.

Adieu Sir Robert Twycross… May your gentle soul attain eternal peace.

Thank you for your support for palliative medicine/hospice care in China.

The photo was taken on 29th September 2017, in Chengdu, China at the 17th International Academic Conference on Palliative Medicine. I was honoured to have consulted with you in person.

缅怀Robert Twycross教授！感恩您对中国姑息缓和医学/安宁疗护相关专业和事业的支持！
照片摄于2017年9月29日，中国成都。我很荣幸能当面请教。

We are grown up with teachings of Robert Toycross.

Dr. Robert Twycross stands as a towering figure in the field of palliative care, whose influence has touched practitioners and patients across the globe, from the UK to India. Known as a pioneer and educator, Dr. Twycross devoted his life to alleviating suffering and transforming the way we approach end-of-life care, setting new standards and inspiring countless others to join him on this noble path.

My own journey in palliative care was significantly influenced by Dr. Twycross. During my basic training at the Institute of Palliative Medicine, his book Introducing Palliative Care became my foundational text. This book offered more than knowledge; it provided a guiding light through the challenges of understanding and addressing the complex needs of patients facing terminal illnesses. In its pages, Dr. Twycross distilled the essence of palliative care with clarity and compassion, emphasizing the profound impact of holistic, patient-centered care. His insights shaped my approach and continue to guide my practice to this day.

Beyond his written contributions, Dr. Twycross was known for his dedication to global education. Recognizing the need for palliative care in resource-limited settings, he actively engaged with communities and practitioners in countries like India, where access to specialized care often remains limited. He invested time and effort, sharing his expertise and training local professionals, so that they could provide quality palliative care in areas where it

It was indeed propitious that I along with my colleague Sr. Casilda from Jeevodaya, Chennai were among the selected few to undergo the WHO sponsored training in Palliative care in UK in 1994 under the tutelage of Dr. Robert Twycross and his teammate Ms. Gilly Burns. Much has been said about his academic qualifications and achievements but to me he was a teacher par excellence. He gave us a strong grounding in PC and here are some pearls from his seminal lectures…

1. Attention to detail.. emphasizing the need for meticulous History taking and Clinical Examination
2. Ass _ U_ ME… (Fallacy of Assuming)
3. Review! Review! Review! … Necessity of revisiting symptoms frequently
4. PC is ‘High touch, low tech’ contrary to what medical professionals are heading to now ‘High tech and low (or no) touch’

Words embedded in stone for generations to follow.

We were very fortunate to get to know the personal side of Dr. Robert too. A soft spoken, kind-hearted person who understood his students well and could give them his personal attention. He and his wife Deidre bestowed parenteral love and affection on all of us Indian students when we were beginning to get home sick. Who can forget the aroma of dhal and rice when we entered his house on invitation for lunch… It nearly brought tears to our eyes, a bunch of Indians starving for Indian food… A perfect example of ‘Attention to detail!’

Dr. Robert was the first to introduce PC to Tamil Nadu by conducting a Workshop in PC.

“The Department of Palliative Medicine, Dr. B. Borooah Cancer Institute, deeply mourns the loss of Dr. Robert Twycross, a pioneer and father of Palliative Medicine.

We fondly recall Dr. Twycross’ memorable visit to our institute in 2018, accompanied by his wife. On this occasion, we had the privilege of hosting a seminar, where we benefited from his vast expertise and insights.

Dr. Twycross’ legacy and contributions to Palliative Care will forever inspire us. His impact on our institution and the global Palliative Care community will be cherished.

We offer our heartfelt condolences to his family and loved ones.

Rest in peace, Dr. Robert Twycross.”

It was an incredible privilege to meet Dr Robert Tycross in one of the iapcon conference. His passion and vision in pioneering this compassionate field were truly inspiring. The meeting had reinforced my commitment to continue advancing palliative care and serving those in need with empathy and compassion.

Interacting with Dr. Twycross was a pleasure during IAPCON and discussing on career pathways in Palliative medicine. Such a humble soul with deep rooted knowledge and always ready to help.

You will be missed. The news of his passing away came to me with mixed emotions as I’m now working at St Christopher’s Hospice London where he started his career in Palliative medicine and lead the way.

My training in Palliative Care began with reading “Introduction to Palliative Care” by Dr. Robert Twycross. I met him at various training programs and IAPC conferences in the late 80s and 90s. This journey culminated in establishing the Department of Palliative Medicine at Gujarat Cancer & Research Institute, Ahmedabad. Currently, I carry forward the legacy of all pioneers by serving hospice patients at Community Oncology Centre, Ahmedabad.

Dr. Twycross touched many lives throughout this journey. My “PRAYERS” are with the departed soul.

Dr. Robert Twycross was closely associated with me in developing Palliative Care in Gujarat. We initiated training workshops in pain and palliative care at the Gujarat Cancer and Research Institute. He provided invaluable support by sharing educational materials, presentations, and videos for doctor and nurse training. With his help, we computerized presentations, a notable achievement in the late 1980s.

Dr. Twycross continued his support in establishing the Community Oncology Centre and Hospice complex in Ahmedabad in 1988. He facilitated Dr. Pamela Sutton and Gilley Burn’s involvement in training nurses for hospice services.

The Indian Association of Palliative Care (IAPC) was established in Ahmedabad in 1994. Dr. Twycross attended IAPC’s 2nd International Conference in Ahmedabad in February 1995.

Dr. Twycross was a simple, dedicated man passionate about educating and training palliative care professionals. His cherished memory will remain with us for a long time.

I attended the 10-Day Foundation Course in Cochin in November 1999, organized by Dr. M. R. Rajagopal. The workshop was facilitated entirely by Dr. Robert Twycross and Ms. Val Hunkin. On the very first day, during the orientation class, I recognized Dr Twycross’ passion for the subject, his in-depth knowledge, and disciplined teaching style.

I can never forget what he said at the beginning: “If anyone cannot attend even one class or comes late, you can leave the hall right now!” Then, his opening sentence resonated deeply: “Palliative Care is about taking time to share time with those who are running out of time.” His vast knowledge, impressive skills, and inspiring attitude left me deeply motivated.

His warm, beaming smile and willingness to listen remain etched in my memory. Later, I attended a 2-day course in Oxford, where he profoundly stated, “Everything in life, in a way, is a double effect,” which struck me as profoundly true.

I share my feelings with everyone who has had the privilege of encountering this truly great person, who imparted his knowledge and helped develop Palliative Care in our own lands. I pay my humble homage to him. May his soul rest in peace.

Dr. Robert Twycross’ seminal textbook laid the foundation for my palliative care education. I was fortunate to receive mentorship from a direct disciple of Dr. Twycross, which further enriched my training and ignited a passion in me and fellow young palliative care enthusiasts.

I first met Dr Robert Twycross in the early nineties when he conducted a workshop at AIIMS, New Delhi, on managing cancer pain, along with Ms Gilly Burn.

The presentations were outstanding and evoked quite a response. I had by then already visited the Palliative Care Clinic set up by Dr MR Rajagopal and Dr Suresh Kumar in Calicut and CanSupport was about to launch its own home care programme, in Delhi, in collaboration with IRCH/AIIMS.

I recall Dr Twycross cautioning me against moving too quickly into palliative care. He was concerned that as a cancer survivor I needed more time to complete my own healing. He suggested that I write an article on my cancer journey for the Indian Journal of Palliative Care which I did.

This was the beginning of several interactions we had at IAPC conferences. He was always supportive and interested in our progress. What I learnt from listening to him over these years was how important it was while treating a patient to never make assumptions and to listen attentively. This meant taking a detailed medical history and reviewing it at every visit. It also required paying careful attention to every medical condition and medication that the patient was taking.

Dr Twycross was passionate in his commitment to quality of life. I remember an occasion when a doctor asked him about a latest medical gizmo. “Why are you so intoxicated by technology” he snapped back.

दर्द की परिभाषा को , सरल आपने बनाया I
जैसा मरीज कहे , उसे ही दर्द बताया II
अध्ययन कर दर्द के तरकीबों का ,सर्वोत्तम पुरस्कार पाया I
कैंसर के दर्द में , मॉर्फिन सब को समझाया II
कड़ी मेहनत कर , रॉबर्ट सर ने लोहा मनवाया I
दर्द क्या होता है मरीज को, CTC में डॉ. सुषमा ने पढ़ाया II
होस्पाइस आंदोलन 1970 मे, अग्रणी भूमिका आपने निभाई I
विश्व मे पैलीएटिव केयर की , अलग पहचान दिलाई II
जब साथ मिला सिसिली सॉन्डर्स का ,
तब मानवता को आपने, बताई सुंदर दवाई I
जब पढ़ाई में आएगी , दर्द की बारी ,
तब याद करेगी रॉबर्ट सर को, दुनिया सारी II

लेखक –
जगदीश प्रजापत
सीनियर नर्सींग ऑफिसर
एम्स जोधपुर

I had the privilege of meeting Dr. Robert Twycross on the second day of joining my MD Palliative Medicine program at AIIMS, New Delhi, in February 2018. It was a fateful interaction, considering the odds of meeting the father of modern palliative medicine, as we study it today, at the beginning of my career in this field. In that brief personal interaction, he left a lasting, positive impact on me. Anyone who has spoken to him will agree that he was a person with a heart filled with kindness and a soul full of empathy, which shone through in his personality.

His words instilled confidence in me when I was uncertain about my future, and from that day on, he has influenced and guided me through his books and articles, which are essential to our education in palliative care. His work will continue to guide young minds joining this field, and those of us who have had the privilege of living in the same era as him will share and pass on stories about his impact on shaping the world of palliative medicine.

He dedicated his life to palliative care and has left a legacy that will live on forever through his extensive work and the values he instilled in all those who had the honor of meeting him.

Robert and Deirdre thoroughly enjoyed their visits to India. They attended many conferences and came to love and admire India.