Britain made and the USA has lost Audrey Evans, Creator of 'Staging' for kids with cancer and Ronald McDonald Homes for their moms and dads

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Audrey, who has died at the age of 97, was born in March 1925, in the cathedral city of York in North-east England, the youngest child of the three children of Phyllis and Leonard. Seen here, on her mother's lap, with the family nanny between her and her older brother and sister. Hers was a comfortably off, middle class family and her father was from a large Congregational family. He had wanted to study medicine but was precluded from doing this because he had been seriously wounded in the First World War and instead joined the firm in York his father worked for that made paper bags and pioneered the manufacture of what became Sellotape.

Audrey had determined from the age of five to become a doctor and having assembled a homemade first-aid kit of bandages, cotton balls and a tiny bottle of antiseptic, used it to tend to any animals in need. Many years later, speaking of the role she played in setting up the St. James School in West Philadelphia, which helped underprivileged children by providing them with an extra year at school, free from tuition fees, she said : "I still have the ability to do something for the benefit of humanity. I've always had a strong belief in an inner God, who watches over us and takes care of us and has expectations of us to do a good job with the life he gave us. I had been fortunate in that I had a very good education and I know what a good education and I know what education does for you".

At some point in her childhood she had a serious accident which resulted in scalp burns and she missed a considerable amount of time from the Mount School, an independent Quaker, school for girls in York. Then, at the age of eleven, she was packed off to a boarding school for girls in Bristol, a distance of 250 miles from her home. She once told an interviewer that her parents : “Believed that girls should do as well as boys” and encouraged her in her education. In the event, Audrey was only in Bristol until she was fifteen. After the Second World War had broken out in 1939 and, no doubt, given the fact that Bristol was a target for German bombing in the War in 1940, her parents called her back to York. Here she rejoined the Mount School, which was run along clear Quaker principles and would, a few yers later, educate the actress Judi Dench and the novelist, Margaret Drabble. 

Her senior year at the school was blighted by the fact that she contracted tuberculosis and spent a year recovering in hospital. The loss of education meant she struggled to get the qualifications she needed to become a medical doctor and follow in the footsteps of her elder sister who had attended the Royal College of Surgeons in Edinburgh. She was twenty-three, rather than eighteen by the time she enrolled. “I always knew I wanted to be a doctor,” she said in an interview for a 2017 episode of 'Modern Hero', an American documentary series about extraordinary women. She added : “Fortunately, my parents believed that girls should do as well as boys, so off I set”. 

Audrey wasn't fazed by the fact that she was the only female student in the medical school and said : "I wouldn't call it hard" being surrounded by men, "More, amusing". (link) Although in her later career in medicine she demonstrated that she had a brilliant mind, in these early days she struggled with her ability to learn and ended up failing her first year anatomy exam, which forced her to resit. Fortunately, she was able to identify her failing by the fact that she learnt best by focusing on listening-based learning methods rather than reading volumes of text. In the case of anatomy, she looked at pictures and was talked through what she was looking at. (link)  

She graduated at the age of twenty-eight in 1953 and then spent a two years residency and was the only woman in the Royal Infirmary Teaching Hospital in Edinburgh. She was barred from the men’s cafeteria and dormitory and slept in a bedroom in a tower and had to share the men’s lock-free bathroom, where she recalled singing loudly to ward off intruders.  

Her next professional move brought her to the United States for two years on a 'Fulbright Fellowship' and to Boston Children’s Hospital, where she studied with Dr. Sidney Farber, the noted cancer researcher. She was affected by a drawing on his office wall which showed a circle of caregivers with the family at the centre, which started her thinking about how illness affected more than just the patient. It would be the start of her career as a pediatric oncologist and was a time when there was little hope of curing children with cancer. Although, in his seminal study in 1948, Sidney had demonstrated chemotherapy’s ability to fight cancers of the blood and he hoped to prove that chemicals could eradicate solid tumors as well. 

Then, in 1955, she went to Johns Hopkins University to finish her medical training and then returned home to Britain, where she was determined to pursue a career in specialty pediatrics, but soon found that this field was strictly for men and not women. As a result she now returned to the United States, to pick up her career in pediatric oncology where she knew she would be less likely to be thwarted by prejudice on grounds of her sex. It was here that spend the remaining sixty-five years of her life and construct a career which would improve the lives of thousands of children with cancer and help families cope with both the challenges of the disease and its treatment. 

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Rejoining Dr Farber in the Boston Children's Hospital, at his request, Audrey and Giulio D’Angio, a colleague who later became her husband when she was eighty in 2005, co-wrote a 1959 study on the effects of radiation and a chemical antibiotic in children with a type of kidney cancer. Their study provided the first evidence that chemotherapy could combat solid metastatic tumors.

At the age of thirty-nine in 1964 she left Boston for the University of Chicago, to work at their 'Hematology and Oncology Unit' and it was here that she was recruited by former U.S Surgeon General and Surgeon Chief at the Children's Hospital of Philadelphia, C. Everett Coop, to create the pediatric oncology unit. In the event, she was to spend the rest of her career there, serving as the Chair of the Division of Oncology from 1969 to 1989 and was appointed a Professor of Pediatrics at the University of Pennsylvania School of Medicine in 1972. 

Audrey herself said : "It was a perfect job for me. I was taking care of sick kids and I was listening to this sermon at church and God calling a woman who cared and I thought : 'Wow, that's who called me. So I knew at that sermon : 'God. That's why I came to Philadelphia : to take care of children with cancer'. Because, the time I came, there wasn't much else you could do". In the years that followed, Audrey played a major part in bringing an end to that bleak prognosis for children with cancer, not just in Philadelphia, but across the USA and around the rest of the world. (link)  Over sixty years later she would tell Julia Fisher Farbman :"I was given a mission and I was given the ability to serve it". (link) 

She now embraced what became known as 'Total Care', to address the physical and emotional needs of patients and their families and as an aspect of this, she allowed frightened children to bring pet parakeets, rabbits and hamsters into the oxygen tent or radiation chamber. In addition, she installed a floor-to-ceiling bird cage stocked with finches to entertain her patients. 

Audrey said : "I wanted to make life in hospital more fun or more tolerable. As far as I was concerned anything that anybody wanted to do would go. One child wanted to bring her bunny into the hospital with her and I said : "That's fine. Go ahead and bring your bunny". This particular child, in radiation therapy, she would not lie still". In the event, Audrey accompanied the child and the bunny to the therapist and after the bunny had been treated, the child, without wriggling had her dose of therapy. (link) 

She later said that she “got away with things,” because few hospital administrators were willing to visit the pediatric oncology ward which was a depressing and increasingly crowded place. She later recalled : “Fortunately, nobody liked oncology. The people who run the place would rather not go to the oncology floor. So I got away with things I could do in oncology, which I’m sure you couldn’t have done on a healthy ward”. 

Audrey said : “A family with a sick child is a sick family. So you must think about everybody - the siblings, the mother, the father, maybe grandmother. You must remember that they’re part of a group”. 

She recalled : “The families just ended up staying in the hospital, in the hallways and in the bedrooms. There were people all over”. Occasionally she used her personal credit card to book hotel rooms for exhausted parents and at other times sent the mothers to the YWCA and fathers to a hostel. What was needed, she said was : "A house where I could send the moms and dads together”. She envisioned a 'bed-and-breakfast' where families could retreat from the hospital and stay for months with other families in the same plight and a large Edwardian house near the hospital at 4032 Spruce St, caught her eye.

This was the early 1970s and the three-year-old daughter of Philadelphia Eagles 'tight end', Fred Hill, was being treated for leukemia at a nearby hospital and he began began raising money for research. Fred's teammates had held a few fundraisers and when they heard of Audrey's needs, they presented her with a check for $100,000'. She recalled : “I gratefully accepted but said : "What I really need is money for a house" ". 

Help came from Jim Murray, the team’s General Manager, who had created a sponsorship relationship with McDonald’s, the American-based multinational fastfood chain. Jim proposed promoting the company's 'shamrock mint milkshakes' in return for a share of the profits to be donated to Audrey's house and in exchange for naming rights and the proviso that the Philadelphia house be named after the company’s familiar clown character. As a result 'Ronnie’s House' opened in 1974. Audrey had often spoken of feeling that God had called her to care for children and Jim said : “I couldn’t cut open a frog. I couldn’t even pass biology and here I was talking to all these doctors" and of Audrey he said : "She didn’t know what the Eagles were, but God put us together".(link)

The Ronald McDonald House later moved to 3925 Chestnut St, with more rooms and better resources and now included summer camps and entertainment. The 'Ronald McDonald House Charities' was officially set up in 1984 and has since expanded to more than 360 locations in 63 countries, including one in a remote part of China, providing comfort and support to over seven million families worldwide, offering long-term rooms near hospitals for either for free or a modest donation. Audrey knew the houses would provide emotional support as 'veteran' families mingled with newcomers and said : “People in these houses know the trials of having a sick child and will help if you want to cry and help if you want to celebrate”. (link)

In the Children's Hospital of Philadelphia, Everett Koop was intrigued by Audrey's research on 'neuroblastoma', a cancer of immature nerve cells that is the most common type of cancer in infants. It had been rarely studied before Audrey took an interest in the disease, which in some cases spontaneously disappeared without treatment. As he had hoped, Audrey succeeded in standardizing treatment for neuroblastoma. Using index cards, she began recording data that would help doctors determine the extent of the disease with 'One small tumor' classified a child as Stage 1, or 'low risk' and many widespread tumors deemed a child 'Stage 4' which needed aggressive treatment. 

She published her staging system at the age of forty-six in 1971. It spared children who did not need chemotherapy and radiation their brutal and long-lasting side effects and today, doctors, around the world, use an international staging system that retains key elements of Audrey's initial parameters, taking into account the tumor’s size, location and spread.  During her career, neuroblastoma deaths dropped by half and today about 80% of afflicted children survive the disease. In 2000 the journal 'Cancer Research' declared, in relation to Audrey : 'More than any other person during the last three decades, she has transformed our thinking about neuroblastoma'. (link)

Audrey partially retired at the age of sixty-four in 1989 and then permanently at the age of eighty-four in 2009. She kept busy riding horses, tending sheep and scuba diving. Her love of horses dated back to her childhood in Yorkshire and she was an accomplished rider, having started with a small cart pony and, with no instruction, rapidly became proficient. However, she said that she : “Missed the kids” and felt depressed until she found a new project. 

Now, involving herself in her Episcopal church’s summer program at a shuttered house of worship in North Philadelphia, she helped raise money to reopen the church as the fee-free, St. James Middle School, designed to address inequalities through education. She was a regular presence on campus, where she could be seen walking arm-in-arm with students and said : “I’m taking care of children here, and I was taking care of children with cancer. These kids need help, too”.  (link)

After marrying Giulio D’Angio when she was eighty, after thirteen years of marriage, he passed away in 2018 and Audrey herself did not live long enough to see the feature film ' Audrey's Children', which has been made this year and is expected to be shown in cinemas in 2023. Natalie Dormer, who plays the role of Audrey, has said : "This film brings to light a woman who has spent her entire career ferociously dedicated to saving the lives of children and supporting families who have gone through unimaginable challenges. Audrey has done so with great heart and modesty. I'm honored to be playing her, and to be a part of this inspiring project".

In 2017, Audrey was the subject for the 'Modern Hero' film series and was accompanied by the journalist Julia Fisher Farbman, who said : "Dr. Evans epitomizes Modern Hero in every way. Our team is elated that her story on Facebook has garnered nearly a half million views and thousands of shares in just a few short days, with no sign of slowing down. All I can say is, thank you Dr. Evans, for being an inspiration and a Modern Hero to so many".(link)

Julia said : "When I would go on walks with her she would literally stop and smell the roses, cuddle strangers’ babies, hand out dog treats, which she always carried in her purse despite not having a dog and she’d strike a conversation with anyone who seemed like they were having a bad day. If you asked her why, she would say : "We just made that person’s day a little better. That wasn’t so hard now, was it?" '

In her office in the Children's Hospital of Philadelphia, Audrey had kept photographs of the children she had saved and those she could not. She said : 

“I have learned to be able to talk to children about what dying is like. One of the best things you can do is to be there and to share”. (link)

She expressed this when she assured one girl that there would be flowers in heaven and, on another occasion, sat vigil with a boy until 4 a.m., granting his last wish for chocolate cake.

Audrey said, with perfect understatement : 

"I always say, it was not that I had a wonderful mind or I was very bright, but somehow or other I'd been given the gift to care".