What does it mean to live despite the fear of death? For me, dying is a mere existential dread, softly bobbing in my idle brain. I’m sure that many can relate, the worry neatly fitting between rushed meetings or supermarket runs. However, for cancer patients, the thought of dying is likely much more constant. Physical pain aside, the fear associated with the disease “is a paralyzing attack in its own right,” wrote UK gardener and landscaper Maggie Keswick Jencks in A View from the Front Line. The book details her own experiences with breast cancer, including her eventual remission in 1993. Her fatal diagnosis was given in the cramped corridors of Edinburgh’s West General Hospital, where she had been told sympathetically, but bluntly, that her life would likely end in three months. Death likely weighing heavy on her mind, Keswick Jencks recounts that personal action had combated this anxiety. This principle would serve as the foundational basis of her lasting legacy: Maggie’s cancer centers.
The Maggie’s organization was founded in 1994, when Keswick Jencks and her nurse, Laura Lee, started planning the first cancer caring center. This program would focus on providing psychological healing and educational resources for patients battling the disease. Their mission was aided by Maggie’s husband, Charles, the Postmodern theorist and designer, whose connections brought in high-profile architects to design the buildings. The first had been designed by Richard Murphy, who produced the first drawings in 1995 for the initial site at Maggie’s Edinburgh. This had expanded an existing stable near West General Hospital. While Keswick Jencks herself would not live to see it, the building would open a year later, in 1996. It was a success, and eventually multiple sites were established, all designed by top-tier architects, Zaha Hadid, Rem Koolhaas, and Frank Gehry among them.
It’s clear that Keswick Jencks intended for more than mere aesthetics. Programmatically, these places would be loosely classified as cancer-oriented community centers, arming their guests with varied books, informational pamphlets, and financial aid resources. These centers would teach cancer patients to “not lose joy in the fear of dying.” Visitors can attend free one-to-one sessions with cancer-support specialists and psychologists. Diverse support groups meet in solidarity to talk, engage in workshops, or fundraise. This last item allows them to remain private institutions, separate from their sister hospitals. Twenty-four locations are scattered across the UK, with a few settled internationally, and holistically these buildings facilitate Maggie’s goal wonderfully. They are warm, light-filled spaces, described as evoking a welcoming safety.
Something has nagged at me, however: they are all completely different designs. This fascinated me, a healthcare designer. Each building’s unique construction notably contrasted yet resonated similarly, from the dark, sharp lines of Maggie’s Fife, by Zaha Hadid and landscape architect Gross Max, to the treehouse-like structure of Maggie’s Oxford, by Chris Wilkinson of WilkinsonEyre and landscape architect Flora Gathorne-Hardy. How were these psychological effects, this hopeful ambiance, present across such variations? Several video calls and one international fight later, my Maggie’s road trip began.
To start, some pre-research groundwork must be laid out. Any center’s initial design is derived from the Maggie’s Design Brief, which is publicly available and given to any prospective architects. It’s a critical must-read to understand the centers’ planning process that lays out approaches for the site, interior, and certain spatial requirements. With regards to site, the brief notes the building must be close to, but not within, a hospital. An impressive garden should lead to the front door, with plants that could thrive in any weather. Herb gardens are encouraged, as chemotherapy can alter the senses of a cancer patient. The changing of the seasons would be incorporated, reflecting a similarly transforming world. Lily Jencks, landscape architect and daughter of Keswick Jencks, also noted that gardens help visitors connect with nature, or “something bigger than themselves.” Plants that dissolve edges and landscapes that cast playful illusions can aid this.
Crucially, the interior should also be domestic, much like a home—no sterile corridors or confusing layouts allowed. Instead, moveable furniture and familiar furnishings are provided. Near the entrance, a community board calendar would be posted, used for fundraising and tracking group activities. The scale of the building would likewise be smaller, with no signposting aside from the main entrance. Natural daylight and garden views should be abundant, subtly blending the exterior and interior. Ideally, there also should be shrubs or trees planted for visual and acoustic screening.
The brief also mentions certain spatial requirements. The kitchen is a must-have, with a large table acting as a social hub. Preferably, a hearth would warmly welcome those nearby, and tucked away would be the resource library, packed with educational pamphlets and books. The two soundproof, ADA-accessible toilets also would serve well for any private moments, including crying. Several sized rooms additionally would be provided: a large one for group activities, a medium-sized one for workshops, and smaller ones for private counseling. Notably, these should also be flexible as needed for privacy. Little “pause” spaces similarly allow guests to freely tuck away in isolation.
This information served as my primary research, but it felt lacking. I needed to see the centers in person. So, I contacted Lottie Ion, a quality and evidence researcher, who facilitated my conversations with the staff of Maggie’s. Their permission in hand, I began traveling across the UK. Over two weeks, with seven site visits crammed between train rides and hotel chains, that experience confirmed my suspicions. There was a philosophical answer to this feeling: heterotopia.
The term “heterotopia” was coined by the philosopher Michele Foucault in his essay “Of Other Spaces: Utopias and Heterotopias.” These spaces reflect reality but retain a separate existence, a specialized smaller world informed by the exterior one. Suddenly, the atmospheric unity of Maggie’s centers made sense to me. The Design Brief does not merely creating optimal cancer centers; it literally crafts isolated, tailor-made sanctuaries free from society’s taboos. Guests are granted a sense of emotional safety here, since only people with cancer or their families can visit. This creates a soft barrier, filtering only those with a shared experience in one environment. The physical and aesthetic distance from the hospitals hints at heterotopia too; it grants a welcome reprieve from the clinical, weighing atmosphere. Additionally, the furniture, artwork, lighting, and kitchen table all reflect a literal residential home: a relatable mirror acting as soothing anodyne.
My first Maggie’s was West London, by Ivan Harbour of Rogers Stirk Harbour + Partners and landscape architect Dan Pearson. The building sits on the bustling street of Charing Cross Hospital. As we arrived, my companion, Dr. Neha Pancholy, and I felt exhausted, two lost tourists on a hot August day. Approaching the center, our stress levels dropped, pleasantly easing during our walk from the garden footpath to the canopy’s dense foliage below. The cacophony had left us, creating a pause as we crossed into the heterotopia. Then, inside, a smiling volunteer welcomed and shepherded us to the kitchen counter, urging us to brew our own tea. The center’s head, Sinead Cope, later explained how intentional this sequence is, before commenting on the other ways people utilize the space.
Some, like the couple we spotted distantly by the entry, rested privately and fill out time. Others perhaps climbed to the spacious, daylit offices above to talk with one of the staff members, who serve as psychologists, benefits advisers, and cancer specialists. Most flocked around the large wooden kitchen table, connecting over the framed garden view. Finally, Cope pointed out a large, closed-off room, where a workshop likely had started. The larger design of Maggie’s West London had seemed so striking to me then, with a bold orange speckled with wooden details. The tall hearth made it homey, reminding me of larger residential homes in my home state of Pennsylvania.
In comparison, Glasgow Gartnavel’s materials were chiefly glass and concrete. Unlike Charing Cross, it straddled the hospital property line and the woods nearby, viewable through expansive curtain walls. This glass donut designed by Rem Koolhaas and Ellen van Loon of OMA did not initially give the “homey” vibes of West London. Cancer Support Specialist Stuart Danskin whisked me through the circular corridor on a tour, illustrating how transparency could equal emotional security, and it began to make sense. I eventually warmed up to the comfortable couches, shorter wooden ceilings, and scattered throw rugs, the familiar furnishings reflecting back to me memories of friends’ apartments.
Later, Stuart recounted how the open concept design unintentionally aided in his one-to-one sessions. Falcons would hunt dinner during discussions of the circle of life, and foxes occasionally escaped inside as strange distractions. The natural surroundings clearly allowed patients to relate to them, forming a cathartic outlet. These gardens that tie into the nearby woods had been carefully designed by Lily Jencks, who at the time had been working with Harrison Stevens Landscape Architects. This mirroring of natural cycles with visitors’ lives aided this heterotopia as well, I thought while gazing outside. I saw the Glasgow Gartnavel General Hospital peek out only slightly from that view, winking behind carefully planted trees.
I found the branding of Maggie’s as a whole interesting, especially in comparison to the context of typical hospital design. Most hospital networks have their own practical standards and distinguishing aesthetics, even for outpatient facilities. It had initially struck me as curious why Maggie’s went with such individualistic designs rather than more consistent branding, even if each facility operated as a community center. Wouldn’t a unifying look make it easier for cancer patients to locate the sites? This thought would haunt me especially at Maggie’s Oxford, where I had become lost due to poor signposting and visibility from the main road. Additionally, I wondered how each Maggie’s had been able to balance the Design Brief requirements with such strong aesthetics. Maggie’s Dundee, for instance, has Frank Gehry’s stamp all over its wavy roof and surreal smokestack. Yet, upon my visit, it still gave that vernacular yet hopeful feeling as the other two sites I visited.
The reality is that Maggie’s does have a strict branding—it’s just more subtle and nuanced. Any design decision, including the kitchen teapot, must first be approved by Maggie’s in-house architect, Diego Seisdedos. This is why the furniture at Glasgow Gartnavel isn’t the sleek, clinical style we know of Koolhaas’ typical projects. Other staff must give their approval as well, such as Chief Executive Laura Lee, who was a former clinical nurse specialist, and, notably, Keswick Jenck’s nurse. Post-occupation surveys are used, and ongoing feedback at existing sites informs new ones, as well as expansions. Benefits Advisor Anne Foster noted this especially at Maggie’s Edinburgh, where they constantly require more space due to the facility’s popularity. As it turns out, these sites are intensive products of collaboration rather than singular visions. I believe their impact would lessen if they had the same “marketable” appearance. Everyone’s home is a little unique after all, and this is why each site carries such strong, hopeful narratives within it. The differences from each heterotopia emphasize their own unique contexts, and our own unique perspectives in turn as well.
There are many examples showcasing this. For instance, psychologist Claire Kempton had pointed out delightful floor cutouts at Oxford Maggie’s, where she recalled how children could be seen running beneath the building’s shade garden. Meanwhile, at Fife, a frequent visitor eagerly spoke of how his Maggie’s supported him, how its smaller size but impressive form made it relatable to his local working-class neighborhood. The group gathered at Maggie’s Dundee, by Frank Gehry, had a similar camaraderie. They chatted actively while gazing at the nearby garden and swirling labyrinth, designed by Arabella Lennox-Boyd. My journey eventually ended at the original Maggie’s Edinburgh, where psychologist David Glass hypothesized that their spaces serve as “a warm glow, womb-like to cushion from the darkness.” This is an easy visual for me, as the cheery landscape by Emma Keswick had cradled the building away from the gray hospital exterior.
These are not my narratives, but I am glad that they exist. For the hopeful liminal heterotopias of Maggie’s clearly are aspirational. Their designs invoke personal agency, providing for those who need them the most. “To not lose joy in the fear of dying,” as Maggie Jencks herself had put it after all, requires great courage. That architecture could somehow aid this, urging others to combat fear … to me, that’s incredibly hopeful.
Featured image: OMA’s Maggie’s Glasgow Gartnavel interior. All photos by the author.