DEAR LIFE by Dr Rachel Clarke
Rachel Clarke is now at the front line of our fight against coronavirus. But earlier this year she wrote an important book. It’s hard to read now without looking through the lens of our current situation, but please do, because Dear Life brings you closer to death, but in an inspiring way.
Rachel Clarke is an unusual doctor. It took her until her late twenties to decide to become a medic, years after first discussing the possibility with her father, a wise and much-loved GP. After initially rejecting medicine in favour of studying PPE at university and then working in TV, her vocation began to call. From the start, Rachel’s real-world background meant she took a mature and questioning approach during her training, particularly when it came to how the medical profession deals with death. Which is not very well. She discovers that student doctors are trained to suppress their feelings. Compassion and sympathy are recognised only as signs of weakness. The junior doctor who struggled in vain all night to save a young woman’s life is told brusquely by his consultant at the following morning’s meeting that his efforts were ‘a waste of time.’ Everyone else studiously ignores the tears coursing down his face. Meanwhile people face death bewildered, battered and in needless pain having suffered endless procedures from doctors hellbent on advancing medical science rather than their patients’ best interests. CPR resuscitation is a full-on assault, a good deal more likely to result in broken ribs and brain damage than the miraculous ‘television effect’ recovery we see on screen.
Hospital medicine appears at times to be a hostile and frightening world where only nurses offer compassion and common sense. It's all a bit depressing, or it would be without Rachel’s own strength of purpose. She decides to become an end-of-life care doctor, entering what yet another heartless consultant dismisses as the “palliative care dustbin”. But here, astonishingly, is a land of hope, where some patients overcome their lifelong fear of death, and others find solace in nature or enduring vows of love. One young woman, in an unbearably moving episode, even gets married.
This book presses your nose up against dying, that last taboo, and it's refreshing, honest and thoughtful. It's also well-written; a testament to Rachel’s bookish childhood and decision to choose English A level over Chemistry. But mainly it bears witness to the influence of her father. Jointly they confront his own death and this provides the framework for the book along with its most personal, poignant and loving moments.
Rachel never shies away from intimate details, such as her last encounter with her father's smartly-dressed corpse, nor from making us confront our own lack of preparedness for our own inevitable demise. Nor the inadequate state of our health service. This book may make you fear a hospital death and want to demand instead a place in her hospice, with its gardens and paintings and imaginative and compassionate nurses. It also, in a postscript, sets out the stark facts: very few people are lucky enough to die good deaths under hospice care. The NHS provides only a third of funding for hospices, and, at a time when the number of people requiring palliative care will rise by up to 47% by 2040, nearly three-quarters of hospices have had their funding cut or frozen.
Rachel is a campaigner, and these facts give the book even more heft and grit. But throughout, it’s the human stories that reach us; her miniature case studies instantly connecting us with her patients and their loved ones. Her clear-eyed observations, huge compassion, and enormous love and respect for her father give this book its real power. It’s a must-read for anyone likely to die. Oh, that's all of us.