"It takes courage to love the things of this world when all of them, without fail, are fleeting, fading, no more than a spark against the darkness of deep time." The author grew up riveted by her father's stories of practising medicine, and eventually she fulfilled her deep-seated desire to become a doctor herself, and a specialist in palliative care. Then when her beloved father received a terminal diagnosis, she had to relive all her training in the most personal way possible.
This astonishing book by Doctor Clarke will make you re-evaluate your own life and priorities. Deeply moving.
Clarke’s writing on her relationship with her father and his eventual death is beautiful and poignant. However, for much of Dear Life, the father-daughter relationship (and to a certain extent, palliative care) takes a back seat; Clarke dedicates the majority of the first half to her time as a junior doctor, covering some of the same ground as her debut. The result is a book that, although eminently readable and often moving, lacks the focus it needs to make it a truly great one. Nonetheless, it is interesting. Clarke challenges our assumptions about what it means to be ‘dying’. ‘If a single principle underpins palliative care,’ she writes, ‘it is that living and dying are not binary opposites.’
Clarke recounts a conversation with an exhausted colleague who patrols those corridors, looking for people who might warrant a rare bed in the intensive care ward – this, in the world’s sixth richest economy. “‘It’s beyond inhumane,’ he mutters flatly. ‘I was literally playing God, choosing who will live or die.’” In moments like this Dear Life is a heartbreaking, exhilarating read: Clarke shows that such choices are a vital but small part of medicine. Like taxes, death is notoriously inevitable; a truly humane society would be concerned not just with when it happens, but how.
I sobbed over the little boy who brought his sixth birthday party forward a couple of weeks so his grandfather would be alive to celebrate it with him. In the centre of the singing, laughter and flying wrapping paper sat a painfully haggard man ‘whose eyes nonetheless seemed to glow’. He died two days later. He had been dreading his final moments in which he pictured himself fighting for air. In the event, ‘There was no panic or fighting or flailing to breathe, just the ebbing of life like a tide in retreat, quietly unveiling cold sand’.
Grappling with the issues concerning the place of compassion among health care staff, she writes: “We might have chosen medicine because we wanted to help people, but doctors could not and should not allow their compassion free rein . . . But, as students, no one ever discussed this with us. Indeed, doctors did not seem to acknowledge the emotional toll of their work at all, affecting, instead, to take it blithely in their stride.” Clarke raises several fundamental issues, like the place of compassion in healthcare in Dear Life, but regrettably, she does not get to the systematic and structural issues underpinning such failings. In part, this may be because Dear Life is simply too ambitious an undertaking in the hands of a junior doctor and as a result issues of critical importance are little more than nodded at.
There is much to admire in this honest account from the front line of death, though I rather itched to take a scalpel to some of the early chapters and found myself skipping over anything unrelated to the core story of life at the hospice and Clarke’s relationship with her father, who had practised in the Swinging Sixties and used to buzz around the streets in his scarlet MG and drink his post night-shift pints with the meat men from Smithfield Market.
Drawn to patients with “life-limiting” illness, she decides to specialise in palliative medicine and goes to work in a hospice, a place “steeped in fear and taboo”, where she spends her days not just as doctor, but as priest, hand holder and confidante. As much as it’s about knowing when to up the dose of morphine, the job is also, crucially, about listening to stories and fulfilling final wishes. One patient, a Star Wars fan, tells Clarke he had imagined the hospice to be the Death Star and she replies that she’ll try to be more Princess Leia than Darth Vader.
Clarke repeatedly describes her own fallibility: the mistakes she makes, the fear and recoil she feels, the cases that go wrong. She lets us see her as a doctor, but also as a daughter, a wife, a mother. The compartments are not neat: she works as a scientist, but also as a counsellor, a teacher, a priest, a fellow human being. Her heart is in her job. There are many thrilling doctor-as-hero accounts, and they are often by men; there are fewer doctor-as-healer ones, and those I know of share the kind, unironic and emotionally invested quality of Dear Life.
The book should also be essential reading for anyone who cares about our beleaguered health system. Clarke powerfully conveys the battering the NHS has endured over the past decade of austerity, neglect that has resulted in overcrowded hospitals and the rise of “Corridor Medicine”.
In his poem, Carver says that “a sweetness” in life prevails at intervals given a chance. Dear Life is a painful read at times, because it forces you to reflect on some of the worst situations anybody ever has to face. However, the book is also a compassionate gem, full of its own episodes of sweetness. I won’t spoil the story, but Clarke’s true anecdote about the “magic string” that helps children facing radiotherapy is heartbreaking and inspiring.