Dear Life: Answering our questions about death without us having to ask them out loud

Dear Life: A Doctor’s Story of Love and Loss

Author: Rachel Clarke

ISBN-13: 978-1408712528

Publisher: Little, Brown

Guideline Price: £16.99

There are some real gems in this tender, at times challenging and almost always vibrant read. Dear Life by Rachel Clarke answers many of the questions many of us have about death and dying without us having to ask them out loud.

It may, however, take a little persistence on the part of the reader to find the gems, in part because Dear Life is somewhat circuitous perhaps due to its ambition. Clark is a relatively junior doctor who is not afraid to take on big issues; an admirable quality but therein also lies the rub.

It is the vitality in Clarke’s writing that carries the reader across the terrain of death and dying almost without knowing how we got there. Clarke writes with a matter-of-factness that is reassuring and lures the reader into areas that we might normally prefer to sidestep.

“Two questions seemed to burden almost every loved one. How long? And, what will it be like when it happens?” is how Clarke describes the concerns of loved ones in the face of death. Dear Life answers these questions, along with numerous others along the way that many of us are afraid to ask.

Clarke is not afraid to grasp the nettle that can sometimes be avoided in hospice and palliative medicine. She directly addresses the use of morphine and the use of syringe drivers as the “feared tools of mercy killing” and assures the reader that neither is true. She goes on to offer a sensitive, yet unsentimental, description of what happens at end of life that I imagine will be reassuring and comforting for people anticipating the death of a loved one or indeed with concerns about one’s own death.

She describes a palliative medicine doctor as a: “Scientist with a hint of shaman. . . . the role of doctor can encompass that of counsellor, teacher, parent and priest.” This is a description I imagine many palliative medicine doctors would disagree with and discourage, keen instead to stress the scientific evidence base underpinning their speciality.

The inadequacy of many hospital environments is (unfortunately) known to many of us who have lost loved ones in such a setting. Clarke offers a fresh challenge to the conventional approach to the built hospital environment: “Why, in short, do you only ever earn a truly patient-centred hospital environment either as a child, on a children’s ward, where surroundings are taken seriously, or by being on the brink of death? Does not every adult human animal deserve this solace in hospital, where distress and anxiety are rife?”

Such a challenge could be considered somewhat naïve. There is no doubt that the built environments making up our acute hospitals are in need of transformation. However, the demands of an acute hospital and a hospice are not comparable.

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.

I did wonder at times if the hospice setting was somewhat romanticised and if Clarke had taken refuge in the hospice herself and sidestepped the underlying issues that bedevil modern healthcare. And who could blame her? She describes palliative medicine as the “one department in the hospital in which I could remain the doctor I had always wanted and hoped to be.” It would be naive to think that there are not many very ordinary deaths and that many people die with all sorts of unfinished business in hospice settings just as they do in hospital settings.

Dear Life addresses one of the most complex and feared realities of what it means to be human; that one day we will die and all those we love will die. Clarke’s vitality, bravery, and humanness serve as a safe emotional embarkation point into a world we one day will not be able to avoid.