What it means to be hu­man

With vi­tal­ity, brav­ery and com­pas­sion, ju­nior doc­tor Rachel Clarke takes on the big­gest is­sue fac­ing us all

The Irish Times - Friday - The Ticket - - BOOK REVIEWS - Paul D’Al­ton

Dear Life

By Rachel Clarke

TLit­tle, Brown, 336pp, £16.99

here 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 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. Clarke 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 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 those 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 naive. There is no doubt that the built en­vi­ron­ments of 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.

‘‘

We might have cho­sen medicine be­cause we wanted to help peo­ple, but doc­tors could not and should not al­low their com­pas­sion free rein . . .

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