Dear Life, by Rachel Clarke

Author: Rachel Clarke. Review by Bob Lovett

This book may change your thinking – it has done mine. It deals with life and death and the journeys of those who are terminally ill. And yet it is about so much more than that. It is joyful, sad, funny, compassionate and above all full of love, celebrating the gift of life. I found it profoundly moving. I was frequently in tears.

The former journalist Rachel Clarke decided to retrain in medicine to follow in the footsteps of her father, a GP. In the course of her training she came to realise that amid the excitement of departments like A&E, the whole focus of medicine was to sustain life. Wonderful though that work was, deaths occurred, and once it was ascertained that nothing more could be done for a patient, interest was lost and provision for that patient then became low priority. Death, despite its inevitability, represented failure. Not of individuals, but of the system and its expectations.

While an active supporter and defender of the NHS, Clarke challenges aspects of its culture and its training. She offers an alternative script for our end-of-life journeys. Life is for living, she says, repeatedly. She believes that with adequate resources and with imagination and understanding, terminally ill patients and their loved ones can face the final journey without fear. It is for all these reasons that she decided to specialise in palliative care, to demonstrate that those with only a tenuous hold on life can still live out their remaining time with dignity, fulfilment, pleasure, and even humour. Most importantly, she reminds us that the dying have something to say to us about our own inevitable end-of-life journeys.

Clarke’s stories are poignant. None more so than that of her own father’s death. They are stories of fears allayed, panics calmed and relatives reassured. They are stories of lives lived as fully as possible, of living adventurously and taking calculated risks. Of course, these are the good news stories. There will have been others too harrowing to tell but Clarke does not flinch from the truth, always reassuring patients that help will always be on hand.

In April, Meeting for Sufferings will consider assisted dying. I have lobbied for changes in the law to make that possible, though protecting all interested parties might be fiendishly difficult. In her postscript, Clarke explains why she has deliberately not dealt with this issue. But given her emphasis on providing her patients with choices, one might assume she would not necessarily be opposed. Her main thrust is to expand palliative care, for it to be given the same status as any other branch of medicine, and for it to be totally funded from the nation’s coffers.

Two quotations from the book remain with me. One is Philip Larkin’s ‘What will survive of us is love’, and the other is from Ted Hughes: ‘The only calibration that counts is how much heart people invest, how much they ignore their fears of being hurt or caught out or humiliated. And the only thing people regret is that they didn’t live boldly enough, that they didn’t invest enough heart, didn’t love enough. Nothing else really counts at all.’

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