Hazel McHaffie

Life, death and empathy

It’s a trite saying: live each day as if it’s your last, but when someone is handed a diagnosis of terminal illness it can become a dramatic reality. ‘Nowness’ – the heightened immediacy of each lived moment – becomes vivid and immensely valuable. How the person is treated, and by whom, matters enormously. This is the substance of the book, Dear Life, by Dr Rachel Clarke; a story of love and loss, both a personal journey and a moving analysis of what truly counts.



People frequently question her as to why anyone would choose to immerse themselves in the world of the dying, but for her there was a kind of inevitability about her decision, because of her natural inclinations and preferences; because of who she is. So who is she?

With a doctor for father and nurse for mother, Rachel had an early introduction to the reality of death, but in her teens she was more inclined to words than science, and she elected to study Philosophy, Politics and Economics. From there she went into journalism and documentary making. It was only when perfectionism and depression led to burn-out and suicidal thoughts, that she retrained as a doctor.

It took a further five years to achieve the transformation from journalist to medic, being tempered, toughened into hard doctorly competence, during which she tiptoed through a minefield – scientific curiosity vying with human kindness; detachment learned the hard way struggling with natural empathy.

… as fledgling doctors-to-be, our role required us to stifle, not voice, our feelings and instincts.

No; emotions were illegitimate and gauche, to be ignored and denied.

She could indeed see and appreciate the sheer necessity of putting emotions on one side to survive in areas like a busy A&E department crammed to the gunnels, with patients on trolleys overflowing down corridors, exhibiting a whole range of illnesses from cradle to grave, living to dead. There was no time to forge relationships or really engage with patients; it was a matter of prioritising the critical, clearing the trivial. Efficient use of time, saving lives. But this wasn’t for her.

I wanted the opposite. I wanted to retain my kindness, my impulse to care, not have it bludgeoned out of me.The spoken word, I had come to realise, could be as delicate and important as any physical intervention, and sometimes equally life-changing. Words are a means through which doctors build trust, assuage fears, signal compassion, resolve confusion, instil hope – and on occasion, remove it.  But they cannot be rushed. Above all, when your focus is people, not body parts, taking time to listen to your patient’s words – seeking truly to understand what matters to them – can have astonishing potency.

And yet, even after all those years of training, she feels ill-equipped for dealing with patients in this way. The knowledge she has acquired relates to illness; she knows precious little about the people presenting with those maladies.

I may have filled my brain to bursting with names, numbers, drugs and diagnoses, but I was taught next to nothing about the muddled, uncertain, inconsistent, illogical, forgetful, fearful, frightened, doubtful, real-life flesh-and-blood people who, just like me, inhabited a nuanced world of endlessly shifting grey, not the black-and-white certainties of my medical bookshelves.

Personal experience of medical treatment teaches her a salutary lesson. She learns what it feels like to be vulnerable and what counts – the harsh and alien world of the unwell, the scale of doctors’ demands on them, the powerlessness of patients, the sheer force of small acts of kindness, and the capacity of simple human touch to transcend primal fear. And in so doing, she acquires something vital: a means by which she can empathise with her patients. She understands what really matters. So powerful is this lesson that she would prescribe a decent dose of temporary illness for every medical student – something sufficiently grave to stoke genuine fear, involving at least a couple of distasteful procedures …!

The deaths from cancer of her mother-in-law and her own beloved father also have a profound effect on her. She learns that in the last throes of life, superlative care is crucial: medicine at its best; the patient, not the disease, centre stage; every single person an individual each with their own history and dreams, likes and preferences, opinions and beliefs; e ach with their own views on dying. And she learns the true value of being with someone, responsive to their fears and grief.

… the act of being present – not walking away from acute grief – can be the best any physician can offer.

Small wonder, then, that this remarkable woman chose palliative care, and works in a hospice, where time and efficiency have a different meaning. Where sitting holding a hand, organising a wedding, providing a beautiful view, can bring peace and solace every bit as much as drugs and interventions.

Dear Life is a remarkable book at once tender and funny, full of joy and grief, kindness and sadness, triumphant and anguished. And beautifully written – as befits a journalist who has loved language since toddler-hood! Dr Rachel Clarke is exactly the kind of doctor we should all want to take care of our nearest and dearest in the event of their becoming terminally ill. Compassionate, generous, kind and caring. Ready to fight for the very best of care. And how the NHS needs people like that!


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