Hazel McHaffie

Love, life, death in a time of pandemic

Rachel Clark was a television journalist before training as a doctor – that probably helps to explain her brilliance with words and her laser focus on exactly what happened, and when, in the early days of the pandemic.

Her latest book, Breathtaking, spans the first four months of the ongoing Covid-19 pandemic, January to April 2020. At its peak, during that first wave, a thousand people were dying each day. And every single day the grit and devotion of colleagues astounded her. She says she has never been prouder of, or more humbled by, the NHS and its people, but that doesn’t stop her probing beyond the heroism, the sacrifices, to the core of what went wrong.

She knew it would be impossible, and probably inappropriate, to try to convey her inside experience to non-medical friends and family, so she used her laptop to vent her feelings. Writing became an anchor, helping to distil her fears, a compulsion that took her through the night and into the early hours of many a morning. Looking back over her insomniac’s diary much later she discovered that what she’d thought of as an unrelenting stream of darkness was actually illuminated by pinpricks of light. Acts of kindness and solidarity, altruism and selflessness, resilience and decency, shone through the storms, and they glimmer throughout the book which evolved from her midnight ‘scribbling’.

Rachel Clark graciously acknowledges the public’s generosity and sacrifice in withdrawing from the public sphere, foregoing so much that makes society and relationship valuable, in order to protect NHS resources.
Invisible threads of everyday sacrifice tie the world outside to the one within the hospital.

But from the outset, she and her colleagues watched with growing horror and incredulity, the UK’s casual approach to the coming tsunami … the effects of deficient supplies of PPE … delayed restrictions … the exposure of the elderly and vulnerable to risk … the appalling gulf between public rhetoric and supplies on the ground … the Prime Minister’s defence of indefensible behaviour when his chief adviser flouted the rules he’d helped to devise … And she’s haunted by the sense that we are all complicit in the betrayal; the alarm should have been raised sooner, been more insistent, more strident.

She is shocked too, by the spin put on the tragedy. When the UK had the third highest death toll from Covid in the world, and was the worst hit in Europe, senior government figure were trumpeting ‘success’!
How very cheap, how spectacularly expendable, one human life must be to them if the avoidance of tragedy is consistent with the deaths of nearly 27,000 people.
(
Since then, of course, the death toll has risen vastly – currently in excess of 128,000.)

For this palliative care specialist every person, every loss, every family, matters. And in her view, the only reason the NHS was not officially overwhelmed was because so much of its function was suspended. Real people suffered the consequences. Many felt abandoned.

The professional workforce too paid a heavy price. Entering the personal spaces of strangers steeped in the virus again and again involved massive risk.
The Covid ward is humid and restive. We are on the move, no pausing or lingering, with strained expressions and a twitchy hypervigilance that is as exhausting and stifling as the masks we wear. It is all around us, the virus. It coats our clothes, our hair, the backs of our necks, the keyboards we type on, the surfaces we touch. It hangs in the air, it drops on to our shoes, it floats and waits, ready to be inhaled by anyone too unwell to be masked up in a hot zone.
They endured appalling working conditions, worked ridiculously long hours, put themselves through agonising processes. Their own families suffered. Some professionals lived in hotels rather than put their loved ones at risk. Some gave their very lives.

And on top of that they were unable to relate as normal to those in their care.
Kindness, undeniably, is the glue that ensures patients feel safe and hospitals humane.
But now, everything human was taken away – contact, personal details, names, faces, relatives (the cruellest feature of all).
Covid, in short, necessarily compromises every instinct to deliver humane and compassionate care. It violates something at the heart of good medicine – and the cost to the team is profound.
All they could offer from behind the layers and layers of protection seemed …
grotesque, a parody of communication. It could not be less warm, and more wrong.
And even in extremis, as death approached, they could only clutch at the remnants of human contact, to ensure no one was alone for that final stage.
In the end, as death bears down, there is almost no situation that cannot be made better by someone reaching out, with love and tenderness, towards one of our own. What we have, in our grief, is each other.

Rachel’s own compassion and care and humanity, perfect attributes for someone dealing with people at the end of life in palliative medicine, pervade the book. And for her, words are the most powerful drug used by mankind.
No one knows this better than a palliative care doctor. When drugs run dry, when cure is no longer an option, I deal in words like my patients’ lives depend on it. Words build trust, allay fears, dispel myths, inspire hope. They clarify, challenge, encourage and console. Words leap beyond the constraints of masks and gloves and gowns. Titrated carefully, dosed just right, words can take a dying patient all the way from the depths of despair to a place of hope and even serenity … Above all, our word must be our bond.

In the midst of this revelation of the flaws and deficiencies that have characterised the pandemic, the pain, the frustration, the humility, the dedication, glimpsed in this soul-searching book, are themselves evidence of what is right with the practice of medicine. Beyond price, beyond value.

 

 

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