Breathtaking
Covid drama
Hot on the heels of the drama about the Post Office scandal, comes one about the Covid pandemic. 
Breathtaking is based on the book by Dr Rachel Clarke which I reviewed during the crisis, and Rachel herself worked with the brilliant Jed Mercurio and Prasanna Puwanarajah (two doctors turned TV writers) to create this series – three powerful episodes. She cried writing it; she cried making it; she cried watching it. Small wonder. The scenes she witnessed, the emotions she experienced in real life, will be forever etched in her memory. I can only dimly imagine the pain of reliving the pandemic this intensely.
For us the programme is raw and unflinching in its portrayal of the horror. Much of it is seen through the eyes of consultant Abbey Henderson, (played by Joanne Froggatt, best known as a maid in Downton Abbey) a young mother of two, who gives her all to patients and staff, all the while knowing her best simply isn’t good enough in these unprecedented circumstances. Because …
..there simply aren’t enough staff to cope with the overwhelming deluge of sick people;
..protective equipment is inadequate and in short supply;
..front line staff are using bin-liners and visors made my schoolchildren;
..care has to be rationed, decisions made about who lives or dies;
..death statistics are astronomical;
..triaging is ineffective;
..colleagues are dying;
..testing kits aren’t available;
..there is no vaccine, no cure;
..relatives are excluded;
..bad news has to be given over the phone;
..government reports and advice don’t match what’s happening at the coalface;
..false reassurances are being issued by the political and medical leaders;
..terrible decisions are being made with dire consequences;
..guidelines and policies, both local and national, simply don’t square with clinical assessment.
On and on it goes, wall-to-wall catastrophe, tragedy, disaster.
The drama certainly brings to life the terrible burden on NHS staff, exhausted and crushed by the horrors they are seeing daily, the terror of the unknown, but it captures too the beautiful moments where human empathy and sensitivity shine through the despair – a doctor playing his violin for a dying patient; rules being bent to allow a young mother to see her two little girls one last time; distraught staff hugging each other on the changing room floor; staff lining up in the corridors in silent tribute to a dead colleague.
It traces the disastrous decisions made by the government, rendered the more vivid and poignant by footage of the actual briefings and the real politicians and advisors we remember all too vividly standing at those podiums, giving false information, obfuscating, trotting out platitudes. Who can ever forget the Barnard Castle scandal? Or the prime minister proudly commending himself for shaking hands with patients and staff indiscriminately, and going without a mask? Or those photos of partying in Downing Street? Coming as it does after the massive coverage relating to the Covid Inquiry and the exposure of political failures and abuses, it’s hard to watch again the false information and hypocritical assurances about ‘protective rings’ and ‘doing all in our power’ and relaxing lockdown for Christmas. Harder still now we know those making the rules were flouting them brazenly themselves, taking the public for fools.
Emotional viewing but spectacularly effective filming. And something of Rachel Clarke’s own humanity and empathy is embedded in it. This drama must surely win prizes and be a catalyst for change. The official Inquiry is supposed to help us learn lessons for future pandemics, but at times it has degenerated into farce. Perhaps bringing the reality into the lives and living rooms of the public through a TV programme will be a more effective instrument in minimising the mistakes and protecting people in the future. We can only hope so.
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.
Hay Book Festival
I’m like a pig in muck this week!! Hay Book Festival is online again. Wahey! They’ve already reached upwards of 2 million people, and I feel privileged to be one of those visiting and enjoying such thought-provoking and stimulating events. I’m immensely grateful to the team that ensures it happens. They’ve had more than their fair share of technical glitches unfortunately, but I think we’re all acclimatising to those kinds of issues in this era of Zoom. Puts our own mishaps into perspective.
In this first week, I’ve already listened to vaccine hesitancy, the effects of the pandemic, motherhood, grief, the first human cyborg (who has MND), deafness, adoption, racial discrimination … I won’t bore you with a rundown on them all, but three really stood out as exceptionally memorable for me. (Please excuse the quality of the photo – screenshot during the performances, so no time for finesse!)
The title, Life and Death with Covid, sums up one brilliant session. Dr Rachel Clarke, Palliative Care Specialist/author, who’s always good value, was in the chair and sensitively and confidently steered the conversation between herself, the legendary author/poet/presenter Michael Rosen, and a specialist in critical care and anaesthetics/author, Dr Jim Down.
The two doctors spoke eloquently about the impact of the pandemic on staff, and the imperative and willingness to care – really care – for all their patients, be they serial killers or prime ministers, to the end of their lives. Their selfless dedication shone through. Michael Rosen spoke from the Covid patient’s angle. He survived 48 days in intensive care and 3 months in hospital, and compared the attention he was given to the love that drives a father to sit all night beside the bed of his sleeping son. The NHS, in his judgement, is the most ‘caring collective cooperative thing’ he could ever imagine – polar opposite of the Holocaust that killed so many of his relations. One of the most engrossing literary events ever. I simply HAD to buy all three books: Many Different Kinds of Love (Rosen), Breathtaking (Clarke), Life Support (Down). Reviews will doubtless follow on this blog! They arrived lovingly encased in red tissue paper too!
I’ve heard Ruby Wax and Alastair Campbell on the topic of their depression before – both appeared again this year with new books to talk about, but new to me was travel writer and teacher of creative writing, Horatio Clare, talking about his mental health experience.
In Heavy Light: A journey through madness, mania and healing, he has eloquently captured the reality of being sectioned/detained when he developed bipolar disorder, an action he believes saved him. And he really underlined the importance of listening to the patient and tailoring care to individual need. What an articulate and sympathetic speaker. I was riveted.
Then there was Rev Richard Coles speaking to psychotherapist Julia Samuel (the ‘Queen of Grief’ as Richard described her). He spoke eloquently of the devastation, and the powerful emotions of anger, guilt, emptiness, he has experienced following the death of his beloved husband David, who was an alcoholic as well as fellow priest. No empty platitudes or trite sayings or pious hopes from him! And what sensitivity he must bring to bereaved parishioners. Julia Samuel concluded with poignant accuracy that, though he is still grieving acutely, he is taking David with him into a planned future of ministering to prisoners where the effects of addiction are seen as their harshest. A wonderfully honest and moving conversation, laced with humour, about a subject that needs more openness and candour. I’ve heard Coles speaking before; here I think he was at his best.
To be continued …