‘This pain, of all pains, cannot be palliated’: a doctor cares for her dying father

Dear Life arrives at a time when the public appetite for the personal accounts of medical insiders shows no sign of abating, with scores of such books having been published in recent years. Their enduring popularity is often — and, arguably, best — characterised as a kind of literary fallout from a decade of austerity and the very public ire this has drawn from health professionals.

Rachel Clarke’s 2017 debut, Your Life in My Hands: A Junior Doctor’s Story, was written partly as a response to the 2015 dispute between NHS junior doctors and the then health secretary Jeremy Hunt, as well as the general impact of austerity measures on the NHS. Dear Life offers shades of the same criticism (‘I wish I could drag a government minister by the scruff of their neck… to see for themselves the reality of a health service pared to the bone’), but here the focus is on broader issues. Clarke writes of the desensitising effect of medical training (‘empathy… was under assault from day one of medical school. With biochemistry and anatomy filling our days, one way or another, people were reduced — either to chemical interactions or to corpses on slabs’) and the impact this can ultimately have on patients.

Conversely, palliative medicine ‘places patient, not disease, centre stage’ — a principle Clarke espouses convincingly in this book: ‘Why do you only ever earn a truly patient-centred hospital environment either by being a child, on a children’s ward, where surroundings are taken seriously, or by being on the brink of death?’

Her reflections on the health service and her career take on a different hue when she learns of her father’s cancer diagnosis. ‘My patients are now the face of Dad’s future. This jaundice, this pain, these thinly papered ribs and sternum, all of it is coming for him, I know it,’ she writes.

As Clarke struggles to reconcile in her mind the fact of her father’s dying, a portrait of him and their relationship emerges. She describes a man who was — as a doctor himself — her ‘two-dimensional childhood hero’, but who, as she grew up, she got to know as a ‘reserved, self-questioning doctor who wore his losses and failures — his patients’ deaths — like rust around his heart’.

Later, she describes the act of bathing his frail body, days before his death — ‘these arms that once threw me high above his head, these ribs into which he would enfold his infant children, these shoulders that carried us like proud little monarchs, these thighs I reached towards while learning how to walk’. These descriptions of her father and their relationship are some of the most touching parts of the book. Grief and love become synonymous. ‘Grief is the form love takes when someone dies,’ she says: ‘Simply and starkly, the one becomes the other.’ She concludes: ‘This pain, of all pains, cannot be palliated.’

Clarke’s writing on her relationship with her father and his eventual death is beautiful and poignant. However, for much of Dear Life, the father-daughter relationship (and to a certain extent, palliative care) takes a back seat; Clarke dedicates the majority of the first half to her time as a junior doctor, covering some of the same ground as her debut. The result is a book that, although eminently readable and often moving, lacks the focus it needs to make it a truly great one. Nonetheless, it is interesting. Clarke challenges our assumptions about what it means to be ‘dying’. ‘If a single principle underpins palliative care,’ she writes, ‘it is that living and dying are not binary opposites.’