Book review: ‘Dear Life’ by Rachel Clarke

By LARRY BALLWAHN | Wilton

“Dear Life” is a must read. The author, Rachel Clarke, is a British palliative doctor. The book is about how she got there. Rachel’s father was a doctor, the kind of general practitioner who used to make home visits and take care of everybody’s well-being. Rachel admired him even when his responsibilities took him away from the family. Even so, her curiosity and writing skill took her to journalism. But her passion for helping people soon led her to train as a doctor.

Along with citing the experiences and emotions involved in training to be a doctor, Rachel Clarke mentions experiences from her personal life. Her boyfriend’s mother was hospitalized with cancer, widely spread. Rachel finished her exams before going to the hospital, where Dave, her future husband, and his father sat vigil. Sending them home to rest, she sat with Dave’s mother, who was clearly dying. As a medical student, she knew only theory, so she followed her father’s advice: make sure she’s not in pain and make sure she’s not frightened. As her advocate, Rachel eventually asked for the hospital’s palliative team. Their effort clearly made the situation less difficult for the family.

During the remainder of her training, Rachel attempted to become that doctor who was so knowledgeable that every action was automatic. She even sought extra experience with trauma to build her skills. But throughout she was aware of the conflict between the doctor’s effort to save lives and need to let the terminally ill have a dignified ending. A clear example was CPR. “Modern CPR is a brutal, undignified process that was never intended to be performed on patients who are dying from an irreversible condition …. ” She noted that the conflict was emblematic of doctor’s unease with their patient’s deaths.

It has long been a mantra of medicine that if the doctor would listen carefully to the patient, he or she would make the proper diagnosis. Modern doctors know more now than ever, but clinical medicine is less likely to offer them time for active listening. One of the goals of palliative medicine is to learn what is valuable to those who are terminal and make it happen if possible. Dr. Clarke provides many experiences that led her to become a palliative doctor. Among them is the story of pain that accompanies loss. “All those years of medical training, I now know, have singularly failed to equip me with proper insight into the magnitude of other people’s grief and of our desperation to keep our loved ones with us …. ”

“Our role, as palliative care doctors, is no longer the extension of life, the fight to stave off the inevitable. Acceptance of what cannot be controlled — working within, not against, the finality of terminal illness — enables us to focus on what we can influence. The quality, meaning and small joys of life, like the moments Joe enjoyed, cuddled up in bed with his daughters in the days before he died.”

One of the most important contributions made by the book is the description of what death looks like and how professionals know to tell family that death will soon occur. Several examples of proper palliative care are given. Dr. Clarke’s beliefs are put to the test as we share the death of her father from liver cancer. The postscript is aimed at British medicine, but the reader would do well to assess his or her own status regarding this important topic.

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