It seems very brave to even write a book about death, because the majority of people seem to be actively trying to avoid any mention of it. Death is the last taboo subject. Rachel tackles this in her writing with grace, compassion and dignity. The book is in three parts, with the first covering her personal life and the reasons that she moved her career from journalism to medicine. The move seemed inevitable, as she was following in the footsteps of her father. As she started specialising in an area of medicine, she surprised herself by becoming drawn to palliative care. The second section covers her thoughts on this branch of medicine – an area that, in my opinion, provides the best medical care, because it focuses on the lived experience of the patient. Clarke describes the usual outlook of the NHS as ‘life at all costs’. I think there is a sort of arrogance in this type of medicine, where some doctors seem to think they have the skills to outrun death. Clarke talks eloquently and empathetically about the fears patients have and how her job is to address and allay those fears as much as possible, to alleviate the pain and suffering. She also includes a very honest portrayal of some of those patients and the range of emotion they go through as they near the end – from denial and anger, through to a certain acceptance for some, All of her training and experience becomes even more important when her father is diagnosed with terminal bowel cancer and the book moves back to the personal.
Clarke understands the luminal space that the long term sick and terminally ill both occupy. That space of the in between. If we are always sick we have to find a way of living regardless, because all of our time can’t be taken up with illness and dying. We still have friends and family, obligations and bills to pay. We need to pass the time. To remember who we are, because we are not this illness; more than this death. As Clarke so succinctly puts it: ‘For the dying are living, like everyone else’. It’s true that I probably appreciate this book so much because I nursed my husband for two years before his death from pneumonia caused by Primary Progressive Multiple Sclerosis. I also have MS so understand how it feels to have a condition that limits my life, rather than being terminal. No matter how much experience Clarke has, she does find that the picture changes when it is someone you love who is losing their life. It’s impossible to retain that clinical distance and any sense of control is taken away. It turns out that nothing can mitigate the pain of personal loss. Beautifully written, moving and breathtakingly honest.