As a specialist in palliative medicine, Dr Rachel Clarke chooses to inhabit a place many people would find too tragic to contemplate. Every day she tries to bring care and comfort to those reaching the end of their lives and to help make dying more bearable. Rachel's training was put to the test in 2017 when her beloved GP father was diagnosed with terminal cancer. She learned that nothing - even the best palliative care - can sugar-coat the pain of losing someone you love. And yet, she argues, in a hospice there is more of what matters in life - more love, more strength, more kindness, more joy, more tenderness, more grace, more compassion - than you could ever imagine. For if there is a difference between people who know they are dying and the rest of us, it is simply this: that the terminally ill know their time is running out, while we live as though we have all the time in the world. Dear Life is a book about the vital importance of human connection, by the doctor we would all want by our sides at a time of crisis. It is a love letter - to a father, to a profession, to life itself.
Clarke’s is an honest, moving, and sometimes wrenching memoir. It covers her childhood with her physician father, her close calls with death in girlhood and youth, the decision to enter medicine in her late twenties after a successful but unfulfilling career as a journalist/documentary filmmaker, and some highlights from medical school and her time as a junior doctor. The bulk of the book, however, focuses on her work in a hospice as a palliative care physician and her experience of her beloved father’s final illness and death from colon cancer. It is one thing for a doctor, in an almost shamanic role, to tend to the dying and witness the grief of those they leave behind, and quite another to be a family member losing your beloved. Nothing prepares you for it.
This is not the book to read if you’re feeling the least bit anxious. As a reader, you’re reminded of the multiple ways in which you and your loved ones can die, and I’m afraid that I was not in the mood to be contemplating any of them. Some years ago now, I recall hearing Sherwin Nuland interviewed about his famous book How We Die. The great surgeon-writer bluntly remarked that there really were no good deaths: the end is never easy. His statement really resonated for me at the time, as I’d seen how poorly pain had been managed in a family member’s last weeks and days. Clarke’s book provides some reassurance that things have changed for the better in palliative care.
This is a fine and worthwhile book, full of well-told stories about the author’s life, practice, and father. Having said that, I think one needs a certain amount of fortitude to read it.
I’ve read so many doctors’ memoirs and other books about death and dying that it takes a truly special one to stand out. Whether you’ve done a lot of looking into illness and death or have never dared to pick up a book about such topics, I would urge you to read Dear Life. Clarke specializes in palliative medicine – “Rarely, if ever, does a week go by in which all of my patients survive.” It takes honesty, realism and tact to get patients and families to understand when death is imminent, but she also relies on the kind of dogged optimism that gets an elderly woman to one last bridge game and pulls off a hospice wedding for a patient dying of breast cancer.
The author alternates her patients’ stories with her own in a completely natural way. She documents her early interest in medicine and her handful of brushes with death in a manner reminiscent of Maggie O’Farrell in I Am, I Am, I Am. Death only came up once in her five years of medical school – on the first day, when students were shown the film Wit, based on a play about a woman with terminal ovarian cancer. Clarke decries that dearth of discussion about mortality by the medical community and in society at large. (“Death is taboo for many reasons, not least the fear that it might just be catching.”) She also reflects on the contradictory demands placed on doctors: they should be compassionate, but also detached; they should be cautious, but also willing to take risks. “We want them human, empathetic, caring – but only up to a point.”
A major theme is her relationship with her father, who was also a doctor, and how she absorbed his lessons of empathy and dedication. She wrote this book in the wake of his recent death from advanced bowel cancer – an experience that forced her to practice what she had always preached as a hospice doctor: focusing on quality of life rather than number of days, ceasing “desperation oncology” treatment before it degrades dignity, ensuring adequate pain relief, and spending the final days making memories. A late chapter entitled “Wonder,” part of which originally appeared in the New York Times in 2018, is a highlight. She is even able to find humor in these wrenching days, as when her father hallucinated a tiny Tony Blair on the faucet.
Like With the End in Mind, this is a passionate but also a practical book, encouraging readers to be sure that they and especially their older relatives have formalized their wishes for end-of-life care and what will happen after their death (e.g. burial or cremation choices and a will to distribute their belongings). Hospice care is so important, but in the UK it’s only one-third funded by the NHS, with the charitable sector stepping in to make up for the shortfall. This is a wonderful book to pair with Being Mortal by Atul Gawande and get people talking about end-of-life issues.
“And there was the palliative care team, swooping in after dawn, armed not just with expertise but also the conviction that even – perhaps especially – in the last throes of life, superlative care is crucial. This was medicine at its very best, placing patient, not disease, centre stage.”
“If there is a difference between people who know they are dying and the rest of us, it is simply this: that the terminally ill know their time is running out, while we live as though we have all the time in the world. Their urgency propels them to do the things they want to do, reach out to those they love, and savour the moments of life still left to them. In a hospice, therefore, there is more of what matters – more love, more strength, more kindness, more smiles, more dignity, more joy, more tenderness, more grace, more compassion – than you could ever imagine. I work in a world that thrums with life. My patients teach me all I need to know about living.”
‘Death is not the opposite of life, but a part of it.’
I am emotionally drained from reading this book however, it has forever changed my life for the better.
I can completely relate to this book. Before losing my dad to cancer in 2017 I was afraid of death, didn’t want to speak about it, think about it or know anything about it. Which left me scared and left me with many unanswered questions when my dad passed.
Ever since then I have been trying to learn more about death. To not be so afraid of it, understand it better. This book has helped with that.
Thank you Rachel for this exceptional book and your help.
So many story’s broke me. So many times I was trying to hold my tears in.
The story with Rachel (Author) and her dad was VERY difficult for me to read. It brought back so many memories of myself with my dad.
MORE needs to be done for palliative care! It MUST be given a priority for us all.
Dying is scary for many. We should be able die without fear, we should have choices, a voice, to have our rights met to the very end.
If it wasn’t for palliative care my dad wouldn’t have been able to die peacefully towards the end. My family and I would not have been able to surround his bed and watch him take his last breath. This was all thanks to palliative care and a lovely hospice that is very dear to me.
I am so honoured I got to read this story before it’s release in January 2020.
‘Dying, a once-in-a-lifetime experience, is never known first hand until the moment of extinction.‘
I feel a bit churlish about giving a negative review.
There is compassion in the book, from a palliative care doctor, including a hastily arranged wedding in a hospice. The stories told of compassion at the end of life were touching but didn’t get much beyond what you might see in a tabloid newspaper.
As well as a sprinkling of these stories there are fragments of autobiography, and most significantly for the author an emotional account of her father’s death from cancer. The book seemed to be trying to do a number of things, and in each one it wasn’t successful. Autobiographies and memoirs are generally written when there is more of a story to tell. Dr Clarke is relatively early in her career, and the stories of the patients that she tells don’t add up to an exploration of the role of palliative care, or hospices, in healthcare, or in medicine. That might be an interesting addition to the growing popular literature based on medical careers. What is the specifically medical contribution to end of life care, and how might it be developed, through for example better collaboration with other medical specialties. You won’t get anything like that from the book.
The description of her father’s illness and death was moving but I felt like an intruder. Like many thousand such experiences every week, it was intensely personal, and I wasn’t sure what purpose it’s public telling served.
Two features of the book were particularly irritating. The first is the many references to ‘my patient’ or even ‘my hospice’. This ‘possession’ of patients by doctors is something that she argues against and so the frequent use of this phrase is puzzling, but it does convey a lack of humility which is inconsistent with the theme of compassion. Just clumsy but I found it irritating none the less.
Secondly, the prose is often far too purple. Dr Clarke was a television journalist before turning to medicine, and the book often seems to owe more that part of her professional career. On Dr Clarke’s website it says another book is coming out in the new year, her third. It does begin to look like the appeal of ‘celebrity doctor’ is as attractive as the compassionate servant of the dying that this book portrays, and in that it is convincing.
”’Maybe,’ I speculated sleepily, ‘you only really appreciate the joy of being alive when you accept that all of it, every single one of your experiences, is destined to be lost. That’s when you savour it. Maybe death makes us love life.’”
It was such an emotional read for me. Honest and moving but also wrenching. It is Dr Rachel’s very personal account of many encounters with life and death, love and loss, her intimate story of her father’s (who also is a doctor) death. She is a journalist who decides to retrain as a doctor and chooses palliative care as her specialism. She talks about doctors as those using medical tools and equipment, knowledge and experience to rip people back from the jaws of death but at the same time she shows them as humans with all sorts of emotions, doubts and fears.
Rachel poses an interesting question of what we want the doctors to be: we want them to be composed, rational and focused on saving lives but at the same time in those same moments we want them to be emotional, compassionate and empathetic, concentrated on the human not only on saving the body. How can we expect all of it in moments of crisis… but we do.
What I found the most touching is her perception of patients and how important it is to see them as humans in the moments of their greatest vulnerability. She gives a lot of consideration to - at what point doctors should not use all their knowledge and tools to save lives, especially of those terminally ill or very elderly whose bodies have been wrecked by illness but also by medical treatment. As a young doctor she learns that sometime the best you can do is to leave bodies in peace and provide physical comfort by painkillers.
The book goes through many incredibly moving stories of patients and fragile life. I was taken aback by Rachel’s observations, how perceptive she is, and some compelling points she makes about life, illness and what is best for patients.
Dear Life is part memoir, part meditation on medicine, death and dying.
Much of the first half focuses on Rachel Clarke’s personal life. After a short career in journalism, Clarke surrendered to the inevitable and commenced a degree in medicine, following in her revered father’s footsteps. While completing her training in the NHS, Clarke unexpectedly found herself drawn to the area of palliative medicine.
As a palliative care doctor, Clarke believes the specialty demonstrates medicine at its very best, ‘placing patient, not disease, centre stage’. Like most I fear death, in part because I am terrified of an end of indignity, of pain, and suffering. Touching also on the ethical questions surrounding the common ‘life-at-all-cost’ practice of medicine, and the importance of Advanced Health Directives, Clarke explains how palliative care aims to address and alleviate those fears as much as possible. Clarke’s portrayal of her patients and their struggle to live, even while dying, is insightful and compassionate. With empathy and honesty the author shares the last days of some of her patients, who approach their end with a mixture of anger, understanding, fear, resignation, and often, perhaps surprisingly in the end, acceptance.
This becomes all the more important to Rachel when her beloved father, a G.P, is diagnosed with advanced bowel cancer, and when treatment proves unsuccessful, she does all she can to ease his demise.
Dear Life is a thoughtful, inspiring, and surprisingly comforting exploration of a subject most us find difficult to discuss, or even contemplate. The hard truth is, Death will one day come for us, and when it does, we will want palliative and hospice services that will facilitate, and advocate for, the inevitable end on our own terms.
This is a book that will touch you in the deepest way possible. Rachel Clarke, a former journalist takes to studying medicine and through her interactions with the people she comes into contact, make us pause and think of what is it that a person wants most when he/she is sick and ailing. ‘Dear Life’ not only gives us a peek into the time when the author is the doctor but also gives personal insights of her experience of being a doctor, care giver and daughter in the section drawing from her most intimate experience of caring for her father, a doctor who is diagnosed with cancer. She makes a compelling point about the meaning of life and its purpose when faced with the inevitable that in the end, it looks like nothing: to be alive in the moment, to draw a smile, to feel the moment. The anecdotes and insights on palliative care and how medical personnel can make a difference in the last moments of people and their loved ones will make you teary eyed for sure but also is deeply informative for mostly, we end up subjecting those we love to what we think is the best. Many sections left me weeping but never despondent and therein lies the beauty of this book: that it takes you to the most intimate and scary notions about illness, dying and grieving but that it also gives profound insights and hope. Thank you @littlebrown for the uncorrected proof copy.
In 2019 I found myself in hospital, Dr's were unable to source the cause of my infection and illness and I was subject to many examinations and tests (MRI, CT, X Ray all happened more than once) it was discovered I had an abcess within my back and in surgery to remove it my body reacted by sending a massive toxic wave of poison through me causing Sepsis. I spent weeks in hospital recovering and months at home recovering and the 100 plus members of staff that looked after me did so as a human, not as my NHS Number.
This book is incredible, it reminds us all that no matter what we think in life we are dealing with people, people who may be alone or may be surrounded by friends and family but they are still people and deserve to be treated as much.
I cried, openly at parts, I winched at parts, I felt frustration and upset at parts. The author took me through Journeys that were uncomfortable yet essential.
Wonderfully written, beautifully paced and an incredible book.
This is Rachel Clarke's second book, as well-written as her first one, Your Life in My Hands. Clear, informative and deeply moving, written from her perspective as a palliative care doctor working in a hospice, and including her own grief at the death of her father from cancer.
I would highly recommend this important book, and also the following, which deal with related issues:
What a truly heartwarming book. Yes it was upsetting, but not in an awful way, but a truly inspiring way. I found it uplifting and I can imagine that anyone who has recently lost someone, or someone whose life is ebbing away, as happens to all of us, that this wonderfully, poignant book would be.
Absolutely the worst time in my life to read this, but I picked it up and kept reading it because it is a wonderful book, clear-eyed on the realities of death and palliative care, but tender and hopeful with it. In part it's a manifesto for better end-of-life care, in part a memoir of the author's relationship with her father, and in a third part, a paean in praise of whatever life remains. I will probably read it more than once.
As a nurse who is lucky enough to have a chance to explore both Emergency Medicine and Palliative Medicine, I was astounded by Rachel's poetic ways of describing the diagnoses, the medical treatments and behaviours of patients, while expressing every word with love and passion. The Palliative Care Teams are underrated teams in hospitals. While I was working in the palliative ward, I had witnessed that a Palliative consultant came straight from home at 3 AM on Sunday morning to be with the family members during the final hours of his patient or how the whole palliative team (doctors, nurses, PT, OT, ST and dietician) spent a few minutes to choose one type of ice-cream for a cancer patient with food restrictions. There might not be over-the-top medical interventions with the palliative care team. But they are able to touch more hearts and souls of patients and families. Also, Rachel beautifully portrayed the final days with her father who was diagnosed with cancer. She was able to combine her childhood memories with her father and the description of a magnolia tree together with the current stage of her father (weak but determined to keep on living) from a simple walk to the park. "The magnolia of my childhood," she described. Anyway, this is a wonderful book that reminds us about the existence of love, loss and passion from some simple acts in this materialistic world. But you will need a box of tissues to wipe your tears. I warn you!!
I recognize the best of my experience of hospice in Dr. Clarke's writing. This is a lovely book that does not shy away from discussions of pain, fear, and grief, but also reveals the amount of joy that is available at the end of life. This is absolutely worth your time.
I read this because a doctor strongly recommended this on medtwitter, and it was truly as excellent as she said. I've read numerous books on death (62 according to Goodreads), and this is one of the best.* Clarke is an excellent writer and a very observant medical expert. She answers so many questions that even the experience of the death of my parents and all my reading had left unanswered until now.
*My other favorites are: Being Mortal: Medicine and What Matters in the End by Atul Gawande, The Death of Ivan Ilych by Tolstoy, The Bright Hour: A Memoir of Living and Dying by Nina Riggs, and A Biography of Cancer by Siddhartha Mukherjee.
This has been an emotional , heartwarming , tear inducing read. Whether you work as an nhs staff member, a carer , a family member or just someone who reads this book , it’s one you’ll never forget. It’s a very poignant read, made much stronger by the author’s relationship with her dad . He has been her tower of support for so long, her voice of reason when she needed it , but Also her dad which is the utmost thing to remember. I think everybody should read this book armed with a box of tissues as you’ll need them.
A very eloquently and beautifully written semi biography by NHS doctor, Rachel Clarke. It is not an easy read at best if one has seen a loved one in or through their last months or days subjected to cancer. I took my time to do so … At first I couldn’t help feel that the author was bashing the NHS for lack of a better understanding and application of palliative care, despite giving many of the reasons why, the important one being lack of funds. Yet she acknowledges that that same very admirable institution came through for her and her family in the last days of the life of her father, one of its esteemed members. Nor could I rid myself of the impression of some self-aggrandizement in the first chapters of her book of her own perceptions of this failing as she goes through the process of becoming a doctor, and pointing out the lack of understanding, sympathy and empathy that is needed by those who choose to go into palliative care - that there isn’t any literature or medical treatise that prepares the individual for what to expect. I think her book would certainly fill that void and hope that it could become obligatory reading. Rachel Clarke spares no detail of what is required from carers in palliative care, be they doctor or nurse or other. She is also extremely adept at describing any and all medical details in layman’s terms. A heart-wrenching tale of those who face the ravishes of cancer, of the reactions or suffering of the loved-ones involved, even selflessness, but also some of the patients’ thinking and feelings about their own life ending.
After reading With the End in Mind (by another English palliative care doctor, Kathryn Mannix), I was curious to see another take on the same topic, and this is certainly a very different angle, despite covering similar material (right down to an anecdote about a patient with panic attacks). Dear Life is more biography than collection of patients' stories; Dr Rachel Clarke presents her stories very clearly from her viewpoint, often with herself taking centre-stage, particularly in the first half of the book, where she's often apparently the sole voice of compassion against a backdrop of jaded or oblivious superiors. Nevertheless, I was inevitably moved to tears, most often in the final chapters of this book. The lovely writing complements the bittersweet material. Whether you'd prefer this book to With the End in Mind probably depends on what you're seeking: if you're after the biography of a doctor who eventually ends up in palliative medicine, this is the book. If not, something else might be what the doctor ordered.
***Thank you NetGalley for the uncorrected proof copy***
“For the dying are living, like everyone else.”
This memoir stirred many past emotions & memories for me as my mum developed cancer and spent her last few months in a local hospice. Thank you Rachel for giving me a better understanding of what my mum went through and how hospices work 'behind-the-scenes'. Each of your patients is lucky to have you caring and fighting for them.
'Dear Life' offers both sides of the story - a doctor working in palliative care and a daughter dealing with her own father's terminal cancer diagnosis. This book is particularly thought-provoking as death and the discussion of it is such a taboo subject in society yet so important for end of life care.
What a book. I had reservations about reading Dear Life by Rachel Clarke as I thought I might find its subject matter too personal and difficult or the author too introspective, patronising or condescending. I’m not a great lover of memoir writing either. So when I consider the negative approach I had to beginning this read I’m slightly embarrassed by just how far from the truth I was. Dear Life is a wonderful, wonderful book that any person facing death (and yes I do mean ALL of us) should read. It is magnificent and has been an absolute privilege to read.
In a world frequently filled with negativity, Dear Life is an oasis of hope and joy. Rachel Clarke has restored my faith in myself and in humanity, for which I cannot thank her enough. She demystifies death and presents in a beautifully written way, the manner in which we can live life to the full even as our own mortality and that of those we love is a stark, and often close, reality. Her style is honest, straightforward, poetic and completely captivating. I simply could not stop reading even when my vision was blurred by the tears her words brought me to. With sensitivity, knowledge and skill in Dear Life Rachel Clarke has made me glad for all the moments of my life; not just those positive, happy memories, but also the times when I have suffered physical and emotional pain, been stressed or unhappy, because she exemplifies how every single experience is part of a life lived and that, even as we die, we can still do so with dignity and love.
Whilst Rachel Clarke explores her own life and the death of her father, Dear Life isn’t simply a memoir. It references history, geography and literature. There are wolrd events and real people scattered through its pages. I loved the quotations that head up each chapter, and found comfort in them as much as the delight in the mentions of my favourite poet John Donne. There’s a practical Postscript of links and advice where readers can research more about how to prepare for their own future, including their own death. As a result, Dear Life transcends the sum of its parts to be something much much greater and more important.
Having mentioned death so many times when reviewing a book called Dear Life, let me say there is nothing mawkish or sensationalised here, but rather a compassionate love song to humanity, to love and friendship and to living our best lives whatever our circumstances. I think Rachel Clarke is a genius because Dear Life is a superlative book. It moved me, it helped me and it made me glad to be alive. I cannot recommend Dear Life highly enough. It is both life affirming and life changing. Just buy it. Dear Life may be the most important book you ever read.
Wow. What an incredibly profound and moving read; I don't even know where to start with my review of Dear Life because I just know that whatever I say will not do it justice.
This was definitely an emotional read; at many times throughout this book the tears were streaming down my face (which was a bit awkward when I had a work meeting in the next half hour) because it is such an emotive and insightful read. Rachel works in hospice; and I think we can all say that our understanding of hospices are so wrong. I honestly thought, as many of Rachel's patients do, that they are the places people go to die. That when you go in you won't come out alive again. So it was really interesting to read about what hospices actually do, and what they could achieve given the proper funding.
Rachel is a Doctor who clearly has a lot of compassion and empathy for all the people she works with; she wants them to be more than just numbers or figures but actually names and faces and the stories of their lives. This really comes across on the pages and it makes you warm to Rachel and empathise even more with all the people she has cared for over the years.
I think this is such an important book because it focuses on not being scared of dying, but being scared of living at the end of your days. So many of Rachel's patients know that they are dying but they don't just give up, they are determined to carry on living for as long as they can and it is just incredibly inspiring; from the young bride who is determined to have her big wedding to the grandfather who wants to reach his grandson's birthday.
Rachel intersperses the book with patient stories, details about her own journey to become a Doctor, and about her GP father, who sadly was diagnosed with cancer and put Rachel into the shoes of the families she saw everyday. It was definitely a hard read at times but I was just hooked by the stories and the writing and i'm so glad I randomly decided to pick this one up. It's definitely a book that will stay with me for a long time and the stories of the patients and Rachel's father, who in the face of death, just fought for one more moment with the ones they love and the things they loved doing.