In Death There is Still Joy: Dear Life by Rachel Clarke

We live in an age when people share the most deeply personal aspects of their life with complete strangers.

Magazines are plastered with articles detailing celebrities’ experiences of eating disorders/sexuality/mental health/abuse just to mention a few. And I’m not sure how daytime television would survive if it didn’t have a steady stream of guests willing to open up on issues that a few generations ago would have been considered taboo.

But there’s one topic about which we are strangely reticent even though it affects every one of us. Death. 

t’s a form of denial, a basic human instinct to avoid what is uncomfortable. We even avoid using the actual word. Instead we turn to euphemisms which sound less direct, less harsh, less final in a sense. We don’t say a friend/relative died, they “passed away” or “passed over” or simply “passed”. 

The Fear Factor

Our own death is more difficult to contemplate than that of our loved ones. So we don’t prepare for it. We treat it a bit like those tax return demands, a task we know we have to deal with – but at heart we’re afraid. So the longer we can delay the task, the happier we are.

Few of us would, out of choice, spend our days surrounded by people whose time on this earth can be measured in weeks or days. 

But that’s exactly the world Rachel Clarke decided to embrace. After more than a decade as a doctor who fought to save lives, using every drug and machine at her disposal, she changed direction. Now as a consultant in palliative medicine she cares for people whose battle for life is over. A specialism that’s little understood or valued.

If neurosurgeons are the rock stars of the medical hierarchy – its sexy, alpha, heart-throb heroes – then palliative care doctors are the dowdy support act. A low-rank medical speciality, we lurk in the shadows, too close to death for comfort …. No one in the hospital is quite sure what we get up to, and usually does not wish to know either. Death is taboo for many reasons, not least the fear that it might just be catching.

Dear Life begins as an autobiography, charting Rachel Clarke’s life as the daughter of a hard-working dedicated GP. She considered following in his footsteps but instead followed the path of literature and the arts, becoming a television documentary maker. 

In her late 20s she re-assessed her life, abandoned the broadcasting world and retrained as a doctor. What she witnessed in the emergency unit, convinced her to make palliative care her specialism. 

Despite my love of acute and emergency medicine, I found myself drawn to patients with life-limiting illness precisely, in part, because some other doctors ran a mile.

Learned Detachment

Clarke is critical of doctors she heard curtly despatching their patients to the “palliative dustbin” as if they felt that once in a terminal phase of illness, human lives were no longer worth engaging with. But she tempers her censure; acknowledging that from detachment is an essential requirement in the medical profession. It’s a lesson that begins the day that an aspiring doctor begins their medical training.

We might have chosen medicine because we wanted to help people, but doctors could not and should not allow their compassion free rein. … The challenge then for every doctor was to acquire sufficient detachment to be useful while maintaining one’s essential humanity.

That need for detachment is put severely to the test when death comes right to the door of Rachel Clarke’s own life. In his 70s her father was diagnosed with bowel cancer. Clarke was ever the professional as they discussed at length his diagnosis and his treatments. But as his health deteriorated and it was clear he was close to death, it was the daughter who took over, who bathed him just as he had once bathed her in childhood.

Candid and Sensitive

Dear Life is candid yet overwhelmingly sensitive and moving account of what it’s like to work in the world of the dying. A uncomfortable book to read you might think, one that would be far too depressing; too emotional, too heartbreaking. 

Of course it’s emotional. Of course it tugs at the heart. How could it not? But Rachel Clarke shows that even when people are at their lowest ebb, they have the capacity to love and embrace moments of unadulterated joy.  Dear Life gives us a wedding, a fiercely independent woman coiffured and dressed in pearls for her final bridge session and an elderly woman who had lovingly frozen portions of fruit and fish so her husband would be able to survive without her.

These anecdotes were the ones that brought the tears to my eyes. Because they’re not about death, but about life and how people like Rachel Clarke help us prepare to say goodbye in a way that truly means we can rest in peace.

Dear Life is quite simply a stunning book. I urge you to cast aside any fears it will touch on too many nerves and get yourself a copy. I guarantee you will not regret it.