Rachel Clarke (3) (1972–)

I strongly recommend this passionate and important book to anyone who cares about the state of the NHS. Dr Rachel Clarke was a key player in the junior doctors' strike in 2016, and she paints a grim picture of the impact of government cuts on the front line of the service. Health Secretary Jeremy Hunt does not come out of the book with a great deal of credit, and the circumstances around the strike itself and the battles with Hunt are told in some detail; junior docs were misrepresented by their own union almost as badly as by the government and the media, which I not been aware of.

I recently read the fantastic Do No Harm by neurosurgeon Henry Marsh (he reviewed Clarke's book in The Times) and it was interesting to consider the comparisons between the two accounts. Marsh, the better writer of the two, is nearing retirement, and reflects philosophically on mortality, altruism, the doctor's role and so forth. While Marsh's book is profoundly moving at times and he does bemoan many developments in the NHS, it's with a certain dispassionate distance. Clarke on the other hand is telling a story right from the front line, and her descriptions of the impact of inadequate funding, government spin and the effects on patients are filled with passion and fury.

In many of the chapters she uses a device whereby she tells a personal anecdote, perhaps about a patient with a certain type of physical ailment, and then uses this as a platform to highlight an analogous systemic problem in the health service as a whole. This generally works well but is a bit clunky at times. For example, after telling a thrilling tale of a man haemorrhaging blood, the next paragraph starts 'The haemorrhaging of staff from the NHS threatens its survival just as surely as unstaunched blood around a human heart.' Clarke is sincere and makes very powerful arguments, and her previous role as a journalist adds credibility to her take on the state of the NHS. However, she acknowledges that 'it's not just about money' and that the NHS could be more efficient - it would have been nice to hear some the ways this could be achieved.



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Best for:
Anyone interested in a health care worker’s perspective on the first couple of months of COVID-19. Anyone who just wants to feel a little more rage at government failure.

In a nutshell:
Hospice physician and author Clarke shares her experiences - and experiences of patients and their families - during the first few weeks of COVID in England.

Worth quoting:
“In a major trauma, it is effective logistics, more than anything else, that saves lives.”

“It is abundantly clear that our patients were no one’s priority. No one in power had properly considered them.”

“Those residents — the very old, the very sick and people with disabilities — are precisely the population most at risk of dying from COVID. Yet far from being cocooned, as the government promised they would be, they are being incarcerated with COVID.”

Why I chose it:
I used to work in Public Health emergency management in the US. We had plans, though they relied on the federal government to have their shit together. Watching the UK national government, led by wildly inept elected officials, flounder and fail repeatedly, I am interested in learning as much as I can about exactly why and how they could have failed so dramatically, in the hopes that they don’t fuck up the response to the next pandemic.

Review:
As I type this in March 2022, two years and a couple of days after the government finally said maybe people should, like work from home for a bit if they can, there are zero restrictions related to COVID in the UK. I don’t even think we have to stay home if we test positive. I mean, they’d like us to, but not needed. Tests are free (like the only thing this government did right), but that ends at the end of March too. Masks are recommended on transit, but even that’s not required. You could also get on a plane and come here without proof of a negative test. Hospitalizations are on the rise, cases are higher than ever even with fewer people testing. It’s not a good look. But it’s not surprising because, in case you couldn’t tell from the first parts of my review, I think that England has royally fucked up the entire response to this disease.

I think Clarke agrees with me, at least regarding the parts that are in her purview. She kept a diary of the first few weeks of COVID in England, and this book is a compilation of that, experiences of some people who survived COVID, family members of those who did not, and people who were impacted health-wise in other ways; e.g. having to delay or defer treatment for other deadly illnesses like cancer.

England locked down too late, and at one point accounted for something like 10% of COVID deaths despite having less than 1% of the world population. And part of that is because of how England treated people who were in care homes. The staff in those facilities weren’t treated like proper health care employees, and so didn’t get the PPE they needed. At the same time, people were discharged from hospitals to care homes without COVID tests, so COVID was basically forced into these care facilities. It’s disgusting and should be a national disgrace; instead the government is still boasting about their world-beating whatever.

Not that I imagine you need it, but the book provides such a human face to what turned into statistics, especially for those of us like me who so far have been lucky enough to both avoid getting COVID and avoid any of my friends or family getting seriously ill from it. We learn of the experience of someone who had to be intubated, and also the discussions that took place within hospice and when people were definitely dying. It’s not an easy read, but it is a book I couldn’t put down. It gives me hope in the sense that individuals are determined and care so much, but it makes me despair at how utterly so many of the people elected to serve us have failed.

Recommend to a Friend / Keep / Donate it / Toss it:
Donate… (meer)

This memoir is about how Rachel Clarke, a palliative care specialist, became a doctor later in life and how life and work intertwined with her father’s diagnosis of terminal cancer. She talks about near-death experiences in her own life, how death is not really discussed in medical school, the attitude of colleagues who “relegate” patients to the palliative care “dustbin”, and our larger societal attitude toward death and reluctance to make known our real wishes for end-of-life care.

If you’ve read Being Mortal or With the End in Mind, you will probably like this book, if “like” is the word. Perhaps “find this book enriching” is a better phrase. I found Clarke’s story interesting, particularly how she retrained as a doctor later in life after a career in journalism—this gave her a unique perspective and perhaps a bit more assertiveness to stand up for some of her patients, whereas her much younger colleagues may not have felt comfortable contradicting a senior physician. I also liked her sharing the experiences of her dad, who was also a doctor and who inspired her to go into medicine eventually, but didn’t force her to go into it. I also liked her descriptions of life in the hospice ward and the things the staff did to make the patients feel cared for, and her questioning why this couldn’t be done in the regular hospitals.

This is one of those books where, if you wear glasses, you’re going to have to take them off periodically to dry your eyes. So perhaps read it without your glasses, if your eyes permit!

(Note: this book was recommended to me a while back by the Guardian’s list of non-fiction to look out for in 2020)… (meer)