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Dear Life: A Doctor's Story of Love and Loss

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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.

336 pages, Hardcover

First published January 30, 2020

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Rachel Clarke

8 books68 followers

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5 stars
2,051 (60%)
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3 stars
285 (8%)
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Displaying 1 - 30 of 407 reviews
February 12, 2020
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.
Profile Image for Rebecca.
3,823 reviews3,153 followers
March 6, 2020
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.

Favorite passages:

“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.”
Profile Image for Julie.
2,115 reviews36 followers
August 31, 2023
Truly amazing and deeply heartfelt. Robert MacFarlane described this as a remarkable book: "tender, funny, brave, heartfelt, radiant with love and life. It brought me often to laughter and - several times - to tears. It sings with joy and kindness," and I agree wholeheartedly.

Favorite quotes:

I had a very emotional response when hearing of Rachel Clarkes's response to Elgar's 'Nimrod' - "I felt the brass and drums inside the cave of my chest as thunder, lightning, all the might of the world somehow distilled into sound." It was her father's anthem, now hers, and it was my Grandma's also.

Clarke writes: "We make paradoxical demands on our doctors. We want them human and pathetic, caring, but only up to a point, we also want the detachment that enables them to swoop to a crisis, the stopped heart, the mangled limbs, the child suffocating before their eyes, and crack on undeterred, all instincts to recoil suppressed."

I nodded in agreement when reading that "storytelling - a patient's describing to their doctor their own illness narrative - is, then, the bedrock of good medical practice." Author Philip Pullman believes stories are "imperative for human survival" and are a "transformative force in medicine."

I loved the creative solution a play specialist came up with to soothe a child who was afraid of being in the radiation treatment room alone. The Play Specialist invented "magic string: a simple ball of multi-color twine, one end of which the child could clasp, while the other would weave out of the room under the door to be held by their parent."

This solution is "simultaneously cheap as chips, and priceless. Magic String helps children with cancer today reframe their experience away from abandonment to being loved and supported."

"No-one is able to inhabit the present quite like those aces of nowness, our children."

Regarding her gently washing her father who is dying from cancer, "I turn my attention to this lattice of bones strung together by skin. Such a tenuous version of a body. From top to toe I sponge every inch of my father, these arms that once threw me high above his head, these ribs into which he would enfold his infant children, these shoulders that carried us like proud little monarchs, these thighs I reached toward while learning to walk." The emotion was evident in the author/narrators voice and I could not help but weep.

Heartbreaking, yet filled with love and empathy. A truly worthy read that gave me much food for thought including her patients' thoughts on suffering through surgery and treatment for cancer and how they might have chosen a shorter time alive spent in quality time with family instead.

Finally, "Summer was on the cusp of autumn and I thought of Philip Larkin's poem, An Arundel Tomb whose famous last line has survived since 1956: What will survive of us is love."

Profile Image for Georgi_Lvs_Books.
1,153 reviews27 followers
December 11, 2019
‘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.‘

Profile Image for Iain Snelling.
161 reviews3 followers
September 21, 2020
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.
Profile Image for Sara S..
25 reviews17 followers
January 24, 2023
”’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.’”
Profile Image for Melody.
2,651 reviews289 followers
October 22, 2022
I liked this a lot. The authorial voice was approachable and warm. The narrative wanders a bit, but didn't lose me.
148 reviews4 followers
October 15, 2021
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.
Profile Image for Shelleyrae at Book'd Out.
2,525 reviews534 followers
January 22, 2020
“For the dying are living, like everyone else”

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.
Profile Image for Chitra Ahanthem.
395 reviews195 followers
January 27, 2020
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.
Profile Image for Daniel Myatt.
748 reviews83 followers
September 28, 2020
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.
Profile Image for Patricia.
632 reviews27 followers
January 3, 2022
I found this memoir to be the account of an interesting life as well as a helpful meditation on end of life issues. Well worth reading.
Profile Image for Judith Johnson.
Author 1 book101 followers
April 23, 2020
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 Can I Do to Help? by Deborah Hutton

In the Midst of Life by Jennifer Worth

Love, Medicine and Miracles by Bernie S. Siegel
Profile Image for Laura.
763 reviews115 followers
December 7, 2020
A moving and heartfelt look at palliative and hospice care today. The author writes so poetically that it’s no shock that she is a former journalist and avid reader herself; she writes about terrifying and difficult topics but still manages to find a way to make the stories beautiful.

I thoroughly enjoyed the authors last book, which I can also heartily recommend to fans of this genre. I’m eagerly anticipating her next release, due in 2021, about the global COVID-19 pandemic.

This is a must read for all staff and patients of the NHS.
Profile Image for Skyesmum .
510 reviews13 followers
August 29, 2020
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.

What a wonderful book.
3 reviews
December 25, 2023
An incredible and perspective changing book. I look a humanity and life itself in a new light.
Profile Image for Rachael Lewis.
3 reviews
June 23, 2021
An incredibly moving pierce of love life and loss. A book that really puts life into prospective and makes you grateful for all the good and humanity in this world.
Profile Image for eleanor.
468 reviews3 followers
April 5, 2024
this made me tear up a little, rachel you are amazing!! the respect with which you write about death is amazing- such an important book
Profile Image for Iona Sharma.
Author 9 books134 followers
April 25, 2020
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.
Profile Image for Kerry.
36 reviews1 follower
April 18, 2021
‘That losing a loved one hurts precisely as much as it should do.’

‘It takes courage to choose to love the things of this world when all of them, without fail, are fleeting, fading, no more than a spark against the darkness of deep time.’

If only I could give this more than 5.
Exceptional.
Profile Image for Kateryna (ЧИТАЙмося).
10 reviews5 followers
June 14, 2023
Чудова книга про життя та смерть. Авторка багато часу та сторінок приділяє тому, аби донести думку, що люди, які помирають, до останнього подиху залишаються людьми і потребують відповідного до себе ставлення.
Profile Image for Jennifer.
74 reviews
August 2, 2022
This is just really beautifully written. She's so respectful and has an incredible job, it makes you think about palliative care differently.
Profile Image for Thuzar.
16 reviews7 followers
February 24, 2021
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!!
6 reviews
January 27, 2024
I don’t think I’ve ever sobbed reading a book like I did this one. Despite some of the heartbreaking stories written in this book, I found it inspiring and uplifting, reminding me of the good we can do in medicine
Profile Image for Mrs. Danvers.
994 reviews49 followers
October 18, 2021
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.
Profile Image for Ericka Clou.
2,361 reviews203 followers
October 16, 2022
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.
Profile Image for Tracey.
2,281 reviews71 followers
August 1, 2021
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.
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