Dear Lit Loves,
In the latter portion of the month of May, I opted to read a memoir written by Rachel Clarke, a palliative care physician in England. The book's title is Dear Life: A doctor's story of love, loss and consolation. Dr. Clarke was educated at Oxford and originally studied documentary journalism specializing in current events. In her late twenties, she decided to return to college to retrain as a doctor, particularly one specializing in how to care for individuals staring down the end of their life journey. I was especially drawn to this book as the author discusses how she coped with the loss of her father who was also a physician.
Initially, Rachel Clarke begins her training in medicine by studying cadavers. I think this is the portion of medical school that readily causes many students to drop the whole notion of going into medicine or at least that is what I have heard among many people over the years who began their career study in the field of medicine and then abruptly ended that endeavor when faced with dissecting a cadaver. Ms. Clarke is most definitely up for the task. The professor overseeing her group of medical students ensures that people who donated their bodies to science are treated with reverence and dignity. Upon working in a hospital for the first time, the reader sees Ms. Clarke observe a patient requiring resuscitation even though the patient has suffered through a grueling illness and enjoyed a rather long life. The whole process appears cruel to Ms. Clarke as this patient does not have an official Advance Directive, a document outlining whether you wish to be resuscitated in the event of a cardiac arrest, stroke, etc. Interestingly, most of the population does not have an advance directive. Without this important document, should you suddenly find yourself in cardiac arrest, medical staff will take all measures to attempt to resuscitate you. And resuscitation can be loud, chaotic, traumatic, and bone-crushing, etc. Oftentimes, resuscitation does not offer the most peaceful way to die, but it often happens because most individuals do not wish to think about much less directly document how they wish to transition from life to death.
For Ms. Clarke, it became readily apparent to her that end of life care was of special importance when she began to notice individuals dying in hospitals where the noise levels are astounding, pain management may not be important to the attending physician, and families of the deceased are often exhausted, unnerved, and traumatized by their loved one's death. Bluntly, it can be horrific to witness a loved one's death not being handled with dignity and reverence inside the corridors of a hospital.
When Dr. Clarke observes palliative or end of life care, she sees that people transition from undergoing more relentless treatment options for life extension to just focusing on enjoying the remaining time they have left in their life journey. In palliative care there should be a focus on a patient coming to terms with mortality, acceptance of the reality of death, and deciding to live their final days with a sense of peace, comfort, and more compassionate care. Death takes on a whole new quality when Dr. Clarke learns that her father has cancer. Her father spends the last year of his life opting for several forms of cancer treatment, but finally accepts that the variety of treatments are not working and opting to cease treating his cancer and live his final weeks with as little distress as possible. The author and her mom along with a palliative care team assist Dr. Clarke's father in a transition to death with as much reverence, joy, comfort, and compassion as is humanly possible. The reader sees that how a person exits life is just as significant and impactful as how and when that same individual entered life. This was quite a thought-provoking and insightful book. Any patient would be lucky to have Dr. Clarke overseeing their final days of life in a palliative care environment.
Till my next review,
Grace (Amy)
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