メイン Dear Life: A Doctor’s Story of Love and Loss

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

From the Sunday Times bestselling author of Your Life in My Hands comes this vibrant, tender and deeply personal memoir that finds light and love in the darkest of places.

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.

発行年:
2020
エディション:
Retail
出版社:
Little, Brown Book Group
言語:
english
ページ数:
331
ISBN 10:
1408712520
ISBN 13:
978-1408712528
ISBN:
B07SZL2LWM
File:
EPUB, 345 KB
ダウンロード (epub, 345 KB)

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発行年:
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Also by Rachel Clarke


Your Life in My Hands: A Junior Doctor’s Story





Copyright


Published by Little, Brown ISBN: 978-1-4087-1251-1

Copyright © Rachel Clarke 2020

The moral right of the author has been asserted.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of the publisher.

The publisher is not responsible for websites (or their content) that are not owned by the publisher.

Little, Brown

Little, Brown Book Group

Carmelite House

50 Victoria Embankment

London EC4Y 0DZ

www.littlebrown.co.uk

www.hachette.co.uk





To Dave, Finn and Abbey, with love





Contents


Also by Rachel Clarke

Title Page

Copyright

Dedication

Author’s Note

Prologue

1 Near Misses

2 Flesh and Blood

3 Skirting Death

4 Ghost Owl

5 Black Wednesday

6 A Numb3rs Game

7 Storytelling

8 Light in the Dark

9 A Piece of Work

10 Clutching at Straws

11 The Price of Love

12 Wonder

13 The Man with the Broken Heart

14 Gratitude

15 Dear Life

Postscript

Credits

Acknowledgements





Author’s Note


The stories told here are grounded in my clinical experience, but elements have been changed in order to protect the confidentiality of staff and patients. In addition, details of the situations and the people I have met and cared for have, at times, been merged or altered in order to further protect privacy and confidentiality. I am extremely grateful to Dr Helgi Johannsson; Andy Taylor; Alice, Sharon and Jonathan Byron; and Diane and Ed Finch for allowing me to tell their stories using their real names.





Tell me, what is it you plan to do

With your one wild and precious life?

Mary Oliver, ‘The Summer Day’

from House of Light





Prologue


There isn’t enough of anything

as long as we live. But at intervals

a sweetness appears and, given a chance,

prevails.

Raymond Carver, ‘The Author of Her

Misfortune’, Ultramarine: Poems



Two men enter an empty studio. They sit down an; d talk at length over a bottle of white wine, finally departing before drugs lay claim to the eloquence of one of them. Wreathed in smoke, a cigarette permanently clenched in one arthritic hand, the acclaimed British screenwriter and dramatist Dennis Potter has been told the month before that he is dying. The hip flask he sets down on the table beside the wine contains not whisky but morphine. As his interview with the arts broadcaster Melvyn Bragg unfolds, Potter will need televised swigs from the flask to blank out the pain of his inoperable pancreatic cancer.

This is 1994. Back then, in Britain, no one spoke in public about terminal cancer, let alone broadcast its assault on their body on prime-time television. But Potter has always loved to shock his audiences into thought, using drama to confront the truths that most disturb us. This evening, he has chosen to dramatise his own, real-time, corporeal decline.

At age twenty-two, a student who happened to be home from her studies, I was tempted to skirt the televised death talk, but my father told me if I did, I would regret it. And so we sat side by side, in front of the television, as I tried to disguise my discomfort at Potter’s dependence on his opiates – this unadorned proximity to dying. Since Dad, a doctor, did not approve of squeamishness, I kept my unease under wraps.

We were watching, it turned out, Potter’s last public words. Two months later, he was dead. Yet he filled the studio, and the minds of those who watched, with the sheer theatricality not of dying but of living. Death’s imminence, its claim on his future, had given Potter licence to live like a child in the present. Every second sang.

‘The only thing you know for sure is the present tense, and that nowness becomes so vivid that, almost in a perverse sort of way, I’m almost serene,’ he said, the paradox prompting a lopsided grin. ‘You know, I can celebrate life … Last week looking at [the blossom] through the window when I’m writing, I see it is the whitest, frothiest, blossomest blossom that there ever could be, and I can see it. Things are both more trivial than they ever were, and more important than they ever were, and the difference between the trivial and the important doesn’t seem to matter. But the nowness of everything is absolutely wondrous.’

For a moment – and I knew it was the same for Dad – I felt like I had been handed the key to everlasting happiness. Experience the world with the heightened intensity of a child. Inhabit now, not tomorrow, or a sad trail of yesterdays. Seize it. Live the moment like it is your last. Needless to say, the humdrum anxieties of everyday existence soon blotted any nowness from my mind. As Potter himself put it so beautifully: ‘We’re the one animal that knows that we’re going to die, and yet we carry on paying our mortgages, doing our jobs, moving about, behaving as though there’s eternity.’

In 2017, twenty-three years after Dennis Potter died, his words were resurrected in my mind. Dad, my dearest Dad, was now himself a dying man. In thrall to a cancer not of the pancreas but the bowel, he had spent half a year on the chemotherapy carousel. Infusions, blood tests, nausea, fatigue, infusions, damaged nerves, infusions, bleeding skin. Hope, more than anything, kept him coming back for more. Even when the scans showed terminal spread, still he yearned, burned, for more life. He took them, these monthly batterings of the cytotoxic drugs, because they gave him a space in which to believe. They allowed him to imagine a future.

We all, including Dad, feared his days were running out. Unable to stop time, we groped for moments of timelessness. If we could help him, I reasoned, inhabit the blossom, then perhaps he could elude the doctor’s curse – too intimate a knowledge of how his days would likely end, as cancer picked off organs one by one.

I thought back to the tales he had always loved to share of life as a young medic in swinging sixties London, all vibrancy, colour and chaos. Partying hard until the early hours, then driving his scarlet MG sports car through the deserted East End because, in those days, no one cared about drink driving. Skedaddling at dawn from his hospital to the pub around the corner to share early-morning pints with the meat men from Smithfield Market, in boozy, bloodied celebration of surviving three whole days and nights on-call. And, every summer, queuing for cheap tickets to that music festival of world renown the BBC Proms, where he would stand high in the canopy of the Royal Albert Hall as Tchaikovsky and Mahler transported him yet higher.

Music, I was certain, was for Dad a form of blossom. In ‘Trenchtown Rock’, Bob Marley sang of its power: ‘One good thing about music, when it hits you, you feel no pain.’ And so, that spring, I secretly booked us seats inside the Albert Hall for an early Prom in the summer of 2017. Berlin’s Staatskapelle orchestra would be playing one of Dad’s favourite pieces, Elgar’s Second Symphony, conducted by the great Daniel Barenboim. Whether Dad would be alive then, or fit for trips to London, I could not say. I suppose the tickets were a talisman, tucked deep inside a bedside drawer, my own small leap of faith into the future.

For Britons, 2017 often felt like the year of hate. Acts of terror came like rain. First, in March, a British-born terrorist, Khalid Masood, ploughed his car through pedestrians on London’s Westminster Bridge, killing four of them, before stabbing to death a police officer guarding the entrance to Parliament. Two months later, another terrorist, Salman Abedi, exploded a bomb in the foyer of the Manchester Arena, killing twenty-two concert-goers, including children. In June, another eight people were murdered when terrorists drove a van into pedestrians on London Bridge, then embarked on a stabbing rampage in nearby Borough Market.

The country reeled from onslaught to onslaught. Already bruised from the preceding year’s referendum – Britain’s decision to leave the European Union had unleashed much division and anger – now we were battered by terror. It was hard to find reasons for hope. Amid the disbelief and rage, the murderous death toll ever rising, we scratched around for comfort where we could. For Dad, like so many, this lay in the innumerable, instinctive acts of courage that unfurled, like little miracles, from the hate.

‘Have you heard about the nurse on London Bridge?’ he asked me on the phone one night.

While terrified pedestrians had scattered from the men intent on killing, Kirsty Boden, a twenty-eight-year-old nurse in the NHS, had chosen to run towards the danger. The price of her selflessness, as she stooped to help a victim, was to be fatally stabbed in the chest herself. Her impulse to save others claimed her life.

‘If ever one person showed us how much there still is to believe in,’ Dad mused, as we asked ourselves whether we, both doctors, would have acted as bravely.

By the time July bathed Britain in sunlight, Dad had been stripped of all his strength by cancer, even as London was reinforced by newly sprouted concrete barriers, placed wherever large groups of people congregated, enticing the men with their vehicles, guns and blades. I had not dared hope for midsummer. But Dad, though frail, was still with us. Overjoyed, I drove my parents to the parking place, booked months earlier, right beside the Albert Hall, in case he was too weak to walk.

Slowly, arm in arm, we climbed the steps towards the hall. Dad’s bones were sharp against my skin. The slabs of anti-terror concrete perturbed us. ‘Has it really come to this?’ he asked. ‘That going out to hear a symphony could be life-threatening?’

He bought Mum and me a pre-concert glass of champagne. I had worried he might try to hide his fatigue, feigning enjoyment for our benefit, while really feeling too spent for pleasure. But, as he sipped his drink, the eyes that roved across the crowds glinted bright as bubbles. My heart lurched. It was just as I had hoped.

We took our seats. ‘Well,’ he grinned, easing his gaunt frame into velvet-covered plushness, ‘this isn’t quite what I remember from standing up in the roof in the 1960s.’ In choosing our seats, I had blown the budget on cancer-friendly opulence. We sat in a box, no less, looking down upon the stage. Beneath the cavernous domed ceiling, the tiers of gilded seats and stage lights, Dad no longer looked frail, but radiant. A hush, reverential, descended. The orchestra entered and, at Barenboim’s signal, Elgar’s opening notes swelled inside and around us.

I forgot the voice that had dogged me for months, asking, on every visit to my parents, ‘How many more times are there left to see Dad now?’ I forgot how much it hurts to love someone while losing them. I stole a glance at Mum and Dad, to see him squeeze her hand and smile. Bob Marley was right. Music, if fleetingly, had just cured cancer.

As the orchestra rose to rapturous applause, I knew I would seal this memory away in the back of my mind where it too, in time, might become talismanic. But the blossom, remarkably, was yet to come.

Barenboim turned from the stage to his audience and, breaking with convention, began to address us directly. Though he insisted his words were not political, ‘but rather of a human concern’, they were sufficiently newsworthy to fill the next day’s press, incurring social media wrath and outrage. Speaking as an Argentinian-born Palestinian citizen who had once lived in Britain, and now in Germany, he spoke of his fears of isolationism and – to deafening applause – of music’s unique ability to transcend national boundaries: ‘If a French citizen wants to learn Goethe, he must have a translation. But he doesn’t need a translation for the Beethoven symphonies. This is important. This is why music is so important.’

To some, his words signified an unwanted rebuke of those Britons who had voted, in the previous year’s referendum, to leave the European Union. But his appeal for more education ‘about who we are, about what is a human being, and how is he to relate to others of the same kind’ seemed to me to deliver an altogether different message. Unity, not division, was Barenboim’s aspiration. Music, fundamentally, was his means of connection, of bringing people together, irrespective of difference. ‘Our profession, the musical profession, is the only one that is not national. No German musician will tell you, “I am a German musician and I will only play Brahms, Schumann and Beethoven.” ’

I looked across at Dad and smiled. We had argued so often, with such vehemence, about Britain’s role in Europe – he a ‘Brexiter’ who longed for British sovereignty, me a Europhile who carried her EU passport with pride. Barenboim’s words touched each of us deeply, surely proving, with eloquence, his point. Poignantly, within this concert hall newly barricaded inside concrete, he continued, ‘Religious fanaticism cannot be fought with arms alone. The real evil of the world can only be fought with a humanism that keeps us all together. Including you. And I’m going to show you I really mean it.’

He turned back towards the orchestra and raised his baton. Silence. And then, gifted to the hall, two encores. First, ‘Nimrod’, from Elgar’s Enigma Variations, my father’s favourite piece of music. Then, the most overtly patriotic of all of Elgar’s works, his first Pomp and Circumstance March, widely known as ‘Land of Hope and Glory’. Two profoundly political pieces, steeped in anachronistic overtones of greatness and empire, yet played lovingly, in London, by Berlin’s finest musicians. There it was. In music more powerful than any words, in a country beset by division and fear, we were reminded of what we shared.

I could think of none of this, however, as the strings ebbed and flowed. My heart had unravelled at the thought, ‘Nimrod’, Dad’s been given ‘Nimrod’. He loved the piece more than any other, passed on that love to me while I was still a child. Too young to understand words like ‘patriotism’ and ‘empire’, I simply observed, as he turned up the volume, the music sweep him upwards, somewhere high. And 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. ‘Nimrod’, I grew up learning, was Dad’s anthem, and so, of course, it became mine.

Beneath the auditorium lights, tears shone from my parents’ faces as I watched them smile, rapturously. How very unlikely, how outlandish, that now, in using Elgar to plead for our common humanity, Barenboim had unwittingly enabled the dying man in the box right of stage to live, for a moment, wondrously.

In today’s developed world it is possible to live an entire lifetime without ever directly setting eyes on death, which, considering half a million Britons and two and a half million Americans will die every year, is remarkable.

Little more than a century ago, this distance from dying was inconceivable. We invariably departed the world as we entered it, among our families, close up and personal, wreathed not in hospital sheets but in the intimacy of our own homes. Now, though, both birth and death have become, by and large, institutionalised. The only two certainties around which our lives pivot have been outsourced to paid professionals. A scant 2 per cent of births in Britain are home births, and only one in five of us will die at home, despite two thirds of us expressing the wish to do so. Hospitals, hospices and care homes are the new repositories of modern-day demise.

Doctors, in involving themselves in matters of dying, therefore do something highly unusual. I am odder than most. By specialising in palliative medicine, I use my training and skills specifically to help people with a terminal illness live what remains of their lives as fully as possible, and to die with dignity and comfort. I have, in short, made dying my day job. Rarely, if ever, does a week go by in which all of my patients survive.

Most people’s reaction on learning what I do for a living is to wince as they mutter, ‘I don’t know how you can bear that.’ You can almost feel the suppressed recoil as they shrink from the thought of all that death. And I don’t blame them. I used to recoil once too. Losing someone you love can be a pain more searing than any other. And there is no escaping the fact that dying, like childbirth, can be gruelling – though far less commonly than I once imagined. As a patient once told me: ‘I’m not afraid of dying, I just never realised it would be such hard work.’

The allure of medicine is easy to understand. There is power, respect, status, gratitude. But why on earth would a doctor, after all those laborious years of study – the hard-won potential to restart a child’s heart, give back the gift of sight, reset a shattered limb, transplant a kidney – choose to immerse themselves in death and dying? What could possibly be the attraction of day in, day out grief and sadness, all of it tainted by the whiff of defeat, of inescapable medical failure?

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, murkily intervening with our morphine and midazolam once our charismatic cousins have exhausted their efforts at cure. 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.

Once, shortly after I qualified as a doctor, a consultant oncologist summed up in one sentence a certain old guard’s attitude to terminal diagnoses. We had just left the bedside of a patient whose cancer had spread widely, despite her last-ditch chemotherapy. ‘There’s nothing more for us to do here,’ the consultant had said by the sink, as he literally and metaphorically washed his hands of her. ‘Send her to the palliative dustbin.’

His words left me dumbstruck. Were there really doctors who dismissed patients as trash, as having lives devoid of value, once medicine could no longer prolong them? At the time I could hardly conceive of a more repugnant sentiment, though today I wonder if the consultant’s remark was really a crass attempt at humour, born out of embarrassment and discomfort at his own perceived impotence. The feelings death stirs are nothing if not complicated.

Even I – someone who works with death on a daily basis – treat the subject with caution. My own children, for example, still do not know exactly what Mummy does at the hospital, and I am not sure how old they will be before I feel entirely comfortable explaining all. They assume, I imagine, that I save lives for a living. That is, after all, the old medical paradigm. The dramatised doctors who stride across our television screens, swoop in, take command, deploy their skills and save the day. Stethoscopes in place of capes, but doctor-heroes all the same, prolonging life, denying death, playing God with impunity.

When I was a child myself, devoted to my physician father, I came to glimpse through him a different, quieter style of doctoring in which medicine perhaps achieved less yet was kinder and more humane. I learned from his inexhaustible tales that even when a patient’s fate seems hopeless, a doctor, if they care, through their basic humanity, can always make things more bearable, and that this was something to emulate. The lesson must have lodged in my brain. Two decades later, upon belatedly qualifying as a doctor myself, I would discover that a frenetic, overstretched hospital environment threatened to stamp out of medicine the very things that had made me most proud of my father – his unassuming attention to his patients, an innate and profound love of people. Exhausted doctors swiftly mutate into burned-out ones who wearily go through the motions of healing.

Perversely, the one part of the hospital that allowed me to flourish as a doctor was the ward most steeped in fear and taboo: the inpatient palliative care unit. If I told you that my work there today is more uplifting, more full of meaning, than any other form of medicine I could imagine practising, you might think too much time in the hospice had addled my brain. But what dominates palliative medicine is not the proximity to death, but the best bits of living. Kindness, courage, love, tenderness – these are the qualities that so often saturate a person’s last days. It can be chaotic, messy, almost violent with grief, but I am surrounded at work by human beings at their most remarkable, unable to retreat from the fact and the ache of our impermanence, yet getting on with living and loving all the same.

One way or another, I have circled death and dying for half a lifetime. Like most of us, blithely pretending our days are not numbered, I have had my share of close shaves. Narrowly escaping a terrorist nail bomb, crawling out of the wreckage of a car on black ice, even fleeing bullets from Congolese child soldiers. Then, in choosing to become a doctor, I elected to attend more closely to death – and to the inevitable grief it unleashes. Finally, upon specialising in palliative medicine, I learned that dying, up close, is not what you imagine. For the dying are living, like everyone else. It is the essence of living – beautiful, bittersweet, fragile life – that really matters in a hospice. You would be surprised by what we get up to.





1


Near Misses


We are, all of us, wandering about in a state of oblivion, borrowing our time, seizing our days, escaping our fates, slipping through loopholes, unaware of when the axe may fall.

Maggie O’Farrell, I Am, I Am, I Am




The first time I remember thinking about dying was as an impressionable seven-year-old. Then, at the height of the Cold War, my early morbid fascination was inspired by Mrs Dewar, my brilliant but idiosyncratic primary school teacher, a woman with the Soviet Union on her mind. Thin and intense, with a piercing stare, she could flip in an instant from subtraction to mutually assured nuclear destruction, holding her young audience rapt and quaking.

‘Children!’ she would warn us, glowering darkly. ‘The Russians are coming. I tell you, the Russians are coming.’

None of us was entirely certain who or what the Russians were, but we were mercilessly brought up to speed. When they came for us, they would slaughter us all, mothers, fathers, brothers, sisters. The world we had happily taken for granted was teetering, all of it, on the edge of oblivion, apocalyptic horrors on the cards at any time. No part of the country, not even the tiny village I inhabited in rural Wiltshire, was impervious to the threat of East–West animosity escalating into full-blown nuclear war. This was too enormous for my young brain to fathom – not a single person’s death, but the annihilation of a species, no human being spared. Dread seeped into my bones.

Children are meant to be so absorbed in the vital business of day-to-day living that their own mortality passes them by. But I remember going to bed, aged seven, genuinely fearful I might not be alive in the morning. I would lie awake, rigid with fear beneath the duvet, and when I did sleep, mushroom clouds haunted my dreams. One night, in the small hours of the morning, my father was awakened by the clanking of a clumsy intruder. Stark naked and armed with only a poker, he crept – half superhero, half Benny Hill – into the living room to find not a burglar, gloved and masked, but his sleep-walking daughter, knocking ornaments flying as I groped my way along the window sill, eyes tight shut, muttering my now-internalised dread: ‘The Russians are coming, the Russians are coming. We are all. Going. To. Die.’ Dad scooped me up in the darkness and tucked me back into bed. I can still recall the feeling of absolute safety, as though nothing could touch me when held in his arms.

My early existential angst at nuclear Armageddon was swiftly superseded by more pressing concerns, like whether seven-year-old Ben Hardy, the boy in my class famed for eating nothing but tomato ketchup sandwiches at lunchtime, would ever agree to marry me. It turned out that, like most children, I was indeed too entranced by living to dwell upon something as abstract and ethereal as dying.

Death, if it cropped up at all, was in the form of illicit entertainment. Every Friday night after school, for example, clean and fresh from our evening baths, my brother, sister and I would eagerly clamber on to the sofa for our weekly treat, on BBC television, of an old black-and-white Tarzan movie. In the title role, Johnny Weissmuller, the Olympic swimmer turned 1930s Hollywood star, ran, leapt and hollered his way through the jungle, his oiled six-pack gleaming. The highlight was never Johnny however, nor even his feral sidekick, a filthy-cheeked child known only as ‘Boy’.

What we loved, as only eight-or nine-year-olds can love, was the terrible scene, towards the end of each movie, when a baddie would receive a very special comeuppance. ‘It’s the tree!’ one of us would scream with ghoulish delight, since not all of the movies contained this blood-curdling finale.

‘The tree’ involved furious natives (as Tarzan referred to them) spread-eagling the baddie upon two crossed tree trunks, then raising him, pinioned, into the sky. His left arm and right leg were tied tightly to one trunk, his right arm and left leg to the other. Far below the hapless baddie, jungle drums beat in a manic crescendo while natives danced themselves into a frenzy. Tarzan himself would be hidden or captured, thus powerless to prevent the imminent slaughter. A machete would be raised, and quiver briefly in the sunshine. Then, all of a sudden, the ropes securing the trees would be cut, a female starlet would avert her eyes in anguish, and the trees would snap apart with a sound like a bullet, ripping the victim clean in half.

‘The tree, the tree!’ we’d laugh uproariously before descending, every week, into the same heated argument.

‘You wouldn’t be ripped in half,’ one of us would declare.

‘Yes, you would! Right down the middle.’

‘No, you wouldn’t. Your legs would get pulled out of their sockets. And your arms. They’d stay on the tree trunks and your body would fall down and you’d bleed to death.’

‘Well, actually, your body would be ripped in half – all the way up to your head – and then your skull would fall off and that’s how you’d die.’

And so it went on. Rarely – an extra special treat – Dad arrived home from work in time to perch with us on the edge of the sofa while we revelled in Metro-Goldwyn-Mayer carnage. He laughed at the tree as much as we did.

For a child of the 1970s, death by Dalek, werewolf, cyborg or shark was the absolute highlight of British television, the grislier the better. We knew our glee at the gore was faintly indecent, but this was celluloid make-believe, fantasy dying, and hence a permissible pleasure.

Once, though, around this time, Dad told me a story that made death – perhaps for the first time in my life – feel unnervingly close to home. My father was a physician for forty years, most of them practising as a general practitioner in an era when family doctors cared for their local community night and day, every day of the year. Before that, like his own father before him, he had sailed the high seas as a medic in the Royal Navy, and his seafaring stories transfixed me. His speciality, in my view, imbued him with the dark arts of a witch doctor. As a naval anaesthetist, he possessed the ominous power, via mysterious vapours, to ‘put people to sleep’ – which was, I noted, what eventually happened to my friends’ pet dogs, a sleep they never woke up from.

One day, Dad began to tell me about an occasion when his naval warship was touring the South China Sea. I adored Dad’s medical stories, hanging upon his every word as he told and retold, at my insistence, all my favourites. Somehow, whatever his patients threw his way – drama, trauma, poignancy, despair – Dad seemed to hold their lives in his hands with confidence, omniscience and a distinct hint of deity. He may have seen himself as only an ordinary doctor – as run of the mill, nothing special at all – but to my child’s eyes he was the undisputed hero of his tales.

This story, however, was not anything like that. Dad was only a young man himself, just a few years out of medical school, when the news filtered up to his ship’s sickbay that an explosion had ripped through the boiler room. Two junior ratings had been caught in the blast. ‘They were even younger than me,’ Dad told me. ‘No more than eighteen, nineteen years old.’ A faulty pressure valve had allowed a lethal build-up of steam which, when it blew, flung the lads across the room and burned most of their skin from their bodies.

‘Did they die?’ I asked him, unable to imagine how injuries so dramatic could be compatible with survival.

‘No. At least, not to begin with. That was what made it so awful.’

Dad relayed what happened next with such absorption he forgot he was talking to a child. The two casualties were successfully dragged from the scene and rushed, still alive, to the sickbay. There, he and his senior doctor worked furiously to stabilise each patient. They dressed the burns, assessed the airways, obtained intravenous access, and started infusions of fluids and morphine.

‘What’s morphine?’ I asked.

‘A very strong painkiller. Although, in fact, they didn’t need it. They were barely in pain at all.’

Knowing how excruciating mere sunburn could be, this confused me. Dad’s explanation was blunt: ‘You need the nerve endings in your skin to feel pain there. They didn’t have any skin left, so they didn’t have any nerve endings. They were pain free. Chatting, Rachel, laughing. They were full of relief. They thought they’d had a lucky escape.’

Something in the way my father said this caused me to sit up and lean closer. He was talking as though he was back there.

‘We were hundreds of miles from shore. We had to sail to Hong Kong to get the lads to a hospital. It was going to take at least a day, maybe two. My job was to stay with them, comfort them. They didn’t know they were dying. Why would they? They weren’t in any pain. Their eyes were bandaged so they hadn’t seen their injuries. But I knew. I knew that full-thickness burns over this extent of the body was fatal. I knew they’d lose consciousness long before we reached shore. My job, most of all, was to lie to them.’

The idea of professionally obligated lying had never occurred to me. As a fairly puritanical nine-year-old, I was not even sure I approved of white lies. I liked my human values rigid and polarised – right and wrong, black and white, entirely admirable and wholly unworthy. But the sadness in Dad’s face, in this moment, was anything but binary. He must have ached with the knowledge, unvoiced to his patients, that one by one their organs would inexorably shut down. His voice softened as he continued talking.

‘The Navy arranged to fly their parents to Hong Kong, so the boys knew – or thought they knew – that they’d be seeing their parents as soon as we arrived there. One had a girlfriend. He was worried about how he’d look to her. So I lied. I pretended they’d have a romantic reunion. I tried to make them feel positive. They hadn’t been adults for very long, Rachel. To me, they still seemed not much more than children. After about twenty-four hours they started to become groggy, and not long after that they lost consciousness.’

‘But … wasn’t there anything you could do to save them?’ I asked.

‘Nothing. Nothing at all.’

‘And, then … did they die?’

‘Yes, they died, Rachel.’

Dad looked away for a moment. I wanted to cry. I was not sure what disturbed me more, the thought of the two young men sailing unknowingly to their deaths or the sight of my father, visibly overcome. Being a doctor, I had assumed, made you close to a god, and I loved having my father on that pedestal. Now I had glimpsed, even if I was unable to articulate it, the uncomfortable truth about medicine that, while the demands of the job are indeed exceptional, the person occupying the role of doctor is, just like their patients, merely human. Whether I liked it or not, I recognised my father as someone with fallibilities and frailties, just like the rest of us. And although I did not know what ‘empathy’ meant, I felt a little of his sadness.

None of Dad’s stories lingered quite like this one. Countless times as a child I had observed his job leave him so numbed and weary on returning home to his family that he could scarcely do more than flop upon the sofa, gin and tonic in one hand, newspaper in the other. But until then I had never considered that the core of his medicine might be kindness, not heroics, and what an instinct for kindness could cost a person.

Many years later it would dawn on me that in those moments, while sweltering below deck in a windowless sickbay, my father had in fact struggled to practise a brief and unusually horrible form of palliative medicine, the pain of which had never entirely left him. His actions that day, his lies to the two young naval ratings, were an attempt to eke out for them some quality of life, no matter how tiny, even as death bore down on them. In conventional medical terms, he had achieved nothing at all. He had not prolonged life, enhanced life, slowed death’s swoop, bolstered health. Yet in human terms, by managing to stifle his horror at the charred flesh and looming demise of two young men, by keeping close at their bedsides, by ensuring they knew they were not alone, perhaps he had helped make an intolerable fate bearable. Perhaps he had done everything that mattered.

Twenty-first-century acquaintance with dying is televised, digitised, sanitised – and everywhere. My first fix of death as on-screen entertainment came courtesy of Johnny Weissmuller flexing his muscles. In the case of my son, however, it was different. At the age of eight or nine, he began returning from afternoons with his friends wired with tales of gore while annihilating PlayStation hordes. Forgetting the childhood frisson of seeing death at one remove, I would fret that this early exposure to make-believe gun crime would somehow bestow a blasé attitude to dying or, worse, serve to glamorize casual killing. Finn, however, put me neatly in place. He knew exactly the difference between a screen and real life: ‘Er, Mum, you do know that trees aren’t pixelated?’

With a doctor for a father, and a nurse for a mother, my siblings and I bucked the demographic trend for human dying to be an abstract experience. The children of medical parents often discover abnormally early that there is no neat demarcation between home and the hospital. Dad’s stories were one thing. But more fundamentally, he was so immersed in his patients’ lives that sometimes, unwittingly, he brought death into the home, and us out to meet it.

Once, on an idyllic Sunday afternoon, a call from the police dragged Dad away from the Ashes. All week the sun had been ferocious, the grass unmown, as an epic sporting rivalry enthralled the nation. Unusually, on this occasion, it was not the urgent need for medical expertise that denied Dad the satisfaction of watching England’s cricketers thrash Australia. Instead, a bureaucratic formality was called for, one that only the on-duty doctor could provide. A few miles from our home, under milky blue skies, a young man had thrown his life into the path of a high-speed train and, as is necessary in cases of sudden or unexpected demise, a doctor was required to certify death as having occurred.

Dad had muttered as much to Mum before he departed but, as you would expect, my brother, sister and I had been kept in the dark. On his return, though, Dad’s expletives were thunderous. None of us could fail to hear what had provoked them. ‘Total waste of sodding time … hardly need a bloody doctor … he was smeared along five hundred yards of track, for Christ’s sake … bits of him stuck in the blackberries.’

I have no doubt I caused Dad’s afternoon to deteriorate still further. ‘Wait, what happened? What do you mean, “smeared”? What was in the blackberries?’ My torrent of questions was relentless. Consumed with anger, which even I could tell was not entirely about missed cricket, he was forced to explain, in child-centred terms, how, even when a body has been reduced to small chunks of flesh on a track, the law still requires a doctor to diagnose and confirm death in writing.

Like his experience of tending to the two dying sailors, the event never left my father. Over the years we would revisit it, many times, in conversation. For all his appreciation of the sheer desperation that drives a person to suicide, Dad’s sympathies lay with the driver, whom he had met that afternoon, on the side of the track, still trembling and retching beside his own vomit.

‘In those days,’ Dad told me, ‘there wasn’t anything like counselling or time off work for someone who went through that. You just went back to work the next day and got on with the job.’

What he never quite admitted – how could he, given what the driver had endured? – was the pain for himself, as well as for the police officers and railway staff, of being yanked from his family one weekend in late July to inspect freshly pulverised human remains beneath serenely indifferent summer skies.

What I learned as a child that Sunday was that Russians were not needed for death to strike from nowhere, suddenly and horribly, and with the power to transform, if temporarily, the lives of those who had never even known the deceased, let alone of those who had loved them. One way or another we were all, I saw clearly, just moments from death. It could be folly, despair or plain bad luck – catastrophe lurked everywhere.

Dad spent the rest of the day impatient and irritable, as we cautiously gave him a wide berth. I could not conceive of doing what he did, and nor, if I were honest, did I want to.

If I thought about medicine at all as a child, it was more with ambivalence than enthusiasm. On the one hand I was addicted to Dad’s tales of doctoring, but on the other, like most children, I was fully aware that doctors did things to you without permission or mercy – even my own father.

The one occasion on which I could, very easily, have died as a child was a prime example. We had driven all the way to Fort William, in the Scottish Highlands, to spend a couple of weeks in a log cabin surrounded by mountains. Old enough to be allowed to play outside by ourselves, my brother, sister and I spent hours damming streams, climbing trees and, most excitingly, swinging on a rope across a river. Except I was rubbish at rope swinging. Nervous at the prospect of falling off, I allowed my legs to trail feebly behind me, while the other children curled up tight as bullets, flinging themselves on to the other side.

As everyone issued instructions on how to do it better, slow-burning shame overtook my wimpish fear. I stood on the edge, clutching the rope with all my might, consumed by the thought that this time I had to make it to the other side. A deep breath, a moment of silence as the other children looked on like a panel of judges. Then, I launched myself into the air, wrenching my knees towards my eyeballs, determined to redeem myself.

My next sensation was of a sound worse than nails on a blackboard, an ear-splitting screeching, from far away, but becoming louder and more hideous with every moment. It took a second or two before I realised the noise was coming from me. I was surprised to find myself sitting in water, submerged in it up to my neck. More baffling still was why I should be screaming when I felt neither fear nor pain. Rough hands started grabbing and clawing. My shrieks had caused adults to come sprinting from their cabins and scramble down the muddy bank to drag me up to the grass. With the hoisting and yanking came the rush of pain. I was fainting with it, too shocked and nauseous to appeal for gentleness.

Carried by my father back inside our cabin, he proceeded, as every doctor would, to conduct a brisk clinical examination. I remember Mum looking on, face pained and anxious, as Dad went straight for my right arm, now dangling at a drunken angle, to assess its range of movement. When he lifted the limb, bone ground on bone. The impact had snapped off the head of my humerus and the pain was like nothing I had known. As she watched me passing out on the sofa, Mum could not stand it any longer. ‘For God’s sake, Mark, stop it. Look at how much you’re hurting her.’

Terse words followed, whose content I barely registered.

We set off for the nearest hospital, an hour or so away along contorted mountain roads, while I slumped on the back seat, trying in vain to keep still as the car lurched and twisted round corners. In the front, Mum and Dad discussed whether surgical fixation with metal pins would be needed, and how only an inch or two’s grace had saved my neck from being broken. I kept my eyes closed, pretending to sleep, filled with gratitude to Mum for demanding that Dad take the corners a little less hastily. One surgical manipulation and a night spent driving back through the mountains later, and I endured the rest of the holiday with my arm elevated into a horizontal position by layer upon layer of dense foam packing, all kept in place by surgical tape wrapped around my torso. I looked and felt ridiculous.

The children’s author Roald Dahl once told an interviewer that adults should get down on their hands and knees for a week, in order to remember what it feels like to live in a world in which all the power resides with people who literally loom over you. Nowhere are the powerlessness and indignity of being a child more evident than in a medical consultation room where you know, at any moment, you may be subjected to a spatula down your throat, a metal probe in your ear, foul-tasting liquids or a doctor’s halitosis. When your parent is the doctor, your entire world holds those risks, even the summer holidays. It would have never occurred to me to question Dad making me faint with pain to elicit a diagnosis, had Mum not reacted against it so fiercely. But it was, I later realised, an odd quirk of fatherhood that protecting one’s offspring occasionally necessitated causing them physical suffering.

Six weeks or so later, while standing in a hospital outpatients department, strip-lit and naked from the waist upwards, I received a smarting lesson in how doctors by no means monopolised the matter of pain and its infliction. My humerus had knitted together, and it was time for the foam packing and tape to be removed. I did not like the look of the nurse who grimly picked at one end of the tape, trying to dislodge it. With her severely scraped hair and thin tight mouth, to me she seemed much like a Roald Dahl antihero herself. And when she pursed her lips and prepared to pull, I was certain she did so with relish.

I gasped. The tape had adhered so tightly to my child’s soft flesh that the force required for its removal took the top layer of my skin clean away. Slowly and deliberately, the nurse walked around me, tearing off translucent ribbons of skin as she went. I looked down to see beads of blood trickling towards my abdomen. Mum was aghast in the corner. I clenched my teeth, stared up into the fluorescent lights, and vowed not to make a sound, even as my eyes, swimming with tears, betrayed me.

‘There,’ the nurse stated, dumping bloody tape and foam into the clinical waste bin. ‘That wasn’t so bad, was it? I don’t know what you were so worried about.’

Weeks later I still thought about her with burning hatred as I picked the old scabs off my ribcage. The fact that a centimetre here or there, a lurch to the left or a list to the right, and it could have been my neck, not my shoulder, that had snapped in two occurred to me not for a moment. Only years later would the realisation dawn that I might have been a hair’s breadth from death. How innocently we all exist alongside what might have happened, yet, on this occasion, didn’t.

Early clues that I might follow my father into medicine included hunting for owl pellets while walking our dog in the countryside, then spending hours dissecting out the tiny rodent bones and meticulously labelling and mounting them on cardboard. Later, when I was first taught about the female reproductive system at school, I was so appalled by the prospect of messy, embarrassing, inconvenient menstruation that I spent an entire afternoon’s double biology discreetly sketching a root-and-branch pelvic redesign that diverted menstrual products from the uterus to the colon, ingeniously avoiding the unwelcome palaver of periods. As far as I was concerned, my new improved female reproductive organs beat evolution’s hands down.

But as a child I did not want to be a doctor, I wanted to be a writer. I could not believe adults were given money for the pleasure of writing stories, or that you were allowed to borrow eight – eight! – books a week from the library, or that a book existed, an extraordinary book, that taught you the meanings of words. My mother describes me tearing downstairs one day and thrusting a book under her nose. ‘Mum! Did you know about this book called the dictionary?’ I announced ecstatically. ‘It tells you what every word means and it even tells you how to say them.’

My own stories were obsessively transcribed, after school and at weekends, into clumsily illustrated, homemade notebooks. Gore featured prominently – disembowellings and amputations – for which I blame my father. Dad had a broom cupboard lined floor to ceiling with bookshelves. The ‘library’, as it was grandly known, was filled with everything from James Joyce to Harold Robbins, Isaac Asimov to Jeffrey Archer. From early childhood, I surreptitiously devoured age-inappropriate fodder, continuing late at night with a torch beneath the duvet, long after Mum and Dad had gone to bed themselves. The James Bond and Modesty Blaise series were best for racy excitement, while the horrors of Edgar Allan Poe both repelled and enthralled me, inspiring my own gruesome dramas.

The best stories, of course, came not from a book but from Dad himself. Dr Mark Rendall came to know intimately many generations of patients – all the loves, losses, hardships and joys that knit families together, or sometimes tear them apart. He could not walk down the street of the little market town where he practised without a string of cheery hellos called out to Dr Rendall. At Christmas, there were so many gift-wrapped bottles from grateful patients we could not fit them all under the tree.

From his children’s perspective, all of this meant nothing. Time spent devoted to the needs of his patients meant time away from us, and from Mum. Often, like so many doctors, Dad returned home at the end of the day as empty and spent as a field after harvest. Having poured all of himself into back-to-back consultations, there was nothing left for his family. The innocuous-sounding ‘one in three’ – his standard GP’s roster – had to be lived to be believed. Every third day of his working life, he worked thirty-six hours straight, from nine in the morning until six or seven o’clock the following evening. All night long, patients would call him out on visits to their homes. Mum answered the telephone calls while Dad was out responding to them, so both my parents suffered semi-permanent sleep deprivation. Sometimes, after a particularly gruelling night, as Dad helped us get ready for school in the morning, he looked so haggard and worn that even making coffee seemed beyond him, let alone another day spent making potentially life-and-death decisions with patients. Fatigue quickened his temper as we fumbled with schoolbags and shoes, dragging our feet in the hall.

Once a year I glimpsed for myself the clinical world that claimed so much of my father. Every Christmas, my siblings and I would rip open the contents of our stockings and devour our special festive breakfast before setting off for Dad’s local cottage hospital in the car with my parents. These small, rural hospitals, now largely closed down, enabled villagers to avoid huge treks to a county hospital, and to be treated close to home by the one doctor, their local general practitioner, who was familiar with their life and problems. Babies were born there, great-grandparents died there. My father knew every one of them.

Each year, a handful of his patients, men and women in their eighties or their nineties, would spend Christmas marooned in the cottage hospital. Dad moved from bedside to bedside, chatting warmly and easily, with his young family in tow. At barely five or six years old, I would hover uneasily at each ancient patient’s side, nauseated by the smells of iodine and bodily fluids. Rarely was anyone else there. Sometimes, it seemed as though the visit from the family doctor was the highlight, so far, of their Christmas Day.

For all my anxieties about what to say, how to behave and whether someone was about to gasp their terminal breath in front of me, one thing was clear. These faces, so wizened and old, would light up with delight at my father’s arrival. And when my siblings and I crept closer to their sides, often they would beam with joy at the chance to chat with a small child. Somehow I knew that in spite of my fears and awkwardness, the little we gave of our Christmas mornings mattered greatly to my father’s bedbound patients.

By the time it came for me to choose my A-levels, medicine felt no more connected to people than school chemistry did to medicine. Except for Dad. He was the link. He made medicine human. As I had grown up, the stories I had once loved for the way they framed Dad as my two-dimensional childhood hero had become a nuanced, complicated and treasured form of father-daughter intimacy. When we talked about his patients, he shared himself with me, the reserved, self-questioning doctor who wore his losses and failures – his patients’ deaths – like rust around his heart. For the first time, it crossed my mind that perhaps, all those years ago, when Dad had manipulated my broken arm, it had hurt him as much as me to do so.

‘Dad, you know if I do English A-level it means I can’t do Chemistry?’

We were chatting one Sunday morning while walking the dog through the farmland that surrounded our house. The deadline for me to submit my A-level choices loomed the next day. My sixth form was small, and Chemistry clashed with English on the timetable. Dad knew exactly what this signified.

‘So, if you choose the subject that’s essential for Medicine, you won’t be able to study the one you love more than anything?’

I nodded. We walked on. The silence hung comfortably between us. Some way in the distance, our Labrador was chasing rabbits with such inept enthusiasm that we both burst out laughing. We stomped through the mud, skirting the cowpats. I hesitated before asking the question I knew my father would not answer.

‘Dad … do you think I should be a doctor?’

Had he said yes, I would have followed his lead in an instant, and he was, I knew, well aware of that. He paused, then smiled. ‘I can’t tell you what to be, Rachel. Only you know that.’

Not once, to their credit, had either of my parents ever tried to steer me towards their vision of the life that was best for me. I knew how grateful I should be for that, yet still longed for Dad to tell me what to do. In the end, ironically, it was because of him that I ruled out a career in medicine by choosing to study books above Bunsen burners. I was wary of becoming a doctor not out of genuine vocation but instead, deep down, to make him proud of me.

Rather than helping people through healing, I harboured instead a vague, romantic, childish notion of using words to make the world a better place. Stories, I knew, were infinitely more than mere entertainment. Not only could stories save lives, but people sometimes died trying to tell them. As an idealistic teenager, I watched transfixed as the BBC broadcast images from China’s Tiananmen Square of a thin man in shirt sleeves standing in front of a dictatorship’s tanks, defying them to crush him as the world’s press looked on. The idea that speaking out, of telling the truth, could easily, in another part of the world, end up being the death of you made journalism seem like a moral imperative. Through all those years hanging on tenterhooks as Dad enthralled me with his tales of doctoring, it never occurred to me that the heart of both jobs, journalism and medicine, might fundamentally be storytelling.

I gave neither medicine nor mortality another thought until, just before setting off for university – Philosophy, Politics and Economics my degree of choice – I was forced to confront, in a rush of adrenalin, the apparent fact that I was about to die.

It was deep winter, one of those dismal English days in which dawn never properly breaks and by teatime, the dregs of daylight are gone. My friend in the village had plans though. Tom rocked up on the doorstep that evening, hardly able to stand still as he spun a battered set of car keys from his fingertips. ‘It’s mine, all mine,’ he boasted eagerly. ‘Fancy a spin?’

I gawped at the banger on the driveway. To me, these superannuated wheels promised more thrills than the world’s fastest Ferrari. A car – any car – was a means of escape from the back of beyond. Pure intoxication.

‘Wait. Is this actually yours? Have your parents really given you a car?’ I gasped.

Tom had passed his driving test a few days earlier. His reward, from his parents, was deliciously unexpected. ‘Yep. Come on. Let’s go.’

There are no surprises as to how this story ends. It was bitterly cold, with frost in the air. Black ice had been daubing the country lanes all week. After a stuttering start and some amateur reversing, we crept sedately through the village at a law-abiding pace and then, out in the open, began to accelerate. Tom whooped as he crunched through the gears. There was a wildness about his desire for speed that initially did not frighten me. We laughed together as the engine strained and spluttered, and the hedgerows began to melt away around us. The speed, the liberation, as we played at being grown-ups, claiming the roads as our own.

But Tom’s first taste of speed had unleashed something primal and dangerous. With his foot to the floor, the engine first roared, then screamed in protest. I began to bristle with fear. ‘Hey, Tom. You need to slow down.’ It was as though I had not spoken. ‘Tom, seriously, slow down. You’re going too fast. Tom!’ The more I begged, the more recklessly he swerved. My screams only seemed to incite him.

Even as adrenalin flooded my body – my panic a kind of bile in my mouth – a part of me observed the road ahead with cold, hard, unflinching clarity. I knew, with utter certainty, how the next seconds would play out. Tom’s shaky hold on the tarmac was about to fracture. The car would no longer be swerving but skidding. He would fight for control and never regain it. We would be flung into oncoming traffic. The shriek of wheels, the smash of cranium on glass, would go unfelt, unnoticed, because moments from now we would be mangled and lifeless, dangling inertly from our seatbelts.

And sure enough, the car began to lurch from one lane to the next. Tom’s wrenching on the steering wheel was futile. I could not tell if the thundering in my head was my blood or the brake pads on metal. Neither of us could change how this would end now. When we were flung, for the third time, into the opposite lane, the car had acquired such drunken momentum that its wheels left the road – we were launched skywards. A thud, a screech, the crumpling of metal and then we were upside down in a ditch, axles spinning above us.

Every window was smashed, the bodywork chewed up, the car a write-off. No one could have crawled from that wreckage intact, yet somehow we emerged, coated head to toe in glass, scratched and trembling but otherwise unscathed. We stood on the road next to smoking scrap metal, silently clutching each other. It was bitterly cold. Our breaths, condensed, were visible proof to the world and ourselves that we were still, against all odds, alive.

On the far side of the road was a country cottage, outside which an elderly woman stood in her nightie. ‘Come here,’ she called, leading us inside. ‘The bang woke me up. I thought there’d been an explosion.’

I borrowed her telephone to call my parents for help, shards of glass from my hair pattering on to the table. Mum and Dad arrived, stared in horror at the wreckage, and drove us home in silence. What was there, really, to say? Tom and I never spoke of what had happened. And, after a day or so of intrusive, slow-motion, high-definition replays, I successfully dismissed the crash from my mind. Move along, I told myself. Do not stop, do not look back. You are eighteen years old and there is all this life to be living.





2


Flesh and Blood


They come to rest at any kerb:

All streets in time are visited.

Philip Larkin, ‘Ambulances’

from The Whitsun Weddings




The first time I saw a dead body, I would be lying if I pretended I’d cared.

It is spring, but the city is giddy with the audacity of summer. Now in my mid-twenties, I have lived in London long enough to know that unseasonal bursts of rare British sunshine bring out the capital’s carnival spirit. During those fleeting moments of snatched not-quite summer, the hard edges of life in the city – noses crushed into armpits on tube trains, altercations between drivers over who hogged the road – melt away as we turn our heads skywards, like plants to the light, marvelling at the blueness and warmth.

On Friday 30 April 1999, the frayed tempers and short fuses of an overcrowded metropolis vanish beneath limitless skies. I am a young television journalist who occasionally indulges a secret pipedream of retraining, one day, as a doctor. By the time I leave the studios that evening with my boyfriend, London has been dipped in gold. Coats off, smiles on, we saunter slowly across Hungerford Bridge, taking our time to savour the light rebounding off the Thames beneath us. We are searching for a pub outside which we can sit to toast this improbable gift of an evening. It seems the whole of London has had the same idea. The streets of Soho teem with young men and women spilling out on to the pavements, pints in hand.

Arm in arm with Matt, semi-intoxicated ourselves with sunshine, I find myself marvelling at the transformative power of something as simple as weather. In place of the hard-bitten commuters, clawing their individual ways home for the weekend, it feels like London has come together in humble worship of the sun.

We weave towards a pub that happens to be located in Soho’s Old Compton Street, the heart of London’s LGBT community. I like the Admiral Duncan. A small but vibrant gay bar, packed with personality. Its swagger and attitude reflect many of its customers. But this evening, unbeknown to us all, somebody wants them dead.

When it happens, we are approaching the pub’s front door. I have no recollection of the actual blast, only of finding myself face down in the gutter. My cheeks are pressed against tarmac. A forest of legs looms above. Although perplexed, I am oddly unmoved by how the street has lurched on its axis, been upended around me, and I can no longer hear a sound.

Slowly I stand, stunned and silent, wondering why the people around me are coated in dust as thick as flour. Of my five senses, only my eyes seem to function. A few feet in front of me lies a body in the gutter. Dimly, I clock how bright the man’s blood is, and that his leg, neatly severed, lies on the ground beside him. The street is flooded with his blood. Other people, I notice, are wandering in circles, ghosts with neither purpose nor direction. I survey them idly, feeling nothing. I cannot remember why I am there.

Suddenly, police officers are everywhere, screaming at us all to get back, though I can tell this only from their contorted expressions, still unable to hear. We are herded at pace away from the scene. I acquiesce, allowing myself to be shunted backwards, baffled by why the police are so frantic, unable to run as they demand.

In the mêlée, I happen to come across Matt, about whom I have completely forgotten, and we set off, wordlessly, across London. In place of conversation is the weight of the unspoken as we walk and walk for aimless miles. Perhaps we are hoping that if we put enough distance between ourselves and the blast we will somehow make it unhappen. At some stage, I start to shake. We have to halt for a while so I do not fall over. Several hours after the attack we find ourselves back in our flat in London’s East End. Ears still ringing, we sit glued to the television, transfixed by the coverage of the explosion that nearly killed us. Another second, another footstep, a purposeful stride in place of our meander. It is only then, late at night, staring at the footage of the chaos we have just left, that I start to feel properly frightened – or, indeed, anything at all.

The facts, as they emerge in the media, are bleak. Three people were killed – one of them a pregnant woman – and more than eighty others injured when the device, a nail bomb, tore through the Admiral Duncan. One man was blown thirty feet into the air by the force of the blast. Was this the man I had seen before me, cleaved, desecrated, lying in a pool of his own blood? The pages and pages of print make me queasy. As a journalist myself, I am acutely aware that nothing makes good copy quite like other people’s misery. Still, I cannot stop reading.

The nail bomber, a white supremacist called David Copeland, exploded three devices in total, deliberately targeting the black, Bengali and gay communities of Brixton, Brick Lane and Soho respectively. At his trial, he declares himself a righteous messenger from God, hailing his nail bomb campaign as the start of a long-overdue homophobic and race war. Convicted for murder, he is sentenced to serve six consecutive, resolutely secular, life sentences in prison.

In the weeks that follow the bombing, my dreams take a nightmarish turn. It seems that all the fear I did not feel at the time is, one way or another, going to force its way out. I never discuss it with anyone, but at night I sometimes wake up in panic, gasping for air; then, during the day, I feel preoccupied with guilt at how I did nothing for the victims around me. The man with no leg, the dead and dying. It had not occurred to me to try and help any of them. You could put this down to shock, but I know that the truth is, even had I been in a state to help others, I would not have really known how to.

Twenty-one ambulances and one air ambulance did help that evening, delivering their crews of paramedics and doctors into, not away from, the danger – in order to keep people like me from harm. Scores of policemen and women did the same. Did death cross their minds, or only duty? None of these hundreds of first responders knew at the time whether there was one bomb, or more blasts to come. In racing to the scene and evacuating the public to safety, they were, depending on your point of view, merely getting on with their jobs or behaving as consummate heroes. Perhaps a modern-day superhero is precisely that, a jobbing, ordinary bloke or woman who, when the situation demands it, steps up without a moment’s pause – squarely ignoring their own vulnerability – and risks their own life to save others.

At age twenty-five, outside the Admiral Duncan pub that day, I discovered that the digitised death that surrounds us daily – in all its cartoon, games console or multiplex varieties – prepares us not a jot for the haunting reality of flesh and blood, actual dying. For nearly two decades I dealt with the first human corpse I ever confronted by pretending to myself I had not in fact seen it. The idea that a man had bled to his death before my eyes while I limply looked on, doing nothing, was too painful properly to acknowledge. I chose, instead, denial.

This early brush with death was, then, typical of my age and our time. Although older adults usually experience protracted periods of ill health and decline – in which the boundary between living and dying becomes blurred, indistinct, and can sometimes span years – in twenty-first-century Britain, sudden or violent deaths and near misses are the most common mode of dying for the young. Road traffic collisions account for over 60 per cent of childhood deaths in the UK, for example. And when, like a thunderbolt or the wrath of God, death strikes instantaneously, there is no time to talk or plan. You are felled before you know what is happening.

Such proximity to dying at the random hands of a nail bomber only cemented my conviction that death denial was sensible. There was little advantage in morbidly brooding on my possible demise when no amount of speculation could prevent it. I could, for sure, become neurotic and fretful, but how much better to live, grabbing each moment, inhabiting them wisely. Who knew, after all, how many I would be granted. As for dwelling on my distant future descent into old age, that seemed like the height of self-indulgence. I knew that my body, still bursting with energy and vigour, would one day wither and decay into something stooped and enfeebled, a husk of the physical form I took now. But why would I wish to contemplate ageing and dying, as a creature hardwired to live? I had evaded death twice now. I had defied her. She was not coming for me.

Many years later, the Soho nail bombing cropped up over breakfast with a friend, a consultant in trauma anaesthesia at St Mary’s Hospital, London, one of the capital’s major trauma centres. Helgi Johannsson specialises in confronting what terrorists leave behind. To a doctor, trauma is not, primarily, distress or anguish but the physical affront of bullet through flesh, car across limb, metal into skull, crushed chest beneath rubble. Trauma teams attend to the bolts from the blue – bodily injuries of such swiftness and severity that they may, unless instantly stabilised, deprive their hosts of life before they ever have a chance to feel traumatised.

Helgi deals on a daily basis with the kind of mangled, twisted, broken bodies that make even other doctors quail, let alone the non-medically trained. Sudden, shocking, brutal death is his bread and butter. He told me he stopped being scared of terrorist activity a long time ago. This is not because London is besieged by acts of terror but because personal tragedy of unimaginable order – lives torn apart with neither reason nor warning – comprises his ordinary day at the office.

‘I treat people who just happened to be in the wrong place at the wrong time,’ he said. ‘You learn how arbitrary and precarious life is. Once, I heard a nurse telling my patient, a young woman who had been stabbed nearly to death by her partner, that there was a reason for what had happened to her, a meaning to it. I said, “No, that’s just the random shittiness of life.” The patient liked that – she really laughed. I truly believe that though. We live in a random world where anything can happen at any moment, but it’s full of beauty and goodness too.’

He paused to relish a mouthful of toast. It was hard to believe that this clear-eyed physician, who regards terrorists as no more of a threat than the infinite cruelty of acts of chance, had ever faced death without equanimity. But even Helgi once baulked at confronting the dying. We discovered, while chatting, to our mutual astonishment, that he too was in Old Compton Street on the day David Copeland unleashed his hate there. A young doctor himself then, only a couple of years out of medical school, Helgi instinctively sprinted towards the carnage in which I had numbly floundered.

‘I probably ran straight past you,’ he told me. ‘The risks didn’t cross my mind for a second. Things like secondary devices weren’t even a consideration, I just ran to help. But I was completely out of my comfort zone. I was completely inexperienced. I had no real idea how to deal with the casualties. I had no equipment whatsoever. And, as you know, you’re stark bollock naked without your equipment as a doctor. You’re so limited. I got members of the public wrapping up bleeding limbs and doing compressions on chests until the paramedics arrived. But I felt utterly helpless.’

I had often wondered whether my own impotence that day, a private source of shame, had triggered a resolve to retrain as a doctor. For Helgi, this early encounter with trauma – one for which he felt wholly unprepared – went on to shape his subsequent career. ‘I hated the helplessness, being unable to do more at the scene. I dealt with that by deciding there and then to go into anaesthesia, and acquire some proper skills, so that never again would I feel that helpless as a doctor.’

Our conversation allowed me to lay a demon to rest. ‘Was he real?’ I asked Helgi. ‘The man with no leg? I’m sure I saw a man with no leg – it was lying on the ground beside him. Was he real?’

Yes, came the answer. Entirely, indisputably real. No figment of a shocked imagination. A young man, full of life, drink in hand, enjoying an uncanny foray by summer into springtime, butchered in his prime.

It is hard, but salutary, to imagine inhabiting an era in which choosing to ignore our inevitable demise is not an option because sudden, shocking, fatal acts of chance are ubiquitous, felling young and old alike. When the eighteenth-century philosopher Thomas Hobbes famously described the human condition as ‘nasty, brutish and short’, he was referring specifically to the state of mankind prior to the formation of central government, a perpetual war of all against all. But to me, the description always struck deeper. Sure, a state apparatus could hold in check the worst of human nature, but it took the advent of modern medicine to liberate us from the infections, diseases, accidents and sheer bad luck that used to snuff us out, in droves, in our prime.

Less than a century ago, for example, my maternal grandmother, Nessie, lived in an area of Glasgow notorious for its urban deprivation. In 1925, more than two decades before Britain created its national health service, Nessie was a girl of ten or eleven. Four children, their mother and father were squeezed into a tiny two-room tenement with no electricity, running water or indoor toilet. The outdoor privy was shared by five, maybe six more families. In spite of owning next to nothing, Nessie’s mother – my great-grandmother – never failed to keep the two rooms spotless.

Invalided on the battlefields of the First World War, Nessie’s father was unable to work, and 1920s Depression Britain was no time for a poor family to be without its male breadwinner. Mammy made ends meet by sewing piecework garments late into the night by candlelight. Annie, the oldest child, had already been helping her stitch for years. There was barely enough money for food, let alone savings set aside for a doctor’s visit that might easily cost a week and a half’s wages.

One night, the two girls, Nessie and Annie, were huddled, unobserved, on a threadbare mattress, conversing in urgent whispers.

‘What is it, Annie, what’s wrong?’ asked Nessie.

‘It’s my belly,’ she said, face flushed and damp with sweat. ‘A bad pain.’

‘Shall I tell Mammy?’ asked Nessie, alarmed at her fifteen-year-old sister’s discomfort.

‘No. No, you can’t tell her. She’ll worry. We can’t afford the doctor anyway.’

Nessie, by nature a timid little girl, had always deferred to her older sister, and did not dare defy her now, however distressing she found the sight of Annie gritting her teeth with pain. She reached out to squeeze her sister’s palm, anxiety knotting her stomach.

Annie turned to the wall and lay as still as she could beneath the blankets. The slightest movement was excruciating. Slowly, the evening wore on. By the time her three siblings clambered into bed beside her, Annie found their slightest shuffle almost unbearably painful. It took great effort of will not to cry out, and even more not to ask for her mother.

The 1920s were a time of extraordinary medical innovation. Breakthroughs included the discovery of penicillin and of insulin, the first vaccines against measles and tuberculosis, and the use of iron lungs to prevent patients infected with polio from suffocating. Yet a doctor’s attention was no basic essential, but a luxury – dispensed, primarily, to those who could pay. All over Britain there were thousands of impoverished families who would never know a doctor’s care for want of the means to purchase it.

Mammy rubbed her eyes, put her piecework to one side, and was asleep the moment she crawled beneath the blankets, unaware that in the bed next door her eldest child lay rigid and wakeful. Pain ebbed and flowed in the darkness. Annie’s appendix was angry, inflamed, throbbing with infection, yet she endured her suffering in silence.

Time crawled. At some stage during the night the pressure grew too great and her appendix burst, flooding her abdomen with pus. Maybe the other children in the bed heard their big sister muttering and rambling as overwhelming sepsis induced a delirium. By the time dawn broke, Annie lay outstretched and cold, dead beside her siblings.

Only very recently, long after my grandmother had herself died, did my mother tell me this story. I was stunned, dumbfounded. You might imagine the most shocking thing about the tale to be the notion of a child electing to endure fatal levels of pain rather than worry her parents with the revelation of an illness for which they could not afford to call a doctor. But it was not. It was what came next.

‘Imagine waking up to find your own sister, a child, lying dead in bed beside you. It must have been so traumatic,’ I had said to Mum.

Patiently, Mum exhaled. ‘I think Nessie probably just accepted it, to be honest.’ She paused. ‘That’s just how it was in those days.’

This took time to sink in. Cosseted by twenty-first-century creature comforts, safe in the knowledge that my loved ones had high-quality healthcare to rely on, I ruminated on what Mum had told me. My own children, at the time, were ten and six. The idea of my oldest, Finn, waking up to find his little sister, Abbey, dead in the bed beside him was appalling enough, let alone that of him being so inured to dying, so exposed to random death, that he would take such a horror in his stride.

But there it was. In Britain, less than a century ago, death in the home was so frequent, so commonplace, that family members regarded the witnessed loss of their loved ones as entirely expected – as normal. What seems to us today a violation, a horror, was just the way it was back then.

*

Being a young, enthusiastic documentary-maker in one of the most vibrant cities in the world was a heady experience for a sheltered twentysomething from deepest rural Wiltshire. Television in those days was fuelled by free-flowing alcohol and small mountains of cocaine. I was surrounded by clever, savvy, urbane folk who could talk virtually anyone into doing anything. Power rested predominantly in the hands of older men, some of whom were predatory, targeting their youngest female colleagues such as me. Once, an entire production team of which I was a member was invited by the boss to a country retreat. We strolled around the grounds, champagne flutes in hand, wittily – as we saw it – dissecting the state of the nation. My boss beckoned me over to a statue on the lawn.

‘Look at her, Rachel, what does she remind you of?’

We were alone, cut off from the rest of the party, and I was, I suppose, twenty-two or twenty-three. I stared down at a stone sculpture of a nubile young woman, lying belly down at my feet. Her back was arched, her face tilted backwards, while a fountain tinkled on to the small of her back, like an eternal al fresco ejaculation. As I tried in vain to think of an answer, the boss supplied one for me.

‘Do you know, Rachel, I’ll tell you who she reminds me of,’ he murmured, while caressing her natal cleft with his barefoot toe. ‘She reminds me of you.’

You always hope you will come up with a devastating riposte in these scenarios, but they are mortifying, cheapening and, more than anything, diminishing. I smiled weakly, not wanting to appear impolite, even while cursing myself for not punching him.

Journalism and I were a queasy fit. Obsessive by nature, prone to rampant perfectionism, I would lose myself completely in every documentary I made, then come up for air, six months lost to a film, feeling hollowed out, pared to the bone. Mum achieved a lifelong ambition when she was awarded a degree from the Open University. But I was not there at her graduation, because I was ingratiating myself with warlords in central Africa to capture footage of Congolese child soldiers. The end justified the means, I told myself – in this case, we would bring a barely covered civil war to the screen – but the means were long and lonely, and too often entailed the relegation of loved ones. I was the friend who let you down at the last minute, the one you could not be certain would turn up in a crisis, the flaky, insubstantial one, careering from story to story, wondering why the good one could do through responsible journalism so often, day to day, felt so bad.

Slowly, insidiously, as the months went by, this hollowness became pathological. One day, the morning after my latest documentary had been broadcast, I lay in the tub, tears dripping into bathwater, each plaudit and celebratory message stoking panic, not pride. The thought of going through it again, fighting tooth and nail to try and tell a story faultlessly, was unbearable. I was shocked to find myself daydreaming about ways of ending my life, and immediately reached for Dad.

‘Hey,’ I muttered flatly on the end of the phone.

‘Oh hello, Rachel,’ came the reassuring reply.

He told me about the garden, his recent walks through the fields, the return, as every springtime, of the skylarks above. Mum was learning bridge, Dad was irate at something Tony Blair had done, they were planning a trek through the mountains of Corsica. Life, in all its banality and glory, comfortably ticking along.

‘What’s wrong?’ he asked, after a while.

‘I’m tired,’ I answered quietly. ‘Really tired.’

A pause. They were always easy between us. He waited for me to go on.

‘I love being a journalist, but … it’s hard and … and sometimes I think I made a mistake … Maybe I would have been happier if I’d been a doctor.’

‘I think you would be an excellent doctor, Rachel.’ I noted the tense, future not past, as though somehow this might be a realisable prospect.

‘Do you? Do you really, Dad?’

Although I did not believe him, the idea still felt like a lifeline. But I was too burned-out to work for a while and went into hiding instead, ostensibly trying to figure out a future, though in reality buried beneath my duvet and depression, scarcely leaving the flat.

In the end, the best I could come up with was this. Journalism, for all its excitement and power – a reach of millions of people each time a programme was broadcast – might have been the dream job on paper, but it gnawed away at my soul. Ingratiation felt shabby. I did not want to persuade, entice or manipulate anyone into appearing on camera. If I were going to work this hard, this all-consumingly, at something it needed to feel cleaner, more straightforward. And it simply could not be this difficult. I knew about imposter syndrome, and that this permanent sense of fraudulence was probably more to do with me than journalism – but how could I be certain without trying something else first? When you are lying in the bath and images of slitting your own wrists float into your mind, at least you have nothing to lose.

I wish I could pretend my decision to retrain as a doctor was some blinding epiphany of vocation and selflessness, but it was more of a scrambled retreat from an intolerable present, a parachute from the here and now. I was trying to save myself, not other people, and so, shamefaced, I concealed my true motives from everyone, even my father.

Turning a pipedream into a place at medical school entailed hauling myself back to work while moonlighting at night on my missing science A-levels. To my surprise, my half-baked plan, for all the desperation that preceded its conception, proved to be an antidote against sinking back into depression. I cared that little bit less about crafting stories for television, and found that caring less made the crafting easier. I could breathe again. And I discovered, to my astonishment, that chemistry, when studied at the age of twenty-eight, was nothing short of intoxicating. The idea that the behaviour of every solid, liquid, gas and living thing could be pared down to the basic chemical properties of the 118 elements of the Periodic Table – and, more specifically, to the number of electrons orbiting their nuclei – had an elegance and power that took my breath away. Every chemical reaction of the human body boiled down to this – gyrating specks in graceful orbits, interacting as predicted by the textbook on my desk at home. It was beautiful, magical, thrilling. An epiphany of sorts – the bewitchery of science.

Securing a place at university, on the other hand, was a tactical exercise. I dutifully bought the expensive guidebooks on how to win that coveted place at medical school, scouring them from cover to cover to ascertain the best strategy for interview and application form. Apparently, much like the ingratiation expected by war criminals, medical school interview panels required their subjects to jump through all manner of hoops that signalled ‘doctor material’. One diktat was particularly strident: do not, under any circumstances, even consider admitting that your motivation for studying medicine was a desire to help people. God forbid, the books implied, you should say anything so crass and naive. The moment you whispered the H-word, you would be kissing goodbye to dreams of stethoscopes for ever.

Despite my newfound obsession with seeing people in terms of orbiting electrons, I read this advice with consternation. It seemed to me that these books, written by practising doctors, were sending a less than subtle message to sixth formers everywhere that their instinct to help others was something to hush up, a clandestine failing that risked incurring the wrath of the gatekeepers to a supposedly caring profession. Even before setting foot in a medical school they were somehow being groomed that talking openly and sincerely about their true motivations could diminish their prospects as a doctor.

When it came to my own interviews, I knew that being an applicant at least a decade older than the rest, with an unusual current career in television, was going to provoke particular interest in my motives. I could not quite bring myself to full disclosure. ‘This is my idiosyncratic strategy for evading a relapse into suicidal depression’ did not quite convey the impression of a safe pair of hands. But I could be truthful about the other things that drove me. And helping people – wanting to do something good for others – was, and always had been, a powerful impulse.

Somewhat surreally, I found myself sitting in front of a panel of professors behind which, stranded in formaldehyde, was an array of human body parts in jars. Ears, brains, eyeballs, hearts and other, more ominous, fillets of flesh, which I fervently hoped I would not be asked to identify. ‘Is this the first test of doctoring?’ I wondered. ‘To manage to answer coherently a question from a professor who is inches away from an embalmed human liver?’ None of us mentioned the anatomy specimens. I was being watched by a pickled eyeball that everyone pretended was not there. A more macabre admission interview I could not imagine.

‘So, tell us, Rachel, what made you decide to study medicine?’ someone asked.

‘Well,’ I answered, refusing to game this, ‘I know you’re not supposed to say that you want to be a doctor because you want to help people, but the truth is, I do. That’s what it comes down to. I could come up with all kinds of clever alternative reasons, but the fact is, I want to go to work each day and do something decent and good, that I can take pride in, and I think that should be the essence of medicine.’

Polite smiles all round. And then, quick as a flash: ‘That’s very interesting. But tell us, what’s it like working in … television?’

‘Oh. Well, television is all about people too, in a fundamental sense. It’s about building relationships with people, ensuring they can trust you, then trying to tell a human story as effectively as you can.’ I even tried to articulate the bits I found challenging, like the risk, always present, that you might inadvertently exploit someone.

At each university, the interview was the same, dominated by intrigue about television. What was it like, had I met people who were famous, why would I want to leave a job like that?

‘Tell us,’ said one interviewer, ‘what’s it like working with Jon Snow? Is he as nice in real life as he seems to be on Channel 4 News?’

‘Look,’ I wanted to say, ‘enough about the bloody television. Can’t we, you know, discuss electrons or something?’

I knew I had got in. The television clinched it. When I called home to tell my parents the news, I could hear the smile in Dad’s voice. Those words, said with utmost sincerity: ‘I’m very proud of you, Rachel.’





3


Skirting Death


Death is not the opposite of life, but a part of it.

Haruki Murakami, ‘Firefly’, Blind Willow,

Sleeping Woman: 24 Stories




It started reasonably enough. The clean-cut, efficient young doctor explaining to the fifty-year-old woman in a hospital gown that he needed to conduct an internal examination. Unflinching, she held her shaved head high.

‘I guess we’ll start the exam,’ said Dr Jason Posner. ‘Why don’t you just sort of lie back and relax. Won’t take a minute.’

There can be no dignity in placing your feet up high in gynaecological stirrups, but Vivian Bearing has been living with Stage 4 ovarian cancer. Indignity has dogged her for some time.

Stoically, she eyeballed the fluorescent lights, preparing to surrender her body, once again, to her doctors. It was then that commonplace indignity twisted into something more unpleasant. Vivian’s doctor had forgotten that an intimate examination required a chaperone – to protect both patient and clinician from the possibility of inappropriate touching.

‘I’ve got to go get Susie,’ an exasperated Jason muttered. ‘I’ve got to have a girl here – some crazy clinical rule.’

He exited the room to find the nurse in question, leaving Vivian alone, still strung up in stirrups, her exposure absolute. As the seconds crawled by, she tried to distract herself by chanting first her times tables, then metaphysical poetry in her head. When, finally, the doctor returned, she had been waiting, laid out like a specimen upon a slab, for what had felt like a forever of shame.

‘Why did you leave her like this?’ asked Susie, horrified.

‘I had to find you,’ answered Jason, brusquely. ‘Now come on.’ His internal examination was thorough to the point of brutality. Afterwards, Vivian commented drily: ‘One thing that can be said for an eight-month course of cancer treatment: it is highly educational. I am learning to suffer.’

Vivian, mercifully, is fictitious, though one senses she is rooted in real women’s experiences. Her creator, the American playwright Margaret Edson, used to work in an oncology department. In 1999, she was awarded the Pulitzer Prize for her drama Wit, widely regarded as the best play ever written about cancer.

On my very first day at medical school I was shown the film version of Wit, starring the actress Emma Thompson. Three hundred of us trotted innocently into the lecture hall, the vast majority still teenagers, fresh out of school. We were intrigued that a movie, of all things, had been deemed sufficiently important to occupy the first afternoon of our medical school timetables. I later realised that whoever in the faculty had decided to inaugurate our learning in this manner was an educational genius. We were about to be hit with a celluloid sledgehammer.

Vivian Bearing is a fiercely intelligent American professor specialising in the sonnets of the seventeenth-century metaphysical poet John Donne. Upon diagnosis with late-stage ovarian cancer, she is admitted to a New York teaching hospital to undergo gruelling treatment with experimental trial drugs. From the outset, the play captures superbly the loss of control patients typically feel upon admission to hospital, as we are stripped, gowned, prodded and scrutinised by a doctorly elite that holds all the power.

As a research subject, Vivian is particularly vulnerable. Even her supposedly informed consent to untested treatments is undone by her consultant’s insistence that in exchange for his trial drugs she must withstand whatever side effects are inflicted upon her.

‘The important thing is for you to take the full dose of chemotherapy,’ he coerces her. ‘There may be times when you wish for a lesser dose, due to the side effects. But we’ve got to go full force.’

To her doctors, Vivian is less a human being than research fodder. Their route to publication in a prestigious journal, perhaps – if only she yields decent results. Even when the therapeutic benefits are doubtful, her team continues to urge her to submit to eye-watering doses of chemotherapy, driven more by a hunger for data than a thirst for healing. In her sterile, strip-lit ward, we witness Vivian endure the inevitable side effects – severe vomiting, pain and humiliation. She becomes acutely aware that her body is now, to her medical team, what Donne’s sonnets used to be to her – an object, to be probed and interrogated ruthlessly in order, at best, to further academic understanding or, at worst, her doctors’ own careers.

In withering asides, Vivian deconstructs her hospital experience with the same rigour she might have applied to a sonnet. After being used by her consultant to teach students one morning, she turns to the camera and comments archly:

In grand rounds they read me like a book.

Once I did the teaching …

Now I am taught.

This is much easier,

I just hold still and look cancerous.



For the whole hundred minutes of Wit we felt pinned to our seats in painful silence. Though I knew the play was to some extent a caricature, more relevant to the medicine of a bygone era, the idea that any doctor could treat their patients so callously was deeply uncomfortable. I was a starry-eyed enthusiast that day, longing to dive unthinkingly into my medical textbooks. Wit drew me up short. It compelled me to consider my future power as a doctor – my potential to dehumanise, distress and even hurt my patients. For an audience of neophyte medics, the film was, in short, the best possible medicine. It forced us to see ourselves through our future patients’ eyes, and to confront our capacity to wound.

But there was more that mattered on screen. In five long years of medical school, watching Wit, I would discover in retrospect, was the one – the only – occasion during which as a student I was ever invited to consider human mortality.

Like Donne before her – whose poems are fiendishly cerebral meditations on death’s inevitability, bursting with intricate conceits and paradoxes – Vivian confronts her terror of dying with an arsenal of cleverness and wit. She intellectualises her imminent demise, using irony and humour to deflect the visceral horrors she knows are to come. Yet the words that have served her so well throughout life become increasingly hollow as life begins quietly to dispose of her.

‘Now is not the time for verbal swordplay,’ she states bluntly after a frank discussion with Susie, her nurse, about whether she would wish for CPR in the event that her heart stopped beating:

Nothing would be worse than a detailed scholarly analysis and

Erudition, interpretation, complication.

No. Now is the time for simplicity.

Now is the time for, dare I say it, kindness.

And I thought being extremely smart would take care of it.

But I see that I have been found out.

I’m scared.



In one of the play’s most moving scenes, Vivian’s old professor from her undergraduate days, the fearsomely intellectual E. M. Ashford, pays an unexpected visit to her former student. Despite her reputation as a merciless scholar, Ashford immediately grasps not only that Vivian is dying, but that she needs, in this moment, nothing more than simple kindness. Instinctively, she curls her elderly frame up on to the bed next to Vivian, as a mother might comfort her feverish child, and begins to read aloud from the picture book she has just bought her great-grandson for his fifth birthday. Words cease to be weapons, or challenges, or clues, but become instead a form of solace, a litany of love and tenderness. As Vivian is lulled into fitful sleep, her professor leans closer. Moving seamlessly from nursery chant to Shakespeare, she whispers to her dying student the same soft words with which Horatio bids farewell to his friend, a poisoned Hamlet: ‘And flights of angels sing thee to thy rest.’

Wit was both a warning and a plea. It cautioned us against browbeating our future patients while beseeching us to recognise the healing potential of small acts of kindness. But empathy – the ability to understand and identify with the feelings of another – was under assault from day one of medical school. With biochemistry and anatomy filling our days, one way or another, people were reduced – either to chemical interactions or to corpses on slabs. In this first, most formative year of medical school, the dead, not the living, took centre stage.

I strongly suspected from the outset that the real point of human dissection was to kickstart the process of detachment. In a contemporary culture that likes to keep its dead behind closed doors, once you have crossed the line into a life steeped in body parts – the stench of refrigerated flesh slowly rotting in formaldehyde never quite leaving your clothes – there is no going back. You have seen and sliced and smelt too much. We were a cohort of students who needed first to be dehumanised, then rebuilt as doctors.

The anatomy room was our site of metamorphosis. I was filled with trepidation before crossing its threshold. Dad had told me that in his day the dissection room was a place from which medical students used to commandeer body parts for laughs. Back then, in the 1960s, after a long day flaying human sinew, nerve and skin, they liked to unwind by terrorising unsuspecting punters with pub pranks involving human hands and eyeballs, purloined when the anatomists’ backs were turned.

‘You know the kind of thing, Rachel,’ he told me. ‘You’d get someone to shake hands with you but offer them the one you’d dissected earlier. They’d drop their pint in horror when it came away in their palm.’

‘Honestly, Dad, I don’t know. I mean, I can’t begin to imagine you doing that. It’s completely repulsive.’

It was also, if I were honest, completely unnerving. If doctors were the kind of people who, even as students, found human dismemberment hilarious, then was I really cut out for medicine? Or, had Dad once instinctively recoiled like me, yet emerged from his time among the silver-slabbed dead with his memory erased of the qualms he had once felt upon taking a scalpel to their cold, embalmed flesh?

For all my misgivings, when I entered the dissection room myself for the very first time the smell of concentrated formaldehyde was oddly familiar. It was, I realised, a scent I had encountered before as a child: whenever I collected too many owl pellets to dissect all at once, I preserved some in small jars, supplied by Dad, ready to delve into after another week at school. Maybe this would not be too bad, I thought hopefully.

A preserved body, I discovered, is so stiff and cold from its refrigerated store that it no more feels like flesh than a waxwork. As long as I did not look too closely at the face, I could pretend what I was doing – coaxing away human hide with my blade – was vaguely normal. Any feelings of revulsion were surprisingly short-lived and, better yet, swiftly superseded by the genuine delight of learning through cutting. For the next year, six of us spent two mornings a week gloved and gowned, stooped over the corpse of a man in his eighties whom we steadily whittled away to bare bones, having politely christened him ‘Henry’.

‘Oh my God, look at this!’ Will exclaimed one day. We had incised Henry’s chest from top to bottom, then peeled back the skin to expose his ribcage. After crunching his way through the ribs with metal cutters, Will had exposed Henry’s lungs to the light, and their appearance shocked us all. ‘Look at them! How many pack years has he put behind him?’ We gawped at lungs so blackened and scarred they looked like they’d been attacked with a blowtorch. One ‘pack year’ was twenty cigarettes a day, 365 days a year. Henry had surely smoked untipped Woodbines for decades. Here, before our incredulous eyes, was the cumulative effect of half a million cigarettes, a core of rotting tar in his chest, almost certainly the cause of his demise.

Eagerly, we burrowed and rummaged for tumour. ‘There’s bound to be a cancer in here, there must be,’ I muttered, gouging deeper with my scalpel. Sure enough, a knobbly, craggy, malignant mass lurked within one lung field.

‘Wow,’ said Will. ‘That is … impressively disgusting.’

The dry textbook descriptions of ‘tobacco smoker’s lung’ had just leapt off the page, reeking of formaldehyde, and its visceral reality – how disease actually looked, felt and smelt in our hands – was unforgettable. For the rest of the day, alongside the lingering trace of preservatives, I wore an unshakeable grin. This five-year project of transformation into a doctor – I was loving it.

I was fortunate enough to be part of a generation of doctors whose first hands-on encounters with the human bodies we dissected were infused with respect, not ribaldry. Our anatomy professor demanded something close to reverence. He expected us to recognise, and to be humbled by, the last act of generosity from the nameless souls who, in the name of helping others, had bequeathed their bodies to our hesitant blades. Following his lead, we took our scalpels’ defacements seriously.

What had not changed, however, since my father’s day was the peculiar act of doublethink required for young men and women, most of them still teenagers, to cluster, scalpels poised, around a slowly decomposing corpse while loudly pretending that carving up dead human flesh was a perfectly anodyne use of Tuesday and Thursday mornings. Our experience of dissection may have been respectful, it may have had the vital aim of rendering us fluent in human anatomy, but it could not, in any sense of the term, have been described as normal. This was an act of violation – the mutilation of the dead, their physical defilement – that tugged at our species’ darkest taboos, and yet at no point was this ever discussed openly.

In failing to acknowledge the enormity of what occurred behind the dissection room doors, our tutors unwittingly taught us something profound. That around the dead swirled unspeakable secrets. That, as fledgling doctors-to-be, our new role required us to stifle, not voice, our feelings and instincts. That any emotions provoked were illegitimate and gauche. That we had to ignore and deny them. That if, instead, we admitted our vulnerabilities when up close with death, we were something of an embarrassment to medicine.

Many of us, I suspect, clung with silent gratitude to the task of naming each tiny scrap of the human form. In the gargantuan effort of committing to memory several thousand Latin labels for every muscle, nerve and bone, came the relief of intellectual detachment. We could keep our weakness under wraps.

There is nothing quite like flirting with death to inspire unguarded living. Immediately before starting medical school I began dating my future husband. On 20 March 2003, the first day of the Iraq War, the sum total of my acquaintance with Dave had been one blind date a year earlier, a date so embarrassing, so excruciatingly awkward, the details must remain forever classified. And yet, ever since that catastrophic evening, I had been unable to suppress the unnerving thought that out of all the men who had ever lived, this one, the catastrophe, was the only one for me. Clearly, a normal person would have done something about this, but I was English, so would have rather roasted my eyeballs. A year had elapsed, and all I had done was sigh wistfully.

Then, three days after the Iraq War began, a Royal Air Force fast jet, a Tornado GR4, was accidentally shot down by an American missile as it returned from a bombing raid over Baghdad. Both pilot and navigator were killed instantly, and the British public swiftly learned a new vocabulary – ‘blue-on-blue’ and ‘fratricide’ – to denote not Cain-and-Abel-style brotherly slaughter but military comrades killing their own in error.

Amid the soaring death toll in Iraq – we all knew what the Pentagon’s ‘shock and awe’ tactics meant for the civilians upon whom the bombs rained down – the loss of two unnamed British airmen should not have haunted me. But Dave, the man I had not set eyes on for a year yet somehow never stopped longing for, was himself a Royal Air Force fighter pilot. For all I knew, he had been flying that jet. I lay awake at night aching to know whether he were s