‘We have never been closer while standing further apart…’
If you have the desire and the courage to hear it how it was, from the centre of the storm, then Breathtaking by Rachel Clarke is essential reading. It may be based on the early days of the pandemic – January through April 2020 – yet the stories told, shortcomings identified, and lessons learned are universally relevant and I fear for the future if we are not prepared to learn from them.
Before retraining to become a Doctor, Rachel was a television journalist, so it comes as no surprise that she recognises the value of ‘attempting to document the rawness of this time.’ With genuine if unnecessary humility she offers us this, her testimony, ‘with all its flaws and its inherent subjectivity,’ and we are invited to make of it what we will.
It was strange to read of the chaotic unfolding of the pandemic, as though it was happening in real time, while living within the midst of a more virulent second (or is it third) wave. If the situation had been otherwise I might have been tempted to read this as fiction, a really smart imagining of an unfolding apocalypse. But it is searingly true, and all the more truthful and authentic because of the lack of disguise or conceit or pretence to objectivity.
Rachel’s frontline engagement with the pandemic is interwoven with reflection and wordsmithing. Her attempts to find perspective from within the maelstrom reveal a raw sense of personal struggle akin to the reflections of war correspondents writing from within the fog of gunfire.
She is right to remind us that the pandemic, caused by a virus described by Sir Peter Medawar as “a piece of bad news wrapped up in a protein”, does not of itself have a narrative arc, but its impact on us does and this Rachel masterfully provides.
I use the word masterful cautiously yet determine it is deserved because of the way in which Rachel interweaves multiple narratives into one unfolding tale.
First there is Rachel’s personal story; not shied away from nor over indulged. ‘I am terrified…’ is said explicitly and seen implicitly within her anger, frustration and general disbelief of the early failings of national leadership – frequently vented at television announcements. As a mother of young children she honestly considers how ‘it is one thing to weigh your own risks of infection, but quite another to know that by going to work you might endanger those you love the most dearly.’ In particular, the risk of working without proper PPE is ‘indescribable’ because of the ‘thought of infecting other patients with a disease that could kill them.’ Later, commenting on being described as a ‘hero,’ she states the obvious, which nevertheless needs to be said, that ‘accolades will not keep anyone safe. For that we need proper PPE.’
Then there are the narratives of other individuals stung by the pandemic: Those being cared for and their families – ‘the supreme cruelty of this disease, perhaps, is how ruthlessly it cleaves the soon-to-be bereaved from those they love so dearly.’ The young doctors stepping up into emotionally chaotic scenarios they could not have imagined – learning overnight how to become ethereal intermediaries between family and patient. The extremely ill for whom the ‘quintessential human acts’ of being held, touched, embraced are forbidden, who struggle to hear what is being said to them, and who – for all the time they are in hospital – ‘do not see a single unmasked face’. Yet, remarkably, these stories are told without despair as they echo equally compelling tales of bravery and fortitude and the many extra miles travelled by so many.
Finally, amidst these raw human stories the reader is regularly reminded of another world: the facts and statistics, the analysis of language used, the politics, the erosion of the NHS over many years, the staff shortages, the numbing graphs and numbers, the crassness of public announcements.
Amidst a litany of failings Rachels most haunting indictment concerned the lack of focus on ‘the elderly, the disabled, the frail and infirm,’ what she called the ‘second tier of lower-priority citizens.’ Elsewhere she forthrightly suggests ‘we did not so much protect the NHS as turn it off.’ While focusing on saving the institution, we failed many of those it is meant to be there for.
Yet, while looking unblinkingly at this unfolding tragedy Rachel held onto her belief ‘that people, fundamentally, are good,’ and I find myself, against my better judgement, wanting to agree with her.
She celebrates the rapid change of her ten-bedded hospice into a twenty-four bedded Response Centre; She is proud to be part of a society which ascribes to the principle of free health for all in need; She praises her professional colleagues and the remarkable ability of the NHS to rebuild itself from the roots up; She recognises the coming together of communities and, of course, above and beyond all of these, she recognises and names the courage of patients and their families.
She might have said more about the sense of ‘moral injury’ that many staff will live with because of failing, through no fault of their own, to meet their patients needs. I also wanted to hear more of her thoughts around the brokenness of language – and how words, and the systems they build, which only measure ‘efficiency, productivity, growth and profit’ – while ignoring the importance of ‘time, words spoken, hands held’ – the ‘unchecked flow of love and care’ – are ultimately unfit for purpose.
Breathtaking is born of the confluence of an experienced writer, a doctor and a compassionate and courageous human being who is unafraid to speak truth to power and to tell it how she experienced it.
‘Here, with all its flaws and its inherent subjectivity, is my testimony. Make of it what you will.’
Breathtaking by Rachel Clarke is published by Little, Brown
The book is dedicated to the memory of four members of staff at Oxford University Hospitals who lost their life to Covid-19 while doing their utmost to help others.
DWP March 2021