Dr Rachel Clarke on Mortality and Time Well Spent

When you work as a doctor in a hospice and someone asks you what you do for a living, it tends to be a tumbleweed moment. People may respond by wincing a little and saying something like, “I don’t know how you can do that. It must be so depressing.” 

It’s a fair point, I always think. Why on earth would a doctor – after all those laborious years spent learning how to save lives – choose to immerse themselves in death and dying?

I wrote Dear Life in order to answer this question. People often fear hospices must be intimidating and dismal places, steeped in fear and darkness. Death is, after all, is a modern taboo from which most of us choose to flinch. But I absolutely love my job and could not imagine practising any form of medicine more uplifting or full of meaning, however implausible that sounds. 

For me, the really striking thing about palliative medicine isn’t the proximity to death, but the sheer quantity of life. The things we know really matter most – such as compassion, courage, love, tenderness – tend to dominate a person’s final days. A hospice can be chaotic, messy, almost violent with grief. But it is filled with human beings at their most remarkable, unable to retreat from the fact of their impermanence, yet living and loving all the same.

The hospice where I work – Katherine House in rural Oxfordshire – is strikingly beautiful. Natural light streams in from skylights and floor-to-ceiling French windows. There are jacuzzis, massage, art therapy, a well-stocked drinks cupboard. We hold weddings here, sneak in pets, organise date nights, break the rules. The hospital death we’ve all been led to fear – a brittle and lonely body breaking down behind curtains, among strangers and machines – is a world away from here. We try to create a place of warmth and safety where patients know they are cherished. 

Tracey, one of the wonderful nursing assistants with whom I work, puts it like this: “When patients come here, we try to put them back together again. They’ve been through so much and we try to give them the time and respect they need. I put myself in their shoes – how would I want that person to behave to me? You use touch, reassurance, kindness. We are the backbone. My role is to help people feel safe and cared for.”

The Latin verb palliare, meaning ‘to cloak’, implies that the primary aim of palliative medicine is to disguise and suppress the symptoms of dying. But we can do better than that. If a single principle underpins palliative care, it’s that living and dying are not binary opposites. The dying are still very much alive. You matter – you are important – irrespective of the time you have left to live.

A good day, for me, in the hospice, is one in which I feel we’ve helped someone die with comfort and dignity intact. But infinitely preferable are the days when we’ve helped a dying patient live – be that through sharing a meal with friends in a family area, watching a movie in bed with the kids, stroking the family Labrador as he tries to eat the chocolates, or watching goldfinches gleam in the trees outside. Simple, ordinary, priceless moments of bittersweet, fragile life.

There is no denying the fact that losing your life or that of someone you love can be the greatest pain imaginable. No matter how skilful the palliative care, there is no softening the enormity of being a living creature who is destined, from the outset, to die. As Bob Dylan once put it so memorably, “It frightens me, the awful truth, of how sweet life can be.” But the pain, it seems to me, is the price of love. Grief is the form love takes when someone dies. 

In a hospice, in the absence of cure, there is still love, joy, tears, wonder, solace ‒ all of life, only concentrated. You’d be surprised by what we get up to.