Tough, caring doctors who tell it like it is
Karen Hitchcock and Rachel Clarke have both written with deep compassion and humility about their experiences as doctors.
I am reviewing two books by doctors; Karen Hitchcock’s essay collection, The Medicine, and Rachel Clarke’s memoir, Dear Life. I am doing so as a lay person and as a patient. I’ll be up front: from my experience as a cancer patient, doctors are heroic on a daily basis and the epitome of kindliness.
This peculiar medical kindliness accompanies a desire to solve a problem according to scientific principles, to reduce and/or end unnecessary suffering, to take practical steps to ameliorate adverse health conditions.
Paradoxically, this highly trained, objective path can lead to the application of a great humanity. And that human quality is linked to the profound thoughtfulness of the process: one full of checks and balances, of deep consideration aimed at ensuring the therapy is the best solution. The excellent doctors of my acquaintance are great listeners.
In Hitchcock’s The Medicine, we find this toughened rationality, and this humanity. She is a Melbourne-based general physician whose clinical work has focused on pain, fatigue, medically unexplained symptoms and obesity.
She is a mother, an athlete, has a PhD in English and was one of the first authorised prescribers of medicinal cannabis in Australia. In this book her essays are grouped thematically and pan across her career.
Throughout she emerges as empathetic but also plain-spoken. In the essay Crazy Pills, while considering our excessive consumption of vitamin supplements, she says: ‘‘The truth is pedestrian: if you want to live well and long, be born in the right place and time, cross your fingers, eat lots of vegetables, and go for a walk. The miracle cures almost always turn out to be lollies or poison.’’
She believes in only one kind of medicine: medicine that can be demonstrated to actually work.
She knows the limits of what medicine can achieve. ‘‘We’re only doctors,’’ she says, but as you read her collection you’ll surely feel a deep gratitude for their existence.
In the essay Working Regional, she consoles a patient with advanced lung cancer:
‘‘I never cry,’’ she [the patient] says. ‘‘I can usually keep myself together.’’ I hold her hand, which she has edged towards me. I say, ‘‘You can cry here … It’s all too terrible. But we’ll get the drain out this afternoon and you’ll be able to go home to your family.” She keeps crying. I keep hold of her hand. ‘‘Bev,’’ I say, ‘‘you have hundreds of days left to live. Hundreds of days.’’ She looks at me, wipes her eyes. I say, ‘‘So go home and live the shit out them.” And then we are both laughing.
The doctor addresses Bev in her own language, understanding that a real connection must be made. And this is consistent with her balanced approach, that medicine is both science and art and that there are elements that make up excellent practice that are elusive.
The science part of medicine can be taught, she notes. “But the rest, the human aspects — how to listen, how to present, how to help your patient bear their suffering — you can’t quantify, distil or institute.’’
She says she pictures the Serbian performance artist Marina Abramovic, who in 2010 sat on a hard chair in the centre of a room at New York’s Museum of Modern Art, from 9am to 5pm every day for three months.
“You took a number and when it was your turn, you sat in front of her silently, and she would look into your eyes — attend to you — for as long as you wished. I have the book that documents in photos the faces of those that sat with her. Most of them are crying, cracked wide open by her offer of a benign, focused attention, by nothing more than Abramovic opening her eyes.’’
Hitchcock’s prose combines medical insight with literary flair to yield essays of the highest calibre. She covers topics that have troubled the profession and the wider community: aged care, nursing homes, the role of Big Pharma, the obesity epidemic, assisted dying. Each essay offers Hitchcock’s unique insights. Sometimes she doesn’t choose to resolve a complex issue, preferring to leave us with a particularly resonant image or anecdote.
Clarke’s memoir, Dear Life, is more conventionally autobiographical than The Medicine. This structure doesn’t make it any less remarkable or affecting.
Clarke is an English doctor working in the NHS, specialising in palliative medicine.
Her father was a GP and she could have followed him but decided instead on a career in journalism. In her 20s TV journalism began to pall and she started training as a doctor.
The first half of this book charts those early days. As a junior doctor she noted instances of how patients were sometimes treated inhumanely.
She also observed a reluctance among her colleagues to deal with death. This was the great unmentionable, seen by many as annihilation, defeat.
A stint in palliative care and a family tragedy brought new insights and Clarke resolved to specialise in this field.
Like Hitchcock, Clarke is a master story teller and a fine commentator on her profession:
We make paradoxical demands on our doctors. We want them human, empathetic, caring — but only up to a point. We also want the detachment that enables them to swoop to a crisis — the stopped heart, the mangled limbs, the child suffocating before their eyes — and crack on, undeterred …
The second half of Dear Life is intersected by the story of the illness and death of Clarke’s father. For all her hard-won professional detachment she is overwhelmed by grief.
The telling is full of tenderness, gratitude for a system that delivered a ‘‘good’’ death, but also terror.
She takes us up very close to the experience of dying, of what actually happens as the body shuts down. Notwithstanding the harrowing aspects, Dear Life is an affirmation — we see the dying living intensely. Clarke doesn’t romanticise but finds in the world of palliative care ‘‘the best of living’’.
There is no doubt that The Medicine and Dear Life will be particularly attractive for those working in the health field, but readers of diverse backgrounds will find each book moving and edifying.
Phillip Siggins is a writer and critic.
The Medicine: A Doctor’s Notes
Dear Life: A Doctor’s Story of Love and Loss
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