Rachel Clarke was a specialist palliative care doctor, working in Oxford, when the pandemic hit and she was redeployed. “People think the pandemic happened in intensive care. The vast majority of people who died never went near intensive care,” she says. “They were too frail and too sick to cope with the treatment of a ventilator.”
I’ve been talking to Clarke for a while about numerous things – the death of her father from cancer, the second Congo war, why the NHS, social care and a lot else besides are bust because of direct policy decisions – and she always maintains the same demeanour: acute but very gentle, compassionate but self-possessed, her face open and unruffled; even her hair smells like everything’s going to be OK. But when we get to the subject of Covid, she says she is worried she’s going to start crying. I say, don’t sweat it, I nearly started crying 10 minutes ago (dads, cancer). But she’s a palliative care doctor: it takes a hell of a lot to make her cry.
These frail patients, she says, “went on to Covid wards, which was where I tended to work. Sometimes, six or eight patients on a ward would die in one day. The hideous, industrial scale of death after death after death – it was utterly horrific. And I say that as someone who is very used to death and dying.” That this entire frontline workforce must have been traumatised by the pandemic should have been obvious, is obvious; I just feel bad never to have sat for very long (as the therapists say) with that thought. “Most people haven’t talked about it,” she says. “You don’t talk to your colleagues about it because that would be self-indulgent; we all went through the same thing. And you don’t talk to the public about it because no one’s asking and who cares anyway? And yet, collectively, everybody went through something that was really very hard.”
Once the immediate crisis was over, Clarke wrote a book, Breathtaking: Inside the NHS in a Time of Pandemic, her third memoir as a doctor. “I wanted the public to know what it was like to go through a pandemic in an NHS hospital,” she says; she has now co-written a dramatisation with Jed Mercurio and Prasanna Puwanarajah, and it is completely unlike the Covid you’ll remember, unless you also worked in the NHS. From the first scene, the terror is palpable. You can see the abyss reflected in Joanne Froggatt’s eyes, as she plays Dr Abbey Henderson, a tightly controlled professional who is confronted by scenes she never thought she’d see – hospitals running out of oxygen before the first lockdown had even been called, medics having to prevent visits to patients on their deathbeds, all the while having no sense of what risk they were at themselves, and whether it was safe for them to go home. Clarke says she wanted the show to be “immersive and claustrophobic – being in a hospital at the start felt like a submarine that you couldn’t escape from”. The drama also captures the sheer sorrow of “caring for patients who are destined from the moment they come into hospital to never even see a human face again,” Clarke says. “Every face they see is masked.”
Their rule while writing – Mercurio and Puwanarajah are also medically trained – was to put nothing in that didn’t happen somewhere in real life. Socially, Covid was more like a war than a plague: we all experienced greater or lesser degrees of it, but only the people on the frontline really saw it. “Especially in the first wave, with that beautiful spring, we could hear birdsong and the skies were bluer than ever,” Clarke says. “I’m not suggesting it was easy for people. But it was the most hellish experience I’ve ever had as a doctor. I wanted people to feel and hear and smell and inhabit that world.”
Clarke was born in 1972 to an almost too-neat medic family in rural Wiltshire, with the men all doctors and the women all nurses. She didn’t want to be doctor. “I worried that my main reason would be because I hero-worshipped my dad, wanted to make him proud.” Instead, she studied philosophy, politics and economics at Oxford, became a journalist, made documentaries and always “had massive impostor syndrome, always felt like I was faking it, trying to act tough”. The final straw was in 1997 after the death of Diana, Princess of Wales. Trevor Rees-Jones, Diana’s bodyguard, was badly injured and someone told Clarke to call his grandma. “I called her and she started wailing: ‘Why won’t you leave me alone?’ I just felt shame, from the roots of my hair, down to my feet.”
Plainly, journalism should have a word with itself, but it didn’t in time to keep Clarke, who in her late 20s started studying science A-levels at night school and applying to medical schools in London as a mature student. At interview, “the first question they asked was: ‘It must be so interesting, working in television. Tell us about working with Jon Snow.’ The second question would be: ‘Why do you want to be a doctor?’ I had already decided I was going to say the one thing that you’re taught not to say: because I want to help people.”
What was the stigma around caring? Was it because medicine was male-dominated, even at the turn of the century? Certainly, it was enmeshed in the interview process, this idea that you had to prove you were as hard as nails. “Feelings are women’s namby-pamby-ness,” is how Clarke describes the attitude, to the extent that University College London “deliberately held the interviews in their anatomical specimen museum, so you’re in front of a panel of people, and behind them, rows of hundreds of jars of human eyeballs and aborted foetuses”.
Clarke got into UCL just before she turned 30, did two years in London, then moved to Oxford for love and more medical school, where she says she was the first medical student to have a baby while studying. She and her husband, Dave, met when Clarke’s flatmate introduced him as a good candidate for a fling. Their first date lasted an entire day, but then circumstances separated them – “I went off to the Democratic Republic of Congo to make a documentary there about the civil war. And he went off and fought in the Gulf war [Dave was a fighter pilot].” Months later he emailed out of the blue, inspired to seize the day after a Tornado got shot down and the pilot and navigator were killed.
“Our second date was a year after the first date. We were just telling each other we loved each other and how many babies we wanted to have. It was astonishing. My own family couldn’t believe it. When my brother met him for the first time, he said: ‘No offence, Rach, but he does actually look like Tom Cruise. You are really punching above your weight here.’” They’ve been married for 19 years and have two children. Dave now works in commercial aviation.
For a long time, Clarke embodied the archetypal doctor. “They are the people-pleasers and the hoop-jumpers, straight-A students who’ve gone obediently through a very hierarchical system. Most doctors just want to keep their heads down and crack on with their jobs.” But then came the Conservative government, and pretty soon the NHS was in crisis and junior doctors were on strike. This was 2016.
Eight years on, junior doctors have just gone on strike again, with none of the original grievances solved and pay and conditions worse: they’re now paid 26% less in real terms than they were in 2008. “It is wild,” Clarke says, “that the starting salary of a junior doctor in Britain today is 15 quid an hour. That is pre-tax, gross salary. And before they start paying back student debt, which is typically upwards of £100,000.
“I worked out my hourly salary. I have been a doctor for 15 years, I’m highly specialised, highly experienced, and it is 30 quid.” The pay decline is as bad, of course, in nursing. “You can instantly earn more by working in Aldi.”
Back in 2016, Jeremy Hunt was health secretary, at that point the worst to have held the post. “He had no qualms, no scruples whatsoever about whipping up the media against junior doctors, and came out with all this rhetoric about junior doctors being militant,” she says. “Are we serious, about doctors being radical firebrands? I don’t think so. I would never normally swear in an interview, but they just didn’t want to be treated like … [long pause] … excrement any longer.” She takes another run-up at an actual swearword. “They don’t want to be treated like shit.”
It’s routine for ministers now to denigrate doctors. The current health secretary, Victoria Atkins, “prefers to describe a junior doctor as a doctor in training, as though you’re still wearing your stabilisers. None of that’s true,” Clarke says. But to talk down medical staff was quite novel when Hunt did it and that is why Clarke started writing articles and appearing on TV. She felt that members of the government were smearing junior doctors, “and I detest bullies. I especially detest bullies who pick on easy targets.”
She was a dangerous foe for the government, coming over so calm, humane and completely un-radical. After an approach by a literary agent, she turned her arguments into her first book in 2017, Your Life in My Hands: A Junior Doctor’s Story, a trenchant and very pacy read. “It felt great. It was so cathartic.” It was her second book, Dear Life: A Doctor’s Story of Love, Loss and Consolation, which came out in January 2020, that became a bestseller and was shortlisted for the Costa biography award.
“I was inspired to write it when my father was diagnosed with terminal cancer,” she says. “I was astonished by how ill-equipped I was to cope with that fact. Professionally, I knew everything. And it was no protection whatsoever against the feeling that this person you love so dearly and so intensely is going to be gone in probably a year or less.”
Palliative care is the “dowdy support act” of medicine, she says, but she didn’t fall into it by accident. “I knew that I wanted all the patients I saw to be gravely unwell. Not at all in a ghoulish sense, but just because I thought if I was going to do this later in life when I was nearly 30, I might as well do it in its most extreme form, where every bit of who I am as a human being can potentially bring benefits to a patient.”
Dear Life is a haunting and joyful book, confronting the preciousness of life without flinching at the loss of it. The heart of the book, like the heart of her work, is that death and its environs is where we see each other at our best. “You see people having the worst days of their lives all of the time, and I am constantly blown away by how phenomenally courageous, generous, full of grace and dignity and quiet strength they are.”
That was one of the things she hung on to, in the first wave of Covid: “Every day I would go to work, and without fail, a colleague, a patient or a relative would behave in ways that were just beautiful and staggering and mind-blowing in their generosity and kindness towards each other. The very bleakness of that backdrop of Covid made these little clumps of humanity burn even more brightly. I can cope with distress, but I felt it really keenly, the unknowability. The irritation with politicians came a bit later. It’s almost a relief when you realise that at least some of it is Matt Hancock’s fault.”
That became another insistent reason to write Breathtaking, then adapt it for the screen: the sheer “amount of misinformation and spin and downright lies from the government; ‘the NHS is coping’, when we weren’t; ‘there’s no rationing’, when there was; ‘everybody who needs a ventilator was getting one’, when they weren’t. All of that was completely dishonest.” A nurse in Clarke’s trust caught Covid, almost certainly at work, and died in an ICU, cared for by her colleagues. “She had the pitiful PPE of a paper mask and plastic pinny; you think of that, and then you think of Matt Hancock, literally going on national TV and saying there are no problems with PPE. At the time it felt grotesque, the mismatch between how brave and selfless frontline staff are being versus these lies on behalf of the government.”
I think of Michelle Mone and the yacht; Boris Johnson and the parties; Dominic Cummings and the eye test at Barnard Castle; how these have become the motifs of Covid – greed, fecklessness and dishonesty the organising behaviours of that national crisis. We’ve built ourselves a story that erases the best of us, with the worst in their place. Rachel Clarke isn’t going to let that lie.
“Even though your heart was breaking, you were losing your mum, your dad, your spouse, you stuck to the rules simply to try and protect other people. The contrast, between that and partygate, was the absolute best and worst of Britain, side by side. It made my blood boil then, and it always will.”
• Breathtaking airs on ITV1 in February
