Olivia: A recent survey found 82% of us have strong opinions on how we want to be treated at the end of life. But want to guess what percentage have actually written it down? Jackson: Oh boy. I’m guessing it’s low. Like, embarrassingly low. Olivia: Four. Just four percent. That gap between what we want and what we plan for is where today's story lives. Jackson: Four percent! That's staggering. We're all thinking about it, but almost no one is actually talking about it or putting it on paper. It’s this huge, silent elephant in the room for basically everyone. Olivia: Exactly. And that silence is what Dr. Rachel Clarke confronts head-on in her incredible, widely acclaimed book, Dear Life: A Doctor's Story of Love, Loss and Hope. What's fascinating is that Clarke wasn't always a doctor; she was a broadcast journalist covering global conflicts. She switched careers at 29, bringing that powerful storytelling lens to the front lines of palliative care in the UK's National Health Service. Jackson: A war-zone journalist to a palliative care doctor. That’s quite a career change. I imagine that gives her a completely unique perspective on what it means to be on the front lines of human suffering, but in a totally different way. Olivia: It absolutely does. She looks at the medical world not just as a clinician, but as a storyteller, and what she sees is both heartbreaking and profoundly beautiful.

Jackson: So how does that storyteller's eye see the medical world differently? I imagine it's not always a pretty picture. Olivia: Far from it. She exposes this deep tension in medicine between clinical work and human connection. To give you the most extreme example, she talks about the case of Simon Bramhall, a liver transplant surgeon in the UK. Jackson: Okay, what did he do? Olivia: While his patients were unconscious on the operating table, he used an argon beam—a tool for stopping bleeds—to burn his initials, 'S B,' onto their new livers. Jackson: You're kidding me. That actually happened? He branded them? Like cattle? Olivia: He branded them. It was only discovered when one of the livers failed and another surgeon saw the initials. He was eventually convicted of assault. Clarke uses this as the ultimate example of dehumanization. The subtext is horrifying: 'You’re mine. Your body is at my disposal and I can do whatever I like to it.' Jackson: That is chilling. It’s a complete violation of trust. But how does something like that even become possible? Is it just one rogue individual, or is there something in the system that allows that mindset to develop? Olivia: Clarke argues it's baked into the training. She describes her first year of medical school, in the anatomy dissection room. The students are given a human cadaver to work on for months. To cope, they give him a nickname—'Henry'—and they have to learn to see him as a collection of parts, not a person who once lived and loved. Jackson: I can see how that would be a necessary coping mechanism. You have to detach to learn. Olivia: You do. But she shows how that detachment can curdle into something colder. She tells the story of Professor Bradbrooke, a linguistics professor admitted to the hospital. The consultant, surrounded by a crowd of medical students, delivers the devastating diagnosis—inoperable cancer in his heart—with all the warmth of a weather report. He just states the facts and walks away, leaving the professor and his wife utterly shattered. Jackson: Wow. No comfort, no kindness, just a clinical data dump. Olivia: Exactly. And the professor’s wife is just left there, holding her husband’s hand, while the medical team moves on to the next "case." Jackson: Okay, but hold on. A surgeon or a doctor can't be weeping over every patient. Isn't that detachment a necessary survival tool to avoid burnout? Can they really afford to feel everything? Olivia: That's the crucial question the book grapples with. Clarke’s own father, also a doctor, told her that you can end up immune to pain precisely because you started out with so much compassion. It just hurts too much not to build a wall. But she makes a powerful distinction between professional detachment and outright cruelty. The goal isn't to feel everything, but to never lose your kindness. Jackson: So what does that active kindness look like in practice? Olivia: She tells a story about a patient named Maureen Gibson, who had motor neurone disease. Her case was so "interesting" that she became a medical curio, with a constant stream of doctors and students wanting to poke and prod her. The author, then a student, had befriended Maureen and saw the distress it was causing her. Jackson: That sounds awful, being treated like an exhibit. Olivia: It was. So one day, an eminent professor, a giant in the field, arrives with his entourage of students to examine her. And the author, just a medical student, steps in front of him and says, "No. She's had enough. You need to leave her alone." Jackson: Whoa. That must have taken some serious guts. How did the professor react? Olivia: He was furious at first. But he saw she wasn't backing down, and he left. It was a small act, but it was about defending a patient's dignity. It’s about remembering there's a person in the bed, not just a fascinating collection of symptoms. That’s the battle for empathy she describes.

Olivia: And that fight for kindness is really the heart of palliative care. It's about pushing back against the idea that once a cure is impossible, the story is over. Jackson: Right, because I think for most people, the word 'hospice' is terrifying. It sounds like the end of the line. A place you go to give up. Olivia: Exactly. Clarke even quotes a dismissive oncologist who referred to sending a patient to hospice as throwing them in the "palliative dustbin." That's the perception she’s fighting. But what actually happens there can be the complete opposite of giving up. Jackson: Okay, so give me an example. How does palliative care rewrite that script? Olivia: My favorite story in the whole book is about a 96-year-old woman named Dorothy. She's admitted to the hospice with a bowel obstruction. A surgeon had told her, with absolute certainty, "You will be dead in six days. On Thursday." So she arrives at the hospice, completely resigned, just wanting to be left alone to read her newspaper and wait for Thursday. Jackson: That's incredibly bleak. To have your death scheduled like an appointment. Olivia: It is. But the hospice team, including Rachel Clarke, refuses to accept that script. Clarke asks Dorothy, "If you weren't dying on Thursday, what would you be doing?" And Dorothy says, without hesitation, "I'd be at my bridge club. I haven't missed a Thursday game in twenty years." Jackson: Oh, I love where this is going. Olivia: So the team launches what they call 'Operation Royal Flush.' They arrange a wheelchair taxi, call her bridge partners, get her pearls and her best twinset ready. And on Thursday, the day she was supposed to die, Dorothy is wheeled triumphantly into her bridge club. She lived for several more days and later said that last game was "magnificent." Jackson: That's incredible! So hospice isn't about waiting to die, it's about figuring out how to live right up to the very end. Olivia: Precisely. It’s about focusing on what makes life meaningful for that person. Another powerful example is Simon, a retired policeman with thyroid cancer. A tumor was pressing on his airway, and he was admitted to the hospice terrified, absolutely convinced he was going to suffocate. Jackson: That’s a primal fear. I can’t even imagine. Olivia: It is. But the team managed his physical symptoms with steroids to reduce the swelling and a sedative to calm the panic. Then, Clarke sat with him and just talked. She asked him what he was afraid of, and he said he was devastated he wouldn't see his grandson Timmy's upcoming birthday. So, what do you think they did? Jackson: They threw an early birthday party at the hospice? Olivia: You got it. They brought the party to him. Cake, balloons, family. Simon got to see his grandson's birthday. He died peacefully two days later, not in terror, but surrounded by love. Palliative care is about creating those moments. It’s like this other story she tells about the 'magic string' used for children undergoing radiotherapy. Jackson: Magic string? What’s that? Olivia: The kids were terrified of being alone in the room with the big, loud machine. So a play specialist invented a simple solution: the child holds one end of a ball of string, and the other end is threaded under the door to their parent, who holds it in the next room. It’s a physical, tangible thread of connection. It reframes the story from one of abandonment to one of being held and loved. That's what palliative care does. It finds the magic string.

Jackson: These stories are so full of hope and ingenuity. But the author, an expert in this field, had to face it herself with her own father. I can't imagine that was easy, even with all her knowledge. Olivia: That’s the most powerful part of the book. She admits that all her professional expertise meant nothing when it was her own dad. She quotes C.S. Lewis, saying, "No one ever told me that grief felt so like fear." She, the palliative care doctor, felt that same raw, primal terror of loss as anyone else. Jackson: It’s almost comforting to know that even the experts are just human. It makes the book's message feel so much more authentic. Olivia: It does. And it leads her to this profound understanding of love and grief. She tells this incredibly intimate story of her father in his final days. He's too weak to shower on his own. So she and her mother, a former nurse, help him. She describes washing his hair, his frail body, and realizing the profound role reversal. He, the strong father who once cared for her, is now completely vulnerable in her hands. Jackson: Wow, that’s such a powerful image. It completely flips the parent-child dynamic on its head. Olivia: It's a moment of pure love and service. And it connects to her central idea about what matters at the end. It's not about the big achievements. It's about these small, tender moments of human connection. She tells another story about a patient named Maria, who is dying in the hospice. Her husband, Pete, is elderly and not in great health himself. Maria's biggest worry isn't her own pain; it's how Pete will manage to eat after she's gone. Jackson: Oh, that's heartbreaking. Olivia: So in her final weeks, Maria spends her dwindling energy secretly filling the hospice freezer with breaded fish, all carefully portioned and labeled with cooking instructions for Pete. It was her final act of love. Clarke reflects that watching Pete’s grief after Maria dies is unbearable, but she realizes you can't have one without the other. The pain of grief is simply the price of love. Jackson: The price of love. That’s a beautiful and devastating way to put it. It’s not a sickness to be cured; it’s a testament to how much someone mattered. Olivia: Exactly. And that’s what her father understood. He didn't want to chase immortality through science or money. He told Rachel, "The only immortality that matters to me is knowing my family and friends might still think of me occasionally." Before he died, he secretly wrote letters to all his children and grandchildren, a legacy of words. That was his version of Maria's frozen fish.

Jackson: So after all this, after all these stories of pain and love and bridge games, what's the one thing we're getting most wrong about death? Olivia: I think it’s that we see it as a medical failure. A full stop. An enemy to be fought at all costs, with every procedure and drug, even if it just prolongs suffering. But what Clarke shows us, so powerfully, is that dying is a part of living. It's a final chapter that can be filled with as much love, wonder, and humanity as any other. Jackson: So the real tragedy isn't dying. It's dying without being seen as a person, without dignity, without our stories being heard. Olivia: Precisely. It’s about shifting the focus from a 'good death' defined by medicine to a 'good life' right until the very end, defined by the person living it. The book ends with a quote from the neurologist Oliver Sacks, who wrote about his own terminal illness. He said, "I cannot pretend I am without fear. But my predominant feeling is one of gratitude." Jackson: Gratitude. Even at the end. That’s a powerful thought to hold on to. It makes you wonder, what are you grateful for in your life, right now? Olivia: It really does. It’s a question we should probably all ask ourselves more often. Jackson: That's a perfect place to leave it. We'd love to hear your reflections. Find us on our socials and share one thing this conversation made you grateful for. Olivia: This is Aibrary, signing off.