Breathtaking by Rachel Clarke and Intensive Care by Gavin Francis review – two superb doctor-writers

Madeleine Bunting
·6 min read

In early April 2020 when lockdown was still a novelty, and the search for bread flour dominated my street’s WhatsApp, we set off on a 30-minute bike ride across east London to a warehouse in Newham where a French bakery was selling flour. The queue snaked down the otherwise deserted street and I got into conversation with the woman behind me. After we chatted about bread-making, she said she was a social worker in the area, charged with overseeing several care homes that had been in special measures long before Covid-19 struck.

“The residents are all dying,” she told me, “we can’t go into the homes and I can’t tell if it’s Covid or poor care or both.” It was at least another week before the media caught up with the care-home crisis, by which time it was too late. Thousands had died.

Many people who were bumbling along with their lockdown lives can now recount vertiginous moments when novelty became nightmare. We still struggle to comprehend the full implications of this pandemic. Self-protective mechanisms kick in: some people have decided that they already have enough on their plate, and don’t want to know more. If this is your disposition, look away now: Rachel Clarke and Gavin Francis, two of the very best doctor-writers to emerge within a rich new seam, spare us no pain in their compelling but tragic accounts of working in the first wave.

Reading their descriptions now, while we are in the grip of a third wave, is close to overwhelming, and several times I was in tears, their words haunting me in the early hours. In Breathtaking, Clarke is describing hospitals close to breaking point last April; in Intensive Care, Francis writes of the GP surgeries struggling with a surge in mental health crises. God help them both now.

Susan Sontag opens Illness as Metaphor with the idea that everyone has dual citizenship “in the kingdom of the well and in the kingdom of the sick”. For many people, the latter is alien territory until we are forced to emigrate there, but for those who are curious, Clarke and Francis act as foreign correspondents or cartographers.

Clarke quotes Zadie Smith’s comment about a “global humbling”. We had believed that many threats to our existence could be, or had been, resolved by the technology and science that had brought unprecedented wealth and convenience to the west’s small portion of the world’s population. But Covid has shattered that widespread illusion and reminded us that we share with our ancestors the reality of our frail and mortal human bodies. Clarke quotes Camus’s The Plague: “The pestilence is at once blight and revelation.” For doctors, the sheer lack of knowledge was terrifying, let alone the shortages of PPE and ICU beds. In many circumstances, Clarke and Francis found themselves with nothing to offer patients but compassion; paradoxically, this helps to make their books powerful, uplifting and even reassuring.

Francis brings in some useful science and medical history as befits an Edinburgh doctor; the city was, after all, the cradle of public health inventions that have saved far more lives than any surgical wizardry. He offers a few pointers to the history of pandemics from Hippocrates to Daniel Defoe and Laura Spinney’s influential study of 1918 Spanish flu, Pale Rider. That sets the context for his descriptions of his patients in a city surgery, on secondments in Orkney, and among the homeless. He offers vivid detail on how this pandemic has affected different communities – from islands dependent on helicopters for healthcare to the fragile marginalised of the inner city.

Clarke’s tone is more intimate, much of the book written at night when she couldn’t sleep for fear, fury and frustration – the last two she attributes largely to the inadequacies and lies of politicians. Rage lurks beneath many paragraphs as she lambasts the delays in decisions, and the “number theatre” of statistics. You get the sense of someone trying to remain calm and reasoned, often on the verge of being overcome.

These busy, exhausted doctors took time to write because they have an argument to make; they are passionate advocates for how the “kingdom of the sick” should be governed. On many of the key details they concur. Both work in branches of medicine that are not about hi-tech fixes – no miraculous heart surgery here – but centre on everyday patients facing unavoidable suffering and death. On every page, they are in effect arguing that strong relationships – trust, warmth and kindness – are not pleasant extras, but absolutely essential to healthcare.

Clarke and Francis refer frequently to their colleagues’ professionalism, dedication and care. Nurses, receptionists, healthcare assistants, fellow doctors, porters, paramedics: all come in for lavish praise as they struggle against the odds to give every patient attention and kindness. Clarke describes the ICU crammed with machines, beds jammed close together, bodies prone, festooned with tubes, and patients known only by numbers; yet even in this dehumanised environment where no faces are visible, staff did all they could to connect relatives, and offer comfort.

Both authors remind the policymakers and politicians that the quest for efficiency, improved productivity and an audit culture has too often destroyed relationships. What management tool can measure the value of kindness? Both champion the NHS ideals of universal taxpayer-funded healthcare, and lament the underinvestment that has left them on a battlefield, woefully underequipped.

Frustration at the PM's litany of mistakes is part of what prompted these books: if he won’t level with us, they will

In particular, they highlight the yawning gap between the frontline experience and the political narrative. While Boris Johnson fumbled through one inane superlative after another, Francis put on his PPE to visit isolated elderly patients and fielded endless desperate phone calls, and Clarke, swathed in plastic, laboured on the wards. Instead of honesty and humility, Johnson offered false hope (12 weeks to see off Covid) and slow, faltering decision making. The frustration at the litany of his mistakes is part of what prompted these books. If the prime minister won’t treat us with respect and level with us, these doctors will.

Covid is a disease of peculiar cruelty; to some extent the selection of victims most viciously attacked seems arbitrary. But the wider tragedy is that the vectors of the disease are the ways human beings connect – through speech and touch. Those who love us most can unwittingly be the means of our death. The fallout for families has been devastating, with burdens of grief, guilt and mourning unshared.

What sustains Clarke and Francis in their work is the inspiration of colleagues, and the bravery of their patients. Francis offers insight from John Berger’s book on the life of a GP, A Fortunate Man. Berger, having observed a succession of patients in a GP surgery, concluded that what most impressed him was “their everyday bravery and tenacity” and that “the notion of endurance is fundamentally far more important than happiness”. These superb books make clear that the revelation of this plague has been twofold: our hubris has been shattered, yet there remains a staggering human capacity for bravery, courage and endurance. Clarke and Francis witness it daily in the kingdom of the sick. From it, they take heart, and urge us to do the same.

• Madeleine Bunting’s Labours of Love: The Crisis of Care is published by Granta. Breathtaking by Rachel Clarke is published by Little, Brown (£16.99). Intensive Care by Gavin Francis is published by Profile (£16.99). To order a copy go to Delivery charges may apply.