Breathtaking: Inside the NHS in a Time of Pandemic
by Rachel Clarke
Little, Brown and Company
Weeks before the first wave of Covid-19 overwhelmed Britain last spring, palliative care doctor Rachel Clarke came down with symptoms that, any other year, would be a dead ringer for the common cold. But one in particular gave her pause: an usual degree of breathlessness.
Her husband, a pilot, had recently flown back and forth from Lombardy, where the first major European outbreak was in progress. She suspected he might have exposed her and wanted to get tested for Covid-19, but didn’t meet the criteria. “This isn’t for me,” she urged the call center worker who picked up when she called the hotline. “It’s to make sure I don’t walk back into my hospice as patient zero and infect all the patients I’m trying to look after. Can I be tested to make sure that doesn’t happen?” The answer was no.
The loss of breath is a recurring theme in Clarke’s latest book, Breathtaking: Inside the NHS in a Time of Pandemic, an intimate and impassioned account of her experience on the frontlines of Covid-19 from January to April 2020. In that time, the virus spread from China to Italy to London to Oxfordshire, the location of the hospice where Clarke usually works and the NHS hospital where she eventually volunteers. But as designated wards overflow with intubated patients and the death toll climbs ever higher, another refrain emerges—the loss of trust between frontline medics and their national government.
As a doctor who specializes in treating patients with chronic or late-stage illness—many nearing the end of their lives—Clarke knows firsthand that “care is inescapably visceral.” Hers is a line of work that demands compassion, empathy, and constant emphasis on the whole of the human, not just the integrity of the body. The nuance and tenderness this calls for, however, are difficult to muster when patients are lying nearly shoulder-to-shoulder in makeshift ICUs and care providers are buried under several layers of personal protective equipment (PPE)—even more so when their protective getup is cobbled together from DIY shops and trash bags, as was the case when government-supplied kits were at their most meager.
According to Clarke, what was hardest to bear wasn’t the insufficient equipment or even the long, exhausting hours. “What hurts staff most about the pit is not its physical demands,” she writes, referring to the heart of the Covid-19 wards, “but the psychological assault of seeing patients so entirely cut off from their loved ones.” These passages of the book—where a patient is on the brink of death but, for fear of exposure, can bid only a virtual or otherwise distanced goodbye to their family members—are among the hardest to get through, not least because Clarke renders them so vividly. Prime Minister Boris Johnson, meanwhile, gave press conference after press conference in which either mixed messages or false reassurances—such as his promise to “turn the tide” in 12 weeks—ring hollow, far and away from the brutal realities faced by the NHS system he praised so fervently.
“Moral injury” is the term Clarke invokes to sum up the psychological effects of bearing witness to so much horror and iniquity. As Downing Street engaged in “numbers theatre” to improve the optics of their pandemic response—superficially inflating quantities of supplies rather than actually increasing them—Clarke and her colleagues fell back on each other to endure the unbearable. Though in April the government finally issued a directive placing due emphasis on PPE, Britain’s 30,000+ long-term care centers—among them, Clarke’s hospice—were given only two days’ worth of masks. By the narrowest of margins, Clarke was able to procure adequate gear and save the hospice from closure. But not all were so lucky; within a month, more than 20,000 British care home residents would lose their lives to Covid-19.
What frontline healthcare workers needed from their government wasn’t unreasonable—not by a longshot. “My needs were more prosaic,” Clarke writes. “Really, I just wanted honesty from those who rule us, sufficient Covid testing and fit-for-purpose PPE.” Instead they were exposed to disease at unnecessarily high rates, left little choice but to make incredible sacrifices—one doctor, for instance, took to sleeping on a mattress in his garage to protect his family—and on top of everything else, had virtually no space to breathe, let alone repair from the physical and emotional toll of their work. Nearly a thousand health workers died from Covid-19 in 2020. If Clarke’s very prosaic needs were met, those hundreds might still be with us.
What kept Clarke going were the “tiny eruptions of kindness” and “improvised altruism” that cushioned the blows delivered by negligence and poor governance. Though such benevolence ultimately reminds and convinces her of humanity’s fundamental goodness, I couldn’t help but despair at the thought of what Clarke and her colleagues went through when the third wave of Covid-19 hit Britain in January, driven by a more infectious variant of SARS-CoV-2 that increased the number of daily new cases many times over. Since the book’s publication in January, Clarke has written for The Guardian about the “daily abuse” and hostility she encounters online for daring to share her perspective from inside the NHS. If we can’t take adequate care of our caregivers, it damages their ability to take care of us—and who in their right mind wants that?
It would be tragic enough if the British government’s dereliction of duty was an anomaly—an exception to the rule. Yet countries like India, several in South America, and certainly the United States are currently suffering from betrayals just as dire, if not more. Around the world the same story seems to repeat endlessly. How many people must die and healthcare workers must suffer for more substantial public health interventions to take place? How much more pain must the combined effects of governmental failure and moral injury inflict on the world before national leaders take responsibility for their mistakes and take action to ensure this never happens again? As a chronicle of the early days of the pandemic in Britain, the government’s ineptitude, and the incredible calamities unfolding at the frontlines, the significance of Breathtaking will persist long after Covid-19 is behind us. But it is as a powerful testimony of the challenges frontline health workers face that Breathtaking has the most impact, for this pandemic period and those to come.