31-07-2025
Doctor's Prizewinning Book Finds Meaning in Life and Death
Dr Rachel Clarke has one of the most unusual CVs in British medicine.
Before retraining as a doctor at the age of 29, she worked as a television journalist and documentary maker, reporting from war zones including the Gulf and Congo.
Since qualifying as a doctor in 2009, she has specialised in palliative care and become one of the UK's most acclaimed nonfiction authors.
Dr Rachel Clarke
Clarke's writing draws deeply on both her clinical and personal experiences.
Her first book, Your Life in My Hands (2017), recounted life on the NHS front line as a junior doctor.
In Dear Life , she explored her work in palliative care and the death of her GP father from cancer.
Breathtaking , written during the pandemic, laid bare the grim realities inside COVID wards.
Her latest, The Story of a Heart , tells the true story of a heart transplant from 9-year-old Keira, who died in a car crash, to 9-year-old Max, who received her heart. The account has won Clarke the 2025 Women's Prize for Non-Fiction, for what the judges described as 'a clear-sighted and vital exploration into the human experience behind organ donation.'
Medscape UK asked Clarke about the process of writing The Story of a Heart :
Clarke: Access was amazingly straightforward. Both Max and Keira's families were very keen to participate in something that might end up increasing awareness of donation and getting people having a conversation with their families about donation.
I was really conscious of the fact I'd be asking them to relive what was obviously an incredibly traumatic time. And I would be entrusted with one of the most personal and poignant stories that anybody has the misfortune to go through in their lives — the death of their child.
Rachel Clarke's book won the Women's Prize for Non-Fiction 2025
I approached them with the same moral standards as I try to apply in my work as a doctor. I explained they could absolutely trust me and if at any point they changed their minds — right up to publication — they could do so, and I'd throw it away.
I couldn't write the book unless they felt I had done their story justice. One of the main reasons I wanted to write the book was that I could see the value of what could come out of it.
You've written four bestsellers. Do you write to inform the public about medicine or to highlight NHS issues?
I very strongly regard my writing as a natural extension of being a doctor.
When you specialise in palliative medicine, as I do, you are incredibly conscious of the harm and the suffering that can stem from fear and taboos around dying and conversations that don't happen because people are afraid to have them.
Writing about that is a way to benefit patients.
All the books I've written have tried to shed light on aspects of medicine and being a doctor that are poorly understood or misrepresented. That includes death and dying, what it was like in the COVID wards, or what it's like to choose to donate your child's organs.
In my first book, I also explored what it's really like to be a professional who has to balance all their feelings and emotions, and the desire to do good, with the essential requirements of objectivity and dispassionate detachment that we need to do our job as doctors.
How do you manage your time as an author and a palliative care doctor?
With some difficulty! I split my time — 50% as a clinical doctor and 50% as a writer — which means I always juggle the two.
It's an incredibly privileged position to be in, to have two jobs that I love so much. Genuinely, I feel being a doctor helps my writing and being a writer helps my medicine.
Fundamentally, the core of both professions is very similar: It's about caring about people, listening very attentively to their stories, and trying to communicate them to other people clearly.
You were a TV journalist after university and didn't go to medical school until you were 29. Are you glad you didn't go straight into medicine?
I think it's helped me incredibly. I'm not even sure I would have survived medical school if I'd gone aged 18, as I was a sheltered teenager who'd experienced nothing in life.
However, with 10 years' experience in the big wide world under my belt, I just had more understanding of what human beings go through in their lives.
Why did you specialise in palliative care?
I'm naturally somebody who hates bullying in all its forms. I hate people being marginalised or silenced — and I think, historically to some extent, palliative care patients fit that description.
I once heard a consultant tell a patient they had cancer, and in an aside to us juniors, said to 'put them in the palliative dustbin.' That disgusted me so much.
I felt it was incredibly problematic that patients could be treated with such derision because they no longer warranted a surgery, and I wanted to do something about that.
I love my work and think palliative medicine is the very opposite of depressing.
I meet patients who so often are showing the best of human nature: They are courageous, dignified, and loving, and I feel privileged to do the job I do.
With that in mind, where do you stand on the assisted dying debate?
I've been relatively active in the public debate about this.
If assisted dying is going to be legalised in the UK, which I think it almost certainly will be, I know there's a real danger that people are going to choose the path of assisted dying when actually they have been denied the path of proper, decent palliative care.
I say that with a lot of experience. I'm afraid that as palliative care is so badly funded, we are going to enter a new world in which the NHS doesn't provide adequate palliative care for a patient, but will fund their death — which seems an absolutely dystopian direction the UK is about to travel in.
What else concerns you about the NHS at the moment?
The mismatch between the care that we are capable of providing patients versus the care they need is gaping.
We have the 10-Year Plan and strategies to address that, but it's not clear to me how on earth that gap is going to be met in the absence of increased funding.
We've heard an awful lot from Wes Streeting about his three main priorities: analogue to digital, treatment to prevention, hospital to community. Fine in theory, but it's just a sound bite unless it's backed with funding.
It's an ambitious plan, but at the same time we are laying staff off — and that's madness.
So, would you encourage young people to go into medicine as a career?
I very sadly know of very few doctors who'd want their children to follow them into medicine, and I think that is tragic.
I am endlessly lucky, and I love my job.
These days, you are coming out £100,000 in debt through paying for your medical degree; you are earning a salary that is, in real terms, much lower than it used to be, and you have no job security.
All of that is atrocious.
It's also the case that valuing the expertise that a medical education provides you with is being really denigrated in the NHS at the moment.
Doctors are being substituted, for example, by physician associates and other groups as well. Is it really the case that somebody who isn't a doctor at all can do the same job of diagnosis and management?
I'd argue most definitely not, but that seems to be the direction of travel.
What's next for you? Have you ever thought of going into politics?
One-hundred percent not, as I like to say what I believe, and I like to be able to express myself with integrity and honesty and not tow a party line. I'm not constitutionally built like that.
Clinically, I will carry on doing my palliative care, doing lots of teaching and training, and I hope to carry on writing as well.
Medicine is such a fascinating form of human activity.
In a hospital, all of human life is there, but it's even more concentrated and dramatic.
Hospitals are more full of huge feelings and life-changing events than any other arena of human life. And so it's endlessly fascinating to explore them in print.
