{"id":31342,"date":"2014-04-07T10:33:25","date_gmt":"2014-04-07T09:33:25","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=31342"},"modified":"2014-04-07T10:33:25","modified_gmt":"2014-04-07T09:33:25","slug":"richard-smith-rediscovering-a-bmj-gem","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2014\/04\/07\/richard-smith-rediscovering-a-bmj-gem\/","title":{"rendered":"Richard Smith: Rediscovering a BMJ gem"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" alt=\"Richard Smith\" src=\"http:\/\/www.bmj.com\/site\/blog\/icons\/bmjh7648e.jpg\" width=\"160\" height=\"110\" align=\"left\" \/>After a class I taught recently one of the students came up to me and said, \u201cMy mother was fond of you. Her name was Clare Vaughan.\u201d I remembered. I met Clare only once, shortly before she died in July 1996 in her early 40s. My memory of the meeting is hazy: I remember beauty, kindness, stillness, a lovely smile. But what I remembered clearly and have now reread many times is <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2351907\/\">the piece Clare wrote for the <em>BMJ<\/em> as she was dying<\/a>. It\u2019s a gem that deserves a special place in the profusion of medical writing, most of it unprecious.<!--more--><\/p>\n<p>Clare describes being with her five year old daughter when she discovered that her breast cancer had recurred. That daughter must have been born in 1990. Was the student in my class 24? She was probably younger and perhaps has only faint memories of her magnificent mother.<\/p>\n<p>The initial diagnosis, four years before the recurrence, gave Clare, clearly a high achiever, great energy. Everything\u2014mothering, working, teaching, doctoring\u2014had to be perfect. But it was dying, which she describes as \u201cthe biggest adventure of all,\u201d that gave Clare insights into her life \u201cin a totally unexpected way.\u201d<\/p>\n<p>She describes herself as a \u201cdoer and a fixer.\u201d \u201cDoctors,\u201d she observes, \u201chave this terrible problem: they need to be needed so badly.\u201d She candidly observes that, like many doctors, she was \u201cquicker and brighter and more impatient than most other people.\u201d She had been plagued with anger. A <em>BMJ<\/em> obituary might use the euphemism that \u201cshe didn\u2019t suffer fools gladly.\u201d She hadn\u2019t dealt with these things, but dying allowed her, taught her, to do so.<\/p>\n<p>Should she have more chemotherapy? She decided against. \u201cMy heart told me to nurture all the wonderful bits of my life rather to try again\u2026to poison the tumour.\u201d That must have been a hard decision for a woman with three young children and a husband who was \u201cdesolate.\u201d But surely it was the right decision. I\u2019d like to think that I will be brave and sensible enough to decide the same when my time comes\u2014perhaps very soon.<\/p>\n<p>Clare describes herself \u201chaving a wonderful time fixing treasures for my children\u2026and writing a book about the dreams I have had, the dialogue I have entered into with my tumour.\u201d I\u2019d like to read that book, but I don\u2019t know how much of it she managed to write. She learnt the \u201cjoy of receiving\u201d despite her education having taught her \u201cnothing about the grace of receiving.\u201d<\/p>\n<p>Most people when dying, she observed, \u201cget medicalised and pitied and feared and isolated.\u201d She concluded that \u201cadvanced cancer is a curious condition\u201d and she believed that we \u201cunderstood it very poorly.\u201d The appearance since Clare\u2019s death of new, often very expensive drugs that offer a few extra weeks of life may mean that we often don\u2019t even try to understand advanced cancer. We simply try to defeat it. This may often be the wrong choice.<\/p>\n<p>Memorably Clare thought we needed \u201cmidwives for dying,\u201d people with \u201cthe particular skills of companionship, passage, and journey with a prescribed endpoint.\u201d There are such people; her Macmillan nurse was one. But there aren\u2019t enough of them. We\u2019ve invested instead in oncologists, perhaps another wrong choice.<\/p>\n<p>My main aim in writing this blog is to urge you to read Clare\u2019s piece. Although short, it\u2019s a rich, deserves multiple readings, and can help us think about our own lives and deaths and how our society deals with death. In the Middle Ages preparing for death was one of life\u2019s main tasks. It\u2019s a task we now neglect.<\/p>\n<p>Why, I wonder, did Clare title her piece \u201cTeach me to hear mermaids singing?\u201d She makes clear in her article the importance of poetry for her in those final months, and I went back to John Donne\u2019s poem that contains the mermaid quote. She probably simply meant that dying had taught her to do something as extraordinary as hear mermaids singing. It\u2019s a poem primarily about the falseness of women, but I think that Clare must have loved particular lines:<\/p>\n<p>Go and catch a falling star\u2026<br \/>\nTell me where all past years are\u2026<br \/>\nTeach me to hear mermaids singing,<br \/>\nOr to keep off envy\u2019s stinging,<br \/>\nAnd find<br \/>\nWhat wind<br \/>\nServes to advance an honest mind.<\/p>\n<p>Note: You may not know this: although you cannot access many <em>BMJ<\/em> articles for free you often can through PubMed Central. That\u2019s why the link to Clare\u2019s article is via that route.<\/p>\n<p><em><strong>Richard Smith<\/strong> was the editor of the BMJ until 2004 and is director of the United Health Group\u2019s chronic disease initiative.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>After a class I taught recently one of the students came up to me and said, \u201cMy mother was fond of you. Her name was Clare Vaughan.\u201d I remembered. I [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2014\/04\/07\/richard-smith-rediscovering-a-bmj-gem\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38364,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[955],"tags":[],"class_list":["post-31342","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-smith"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Richard Smith: Rediscovering a BMJ gem - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2014\/04\/07\/richard-smith-rediscovering-a-bmj-gem\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Richard Smith: Rediscovering a BMJ gem - The BMJ\" \/>\n<meta property=\"og:description\" content=\"After a class I taught recently one of the students came up to me and said, \u201cMy mother was fond of you. 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