We sat down for an exclusive interview with Farine Clarke, GP turned playwright and writer of Heartsink, which plays at Riverside Studios from 21 April – 10 May.
As someone who has lived on both sides of the consultation desk, what surprised you most about how illness reshapes a person’s sense of identity and agency?
This is the vital question. From the day you enter medical school you’re trained to be a professional with the title doctor. That’s the first word on your name tag and to a very great extent, it’s what defines you. No one minds saying, “I’m a doctor” which translates into, “I’m the one with the knowledge, the control, the ability to advise and, to a significant extent, the power”. No one starts a conversation with, “I’m a type two diabetic” with its accompanying translation.
Serious illness had both immediate and slower-burn effects.
Firstly, the title, ’Dr’ became pretty meaningless quite quickly. I was no longer on the inside but found myself observing a group I knew well, from the outside. It’s an out of body view, which surprised me. I also found it funny, which isn’t as glib as it sounds but I was listening for what people weren’t telling me. Rather like in a Snoopy cartoon, I found myself filling in the consultants’ speech bubbles.
“Let’s see how it goes” was said; “this isn’t looking so good” was inserted by me.
Secondly, it slowly dawned that the system itself defined me by my condition. So not only was Dr gone- and with that my professional identity- but it was replaced by a label, which was the condition.
Everyone knows it’s bad for patients to adopt illness behaviour and yet at every turn I found the system emphasised the condition and made me the illness, stripping my identity further and forcing me to identify as ill. That’s not detracting from the excellent work the healthcare profession continued to do, it’s just that when you’ve been on both sides you feel the change in position acutely. It’s a collision of perspectives. A juxtaposition of two worlds which are intrinsically linked in purpose but miles apart in experience.
How did your own experience as a patient influence the way you chose to portray vulnerability and power dynamics in Heartsink?
I write because I love writing and my other plays are not about being a patient. But my company is called ‘unequal productions’ so the plays always reference the constant inequality and power struggles around us. This is as acute in healthcare as it is in any other environment.
I like to surprise audiences and tell stories in a way which they enjoy while also stimulating lively conversation and debate. I know how it feels to be empowered by a white coat but also how vulnerable and terrifying it is to lie in bed sporting an NHS nightie and paper knickers. My job in Heartsink was to show both sides- always with humour, often gallows humour, because at times in life you can’t make it up. I’m always on the outside looking in, but being a patient heightened that distinction between patient vulnerability and power.
With the Assisted Dying Bill prompting intense public debate, what kinds of ethical questions did you most want audiences to wrestle with after seeing the play?
I’m so pleased that the first group that saw this play really enjoyed it. “Heartsink” is a depressing word- but the play is not. It’s a biting comedy which uses humour to raise ostensibly unfunny issues. These include assisted dying. The idea that we should all be allowed to exercise our right to choose how we die is, by enlarge, a no-brainer.
However that’s the easy bit but I don’t see those of us in the street openly debating the unforeseen consequences of the AD bill. That doesn’t mean I don’t agree with it, just that it is always the case in medicine that where there are ethical dilemmas, there will be two sides. Heartsink is a vehicle for society i.e. the audience to witness two sides and then have that conversation. Many doctors do fundamentally disagree with the Bill seeing it as the slippery slope for their patients.
Then there’s this point about how we label. Is it right to call someone by their condition ‘an asthmatic, a diabetic, a cancer patient?’ or should we rethink that phraseology? Once we label people we define them and all sorts of images come to mind about who they are. Society has pulled back in some areas, particularly around mental illness – we don’t call people a ‘manic-depressive’ anymore and physical appearance, we don’t keep people ‘fat’.
When it comes to physical illness there’s still a lot of labelling by everyone, not just healthcare professionals, with all the associated assumptions. Some people don’t mind being labelled by their condition and will share widely. But others do. I think the time has come to be a bit more sensitive.
In writing about the NHS with both affection and critique, how did you balance honesty about its pressures with compassion for the people working within it?
I was a doctor, am married to a doctor and have loads of medical, nursing and other healthcare friends all of whom I intend to keep once this play is out. The medics who were at Heartsink’s first outing, loved it exactly because they know it’s honest. They also know it highlights the very things which frustrate them too.
The main protagonist is a doctor and I remain eternally grateful to the people who treat me & publicly thanked the medical team who came to see my first play, from the stage (I can share the video!). However, the NHS is an enormous ‘system’ and sometimes parts of that system contrive to do exactly what healthcare professionals don’t want.
When a consultant’s struggling with their screen instead of making eye contact with their patient, or as one ophthalmologist said to me at an appointment, ’I could have done a cataract operation in the time it’s taken me to do this,” something’s very wrong.
What emotional challenges did you encounter in transforming deeply personal medical experiences into comedy, and how did humour help you process them?
If not outright humour, then irony has always governed my life. I learnt pretty early on that whenever I think everything’s wonderfully well, God will decide to have a laugh and pull the rug from under me. Writing for me is cathartic. I think in dialogue and thoughts buzz around in my head, so putting them on the page is actually a relief.
Interestingly one of the stories in Heartsink came out of the blue from a very painful experience I had as a junior doctor treating a child. I had kept that buried for a long time only letting it out when the character called for it decades later; it’s a fitting homage to the people involved. I’ll never forget that child, nor his family, their bravery and compassion. Life can really stink sometimes and medicine can be brutal so comedy is a vital tool to handle the accompanying, inexplicable pain.
On a very personal level I’ve always viewed my own health with a large dose of resignation. It isn’t over… until you die. In the interim you might as well do something useful.
Having moved from a medical to a creative profession, what do you think theatre can offer conversations about healthcare that clinical settings often cannot?
I often think that being a once-medic who is now a writer is like being a soldier who is no longer at war. When you’re in it you’re fighting to survive. I remember doing 120 hour weeks and running around the wards (we all did) fuelled by adrenalin just trying to make sure everyone was treated properly. It was exhausting and fantastic at the same time. I didn’t leave medicine because I hated it- I loved it- but because I really wanted to write.
Just like soldiers stay quiet about their war experience, I think medics don’t acknowledge or share the pain. It’s best kept buried and anyway, to stay professional requires a clinical approach to self-control. Medics are guarded by nature. They’re bound by confidentiality—which is what we all want them to be—and they’re cautious by nature—again, what we want. Clinical situations are often about managing the message to patients, because that’s the compassionate thing to do.
Theatre is where truth can be told openly and the audience can decide. Theatre imparts trust and control. Clinical situations – for good reason – don’t do that. When people try to shut down theatre they’re attempting to silence truth; akin to burning books or doctoring a picture. Even then theatre and anyone with clinical insight has a duty to be careful: gratuitous clinical truth or single agenda truth doesn’t help. The challenge is to arm people with more information whether they are delivering or receiving clinical care.
Heartsink is a funny play designed to entertain everyone but with unique insights into why clinical environments can overwhelm us all. Theatre is the best and most entertaining vehicle to deliver that message.