Jennifer Worth is best known for her first memoir, Call the
Midwife, which was made into a successful television series
(Features, 20 January). That book formed part of a trilogy which
recounted her experiences of midwifery in east London in the 1950s.
In the Midst of Life is the thought-provoking fourth
volume of Worth's memoirs. It focuses on her reflections on nursing
those with terminal illness, and her thoughts on how we die in our
Over the summer, I was at a discussion group on assisted dying
at a parish holiday. The main issues were well outlined and debated
for most of the session. Then a participant told us about her
mother's terminal care in a hospice. Her mother's pain was not
adequately controlled, and she had been in distress. In tears, the
daughter told us how, for much of the last few weeks of her
mother's life, she felt like taking the pillow, covering her head,
and aiding a quicker death.
As I read In the Midst of Life, I thought of that
woman. I think she would find its tone reassuring in the face of
the guilt that she openly expressed. It is a book that should
appeal to anyone who wishes to reflect on how advances in medical
care affect the quality of both our lives and our deaths. It is a
book that we should all read, as these issues will have an impact
on all of us, at some point in our lives.
In the Midst of Life is an important contribution not
only to thinking through these issues, but also to feeling them,
too. Worth's writing is thoroughly grounded in her practical
nursing experience. This makes is both accessible and engaging. But
it also renders it refreshingly free from the moral
over-generalisations that come from some Christian ethicists.
The book also offers a mixture of styles of writing. The bulk of
it comprises stories of nursing care that Worth was involved in.
These are told with a compassionate and critical voice. Narrating
the stories offers her the opportunity to raise questions about
what constitutes good medical and nursing care.
There are also biographical chapters on the work and influence
of Elisabeth Kübler-Ross and Cicely Saunders. Others are essays
that focus on the social taboos of death, the separation of nursing
and caring, resuscitation, and assisted dying.
Worth invites us to reflect on how we think and feel about
death. In her preface, she says: "This book assumes that death is
sacred," and that it can be experienced as a friend rather than an
enemy. She tells us the stories of what she describes as the
"natural death" of her grandfather, and the "unnatural death" of
Mrs Ratski. The former died of "old age", while, in the case of the
latter, medical interventions are depicted as causing further
In Mrs Ratksi's case, the medical profession is seen as treating
diseases rather than people, and of making decisions without
reference to the patient or the family. This story is doubly
tragic, in that the burden of care on the family leads to the
break-up of Mrs Ratski's son's marriage. In a conversation with a
Matron about this patient's care, Worth says: "What's wrong with
dying, anyway? We're all going to die."
Worth focuses on the denial of death in modern medicine. For me,
this also raised questions about similar denials that may come from
Christians when healing and miracles are over-emphasised, at the
expense of the life-cycle.
Later in the book, a chapter on dementia expands her insights
about the aims of medicine. Because of its focus on prolonging
life, modern medicine is ill-equipped to assess the qualitative
outcomes of its own interventions. This is exacerbated when
medicine and care become business. Worth notes that residents in
care homes are often fed by tube simply because it is more
cost-effective. It is also expedient to keep residents alive, as
they are the main revenue stream. As the rate of privatisation of
health care increases, these trends will become more prevalent.
Worth also reflects on hope. In the face of illness, hope is not
only or necessarily about cure, but can mean something different to
each person. "Hope, directed towards an achievement, is the driving
spirit that makes the future endurable."
On the questions surrounding assisted dying, Worth comes to a
tentative, ambiguous, and honest conclusion:
I am a Christian; with every breath of my body, every beat of my
heart, I trust and love God. Christian teaching guides my thoughts
and my life. But, when it comes to euthanasia, I flounder in a sea
of uncertainty. It is horrifying, and contrary to the Ten
Commandments, to think of killing the weak and helpless. Yet I also
believe in evolution, and it may be that the necessity to decide
the time of death for ourselves and others is part of God's purpose
for the evolutionary development of mankind towards responsible
maturity, to which we will have to adapt mentally, spiritually, and
emotionally. Yet still it shivers me, and I don't know the
Her comments brought me back to the parish discussion group.
Worth helped me to feel the issues.
The Revd Robert Thompson is Lead Chaplain at the
Royal Brompton Hospital in London.
In the Midst of Life by Jennifer Worth is published by
Phoenix/Orion at £7.99 (CT Bookshop £7.20
-Use code CT941 ); 978-0-7538-2752-9.
- Did reading this book make you think about anything in
particular relating to your own mortality?
- "This book assumes death is sacred." How does Jennifer Worth
show this in her writing?
- Whose was the first death you experienced? How did it affect
- What have Dr Elisabeth Kübler-Ross and Dame Cicely Saunders
contributed to the field of death and dying, in Worth's view?
- Worth is opposed to euthanasia, as she makes clear in her
writing. What is your view?
- How would Worth sum up good care for the dying?
- Has your view of resuscitation changed after reading the
- Were you able to discern how Worth's faith affects her views
about the care of dying people?
- "It is well nigh impossible to talk to anyone about death, I
find." Do you agree?
IN OUR next reading-groups page, on 2 November, we will print
extra information about the next book. This is Death Comes to
Pemberley by P. D. James. It is published by Faber at £7.99
(CT Bookshop £7.20 - Use code CT941
P. D. James was born in Oxford in August 1920, and
educated in Cambridge from the age of 11. Her career began in the
National Health Service in 1949, before she moved to the Home
Office as a civil servant, where she worked for both the police and
criminal policy departments until retirement in 1979. Her first
book, Cover Her Face, was published in 1962, although she
had had a desire to be a novelist since childhood.
Since then, she has written 20 books, including an autobiography
which was published to coincide with her 80th birthday. She was
made a life peer in 1991, and has received numerous awards. In
addition, she has been a member of the C of E's Liturgical
Commission, and served as a magistrate.
Death Comes to Pemberley is a form of sequel to
Pride and Prejudice. Mr Darcy and Elizabeth Bennet have
been married for six years. They are planning their annual ball
when Elizabeth's younger sister Lydia turns up, claiming that her
husband has been murdered in the woods on the estate. It turns out,
in fact, that it is not he but his friend who is dead, and words
that he utters are taken by some to be a confession of murder. As
the story unravels, however, the truth about what happened in the
woods becomes clear.
Books for the next two months:
December: Effie Briest by
January: The Paris Wife by Paula