Interview with Dr Rachel Clarke – Writer and Executive Producer of ITV Covid drama Breathtaking


ITV Press Centre

What was your path to becoming a doctor?

I loved arts subjects at school and I loved medicine. I came from a medical family - my father was a GP - and found it all really fascinating. But I also loved writing and stories and I thought journalism was this incredible way to use words to try and do good, make change and speak up on behalf of people who didn’t necessarily have a voice. I became a television journalist and produced and directed current affairs documentaries. Some of those were very hard hitting - stories about civil war in the Democratic Republic of Congo and so on.

But I never stopped having this nagging feeling that I should have been a doctor. That was the thing that I felt in my heart most represented me. So I did my science A-levels in the evenings while doing a day job as a journalist. And eventually went to medical school just before my 30th birthday and literally from day one loved it to bits. I felt like I was ‘me’ at medical school. That I was absolutely doing the thing I was meant to do. And strangely, I think there are lots of parallels between good journalists and good medicine. At the heart of both professions are people’s stories. You cannot be a good journalist or a good doctor if you don’t care about people and their stories. So I found that all my skills as a journalist actually came into play as a doctor. I just love working with patients in that sense, treating them as a human being in need of help.

My father was one of those incredible traditional family doctors that sadly are very rare these days. He knew everybody in his local community. Sometimes three or four generations of one family ranging from babies through to 98-year-olds. He adored being a doctor. I very definitely try to model myself on him as a doctor. Every time I saw a patient I wanted the patient to feel as though they were the only thing that matters to me in that moment. And my single job, my only job, was to try and help them. I think that’s the doctor I still try to be to this day.

You had already written two books before Breathtaking was published in 2021. Where were you working at the start of 2020 before the pandemic hit the UK?

I was working in a hospice as a palliative care doctor. As the pandemic unfolded I knew from very early on when those awful haunting images started to appear from China and then from Northern Italy that this virus was going to have a catastrophic effect in the UK and I wanted to be where the need was greatest. So I asked if I could move out of the hospice sector into a hospital setting where, sure enough, ward after ward after ward was filled with patients dying from Covid. So the need for palliative care doctors on hospital wards was absolutely immense and that’s where I wanted to be. I wanted to help as best I possibly could with all of the skills I have. I’ve actually stayed in hospital palliative medicine ever since because I’ve realised I can’t go back. I need to be where the need is greatest. And it really is in hospitals.

The book Breathtaking is about my own personal experiences and those of others I interviewed in my hospital trust. While this TV drama is based on much wider experiences. Dr Abbey Henderson, played by Joanne Froggatt is a fictional character and she is not me.

What drove you to write down daily notes about the experiences you and your colleagues were going through in the first wave of the pandemic?

Like I think everybody in the NHS I found those first weeks of the pandemic incredibly stressful and when I’m stressed I tend to not sleep, like lots of people. I develop insomnia. So I was pacing up and down in the kitchen at night sometimes really overwhelmed by what I was witnessing. It was like nothing I had ever experienced in all my years as a doctor. It felt more like a wartime crisis situation than anything you would have expected in the NHS. I’m the kind of person who finds writing therapeutic. It’s how I make sense of the world. So I used to sit up at 3am, 4am bashing out words on my laptop which were not intended for anyone else. They were just my own diary, my own attempt at therapeutic activity in the night. And gradually, as the pandemic continued through 2020, I started to realise that these words, albeit very emotional, very subjective...they were my raw experience of this pandemic as it unfolded inside a hospital. I felt as though that mattered. This was a kind of rough draft of history. My testimony of something extraordinary as it swept the country. And I felt it was valuable to try to share that with the public because I really wasn’t confident the NHS experience inside hospitals was necessarily getting out there to a wider public audience.

I felt an enormous weight of responsibility when the book was published because I desperately wanted it to succeed in my intended aim of communicating to the public something real, honest and truthful about the NHS experience. But I was horribly conscious of the responsibility of that and I was worried about whether I would get it right. Would I successfully manage to communicate what it had really been like? Would it strike a chord with other health care professionals as well as the public? The book was based not just on my testimony. I interviewed many other members of staff in my hospital trust from lots of different areas of the hospital - intensive care, surgical wards, medical wards and so on. But I really cared so deeply to get it right. And tell the truth as I saw it in a way that accurately reflected reality. I was also very nervous when the book came out because by then there was already a huge backlash against health care professionals from many different quarters. From anti-vaxxers, who hated the Covid vaccine, from Covid deniers who use to run around social media claiming there wasn’t a pandemic, it was a scamdemic and all made up. I was already by that stage getting relentless abuse on social media for trying to tell the public that vaccines were safe and incredibly important in preventing loss of life from Covid. So I was fearful of a lot of unpleasantness, trolling and abuse from social media and, sure enough, that all came in depressingly predictable ways.

How did this TV production originate?

One of the other co-writers Prasanna Puwanarajah and I have known each other for nearly 20 years. When I was a medical student in Oxford he was a very junior doctor in his first year of training as a doctor. We met in the same little medical firm and he taught me how to give people injections. He was this incredibly kind, enthusiastic and very committed young doctor who I looked up to then and thought, ‘Gosh, I hope I can be a doctor like Prasanna one day.’ Ironically enough he left medicine soon afterwards but our paths crossed again with both of us having moved into more artistic areas of work as well as performing medicine in my case. So that was an absolutely wonderful surprise and it’s been a real delight to meet him again.

Not as a medical student and a doctor but as two writers on this TV production. I never dreamed that would happen. While Jed Mercurio and I’s paths had not crossed before this, aside from on social media. I obviously knew him from his incredible track record in TV but that was it. Prasanna got in touch with me about Breathtaking to say, ‘I think this would be really powerful and important. It matters that the NHS experience is out there and I’d like to talk to Jed about it. What do you think?’ And I wholeheartedly trusted Prasanna. I also knew that Jed had also been a doctor as well and I thought that was a tremendous idea. So I said, ‘Yes, go ahead.’ Not necessarily believing anything would come from it but thinking this was a wonderful idea. The three of us met up soon after.

Can you tell me about the differences between the book and the TV drama?

The TV drama covers a much longer period than my book which was explicitly based on the experience of the hospital trust where I was working in a very brief time frame. It began on the first of January 2020 and finished as that horrible first wave of Covid started to abate in April 2020.

So it was a very compressed time frame. When I started to think about adapting the book into a television series it seemed to me to be incredibly important to prolong the time frame into 2021. And the reason for that was because the second wave of the pandemic which really smashed the NHS to bits in late 2020 and January 2021 was first of all the most traumatic experience that NHS staff lived through. Secondly it led to the most catastrophic loss of life. So we had the greatest single death toll in 24 hours in January 2021. But thirdly, and most importantly, I was very aware that the second wave had taken place in the teeth of fierce opposition on the part of the government to the advice the scientists were stating over and over again to lock down more quickly, more gravely, more significantly, in order to prevent avoidable deaths from Covid. And that seemed to me an incredibly important part of the story to tell because the only way in which a country successfully survives a pandemic is together. You have to act together collectively, not just as individuals doing things for ourselves, to survive and get through a pandemic. What we witnessed in the first wave in 2020, I would argue, to a great extent was a kind of unity of the population, the government, the press. We were all facing this unprecedented catastrophe and we were all muddling through trying to do the best we could together.

The TV drama is located in a fictional hospital with fictional characters. They do not directly map on to any individual doctor, nurse or other health care professional in the NHS. However, it was very important to me that we should have one underlying and unshakeable principle in the writing of this drama. And that was that everything that appears on screen has to have really happened in some shape or form to a real patient or member of staff in the NHS. So nothing you witness on screen has been exaggerated. Nothing has been fabricated. Everything you witness has come from exhaustive research, talking to members of staff and patients from a whole variety of different hospitals and settings across the country. And everything on screen is united by this fundamental underlying principle. It is real. It has happened somewhere to somebody. This is what it was truly like. What you are witnessing is true.

As with all things at the heart of the NHS, this is a story about people...

One of the things I was desperate to try and convey when I was writing the scripts was the extraordinary humanity of patients and staff alike. Everybody was thrust into view in these horrible, unimaginably traumatic circumstances and yet they seemed so often to rise to the challenge and you would see the very best bits of human nature coming to the fore. People’s strength, decency, courage and compassion over and over again. That was the most incredibly life-affirming and humbling counterpoint to the terrible statistics cited on the news every evening. This was a pandemic for staff and patients that was lived through human beings and the human cost of Covid.
Shining throughout - even in the darkest moments - is the good and humanity in people, how important was that to convey?

It absolutely is a story about life as well as death. Because I work in palliative medicine I know perhaps better than many people how important our mortality is in making us appreciate how precious life is. And somehow I think the pandemic was an extreme example of that. More extreme than anything I had ever known as a palliative care doctor. I remember thinking one day, ‘I have seen enough death and dying in the last few months to last anyone a lifetime. Even as a palliative care doctor. There has been too much of this.’ But the flip side of all of that dying is the awareness that life is simple for all of us. None of us gets the time we want. And you never know when something will strike us down. So cherishing the time we have with the people we love should be the first thing we think of when we wake up every morning. And somehow in those awful days on the wards, every single opportunity we all had to help somebody feel human, to bring a little bit of humanity into somebody’s final hours, to connect a grieving family with the patient they love so dearly but couldn’t be with, that was so important. It almost felt as though we were fighting for everything that matters in life against these terrible barriers of PPE, of visors and masks separating you from the people you love.

There are some very moving moments in Breathtaking. I remember in the first week of the pandemic, when I saw my first ever patients with Covid, realising that one of the most horrific things about this disease was the fact it separated people from each other at the one time when they needed each other the most. I remember looking at my patients on this first day, all of whom were dying from Covid, all of whom died in the next 24 hours, and I realised that from the moment they had arrived at the hospital they were never ever going to see another unmasked human face again. That was the cruelty of Covid.

And therefore anything we NHS staff could possibly do to bring humanity back into patients’ lives, despite everything the virus threw at us and at them, was critically important. So doing things like setting up video calls with families, reading out letters from family members, playing patients’ favourite music, even sometimes moving two patients into the same room so they could literally hold hands as they both died from Covid. All little gestures. NHS staff did everything. And sometimes I wished the public could see that. Because they had no idea about the lengths we went to, to convey love, care and compassion at patients’ bedsides. I would think to myself, ‘If they could see this they might not feel so horrified. Because they would know how much we care about their loved ones inside the hospital.’ I wanted to show that in this drama because it’s an untold story. People just don’t know about it.

How does Breathtaking pay tribute to health care workers who lost their lives in the pandemic?

It’s hard now to think back to just how frightening those first weeks of the pandemic were in 2020. This was a disease that was completely new. We had no treatments whatsoever, no guidelines, no protocols, no vaccines. We knew, every single one of us, that if we caught Covid it could kill us. And, in fact, a few weeks before Covid hit the UK I remember vividly seeing on social media the stories circulating of a young doctor called Li Wenliang in Wuhan, China, where the pandemic began, who had tried to alert the authorities to a pandemic and ended up dying from Covid. He was just 34. And we knew that could be us. So every single person who, gladly, walked forward into these virus filled wards and rooms inside our hospitals were doing so knowing that this could be the death of them. And you do it because you are trained to help and you couldn’t live with yourself if you didn’t. It’s not that the NHS if filled with heroes at all. NHS staff are every bit as frail and vulnerable and full of strengths and weaknesses as anyone else. None of us were heroic. We were scared. But you just had to try and help. And I think when our PPE supplies ran down and when the very high level PPE was downgraded into a lower level of PPE for the majority of staff, myself included, that was terrifying. Because we knew it didn’t make scientific sense. We knew that it had to be due to lack of supply. And all of a sudden we were facing a disease that we knew could kill us with nothing but a paper mask covering our faces.

Of course, sure enough, every hospital’s intensive care unit started to fill up with one or two members of staff who had caught the disease. And we knew they had caught it at work. They were spending all of their time at work with nothing but a bit of paper between them and the virus. And suddenly there they were hooked up to a ventilator and staff found themselves trying to save the lives of their own colleagues and failing to do so. In circumstances that were absolutely devastating. I remember when the first individuals in my Trust died from Covid. I was walking along outside the hospital and I felt like I had been punched almost in the gut by the news and I just burst into tears. I didn’t know them personally but they felt like part of our NHS family and they had died trying to do their best for patients. That is extraordinary. Sometimes I feel very angry because the politicians of this world will wriggle furiously and try to defend the indefensible and pretend there were no problems with lack of PPE in our hospitals. And all I can think is, ‘I’m sorry. That behaviour when set against the behaviour of staff who stepped up and risked their lives, and some lost their lives because they cared so much about patients, is pretty dreadful.’

Breathtaking uses real archive footage of Boris Johnson, Matt Hancock and others at No 10 press conferences. Why?

First and foremost, the use of archive footage in the series is to remind people of what this incredibly traumatic period of our national life was like. Secondly, it is a bridge between completely distinct and alien worlds. My world inside the hospital during Covid was so totally at odds with what I witnessed on the way home after the end of a shift. I couldn’t make sense of the gorgeous unfolding beautiful sunny springtime of that first wave of Covid. My husband and kids would say, ‘We’ve been on a lovely bike ride today and had a picnic in the garden.’ And it was so completely alien to me because I inhabited this world where there was nothing but anxiety, stress, claustrophobia...and death and dying. So we needed to find a bridge to connect the public experience of Covid with the untold story of Covid as it unfolded behind those closed hospital doors. And the archive footage was a very valuable way of achieving that.

But also one of the main themes of the drama is truth telling and the matter of whose story, whose truth, is heard and whose story is silenced. So the entire unfolding of the story inside the hospital is one that has not been told very loudly on a public stage. I wanted to address that gulf between the government’s public narrative of Covid and the unfolding reality within the NHS because partly that gulf has a huge human impact. When we got into the awful January 2021 wave, the very worse thing about that experience was not how many people were dying, although that was horrific. It was the absolutely sickening knowledge that these people’s lives could have been saved if political decisions had been made differently. I found myself very close to having a complete and absolute breakdown during that period because I found that knowledge so unbearable. So I wanted the public to know about that. Because they don’t.

I hope this drama will speak for itself. For me, I didn’t ever want this to feel like a didactic drama. Rather I wanted it to be a humane drama grounded in real human experience. And in exactly the same way as my book tried simply to bear witness accurately and truthfully to the experiences of the hospital in which I worked during Covid, so I hope that this drama will accurately and truthfully bear witness to the collective NHS experience of Covid. I think it’s very telling how many groups of individuals are devoting their energies into attempting to rewrite the history of 2020 and 2021 for whatever motives. This drama is not in the business of pointing fingers at all. But in simply trying to show the public what really happened and what if really felt like inside our hospitals during Covid, I think it is a very powerful hard-hitting and in many ways provocative series.

Who is Dr Abbey Henderson, played by Joanne Froggatt?

A lot of my experiences of Covid are channelled into the writing of Abbey, her character, her journey. Although she is actually a fictional character. I wanted this drama to be located not primarily in intensive care but on the ordinary medical wards of the hospital. Because that is actually where the vast majority of people had died from Covid inside the NHS and it is a largely untold story. People are very familiar with the idea that the epicentre of Covid inside our hospitals was intensive care. I would argue it wasn’t. There were many more patients with Covid on ordinary medical wards where they’d had very insubstantial PPE and often not the same degree of support that perhaps intensive care teams had. So I wanted Abbey to be plunged into this much less well known, much less talked about, part of the hospital. The ordinary medical wards where she actually had almost nothing with which to treat the patients. She had oxygen, a paper mask, a plastic pinny and a pair of gloves. That is not much to face a deadly virus.

Abbey starts out an incredibly principled, determined doctor who really wants to do her best for patients. But finds herself in a world that is alien, bewildering and at times doesn’t even seem to make sense to her. She cannot understand why all of a sudden the PPE that staff had been given gets downgraded to something that was so inadequate. She cannot believe her own nurses on her ward are having to dress themselves with bin bags because they’ve not being given anything more substantial by the hospital. And crucially she has to, very early on in the series, contend with a member of her team becoming infected with Covid and becoming gravely unwell. So Abbey is thrown into this maelstrom of pressures and tensions and traumas. She is traumatised, frightened, she starts to become outspoken, she challenges authority, she is devastated at times, full of guilt and grief. But slowly she finds her convictions about what really matters to her as a doctor wrestling with the global pandemic. And she goes on an astonishing journey to places, actions and behaviours she would never have imagined for a millisecond she
might have been capable of before Covid hit her hospital.

What does Joanne Froggatt bring to this role?

Joanne is phenomenal. When I met her for the first time before filming she had taken it so seriously and done an incredible amount of research. Her questions were absolutely piercingly to the point. I sat there in that first conversation thinking to myself, ‘I could be talking to a real NHS consultant.’ She is absolutely convincing as an NHS doctor. That was really uncanny. I remember saying to her, ‘I honestly feel as though you shouldn’t act at all when you go on to the set. You should be exactly as you are now because you feel as though you’re an NHS doctor.’ She was thrilled with that. Joanne came across as NHS to her boots. And on screen even more so. She’s got these incredibly expression-full eyes. So that even when her face is masked you can see all of the emotions flickering across her eyes. I don’t know how she does that. It’s really remarkable. She is perfect in the role. This incredible combination of fragility and strength.

Joanne and I have had lots of long conversations about Covid and in those she expressed how much this series meant to her. How determined she was to make a good job of it. Because she wants to do justice to the NHS experience and really wants the viewing public to feel what it was like for us in the NHS during Covid. All of the cast and crew are the same. They were sometimes incredibly emotional when I chatted to them about the series because, like everybody in Britain, they too have got their stories from Covid. Perhaps they have known someone who died from Covid or found the pandemic very traumatic. It’s extraordinary to be part of a collective team of crew and cast, all of whom are so strongly motivated to celebrate the NHS unseen and display accurately what NHS staff tried to do for patients during Covid. It’s very humbling.

What was your reaction when you first saw the hospital set?

I visited the hospital set in Belfast during filming a number of times. Setting eyes on the set for the first time was mind-blowing. They created the most astonishingly realistic NHS hospital that I think we will have ever seen on television. I do not think the NHS has been portrayed this accurately or this realistically at any time on screen in its entire 75 year history. It’s astonishing what they achieved. The level of detail - this loving, painstaking recreation of all the details of an authentically crumbling, tatty, true to life NHS hospital is extraordinary. Right down to the stains on the ceiling, the scuffs on the walls from the ambulance trolleys, the ancient yellow tape sticking up an important notice on the wall. The set is extraordinary and I think what the designer Ashleigh Jeffers has achieved is incredible. I felt a genuine shiver down my spine when I arrived for the first time because I felt like I was in a functioning hospital and that I ought to be getting to work.

Breathtaking depicts the mental and physical impact of the pandemic on NHS staff, tell us a bit more about that...

I don’t think it’s possible to overstate the ongoing scale of traumatic feelings in NHS staff to this day provoked by Covid. I find if I talk to anyone in my hospital about Covid for more than a few minutes they will start to compulsively relive the traumas they witnessed and endured through the pandemic. Staff don’t talk about this publicly. They don’t typically talk to each other about it because we all went through the same thing. So why would you? You feel as if you just have to get on with it. But actually we have a frontline NHS workforce that remains deeply scarred by Covid and what we witnessed. I dearly wish that every member of NHS staff had the opportunity and the resources to talk to somebody about that if they so wished. Because it is buried trauma at the moment. 13

The drama also reflects the horrific abuse and threats faced by NHS staff, why was it important to include that element?

Many NHS staff, and most definitely myself, feel an enormous debt of gratitude to the British public who themselves stepped up in the most incredible way when Covid began to help everyone in society who was most vulnerable. And part of that stepping up involves this public outpouring of support for the NHS which we all found so moving and wonderful. It gave us such strength and hope and helped us keep going. So for most people that is all they will have seen.

However, as the months of the pandemic went by an increasingly hostile, aggressive and ultimately very abusive anti-NHS feeling developed. Anybody who spoke in public, whether on social media or mainstream media, about the need to lockdown, the need to wear masks, the need to have our precious Covid vaccines when they appeared, would be subjected to the most horrible tirades of abuse. I used to be relentlessly subjected to death threats, to rape threats. At one stage the threats were so relentless and so frightening I had to seek the support of the police who took the threats very, very seriously and acted upon them. I’m by no means alone in that. There are other NHS doctors who have equally been subjected to abuse and threats. And it really mattered to me to include that aspect of the pandemic in this drama because those threats all had one single aim and intention. That was to silence frontline NHS members of staff. To erase our voices, to make our voices go away.

We need to be aware of how powerful, unpleasant and relentless those trolls and abusive voices are. Because there will be another pandemic and this abuse will return and I think society needs to be better equipped to deal with it. It should not cause individual doctors to seek protection from the police because the abuse had got so out of hand. So it matters greatly to me that this was a part of the story.

You believe that despite all of that, people are fundamentally good?

I do believe that people are fundamentally good. I look back now on the first weeks when this all began and everybody was frightened, everybody was fallible. Of course the government made mistakes. We all made mistakes because we were dealing with something unprecedented to the best of our abilities, which were not perfect. I don’t think any of that matters. That’s human. It’s really important to learn from mistakes, not to castigate people for mistakes. In the NHS every mistake was an opportunity, as a way to make things safer for patients in the future. It’s important to remember that. But crucially the one thing that is unforgiveable is pretending that mistakes haven’t happened. It is burying them and trying to rewrite history in a way that’s not accurate.

When I look back today at the pandemic we experienced I see a time that was chaotic, dark, traumatic and frightening. But at the same time, literally every single day at work, I saw a patient or a colleague do something remarkable. Even in the midst of all that darkness and trauma they would go out of their way to be kind, to be decent, to support someone who was more frightened than them. Sometimes patients would even try to support staff in the pandemic. That’s how incredible some of our patients were. In the NHS we witnessed people being absolutely amazing. On the one hand, what a horrible, horrible disease to infect people’s lungs, to take away their ability to breathe. But I have never felt prouder to be a member of the NHS and a member of the human race than during the pandemic. And that was because of the extraordinary qualities of the people I was surrounded by at work. That’s why I called the book ‘Breathtaking’. It’s the people who were breathtaking. They literally took my breath away by their goodness, strength and decency.


Breathtaking airs on Monday 19th, Tuesday 20th, Wednesday 21st February on ITV1 and ITVX as well as STV and STV player.

February 20, 2024 2:00am ET by ITV Press Centre  

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