‘Prescription: Ice Cream’: Unveiling joy amidst pediatric palliative care

If you don’t hear the message of author Alastair McAlpine’s literary début Prescription: Ice Cream, then life must have badgered tone-deafness into your daily state of being. It’s powerful and makes you think. It also plucks at the heartstrings in a melody of sadness, joy and importantly, hope.

Prescription: Ice Cream shares the wisdom and unexpected joy discovered in the lives of terminally ill children. It’s a memoir, grounded in the stark realities of pediatric palliative care. The book unearths the essential truths about what it means to live fully, even when life itself is fleeting.

In 2018, McAlpine, working in Cape Town as a palliative care paediatrician, shared a series of insights from his young patients on Twitter, now X. “I asked some of my terminal paediatric palliative care patients what they had enjoyed in life, and what gave it meaning. Kids can be so wise, y’know. Here are some of the responses,” he tweeted.

This thread, brimming with the children’s simple yet impactful reflections, quickly went viral, capturing the hearts of millions around the world. McAlpine’s intention was never to become an internet sensation. Rather, he sought to share the wisdom of children who, despite their dire circumstances, managed to find beauty and joy in their everyday lives.

From aspiring doctor to battling addiction

Before reaching this point, McAlpine’s life was a turbulent journey marked by immense personal and professional challenges. Growing up in Johannesburg, he pursued a career in medicine, driven by a desire to make a significant impact. However, the brutal reality of medical training, particularly in the harrowing environment of Baragwanath Hospital, coupled with the HIV pandemic, began to take a toll.

Amidst these pressures, McAlpine turned to alcohol as a means of coping. His drinking, which started in his teenage years, escalated during his medical training. “There’s still so much shame and stigma around addiction. You’re considered a weak person who can’t control your impulses,” he said. His addiction spiralled out of control, leading to blackouts and ultimately a suspension from medical school.

From rehab to healing

Faced with the possibility of losing his future as a doctor, McAlpine entered a rehab facility in Cape Town at just twenty-one years old. “It was a horrible feeling, but it was necessary for me to get better,” he shared. The road to recovery was arduous. He resisted treatment, relapsed, and struggled with a profound sense of shame and failure. It was only when he ceased fighting, he said, and embraced his recovery that he began to heal.

This experience of overcoming his personal demons shaped McAlpine’s approach to medicine and his connection with his patients. “I think the kids responded to the fact that I’m not a shiny Porsche of a physician. I’m a banged-up old Ford. I’ve been through it, and I’ve been on the other end. I’ve been in hospital; I’ve been in a mental institution. Furthermore, I’ve been at the bottom,” he said. This authenticity, this willingness to share his imperfections and vulnerabilities, he suspected, helped him forge a stronger bond with his young patients. They saw in him not just a doctor, but a fellow traveller on the road of hardship, someone who understood pain and struggle intimately.

Redefining medical care: McAlpine’s vision

Traditional medicine often prioritises saving lives at all costs, McAlpine said. However, this is sometimes at the expense of the patient’s quality of life. He believes in a different approach, one that focuses on maximising joy and comfort for those with limited time. He recalled a moment with a young patient who, instead of enduring more medical tests, simply wanted to go home and be with his dog. “That was a light bulb moment for me. Our whole focus shifted from keeping him in the hospital to how we could get him home. That’s where he really wanted to be,” McAlpine shared.

 “People want to feel heard and have their fears and concerns taken seriously. They want someone to listen to them and treat them like human beings, not just broken bits,” he said.  

To McAlpine this means that a fundamental change in how medical professionals are trained and how they interact with their patients is necessary. It demands a balance between the clinical detachment necessary for survival in the medical field and the empathy required to truly connect with patients.

McAlpine’s prescription: Embrace life’s simple joys

In many ways, Prescription: Ice Cream infers his philosophical views about medical care, but also the significant lesson of life’s small pleasures; playing with friends (sic), spending time with family, and enjoying nature. “They were the ones facing their mortality, yet they were still able to find joy and happiness and laughter,” McAlpine said. It’s a reminder of what truly matters in life. This often gets lost in the hustle and bustle of adult responsibilities and pressures.

Prescription: Ice Cream has also shifted part of his personal universe into a new direction. “I think there is another story in me. Writing is like a bug, maybe an addiction. Once you’ve got it, you want to keep going,” he said.

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