Carers of whom? Considerations on the book Never let me go

When we talk about organ transplantation, we know that  we are dealing  very often a matter of life and death. It depends on which part of the body requires a transplant, whether bone marrow, and if in this case, it can be autologous and heterologous, without implying the death of the donor, the liver, and also in this case, although very invasive, the liver of the donor will continue to regenerate up to a certain point, allowing the survival of the donor or the heart.  Nowadays,u ntil the staminal cells will not be able to be “cloned” enough to form hearts, unfortunately we have to rely on the sudden or announced death of somebody who wish to done his organs, including heart, or onto the relatives’ willingness to donate organs, while the person is dying, and kept apparently alive through technology. A new heart is indeed a new life for one person but this “in the cycle of life” forecasts the death of another human being.

Generally, strict ethics rules regulate the donation act, signed by the informed consent of the person who in his/her last willingness wish to help with the death somebody else who need “functioning organs” or by the close relatives, or many times, even parents, if the death of a child occurs suddenly. Informed consent is asked: very rapidly because the body part should be kept “alive” and “functioning” for being integrated in another human being.  The question which is often yet matter of debate is how to define death. Cerebral? Circular? Both including cerebral and circular? This will not be a topic for this commentary, however, one thing is quite sure: before the age of transplantation, there was no particular attention in defining death condition. Also, because, if transplants now are a reality, it is also true that resuscitation techniques improved so dramatically, that the body labelled “dead” twenty years ago, now has prolonged hopes to survive.

In “Never let me go”, a dystopic novel written by Kazuo Ishiguro, Nobel winner in 2017, human clones – but they will come to know that they are clones only after childhood- are programmed for becoming as a first step good carer, and in a second step, donors of their organ, piece by piece, up to when they are “completed”, an upgrading word for not mentioning the word “death”.

The question is “carers of whom”? And the reader, as myself can guess, thinks “carer of normal people of the society.” The fact is that, in this novel, there is no “normal people”, the society is split in two, an invisible part who doesn’t need even the clones’ caring because they are “nourished” by their organs, so to prolong their lives, and the clones’ society who is programmed all over UK to bring caring to the donors, until they are executed.

Kathy H, is a clone of 31-years-old, and she is a carer: she has lost her two very best friends, Ruth and Tommy. They both died because of the multiple donations. The three of them have been educated since the very primary childhood in Hailsham school, where they studied literature and art, and they were even allowed to have, later, sexual intercourses, however among the people they know, that is, the group of students with whom they grew up. In Hailsham, particular attention was given to art, with children running a competition to perform an exhibition of their drawing. We will come to know, at the end of the novel, that Hailsham was an advanced experiment to show through arts, that clones had a soul as well as all other human beings.

Of course, these clones have souls, feelings and fall in love: the “Triade” composed by Kathy, Ruth and Tommy, have to manage the reciprocal attachment of friendship and love. When children, it looks like that Kathy goes very well along with Tommy, a teased and taunted boy at Hailsham, because very profound and reflective, in fact he is always wondering what’s behind the veil of school, like unconsciously perceiving that something evil can happen. The same happens to Kathy, very clever and careful to the details…. Ruth is totally in a denying situation, very much dependent on what the others are saying, and when the three of them leave Hailsham, since finished to be educated, for an Intermediary station- the “Cottages” where to live their adolescence, before becoming carers and eventually donors, Tommy will choose the naive and superficial approach of Ruth as a mate. Things will move on, and Ruth will split up with Tommy.

Their fate is already determined, and in a passive way, without even asking the informed consent, they never put into question the life that they have been assigned, Ruth and Tommy will be donor earlier than Cathy. It is like that the choice to become donor has something to do with a “loss” a “failure” in their private life that causes a loss of vital energy.  This inhibits them to continue as a carer and they will apply to “sacrifice” as donors. Even love stories are among them, with no possibility to melt with the healthy part of the society, no possible love outside their cast. However, clones’ love is complicated by knowing their mission on earth that is to die young to help the others.

The conflict between the vital strength that they are a human being with soul, and their conditioning that they have received at childhood is unaffordable, thus, even if when teenagers they are left free to love each other, they will come to terms and they will cope with their shortened lives than the other part of the society. The environment of being a career does not help to prolong their zest for life:  they breath continuously the death of the other carers, who complete, all the friends, one by one. No ethics of free willing is applied, no last willingness, nothing of the care that is applied in reality to ask organs for donation. They are presumed not to have soul.

Hailsham was closed because too liberal and too innovative; there fore the new schools where educating clones will be without art, sports and without any of this experiment to see if the clones had soul. The wealthy and rich part of the society which can pay for their organs, does not want to be informed that these children have souls. Better not knowing.

Ishiguro, the writer, told that we wanted to write a novel on love and friendship in the limited time, and this “limited time” is a metaphor of our lives: therefore, we are all clones, according to his mind, fighting for keeping love and friendship all over life, with an energy which will fade eventually in a physiological way.

So, what can we take, and what can we, or at least myself, personally, give back to the author? Considering as a certainty that we all have a limited time, we can take the beauty of the concept that it is through art that the soul is revealed, and the longing to know, consistently from the type of drawing, our roots. The clones, lacking completely of any parenthood in every step of their lives, but left to educators, to themselves and to their fate, say that they were fabricated with garbage, clutter, mud, … and then if we think to our holy texts, aren’t we also created by mud? As the clones? The way that life generated needed the mud and sunshine to create the first amino acid and, from this, the cell. Nature is important also for the clones, not only for us in searching our root.

We can learn from the clones the fact that they are more aware of the time which is passing by, differently from our society where aging is forbidden and always judged by our level of youth, but more than this, our vital energy, but more than this, our productivity. The finitude of the time gives to the clones, and in particular to Kathy and Tommy, a special attention to the little things, the environment, their bonds, their loves which occurred in the past and in the present, the here and now, since the future is already written.

We can learn from the clones the fact that it is more important for them to stay than to escape to this crazy, bur harshly metaphor of life, situation: “Never let me go” is a clear invite to keep people staying in every situation, even in front of huge difficulties, even in front of the concept of donating their organs despite an innate impulse to escape.  It sounds absurd, but Kathy says clearly “I’m proud to be a carer, and I will be proud to be a donor”. It could be that the brain washing done at Hailsham was so well conducted to achieve this goal. However, there is something more: the willing to sacrifice- and this is also very typical of the Japanese culture, we should not forget that Ishiguro comes from two cultures, the Nagasaki one and the English one, with which he was educated. The willing to sacrifice in the book, apart from an rebel yelling by Tommy in the middle of the countryside where nobody except Kathy can hear, before his last third transplant, is accepted by the clones, quietly and peacefully, after having been fighting more to understand where they come from than to know how to rebel to the fate.

We can learn from the untold of “Never let me go” that staying always with ill and close to death people can impact vitality of the clones’ carers since they will never have a heritage transmission either to their children, or to know where their organs are ending up: the lack of the continuity endangers seriously their attachment for life.

Again, a word I love is balance: on one hand the beauty of the self-giving, the awareness of the here and now, of accepting the things how they are, on the other hand the beauty of self-caring, of fighting for a better world even among us clones. However we, as mud-clones may try to find out a possible delicate, instable balance between the self-giving and the self-caring, between altruism and egotism. Both these qualities are needed, in my personal point of view, to face our immense number of possibilities in our given time.

And to come back to reality, what happens in real hospitals, we know that our society is not so split as in “Never let me go”. One thing that is a fuel for family members of a family of young died person, is not only to know that they have helped someone to stay alive, but to stay in touch with this person, not creating a world apart. They feel like there is still a continuity, a reason why, and a tangible future that continues in our society.

Hoping that in the next future organs might be biotechnologically created, anyhow, Never let Me Go is a masterpiece to be read and spread for medical humanities, as it tackles the most profound questions; Who we are? Where do we come from? Where do we go?  Never let me go.


Written by

Epidemiologist and counselor – 30 years of professional life in health care. Classic humanistic background, including the study of Latin and ancient Greek, followed by scientific academic studies, chemistry and pharmacology. First years of career, in private international environment. I worked in medical research, moved to health care organization, getting academic specialization in Epidemiology. Later, in consultancy and health care education. Counselor with transactional analysis orientation. Currently, director of Innovation in Health Care Area of Fondazione ISTUD, an independent not for profit Italian Business School with an humanistic approach acknowledged by the Italian Ministry of Researech.. Active member of the board of Italian Society of Narrative Medicine, tenured professor of Narrative Medicine at Hunimed, Milan, and in 2016, referee for World Health Organization for “Narrative Method in Public Health.” Writer of the book; “Narrative medicine: Bridging the gap between Evidence Based care and Medical Humanities,” edited with Springer and of international publications on narrative medicine in scientific journals. Last book “The Languages of care in narrative medicine: words, space and sounds in the healthcare ecosystem”. Lecturer in different international contexts from Academy to Public and Private Foundations.

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