A testament to love, altruism, and modern medicine, The Story of a Heart by Rachel Clarke is one of sixteen titles unveiled on the 2025 Women’s Prize for Non-Fiction Longlist. In this compelling account of one child’s gift of life to another, Clarke introduces us to Max, a nine-year-old with a failing heart, and Keira, a girl whose heart will sustain him after her death in a car crash. With unfailing warmth and sensitivity, Clarke relays the story of two families during the bleakest moments of their lives, and the aftermath of their decisions. Alongside this, we learn the medical and cultural history of the heart transplant and the philosophical significance of ‘the chief mansion of the soul’.
This remarkable book opens with two almost unimaginably painful scenarios. In the first instance, Max, a former bundle of boyish energy, wasting away with a severely damaged heart muscle, his parents, Emma and Paul, grappling with the crushing knowledge that the only way he can be saved is through the death of another child. When the green light for a transplant comes through, Max has spent many months on the waiting list, his condition approaching ‘end-stage heart failure’.
And then, there’s Kiera, his kindly, horse-loving saviour. Comatose after a car crash, and declared brain dead, her anguished family are coming to terms with the news. Incredibly, Kiera’s 11-year-old sister, Katelyn, knows exactly what her sibling would’ve wanted, it has to be organ donation. The logistics of the operation will be daunting but this decision potentially offers others the gift of one liver, two kidneys, and of course, a heart for Max.
Clarke is a palliative care doctor and author of three bestselling books, here her storytelling skills work in tandem with her medical training to portray a harrowing situation with a clear-eye, and compassion over sentimentality. She also writes beautifully about our notions of the heart.
‘Hearts sing, soar, race, burn, break, bleed, swell, hammer, and melt. They can be won or lost, cut or trampled and hewn from oak, stone, or gold.’
Our ancestors believed the heart to be the seat of our deepest emotions, and the symbolism remains.
Max’s cardiologist is, however, more down to earth. The heart is basically a workhorse, he says, whose job is to shift blood, and unfortunately Max’s is like ‘a leaky bucket.’ Thanks to centuries of medical daring and research (the first open heart operation took place in 1895), Max has a chance of survival.
Although we know the outcome from the beginning, Clarke keeps the tension high, through every fascinatingly detailed step of the transition of Keira’s heart to Max. Inevitably, some of those details are hard to read; Kiera’s dad, Joe, standing outside the hospital, waiting for the crate containing his daughter’s heart to be carried to the ambulance, compelled to bear witness to the event.
Amongst many glorious sentences, Clarke’s words on the heart’s arrival at Max’s hospital stand out.
‘Infinitely more spectacular than some minor lunar footstep, this heart wipes the floor with human engineering. Heart of hearts, Max’s lifeline, purest love gift, marvel on the brink of beating.’
A profound and memorable read.
The Story of a Heart by Rachel Clarke is published by Abacus, 288 pages.
Mend the Living by Maylis de Kerangal is a novel touching upon the same themes which we also loved.
