Tony Holohan: ‘My wife was slowly dying and would be cut off from her friends and family in the last few months of her life’

Dr Tony Holohan’s Terenure home doesn’t feel like a place that has known prolonged and recent grief. Part of a late 1930s south Dublin estate, decorated in calm off-whites, it feels light and comfortable with no designer spaces or flourishes. The only sound is when his son Ronan drops in to borrow his dad’s smartwatch for a run. In a small bright sittingroom overlooking a pretty, flourishing garden, a couple of guitars hang on the wall across from an old upright piano. An orderly, musical family lives here.

When he and his wife Emer moved here more than 20 years ago, the year Ronan was born and their daughter Clodagh was still a toddler, it was within easy walking distance of Emer’s parents and enthusiastic babysitters, Frank and Ita Feely. Their new home was almost in the shadow of the church where she was baptised and where she married the man who spotted her, a tall, glamorous, quick-witted medical student in a yellow top, at their first lecture in UCD. It was also where her funeral took place two and a half years ago on a freezing February day, with only 10 mourners.

She was not yet 50 when she died after a harrowing eight-year illness – her pain and suffering greatly exacerbated by missed diagnoses.

Over time, multiple myeloma robbed her of her energy and vitality and her long dark hair, and even took five or six inches off her height. Constant infections and fear of sepsis meant repeated hospital admissions.

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[ We Need to Talk: Tony Holohan doesn’t shy away from saying when he felt let down by others ]

Twice she went to a hospital emergency department armed with detailed referral letters written by her husband – then the State’s chief medical officer (CMO) – and twice she was reassured and sent away with no further investigation or follow-up. He is clear that an earlier diagnosis would not have saved her life, but the resulting pain and disability would not have been so extensive.

He wrote a book, he says, because Emer wanted her story told. As an accomplished public health specialist herself, she was acutely aware of her own prognosis and of the early failings in the system that let her down.

She is the spiritual spine of the book, her condition deteriorating in parallel with huge public health events in which her husband was centrally involved, such as the Cervical Check scandal, the abortion referendum and Covid-19.

In many ways, this is the story of how a family with two teenage children negotiated a devastating diagnosis and chaotic illness together.

It could also be read as a 300-page rebuke to those who contended that the CMO and head of the National Public Health Emergency Team (Nphet) didn’t live in the “real” world. The book suggests it was more “real” than most.

It could also be read as an indictment of political imperatives and manipulativeness, opaque agendas, leaks and spin, with a big pinch of cowardice and ass-covering. And not just about politicians – whom he greatly admires for the most part: learning to deal with the Civil Service was a job in itself, he says at one point.

The Cervical Check scandal, like so much else, has left a bitter taste. He had witnessed a service leap from pathologists reading slides at their own kitchen tables to a State-wide quality-assured programme, something he credits to two women: former minister for health Mary Harney, who managed to scrape up the money when was none, and the passionate advocacy of Dr Grainne Flannelly – forced to resign at the height of the controversy – who made the compelling contrast between the effective UK screening programme on the one hand and the young Irish women she was seeing being diagnosed at incurable late stages of cancer.

Now all are “portrayed in a completely different light with almost malevolent intent [ascribed to] some of those individuals…”, he says wearily, saying Flannelly “was really badly treated…”.

The initial rush to judgment he hangs resoundingly on former minister for health Simon Harris’s insistence on, he says, immediately announcing a HSE investigation “without first establishing the facts”. The narrative that took hold and never quite left was that every false negative from a screening was negligent. (Two independent reports found that the quality of the screening programme was up to standard by all international measures).

But no one emerges from this account with any credit – not the Public Accounts Committee member who shouted at then HSE director Tony O’Brien; not some members of the media vying for most emotive commentary – “I’ve never experienced anything like the levels of emotion among the media”, he remarks about one press conference; and not least, the lawyers...

He refers to one report that showed the “off-the-chart levels of legal activities around cervical screening [in Ireland] compared to other countries”.

Meanwhile, Emer was entering hospice care for the first time and would never go back to functional independence, “which was deeply, painfully frustrating for her”. And him. “… And if I am honest… it was difficult for me too…”. It placed great pressure on them as a family for many years, he says.

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“She was clinging to her independence… kind of saying, ‘Look, I want it this way’. We did have rows and differences of opinions and I’d say, ‘Look I’ve got loads of things to be doing’… But I understood; to be fully cared for is to completely give away your independence.“

The reality he says is that something as debilitating as myeloma, or any serious chronic illness, changes the nature of an intimate relationship. “A relationship – a marriage – that has been equal, becomes unequal, divided into a person who needs care and a person who is caring… I know we both struggled with that… that is not how we ever were together.”

Then along came Covid-19, a new terror for those around Emer, by now on morphine full-time and too vulnerable to have hospital visitors.

And with that, the relatively anonymous man who had held the CMO job for 12 years also morphed into one of the most familiar faces in the country.

Even back in his student days, he understood that preventive medicine wasn’t sexy. “No one ever thanks you for not having cholera,” as one of his lecturers put it.

Covid-19 changed all that. Tony Holohan landed before the public like someone from central casting. The unflinching gaze to camera, the dogged tone, the firmness of purpose, inspired trust. His unshakeable decision to make those briefings – and Nphet meetings – a politician-free zone boosted the vital aura of independence. He became the human face of the fightback.

It was a novel virus. From the start he knew they were asking people to take remarkable steps without the certainty of knowing that they would work. “A lot that’s being said now about what should have happened is with the benefit of hindsight,” he says.

Some things clearly sting: the accusation that they used fear to force compliance, “which I absolutely reject”; the “despicable” idea that some lives mattered more than others, an attitude that even “began to creep sometimes even into officialdom”; the “gotcha” games often played at press conferences and by politicians about public health advice – why leave pubs open in hotels but close them in the community? Why was it okay to have a burger with your pint but not okay to just have a pint?

You can say all you want to people about the risks and dangers of congregating – but tell the people in this country that the pubs are open? Yeah. That’s all they need to know

—  Tony Holohan

He dismisses the theory behind the Zero Covid campaign as “magical thinking” – “we’re not New Zealand” – but reserves a special tone for the “small number of medical doctors and scientists” in Ireland who expressed antivaccination views or played down the impact of Covid. It raises questions about their ethical standards because some who had the privileged status of doctors were no more informed about public health than a regular member of the public, he suggests.

Golfgate created “a lot more heat about that than there ever should have been”, in his view but he adds: “People in leadership positions do have a responsibility. The people involved should have accepted that from the get-go and avoided the big row about whether they were or weren’t and trying to explain compliance and what they knew... It didn’t comply. They should have accepted that and they should have moved on and I think people would have respected them more for that…”

In February 2022, a District Court judge dismissed charges against four men accused of organising an Oireachtas Society Golf dinner in a Clifden hotel. Judge Mary Fahy said: “They were all responsible people who would not have gone to a dinner unless they felt comfortable and unless the organisers had not put in place all that was required to make it safe... I’m satisfied the organisers did everything to comply – not in a court of public opinion – but in the court of law in my opinion.”

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While details get lost in time, he devotes considerable space to the rows leading up to the “meaningful Christmas” of 2020 when the pubs remained open and socialising returned to pre-pandemic levels. “You can say all you want to people about the risks and dangers of congregating – but tell the people in this country that the pubs are open? Yeah. That’s all they need to know.”

Emer had become very ill during the summer, and he stepped back from the job to be with her, and her precarious condition became public knowledge. But as she rallied again, they watched from home as the Covid case numbers rose inexorably in August and September. After weeks of discussion, the couple agreed he should return to work and within days he had called the pivotal Nphet meeting where the consensus – each member was asked to state their view out loud, he says – was that restrictions should go up to Level 5. A letter was sent to Minister for Health Stephen Donnelly and copied to Liz Canavan, the assistant secretary to the Taoiseach’s department.

The letter, infamously, was leaked on a Sunday night before any high-level government discussions or processing could take place, effectively channelling the discussion into how the decision was made rather than the vital need for it. He carefully lists in the book those who, he says, did not leak the letter.

The following night, as he sat watching the Claire Byrne Show with Emer and Clodagh, a clearly agitated then-tánaiste Leo Varadkar appeared and declared how insulated Nphet members were from the effects of their own advice. “This wasn’t fair or true… Our families were impacted, financially and emotionally,” he says. “Emer was slowly dying and would be cut off from all her friends and family in the last few months of her life.” To Emer, it felt like a betrayal. “I had no real answer,” he says, “except that this was politics.”

In the meantime, Emer decided to decline further treatment. New symptoms suggested the lesions had spread to the base of her brain. She wasn’t prepared to lose her hair again and admission to Beaumont for radiotherapy would have meant that Clodagh and Ronan would be unable to visit. And so, after long, heartbreaking discussions, she was taken home by ambulance where a kind of liberation happened. While outside the walls, the battle raged over untaken advice and Covid death numbers, Emer – now free of the side effects of drugs and radiotherapy – became mobile again and like her old self.

It shows the benefit that can come from difficult conversations about the value of treatment and its goals, Holohan says now. “I think it was the first time in 15 years that we were just four. It was our last Christmas together and it was lovely.”

The January of 2021, after that Christmas, saw the single worst month of the pandemic, with deaths of 1,500 people known to have tested positive for Covid. He is adamant that at least some of those lives could have been saved, and has harsh words for those who contributed. “The decisions made and not made regarding the advice from the Nphet, also from me as CMO, as well as the signal that retaining hospitality gave, created the circumstances in which so many people died.”

He stands by those word but thinks it’s fair to add that the January story does not describe the entire relationship. “The political alignment of the public health advice over the course of the pandemic was very high… The indicators are that we did much much better than most other countries in Europe.”

He looks forward to the Government’s “overdue” review – or “lessons-learned exercise”.

On February 8th that year, Emer went to the hospice for the last time. It was her wish, expressed in conversations structured with the help of the Irish Hospice Foundation’s Think Ahead materials, to die there. They all knew it was her time to go. The three of them were holding her hands as she slipped away.

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The wake and funeral were held under the toughest Covid restrictions. With church attendance limited to 10 people, so many watched online that the feed crashed several times. Afterwards, friends and family visited in separate groups, standing in the driveway in the February chill, eating pizza.

Two and a half years on, Holohan seems happy to talk about moving on with a new relationship that began nearly a year ago. Ciara Cronin, a psychotherapist and yoga teacher-trainer described in the book’s acknowledgments as “a source of joy and optimism and hope for the future” also features in a photograph with him.

If the development of the relationship seems too soon, he places it in the context of Emer’s expressed – spoken and written – hopes for another relationship for him when she was gone. He also talks about the concept of “anticipatory grief”, which he believes enabled him to “come to terms with that was happening, in a way long before it happened…“.

He talks happily about a developing “separate and independent connection” between Ciara and his children – both now at university, still living in the family home – and how comfortable they are talking about Emer.

“It all feels very good and very natural.”

At a personal level, his future seems settled. His professional course is less assured. While he talks firmly about “no regrets” about his decision to leave the CMO job and about taking a “particular” enjoyment from not quite knowing where the coming years will take him, that positivity is hard to square with his account of how his plan to move to academia via a secondment arrangement was scuppered, along with other prestigious job offers that might have come his way.

The public servant who successfully managed Ireland’s gravest public health crisis in a generation and became one of its best-known, most trusted figures, now occupies himself with a few part-time or honorary roles. His work as adjunct professor of public health at UCD and for the board of the Irish Hospice Foundation is unpaid. He gets “some” payment for working with the World Health Organisation’s country office in Azerbaijan and he also does “a small bit of advisory work” as chair of the medical advisory board for Enfer Medical.

It’s a strange curtain call for a man of only 56, vastly experienced and brimming with ideas about a holistic approach to public health and preparedness for future pandemics.

It’s still a mystery to him.

Does he believe he was professionally damaged by the fallout over the secondment?

“It has damaged me, yes... I have to conclude that I am where I am due in some part to the impact of that – I do feel aggrieved at that fact. I’m not given to excesses of emotion really but yes, I do believe that’s unfair because it’s not proportional. ‘Man seeks secondment’ – that’s what actually happened, no one was saying ‘No’ to me… And suddenly it was being portrayed as something clandestine and inappropriate… The responsibility to inform the Minister for Health, DPer [Department of Public Expenditure and Reform] and the Taoiseach was not mine…”.

He was listening to Morning Ireland when he heard then taoiseach Micheál Martin call for a pause on the process and knew that was an end to it.

There were “no facts to support” the subsequent report which accused him of being “exclusively personally involved in the negotiation of research funding linked to my possible secondment”, he says flatly.

“Political controversies… often have limited – if any – relationship to the facts,” he concludes. “This was one such.”

We Need to Talk by Tony Holohan is published by Eriu