NO APPARENT DISTRESS
A Doctor's Coming-of-Age on the Front Lines of American Medicine
By Rachel Pearson
260 pp. W. W. Norton & Company. $26.95.
Just after residency at Bellevue Hospital in New York City, I worked briefly in a private practice in rural Florida. One afternoon, the E.R. called about a man with very high blood pressure — not high enough to be admitted to the hospital, but high enough to need prompt treatment. "Send him over to our office," I said.
When the Mexican farmworker arrived, the office manager hissed at me: "You can't just bring these patients here." Initially I was perplexed; I was preventing an admission to the hospital, saving thousands of dollars. But then I realized — this office would not treat him because he lacked insurance and means.
As the only person in the office who spoke Spanish, I had to break the news. This was the lowest moment in my medical career and I vowed never to have to utter such words to a patient again. I scrambled back to Bellevue and never looked back.
Rachel Pearson repeatedly found herself in the same miserable situation during her medical school training in Galveston, Tex. The island city had been devastated by Hurricane Ike in September 2008, just before Pearson arrived. There's no doubt that the University of Texas Medical Branch (U.T.M.B.) took a financial hit from the natural disaster, but many suspected that the draconian cuts to charity care were already in the works; the hurricane was merely convenient cover.
"It was January when Susan's patients began to die," Pearson writes in her engrossing book, part med-school memoir, part probing moral inquiry. Susan, a cancer surgeon at U.T.M.B., was unable to treat her patients after the medical center — without her knowledge — sent her patients a letter saying the doctor would be "discontinuing her professional relationship" with the people in her care. Without an operating room (and access to chemotherapy and radiation), the surgeon could only visit her patients at home and hold their hands as the disease killed them.
Pearson, who comes from a working-class family herself, finds her element at St. Vincent's House, a social-services center in one of Galveston's poorer neighborhoods, which were disproportionately devastated by Hurricane Ikeand then disproportionately ignored during the rebuilding. At first, she is "under the impression that there was a safety net." With the bare bones of donated supplies, the students diagnose cancer, heart disease and other standard medical fare. But they quickly learn that U.T.M.B. and other hospitals would not be stepping in to deliver medical treatment. A fellow medical student concludes bitterly, "I didn't realize that we were the safety net."
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