Pearson - No apparent distress: a doctors coming-of-age on the front lines of American medicine

ACKNOWLEDGMENTS

I am grateful to, and humbled by, the patients who have so gracefully allowed me to be part of their care. Thanks to Mr. Michael Jackson and the whole community at St. Vincents, particularly my crop of directors: Sarah Baker, Toug Tanavin, Julian Vellucci, Roxi Radi, Kelli Gross, Sean Kelly, Lauren Fuez, Samantha Dorer, Jamie Hinderliter, and Suzanne Snow. One of our group, David Gersztenkorn, passed away before this book was published; his death was a loss to us all.

My research mentor Jason E. Glenn opened my eyes to many of the structural and social issues that emerge in this book. I am grateful to him and to all those at the Institute for the Medical Humanities who helped form me as a scholar and humanist.

Many thanks to my first and best mentor in writing, Michael Adams. Also to Forrest Wilder and all the folks at the Texas Observer, for keeping the Great State on its toes. Thanks to my excellent agent, Zo Pagnamenta, for seeing this work through from scratch. I am grateful for the sharp editorial guidance of John Glusman at Norton, and all the folks there who have contributed so much to this book.

Im grateful to all those who have taught me medicine, but particularly to Susan McCammon, Robert Beach, Patricia Beach, Howard Brody, Michael Boyars, Bruce Russell, Adrian Billings, and Serena Aunon. Thanks as always to the John P. McGovern Academy for Oslerian Medicine, for crucial financial and moral support during my medical education.

And of course my friends, especially Delaney Hall, Caitlin Sweetlamb, Graham Schmidt, Katherine Strandberg, Freddie Joseph, Christina Gomez-Mira, Ryan Kiesler, Amerisa Waters, Katie Ray, Margaret Wardlaw, and Parth Gejji. Thanks to the Historic Pleasure Palace, the Big Yellow House in the Sky, and all the physicians and scientists who shared their homes and years with me.

And of course my family. And Ben Laussade, my lantern on the trail.

NO

APPARENT

DISTRESS

A Doctors Coming-of-Age on the
Front Lines of American Medicine

Rachel Pearson

W. W. NORTON & COMPANY

Independent Publishers Since 1923

New York London

No patients real name is used in this book without such patients express consent. Even then, certain potentially identifying details have been changed. The names, physical features, and other potentially identifying characteristics of many other people in this book also have been changed.

The views and opinions expressed in this book are solely those of the author. They are not and do not reflect the views or opinions of any organization or institution with which she is affiliated or has been affiliated or of anyone else employed by or affiliated with such organization or institution.

Copyright 2017 by Rachel Pearson

All rights reserved
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The Library of Congress has cataloged the printed edition as follows:

Names: Pearson, Rachel, 1983 author.

Title: No apparent distress : a doctors coming-of-age on the front lines of American
medicine / Rachel Pearson.

Description: First edition. | New York : W.W. Norton & Company, [2017] |
Includes index.

Identifiers: LCCN 2016055803 | ISBN 9780393249248 (hardcover)

Subjects: | MESH: Students, Medical | Education, Medical | Healthcare
Disparities | Health Care Rationing | Socioeconomic Factors | United States |
Personal Narratives

Classification: LCC RA418 | NLM W 18 | DDC 362.1dc23

LC record available at https://lccn.loc.gov/2016055803

ISBN 978-0-393-24925-5 (e-book)

W. W. Norton & Company, Inc.
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For my father

EPILOGUE

SOMETIMES I DREAM OF MEETING MR. ROSE AGAIN. THIS is not a dream I have at night, but a daydream. In it, we are back at St. Vincents in the sweltering Galveston summer, and he is himself then but I am who I have become now. In the dream, I get it right. I think clearly and systematically like a physician, instead of being baffled by his illness. I dig deeper, slow down, ask more questions. If in the dream I make a mistake, I am able to explain it and apologize. And if in the dream he is still dying, I stand by his side. I visit him in the hospital; I get to know his family.

In the daydream, sometimes I am so good that I am able to take his pain away, or to finagle a late-breaking, miraculous cure for him. Other times it is more realistic: I cannot make the cup of suffering pass from him. But I am able to sit with him a while longer in that hospital room, to breathe in deeply of his suffering and offer what I can of my compassion. I am able to apologize.

At times I even feel compassion for my poor baffled medical student self. I was early in my training, and I was trying so hard to help. I made a mistake, and I neededfor my own human reasonsto apologize. I lost my chance to do so because I didnt have the guts, or the grace, to return to visit my patient. I know now that returning to be with those who are suffering is no easy thing. I also know that it is my job.

I can only apologize to the sky now. I am sorry.

NOTE

This is a work of nonfiction that includes some stories about people who have been my patients and the patients of my friends. Whether or not I was able to ask a particular patient for permission to use his or her story, I have changed details that might make that person identifiable. I have done the same with some of the health care professionals and medical students whose stories I tell.

We live in a time of hardening of hearts. Please dont ask me why. I dont know why God hardened the heart of the pharaoh. All I know is that right now, we are living in that time.

Michael Thomas Jackson,
lay minister of St. Vincents House, 2015

Any mans death diminishes me, because I am involved in mankind.

John Donne,
Devotions upon Emergent Occasions, 1624

NO APPARENT DISTRESS

INDEX

Page numbers listed correspond to the print edition of this book. You can use your devices search function to locate particular terms in the text.

Note: Many of the names in the index are pseudonyms.

abortion clinic, 1120

addiction, 229

Affordable Care Act (ACA), 173, 207, 237, 247

African Americans

and alcoholism, 96

among St. Vincents workers/volunteers, 6061

and cadavers, 6768

and cervical cancer, 24041

criminal records and medical care, 217

and diabetes, 13031

on Galveston Island after Hurricane Ike, 61

and Juneteenth, 37

and medical professionals racial bias, 13033

and pain medication, 229

and segregation in Galveston, 39

Alaska, 15359

alcoholism, 95, 96

Alpine, Texas, 13652

Alyssa (friend), 91, 92

Alzheimers disease, 177

amputations, 12735

Amy (friend in Portland), 27

anatomy lab, 6570, 7374

Anderson Cancer Center.