No Apparent Distress Book Review

In No Apparent Distress: A Doctor’s Coming-of-Age on the Front Lines of American Medicine RA418.P397 2018, Doctor Rachel Pearson examines the inequities of the American medical system through her experiences as a medical student. Pearson’s memoir illustrates how the inadequacies of the system are borne most heavily by the poor.

The author briefly describes her working-class upbringing in rural Texas and path to medicine in the opening chapters of the book. She credits her experiences working as a patient advocate in an abortion clinic with causing her to abandon her creative writing MFA for medical school at the University of Texas Medical Branch in Galveston (UTMB). St. Vincent’s student-run clinic, affiliated with the UTMB, is the setting for many of the stories in the book. The charity clinic and UTMB Medical Center are strained by devastating budget cuts in the wake of Hurricane Ike (2008), leaving many patients homeless, geographically dispersed, and ultimately denied much of the medical care they need, despite the heroic efforts of Pearson’s colleagues.

From medical school courses through residency, Pearson highlights the ways in which her medical education owes much to the poor patients on which she practices. In turn, she recognizes that these patients are obliged to endure the errors and inadequacies of inexperienced residents in under-equipped facilities. As she summarizes after one humbling experience with a patient:  “The problem of course, is that these mistakes happen systematically, and not just to anyone. They happen to the uninsured and to people on Medicaid or county indigent programs. They happen to the free-clinic patients, prisoners and undocumented people. They happen to working-class whites and people of color. If you are a patient at a private clinic … then you can be pretty sure your doctor’s mistakes have already been made. They were made on the bodies of the poor.” (p. 210)

Pearson’s creative strengths as a writer shine as she describes her patients as whole people- their histories, families, personalities, and life circumstances. The stories are often tragic, but Pearson’s moral arguments and vivid storytelling are compelling. Her perspective not only gives a human face to the patients affected by policies and systems, but displays the intersecting effects of class, social status, race, and environment on an individual’s overall health and vulnerability, and ultimately their chances at successful treatment. Her candid and accessible descriptions of medical conditions and procedures, complicated bureaucracies, health policies, and social issues are well-sourced by studies and reports footnoted throughout.

This book is highly recommended for students interested in medicine, public health, social work, or healthcare administration. It is available in print at the Freeman Lozier Library and can be checked out for 21 days.

Originally posted in the Freeman/Lozier Library’s quarterly newsletter, More Than BooksV. 22 No. 4, Fall 2019.

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