April 2018 – No Apparent Distress by Rachel Pearson, M.D.
Blog by Cindy Bushey
As readers, Zion’s Book Club members sometimes tackle uncomfortable subjects. This month it was health care in this country. Our April choice was No Apparent Distress, a memoir of sorts of the author’s experiences as a medical student in economically depressed Galveston, Texas. Our readers, while aware of the exorbitant cost of drugs and the general feeling that health insurance companies and pharmaceutical manufacturers are ripping off the population for immense profit, nevertheless generally have good health care. We may have friends or family members who pay high COBRA policy premiums until they can qualify for Medicare, but our health needs are met. In the pages of this book, we came face to face with a percentage of the population who cannot afford health insurance and therefore are denied life-saving treatments they need. A very uncomfortable place, indeed.
Medical students at the author’s college staff a local clinic which is the only available place for the poor to try to have their health needs met. She talks of the frustrations of diagnosing problems, sometimes terminal illnesses, and not being able to provide treatment even after canvassing hospitals further afield. Treatment depends on being able to afford it, and that can make med students question their understanding and beliefs about practicing medicine.
We found this book to be a scathing indictment of health care in our country. There is something fundamentally and morally wrong when health care is not a right and access to care is determined by income. Obviously, all people are NOT created equal yet in this country (although it was pointed out by one reader that this founding declaration was oriented toward capitalism and not human rights – this thinking needs to change!). Disturbingly, the author shows this view is institutionally enforced during doctors’ medical training. The author’s accounts of her different patients could touch your heart strings. We applaud the dedication and perseverance she showed to try to get her patients adequate health care. It would seem that if the Hippocratic oath says doctors will abstain from all wrongdoing and harm, our doctors on the front lines of family practice must find themselves caught on the horns of a dilemma often. It would be interesting to know the opinions of the doctors in our congregation about this. It makes us wonder if all the med students who go into specialties are subconsciously avoiding these dilemmas by dealing only with patients who have insurance and/or money.
Our discussion touched on other things that affect the cost of health care including uninsured or underinsured patients using emergency rooms as primary health care, the debilitating cost of malpractice insurance in a litigious age, and the need to recognize that every dollar spent on preventive medicine saves multiple dollars down the road by controlling diseases and illnesses. The trend of OB-GYN doctors dropping the obstetrics part of their practice to save malpractice premiums is disturbing. Health care is run as a for-profit business rather than a service which makes the bottom line the target rather than patient health. By chopping up any proposed change in health care laws at the behest of insurance lobbyists, and by allowing loopholes in the appliance of laws (Texas never signed on to the federal Medicaid expansion plan), our Congress adds to the uneven distribution of health services. We had better figure out a way to make health care equitable before the poor simply revolt. Unfortunately, no one wants to sign on to the Canadian or European models with higher taxes. Expanding Medicare might merit consideration, but Congress would need to be brave enough to confront the insurance companies and change their roles and payments.
Interestingly enough, the author never suggests any solutions. In fact, the weakness of her book was that we never could figure out where she was going with it. She seemed to be trying to make a point, but she never actually articulated it. It felt like a chapter might be leading to something, and then she branched off on another story leaving us unsatisfied. It was jarring and effective to run up against abortion early in the book. We would think that is an issue that deeply divides individual practitioners. Even if you oppose abortion on philosophical or moral grounds, you can appreciate a young mother’s struggle who simply can’t feed another child. Patients’ and doctors’ moral struggles need to be put in front of the general populace, but this book did not quite fit the bill much to the chagrin of the member who recommended it based on a New York Times review.
Still, there were good takeaways. One line that stuck with a reader was when Rachel’s friend’s father (also a physician) tells his daughter that as she moves from black and white to grays, she will need God. Our reader has long felt that as we age we move from black and white absolutes and discover how life is composed of different shades of gray. So the wisdom you acquire as you age is a recognition of how much you don’t know. As young 20-somethings, you know everything. As you hit your 60’s, you realize how much is uncertain.
Our readers voted in this way: one gave it one thumb down, five were neutral, and five gave it one thumb up for its thought-provoking content. It wasn’t a book we’d necessarily have chosen to read, but it’s one that needs to be read as the country searches for solutions. In May, we move on to Behind Closed Doors by B. A. Paris where reality is not what it seems. Happy reading!