No Apparent Distress: A Doctor's Coming-of-Age on the Front Lines of American Medicine

by Rachel Pearson MD

Overview

A brutally frank memoir about doctors and patients in a health care system that puts the poor at risk.

In medical charts, the term “N.A.D.” (No Apparent Distress) is used for patients who appear stable. The phrase also aptly describes America’s medical system when it comes to treating the underprivileged. Medical students learn on the bodies of the poor—and the poor suffer from their mistakes.

Rachel Pearson confronted these harsh realities when she started medical school in Galveston, Texas. Pearson, herself from a working-class background, remains haunted by the suicide of a close friend, experiences firsthand the heartbreak of her own errors in a patient’s care, and witnesses the ruinous effects of a hurricane on a Texas town’s medical system. In a free clinic where the motto is “All Are Welcome Here,” she learns how to practice medicine with love and tenacity amidst the raging injustices of a system that favors the rich and the white. No Apparent Distress is at once an indictment of American health care and a deeply moving tale of one doctor’s coming-of-age.

Product Details

ISBN-13:	9780393249248
Publisher:	Norton, W. W. & Company, Inc.
Publication date:	05/09/2017
Pages:	272
Sales rank:	537,428
Product dimensions:	6.20(w) x 9.30(h) x 1.20(d)

About the Author

Rachel Pearson, MD, PhD, is a resident physician who also holds a PhD from the Institute for the Medical Humanities. Her writing has appeared in Scientific American, the Guardian, the Texas Observer, and the New York Times Book Review.

Editorial Reviews

…engrossing…part med-school memoir, part probing moral inquiry…Pearson's vivid writing sometimes lulls you into the trance of a good story—character, voice, plot, conflict—but there's always the sucker punch at the end to remind you of the gruesome endpoint of the American health care system: If you don't have money, you can be sent out to die…Pearson was a writer of poetry and fiction before she turned to medicine, and her literary skill is apparent in her book. Her courage, honesty and doggedness are evident on every page.

The New York Times Book Review - Danielle Ofri

"Passionate....one of the better doctor-in-training books."

Booklist

"Rachel Pearson comes from a hard place. In her memoir, No Apparent Distress, she tells the story of a Texas hospital that has been flattened by a hurricane and is being rebuilt—literally rebuilt—around her and her colleagues while they pursue their medical training. Working at a clinic for the poor and uninsured teaches Pearson the empathy she will need to cultivate if she expects to act as an effective advocate for her patients. It also teaches her about the inequities and injustices of the American health care system, and the labor of love required of anyone who decides to pursue the practice of medicine in this country."

Judy Melinek

"No Apparent Distress is filled with the moving stories of a medical student’s journey providing health care at the margins of American life. Rachel Pearson shines a spotlight on the brutal inequalities present within our healthcare system."

Damon Tweedy

"Engrossing....Pearson’s vivid writing sometimes lulls you into the trance of a good story—character, voice, plot, conflict—but there’s always the sucker punch at the end to remind you of the gruesome endpoint of the American healthcare system....Her literary skill is apparent in her book. Her courage, honesty and doggedness are evident on every page."

Danielle Ofri

★ 04/01/2017
Writer, MD, and PhD student (Inst. for the Medical Humanities, Galveston) Pearson writes movingly about American medicine and medical education from the perspective of a working-class student who comes to realize that her medical education (and that of many) is based on learning from the poor and uninsured. The author spent years practicing at the St. Vincent Student Run Free Clinic, learning that treatments for diseases are not always available to patients, even under the Affordable Care Act and with heroic efforts by health professionals. She discovers the extent of bias in medical care, including in herself. "No apparent distress" is used in medical charts for patients who appear stable. Pearson also considers the American medical system of treating the underprivileged, who provide critical experience for medical students to learn from their mistakes on these patients. VERDICT With similarities to Victoria Sweet's God's Hotel, this timely, highly recommended title is for readers interested in medicine, public health, disparities in treatment, and the complicated politics of health care and poverty.—Mary Chitty, Cambridge Healthtech, Needham, MA

Library Journal

2017-04-02
A sensitive doctor describes her beginnings navigating the unpredictable, woolly world of modern American health care.Pearson's inspired collective of illuminating clinical episodes immediately sparks to life with anecdotes from her early work in a female-owned and -operated abortion clinic in her 20s. Her experience there as a young, bilingual patient advocate counseling Spanish-speaking women greatly broadened her perspective on women's issues, "the suffering that women go through," and it solidified her decision to pursue a career in medicine. Because many of the artfully and creatively compressed stories she shares are so personal and admittedly "hard to tell," the book takes on an intimate tone, even while the details veer toward the gruesome or the emotionally raw. Intensive medical school classes on Galveston Island led to hospital and family medicine rotations, and all of the experiences exposed the author to the trauma and heartbreak of pain, cancer, and disease and the frustrations of age and death—but also the sincere appreciation from those she was fortunate enough to assist in creating wellness. Pearson's history as a poet and a fiction writer aids with the flow and the tone of her memoir. Eloquently and briskly written, the narrative is moving and will be inspirational and particularly enlightening for pre-med students eager to discover and explore the real insider details found both in and out of school. The author offers a helpful, pragmatic perspective on how the American health care system operates, how and who it helps, and what it has become hobbled by, though, disappointingly, only a few closing pages are devoted to these thoughts. On the whole, Pearson's well-balanced book provides a smooth combination of personal history and patient care cases. Educative and thoughtful—important reading for patients and fellow medical professionals alike.

Kirkus Reviews