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

by Rachel Pearson

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 No Apparent Distress, she chronicles her experiences and the raging disparities in a system that favors the rich and the white. This is at once an indictment of American health care and a deeply moving tale of one doctor's coming-of-age.

Genres: Nonfiction, Memoir, Medicine, Medical, Audiobook, Science, Biography

Audio CD

First published May 9, 2017

Reviews

[Petra X · Rating 5 out of 5]

Review This book is as much the story of Rachel Pearson and her family as it is her years as a medical student. It is a really interesting and readable book. Rachel burns with social injustice and works in a free clinic for those that have no means of paying for any medical treatment. I want to just concentrate on abortion and the medical care extended to poor people, especially black people, in Texas.

Abortion Before the author was a medical student she worked in an abortion clinic. It was by far the most harrowing of abortion stories I've read, although I've recently read two other books about abortion. The author describes what the fetus looks like after an abortion from when she was in the path lab.

The very early ones were soft and delicate. You could see the amniotic sac, which looked like a jellyfish, and the thin twisty umbilical cord that had connected it to the woman’s bloodstream. There was no body. Many of the ones I saw were like this.

In later pregnancies, the fetuses were farther along, and they looked like little fish-people, with curved spines and tiny arms and legs. Some, more developed, just looked like the tiniest possible babies, but thin and red-skinned and bloody. My mind went cool and silent when I saw them, and I turned to my work with calm remove.

Everyone who worked at the clinic had abortion dreams.

The saddest story she tells is of a Latina woman who has three children and is very poor, sometimes she and her husband go to bed hungry so that they can eat. She falls pregnant. She knows that her husband will not allow an abortion - they are deeply religious Catholics and abortion is murder. She cannot bear to take away the little she has from her children. After the abortion she gets contraception. She has, in her own mind, in her husband's, in the church's, sacrificied her immortal soul for her children.

Poor people, illegal immigrants, black people And so my parents, the carpenter and the rtired high schoolteacher, walked into the cathedral-like entryway of the most elite hall of American medicine, that top-level clinic that caters to the wealthy of the United Arab Emirates but does not accept poor patients with Medicaid. Finally, that had the kind of lives deemed worthy of care at the pinnacle of American medicine. A pianist was playing in the lobby. Finally, because they now had decent insurance. There was a young boy, black, 19, he'd had childhood diabetes and having had a very hard family life ended up on the streets unable to look after himself. He was now facing his second foot being amputated as he had not been able to access health care, not being insured, not able to work and not having an address.

The studies that the IOM report considered controlled for factors such as socioeconomic status and access to care, and showed that race alone often affects the quality of care patients receive. For example, National Institutes of Health (NIH) researchers found that black veterans treated for their diabetes at Veterans Affairs hospitals were less likely than white veterans to get basic standard-of-care tests like an eye exam—which is particularly important because diabetes can cause blindness.

Discouragingly, another 2014 study found that even in a patient-centered medical home run out of an academic medical center in Washington state—which should offer topflight primary care—black diabetes patients got worse care. Doctors were less likely to do eye exams on their black patients, less likely to vaccinate black patients for the flu, and even less likely to check their hemoglobin A1c (a standard test that tells us how the blood sugar has been running on average for the past three months). Black patients in the study population also had higher average blood sugars than whites—placing them at an increased risk for complications like Damien.

And it goes on. The clinic spends much time applying to charities, hospitals, churches for financial assistance but they generally get turned down everywhere.

The saddest of all cases was a man who was living in a Salvation Army shelter and he had throat cancer. He had been unable to get the opiates needed to treat the pain as there is some presumption that blacks are more likely to become street addicts even though the reverse is true. He could not get any treatment at all until the clinic finally got a church to help. The hospital proviso was that he had to live within walking distance of the hospital if he didn't have a vehicle. His brother helped out and bought him a trailer. The church stopped funding him as he now owned property and wasn't indigent. He died.

The book is not downbeat at all, despite the two subjects I've chosen to focus on. It's a really good read, the author is a cheery, positive person who lives life to the full, has many skills including housebuilding. Her family lived for a few years in a campervan - two children and two adults while they all physically built themselves a house. And from that can-do attitude, nothing, no matter how big a project fazing them, comes the author, who is out to change the world with her words and her book. Very enjoyable, a great read.
__________

I know I will get trolled for this but a society that doesn't look after the health of its poor, especially children, no matter what race they are, no matter they are legal or illegal, is not truly civilized. It is capitalism run rampant where everywhere a patient and their advocates turn for treatment it is, if you can't pay, just go away and die, we don't care. The geniuses of the world who invent things and move us forward don't usually come from the homes of the wealthy, they just spring up. It is our duty to the people of the future to care for all the children at the very least, good health care, good education, adequate housing and food, no matter what we think of their parents. All the children of the world deserve this. We can start by being responsible in who we elect in our local town councils, that is a start.

[Julie · Rating 4 out of 5]

No Apparent Distress: A Doctor's Coming of Age on the Front Lines of American Medicine by Rachel Pearson, MD is a 2017 W.W. Norton Company publication.

This book is an eye-opening shocker told from the personal experience of Rachel Pearson a young woman who enters the medical profession and trains in various public hospitals and small town clinics, learning the hard way that despite her compassion and will to care for patients, the poor and uninsured face more challenges in getting the care they need, due to an incredibly flawed system.

Rachel relates to the reader the many ways mistakes can be made, unnecessarily putting patients at risk, the bias that can affect treatment options, and the limited resources available to patients who are uninsured.

But, we also watch Rachel's struggle with the inclination to offer basic human compassion and the way she was being taught to keep her emotions in check and remain professional. These cases are difficult to read about, but exposes the system's flaws, in a way many people just can't understand or don't want to admit to. The fact that Rachel experienced this first hand, and is a doctor, not a politician, or pharmaceutical salesperson, or insurance agent, but someone who has been there on the front lines, so to speak, should convince anyone who may be skeptical that this is a stark reality in our country. It's shameful to be frank.
But, I will say, that as someone who has seen even the most priviledged, affluent, and well insured patients herded through hospitals like cattle, with little or no bedside manner to be seen, or with doctors literally rolling their eyes at patients who ask questions or express concerns about their treatment, Rachel's struggle with her initial innocence and idealism which contrasted sharply with the reality of her situation, proved that there really are doctors out there who care about their patients, whether they are insured or not. I highly recommend this book for no other reason than to educate yourself about how the poor are basically used as training specimens, the many disadvantages they have compared to those have insurance, and the heartless blind eye that is turned on this ugly, hidden truth.

Rachel also reminded my cynical self that doctors are human beings too, and helped me see a different side of the equation. Some of these cases still haunt Rachel, but I hope she will focus on the good things she will do for her patients now, and that she did learn something from this experience.

On a more positive note- While this book highlights an area of healthcare that many are unaware of unless they are in the trenches, there are many heroes in the health care business who perform miracles every day. This book merely draws attention to some of the issues we need to work on, especially in public hospitals.


4 stars

[Phoenix Perpetuale · Rating 4 out of 5]

It was a pleasure to listen to Audible's No Apparent Distress: A Doctor's Coming of Age. Story from the first lips. How is the life of a doctor and how experience is acquired?

[Rebecca · Rating 4 out of 5]

I’d recommend this clear-eyed insider’s glimpse into American health care to readers of Lab Girl and surgeon Henry Marsh. Like Hope Jahren’s memoir, it’s a detailed and earnest story of finding a scientific vocation; like Marsh’s books, it has something of a confessional tone. Rachel Pearson is keenly aware of her failings as a trainee doctor and expresses regret about the patients she didn’t save due to her greenness. She opens and closes with the story of Mr. Rose; she missed a tumor the size of two grapefruits in his belly because both of them were such “poor historians.”

From here she retreats to tell of her Texas upbringing and the many different hands-on stages involved in her medical training: a prison hospital, gynecology, general surgery, rural family medicine, neurology, dermatology. Each comes with its own memorable stories, but it’s her experiences at St. Vincent’s Student-Run Free Clinic on Galveston Island that stand out the most. Many of their patients were minorities; some were ex-cons, and those who weren’t homeless were most likely living under the poverty line.

Pearson speaks out clearly about the divide between rich and poor Americans (often mirrored by the racial gap) in terms of what medical care they can get. In many cases people are dying simply because they cannot afford the best care. (She doesn’t really talk about whether the Affordable Care Act has made any difference; this is something I wish she’d covered.) For instance, her patient Vanessa’s husband died quickly because they were uninsured and weren’t offered the special CT scan that could have caught his lunger cancer in time. Contrast that with the posh general practice clinic where she did a placement, the kind of place that hosts evening “Botox parties.”

“We become physicians when we are honest about our mistakes, and start listening a little harder,” Pearson writes, and this book is the proof that she’s kept her eyes and ears open to what ordinary people are going through – and her heart open to what she’s done wrong and what she can do better.

[Cheryl · Rating 3 out of 5]

When Rachel Pearson was a medical student at the University of Texas Medical Branch in Galveston, she was given the opportunity to work at the St. Vincent community clinic. Medical students who volunteered there were able to acquire “hands on” experience while working with poor, uninsured patients who were primarily minorities, as well as with prisoners in the nearby correctional facility.

In this revealing memoir, Dr. Pearson sheds light on the injustices imbedded in the American health care system which provides better treatment to patients who are white and insured. Medical students gained skills and learned more about the practice of medicine while working with the underprivileged patients. Mistakes were made unintentionally at the patients’ expense. But lessons were learned.

Dr. Pearson’s honest and heartfelt account focuses on the training of new doctors and the problems that exist in the health care system currently in place in the United States.

[Barbara (The Bibliophage) · Rating 4 out of 5]

Pearson is exquisitely vulnerable throughout this book. She never shies away from telling the painful truths of her experience, even when it makes her look incompetent. As the book progresses, she gains so much knowledge and, yes, competence, that she ultimately seems almost too hard on herself. I applaud her ability to tell her unvarnished truths. Super medical memoir!

Full review on my book blog, TheBibliophage.com.

[CanadianReader · Rating 3 out of 5]

Pearson has written about her fairly recent medical training in south Texas in a sort of hybrid memoir/social justice issues piece. She includes a few representative details about her childhood. The daughter of hardworking, poor, and, for some time uninsured parents, she—and her brother—were much loved and very clever. Originally planning to pursue a career as a writer, she realized through discussion with her dad that she preferred practical work, whose impact could be seen and felt. Medicine just made sense.

Pearson spends a good deal of time documenting the errors she made as a doctor trainee. For the most part, students at her medical school learned on the indigent and disadvantaged. Pearson appears to have had few encounters with the middle class. One insured patient she meets during her internal medicine rotation refuses to be seen by her—a student. The contrast in the agency and entitlement of financially comfortable patients and poor ones is stark and telling.

Pearson’s patients don’t really come alive on the page. Indeed, the author appears to be more preoccupied with addressing (and possibly atoning for) her diagnostic and treatment errors—through writing about those mistakes—than she is about the patients themselves. On the whole, her book is an informative read that addresses many issues—not just the disparity in care between the insured and uninsured, but also the inferior medical care received by Latinos, Blacks, and prisoners.

[Ocean · Rating 5 out of 5]

as someone who's spent four years working with mentally ill homeless people, i relate strongly to the feeling that, to paraphrase the author, your life becomes unspeakable. the vast majority of the world can't handle these stories, but you need to let them out somewhere. where do they go? rachel pearson turned hers into art. mostly pitch-perfect little keyhole-glimpses into a world that is impossible to explain, to define, to really convey the true meaning. it's difficult to put down, mesmerizing, heartbreaking and inspiring. and, to be honest, a 4-star book, but i gave it 5 stars to counteract that one-star dumbass who clearly didn't read closely and just let her own shitty politics get in the way.

[The Geeky Bibliophile · Rating 5 out of 5]

If you are deeply concerned about the plight of the poor in America—and, in particular, the roadblocks they face in getting even the smallest health care need met—then this is going to be an extremely difficult book for you to read.

As I write this review,the date is currently January 23, 2017. Three days ago, Donald Trump was inaugurated as the 45th President of the United States of America. The House of Representatives and the Senate is in Republican control and it’s just a matter of time before a new Supreme Court Justice is appointed—who will most certainly be a Conservative—which means all three branches of the Federal government will be under Republican control. By the time this review is published in late April, it is very likely that under this Republican majority, the Affordable Care Act will have been repealed, which will be particularly devastating to the most vulnerable in our society who gained coverage through the medicaid expansion (if they were fortunate enough to live in a state that expanded medicaid).

Which makes this a most timely read, indeed.

No Apparent Distress recounts the author’s days as a medical student in Galveston, Texas, detailing some of her experiences working in St. Vincent’s Student-Run Free Clinic. Staffed by volunteer students and physicians from University of Texas Medical Branch, St. Vincent’s offered health services for the uninsured poor. Financial limitations restricted the care patients received, sometimes with deadly results.

Pearson doesn’t shy away from admitting her own mistakes and shortcomings as a medical student; she shares those stories with regret and the 20/20 hindsight that wisdom brings. Nor does she hide her frustration about the disparity of care available to the insured vs. the uninsured, given examples of the inequalities she noticed while working/learning at the office of another doctor whose patients were insured and had considerable financial means, as well.

The Haves… and the Have-Nots.

If ever there was a book that inspired compassion for those less fortunate, it’s this one. If you’re seeking understanding about what it’s like to be poor and uninsured in America, I urge you to read this book. It’s definitely an eye-opener.

I received an advance review copy of this book courtesy of Netgalley and W. W. Norton & Company.

[Diana · Rating 3 out of 5]

This is a pretty good book but it had some problems that made it very tedious at times. Her editor should have told her that if a character in your book appears for a short finite time you do not need to give their entire life history and your reader most definitely does not want to read that. Going with your brother on a commercial fishing trip is interesting; a detailed description of how the boat and commercial fishing works is not, at least not in a medical memoir. This is more a memoir than a book about social injustice in medicine. I think we've all figured out that if you're poor and sick in Texas you're pretty much out of luck but even so the best parts of this book were the stories of truly heroic doctors and medical students struggling to help people in very dire straits, very often to no avail.

[Melissa · Rating 5 out of 5]

What a great book that I didn’t even know I needed to read, so glad it came my way. It’s an excellent view into the life of 1 medical student on her journey to becoming a doctor and all the many pitfalls of the process and our American system of healthcare that became abundantly clear along the way. A great read for at this time and place as we once again fight out the idea of equal rights to quality healthcare for all of our citizens.

[Jamie Holloway · Rating 5 out of 5]

I liked reading about a doctor and her journey through school and life and with her patients. I know I sometimes forget that doctors are humans with emotions. This is a good book for viewing doctors as humans who feel and do care about their patients.

[Rachel · Rating 3 out of 5]

This book shows in no uncertain terms the inequities of our current health system. I knew there were major problems, but never had read about people who are diagnosed with, for example, cancer and who can't get any medical help for it. They are literally turned away from all the hospitals and assistance programs in a pretty wide area. I thought there was more of a safety net than there actually is. At least, there's hardly any safety net in Texas, and those who are poor and nonwhite fall through it most. Barbaric and disgusting.

However, the book didn't seem to know exactly what it wanted to be. Personal and family memoir, journalistic expose, human interest journalism, and stories of being a medical student were all jumbled together. Most of it was interesting, but it seemed a bit disjointed do me.

[Rick Reitzug · Rating 5 out of 5]

This is an engagingly-written and powerful story of a medical student's journey to becoming a doctor. More importantly, the story highlights the inequity of our healthcare system. While it is not a book about the Affordable Care Act (ACA), the author's experiences make a strong case for a healthcare system that goes well beyond the ACA and truly provides affordable care for all people. Every elected official with a moral sense should read this book (it wouldn't make a difference for those without one).

[Theresa Smith · Rating 1 out of 5]

It boggles the mind that someone who wants to save lives begins her book with stories of abortions. She chose stories that may, to her, have shown compassion for a woman but, in reality, displayed a total lack of empathy and concern for the woman and especially for the babies. How can you go through so much expense and study and work to save others and yet so casually destroy human life and present it as a good? Women deserve better than this.

[Sanjana · Rating 5 out of 5]

4.5

A breath of fresh air after reading some less savory medical memoirs. Dr. Pearson has strong command of language (likely due to her background in humanities; side note, this should be required for all science/medicine-inclined people but ESPECIALLY science/medicine writers) and deftly weaves together her life experiences, patient encounters, and medical history into a poignant, sobering narrative. She speaks honestly about her personal and professional struggles without being overly confessional or self-deprecating–her point about being honest about making mistakes and asking for help, the alternative to which is putting patients in danger, is absolutely on the money.

I only took a couple points off because while it is incredibly personal, it isn't paradigm-shifting, and that's totally fine but I reserve my 5-star ratings for books that make me say "woah" out loud.

[Emily · Rating 4 out of 5]

A lot of familiar lessons that I am glad to keep thinking about.

[Eric Wurm · Rating 4 out of 5]

It can be difficult for a patient to understand just how much a physician must experience in order to be called "Doctor". Dr. Pearson takes us on her quest through the trials and tribulations on her way to taking the hippocratic oath. Hippocrates surely had less philosophy to master than the modern day practitioner.

Whether its dying patients or turning away the cancer-diagnosed for lack of funding, Pearson elucidates the struggle to achieve care for the sick even in the age of the Affordable Care Act. Can a truly enlightened society be one where the sick can be diagnosed but not cured?

The author of this book spends a great deal of time explaining the quandaries of low-income health care and the lack thereof. From one heart-breaking story to the next the reader has thrust into full view the process of becoming a doctor and the process of attempting to get care to those who "Do not qualify".

The writing is far better than one might expect from a physician. This is a story, or more a series of them, and not a clinical diagnosis. One might expect a book of scientific and medical jargon. This book contains neither.

If you have interest in becoming a medical student, how a student becomes a physician, and particularly well-told stories about these endeavors, I recommend "No Apparent Distress".

Disclaimer: This advance review copy was provided by the fine publisher WW Norton free of charge for the purpose of review. The public-release copy may vary from the copy that was the subject of this review.

Further Disclaimer: Any publisher that sends me a quality book free of charge for review will be referred to as a "fine publisher".

[Laura · Rating 4 out of 5]

Thought-provoking. New and relevant perspectives about healthcare in the United States.

[Jill · Rating 4 out of 5]

Is health care a "human right"? If so, what does that mean in practice?

In my profession in the social work field in a hospital, I see many of the injustices that Pearson writes about on a day-to-day basis. Luckily, the state I live in has expanded Medicaid to help many more people, so it's not quite as desperate as she describes. However, I appreciated her insight into the other ways that medicine treats the poor badly - through experimentation and practice, to name a few - as well as how her practice has shaped her as a physician and a human being.

There was likely a lot more history she could have brought in, and more calls to action to deepen the story, but overall a clear enough picture of what we face in this country in our medical system. If you are reading about the proposed changes to the ACA and wondering what's the big deal, read this book. I'd also recommend it to new or aspiring doctors and social workers entering the medical field.

[Lola · Rating 3 out of 5]

Rachel Pearson's memoir of going through medical training in Galveston, Texas.
Reading the back cover was unnerving where she says that medical students learn
on the bodies of the poor, and the poor suffer from their mistakes. **gulp**
Some of her training took place in a clinic for the uninsured. They didn't have access
to the same tests, procedures, surgeries, that people received when they had insurance.
So unfair. But it all comes down to money. The health system favors the rich and the
white patients.
Pearson has an easy to read style of writing. You will learn a lot that you likely didn't
know before. It's also entertaining.
THANK YOU so much--I received this book from the Goodreads Giveaway. Much
appreciated!

[Sara'la · Rating 4 out of 5]

pretty good writer... engrossing read. the whole premise was about the disillusionment of the free-medical care system and bureaucracies and such but she then closes with how without those experiences it wouldn't have made her the would-be doctor and human she is today... it was like she had to write a paper or this novel was a dissertation of some sorts where she had to put some positive acknowledgements of the system so she doesn't get ostracized by the medical community. Which totally put a damper on the book cuz basically that whole stage in life was just that? a stage? Did she take those experiences and bring it forward in a practical manner to something in which she can better? or was she just lamenting the system being too big to fight?

[BMR, LCSW · Rating 5 out of 5]

I won an advance reader's copy in a Goodreads Giveaway.

Every one of the 217 would-be killers in the House of Representatives who voted for the AHCA last week should be forced to read this book, and/or spend a day in their local safety net hospital assisting people to apply for Charity Care.

Real stories from a real doctor who worked in rural Texas during medical school.

Recommended for anyone who cares about healthcare in the US.

[Kristin · Rating 4 out of 5]

An interesting glimpse into the author's years in medical school, focused primarily on her work in the St. Vincent's clinic for the uninsured near Galveston, TX. Pearson winds in personal stories about family members who sought medical care, comparing and contrasting them with her experiences treating St. Vincent's patients. There were many parallels despite the fact that all but one family member had insurance and access to care that Pearson could not offer her patients.
She expressed well the feelings of futility that were the theme of these early years of her training. The St. Vincent's clinic was student-run, serving patients with no other options for medical treatment, so the students were truly learning the 'practice' of medicine on a poor, ethnic minority population. While St. Vincent's wasn't an official part of the med school rotations, volunteering there was an ideal place to hone their skills. That she could do so little for the patients was frustrating, with the biggest hospital in the area unwilling to take on 'charity cases' after being hit with back to back hurricanes immediately before Pearson's training began. She could suspect a patient had cancer, but without access to scans, lab tests, or chemotherapy/radiation, palliative medicine (though without narcotics available either) was the best they could do. Most of the patients also didn't come to the clinic spontaneously unless something was really bothering them, and usually 'really bothering' meant they were seriously ill.
An expression towards the end of the book is the goal of getting a patient starting at a level of 'zero' in terms of medical care to 'five', meaning they have access to everything needed to maintain good health. Pearson learns from the head of the medical clinic that getting patients to a 'one' is usually the best they can hope for, and she can't help but wonder if they really are helping anyone at all.
I felt the book lacked closure, that perhaps it was too hyper-focused. Pearson talks about all these things she learns during her training and injustices she perceives, but the book ends with her handing over the keys to the clinic to the next 4th year medical student who will begin their own year of leading the clinic, supervising the new crop of medical students coming in to provide whatever care they can offer to the St. Vincent's patients. I'd be curious where Pearson's path led next, if she chose to take a lucrative private position providing financial stability that her family never had or felt pulled to continue working with the medically underserved, fighting day in and day out against roadblocks imposed by people far away from the front lines of medicine

[S. · Rating 4 out of 5]

Honestly, this was incredibly good, despite the content being--very, very often--extremely difficult to read. There were parts in some of the chapters that left me wondering why they were even included (such as a rundown about commercial fishing ships...?), but for the majority of the book, the text was concise and brutally honest about the author's experiences as a student physician and then as a medical professional--and especially about the patients she treated, including the status or lack of it when it came to their medical insurance.

Pearson also confronts the elephant in the room when it comes to medical training (especially in Texas)...that the bodies of the poor, and the imprisoned, are often used as 'guinea pigs' for medical students to 'practice' on. She confronts the difficulties of racial bias in medical treatment, and how that can decimate a patient's quality of life, as well as poverty and/or lack of insurance--hell, she even talks about the high medical costs for those who *do* have health insurance.

And, importantly, she discusses how surgery dehumanizes patients, because too often, there are doctors and surgeons trained to view patients as bits and pieces to be tweaked or fixed or cut up, rather than as individuals with their own lives and dreams and hopes. (For what it's worth, she is honest about the high suicide rates among physicians.)

I don't know that I could ever read this book again, but as difficult as it was to digest (nearly every chapter had me in tears), it was worth the read.

[Ronald Brady · Rating 4 out of 5]

This book as the title might suggest… Is a memoir about one young woman’s journey through medical school to become a doctor. Along the way, she learns about the inherent biases that exist, both in medical training, and in the practice of medicine. She works in various community clinics as she makes her way through medical school.

And since she went through a PhD program at the college of medical humanities, while she was in medical school, she drops some history lessons on us, like the fact that back in the day we used to involuntarily solicit blood donations from the prison system, which is what caused an outbreak of hepatitis C before we knew what that was.

Another startling fact, is that some hospital systems that used to be largely charity centered, have gone on to favoring more commercial medicine, she talks about the insurance crisis in America, and how the uninsured are the least cared for even when they qualify for things like indigent care programs, emergency, medical coverage or charity care. And while it’s wonderful, that things like charity care do exist, we definitely need to do better.

This book was simultaneously heartbreaking and eye-opening. And it basically confirmed for me that we should look at adequate medical care as a right rather than a privilege in this country. I am very glad I read this book.

[Lisa · Rating 5 out of 5]

This book opened my eyes to its thesis:

"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 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—as I am myself—then you can be pretty sure that most of your doctor’s mistakes have already been made. They were made on the bodies of the poor."

It took me a while to come around to this. I'm used to teaching hospitals being top-tier tertiary research institutions, but explaining a gist of the book to someone, out loud, made me think more deeply about how medicine is taught and which people are used as guinea pigs.

I wished the author had made more statements about any solutions - universal healthcare, how other countries teach medicine - but this was more of a memoir than an academic text. For me, that often took away from the messages of the most interest, but the history and author's personal/family connection to hepatitis C was fascinating and awful.

[Cheryl · Rating 5 out of 5]

A very timely telling of the terrors of today's medical opportunities to the less privileged. Through her schooling and clinic volunteering, Pearson experiences the heartbreak of having to let people suffer due to not having the right insurance to get them the needed care. Doing all she (and her comrades) can to help those in need, it leaves an abyss of what can actually be done. I was surprised that she admitted to a number of medical errors she made in her training, but applauded her frankness. This book was a real education for me, as I really had no idea just how bad it is out there for the uninsured or even under-insured. I guess the Hippocratic Oath is as passe as looking up from your cell phone to say "Hello."

Can copies be sent to Congress?

[Laura Jean · Rating 5 out of 5]

This is a fascinating look at the evolution of a doctor. It's also a pretty insightful insider's look at health care for the indigent and working poor in Texas. Finally, I found the author's philosophies about working in medicine and helpful for me as a librarian. I often also deal with ill and/or indigent patrons, and I want to provide the best service I can, while still not burning out. So I tried to consider some of her ideas for myself.

[tisasday · Rating 5 out of 5]

This book has many layers of meaning that explored the lesser known areas in the high profile subject matter, that is medicine, which most people claim to know a great deal about. “No Apparent Distress” is such a substantive title. It’s true that the best way to go about empathising with others is to experience what others have experienced, but the fact of life is we can’t live out ten thousand different lives just so we can empathise with the many people we encounter. But we can hear out their stories and listen. Sometimes just being there is enough.