This engaging memoir describes Pearson's medical training at the University of Texas Medical Branch (UTMB) on
Galveston Island from 2009 to 2016. During these years her personal values
become clear, and she finds fault in her training, in medicine as
practiced in Texas, and even in her own errors in treating patients.
Having left a graduate writing program,
Pearson took a "postbac," a year of pre-med courses in Portland,
Oregon. She interviewed at medical schools "all over the country" and
writes satirically about them; she concludes "nothing out of Texas felt
quite right," having lived there and done her undergraduate work at
University of Texas at Austin. She's a Spanish speaker with a
working-class background. When her classmates provide the annual
“white-trash”-themed party, she wonders, “do I go as myself?” (p. 21).
Pearson's education continues on three tracks:
the formal UTMB courses in medicine, a simultaneous Ph.D. program at the
Institute for the Medical Humanities at the University of Texas, and her
volunteer work at the St. Vincent's Student Run Free Clinic. The Ph.D. program
is off-stage, not mentioned, but the St. Vincent's Clinic becomes pivotal
to her development as a doctor and a moral person.
As for medical school, she finds the relentless
"truths of biochemistry and anatomy" so reductive that the suffering
of people and surrounding politics seem "not to matter at all" (p.
70). Among the politics are: the lack of safety nets for poor people, the use
of uninsured (including prisoners) for students to practice on, failures
to extend Medicare, pollution (notably from the oil industry), losses of
charitable care, and income disparities that include crushing poverty for many.
Something of a rebel, she writes that medical school "felt like junior
high" (p. 44). She does enjoy the "clinical encounters" with
real patients.
St. Vincent's, by contrast, was “a relief.” Her
pages sparkle with her conversation with clinic patients, some
homeless, all poor, and all suffering. She reports--confesses, she even
says--her errors that had consequences for patients. She writes that errors are
an unavoidable part of medical education, but that it's wrong that they should routinely
happen to the poorest members of society.
Chapter 8 discusses depression, which she
felt after the second year. She writes about high rates of suicide among
medical students and doctors; indeed a close friend killed himself during the
"post-doc" year. Because some states require doctors to report
psychiatric care, some doctors avoid such care. This consequence “drives a suicide-prone
population away from the help we may need" (p.92).
The last two years are the rotations through
specialties: surgery, dermatology, trauma, rural medicine,
neurology, internal medicine, and so on. These are clearly and
insightfully described. In one case (internal medicine), she allows the reader
to see the irony of a doctor providing hair removal by laser, diet foods, and
Botox treatment for wrinkles, “a pure luxury transaction” (p. 183).
Pearson describes the storms, hurricanes, and
floods that hit Galveston Island, also the pollution from the oil industry that
causes a “cancer belt” along the Louisiana and Mississippi coasts (p. 104).
At last she finishes her program, understanding
that her identity is simultaneously a person, a physician, and a writer (p.
248).
