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  1. Book ImageNo Apparent Distress: A Doctor's Coming-of-Age on the Front Lines of American Medicine

    Rachel Pearson

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

Discussion Questions

  1. What was your perception of American medicine prior to reading No Apparent Distress? What did you learn from this book? How has it altered your views about the way people are treated by the medical system in the United States?
  2. What steps do you think might be taken to improve medical treatment in the United States? Are there any easy answers?
  3. Rachel Pearson gives many examples of how the poor and marginalized are given worse treatment than wealthy patients. How do you think this came to be? What does it mean for the future?
  4. What do you make of the epigraphs at the beginning of this book? Do we truly live “in a time of hardening of hearts” (ix)? What does it mean that the quotation comes from a black man, whereas the claim that “any man’s death diminishes me” came from a white man? How do these statements resonate with you?
  5. Pearson is remarkably forthcoming about her mistakes as a young medical student. How do you think doctors and students might be encouraged to be more open about past errors? How would this attitude improve the situation?
  6. In Chapter 4, after Frank’s suicide, Pearson calls her friend Jonathan, who says, “If we mourned fully any one loss, . . . that would take a whole lifetime. . . . But other things happen” (35). How do you think this statement pertains to Pearson’s experience in medicine—or in the practice of medicine at large?
  7. In Chapter 5, Pearson writes that “the promise of nonabandonment is sometimes the only comfort we can give” (50). When have you promised to be there for someone, even though you could not fix their problem? Would you want your doctor to offer you that “comfort”?
  8. Mr. Jackson says St. Vincent’s patients feared that white students were “experimenting” on them (61). In what way is this fear justified?
  9. Pearson asserts that, in rural Texas, “The barriers to care often begin well before the hospital” (57). What does she mean by this, and how might the situation be helped?
  10. In Chapter 12, Pearson writes, “I just played the role I was being taught, instead of acting like a decent human being” (124). Can you think of other examples of this phenomenon from the book, or in your own life?
  11. In Chapter 13, Pearson describes her surgery experience as “dehumanizing” (127). What does this word mean, and how it might it apply to other scenarios in medicine?
  12. Of her doomed patient Elias, the author writes, “His family wanted us to be heroes, and we tried too long to play that role” (173). What is the danger of a doctor playing the role of hero? What role might she play instead?
  13. Pearson says she doesn’t like “to use the battle metaphor” when it comes to cancer (175). Why do you think this is? How might the concept of “battling” cancer cause harm?
  14. When Pearson discovers that her mother may have received a blood transfusion from a nearby prison, thus potentially infecting her with hepatitis C, she writes, “The brutality of prison has affected my family just as it has so many others” (188). Can you think of other examples of the ways that brutal conditions among the poor and marginalized might cause troubles for other areas of society?
  15. How does Pearson’s status as a writer fit with her position as a healer? What qualities do the two vocations share in common?
  16. At St. Vincent’s, Pearson is a white medical student volunteering in a historically black community center. Does she successfully avoid pretending to be a “white savior”? How should white volunteers relate to communities of color?
  17. Pearson struggles with the question of whether St. Vincent’s actually prevents poor patients from receiving better care elsewhere—whether the clinic is a “moral safety valve” (151). Late in the book, Mr. Jackson says of the patient Malachai, “He comes in at zero . . . [a]nd you want to get him up to five. . . . [Y]ou can’t get him to five. . . . But you can get him to one. Even just coming through this door, that’s getting to one. And one is better than zero” (222). Can “half measures” be harmful in medicine? Is one better than zero, or is one “still an injustice when somebody needs five” (222)?

About Rachel Pearson

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, and the Texas Observer.

Books by Rachel Pearson

  1. Book CoverNo Apparent Distress: A Doctor's Coming-of-Age on the Front Lines of American Medicine

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