On The Ragged Edge of Medicine: Doctoring Among the Dispossessed

Book Title: On the Ragged Edge of Medicine: Doctoring Among the Dispossessed

Book Author: Patricia Kullberg

Publication Information: Corvallis, OR, Oregon State University Press, 2017, 162 pp., $18.95, paperback

The stories are also reflections about the work of doctoring. The physical, psychological, and intellectual demands. The terrible uncertainties. The confines of the system we work in, with its twists and loops and blind alleys, a system neither very rational nor functional, especially not in the outposts that serve the poor, out on the ragged edge of medicine (p. 6).

I felt I already intimately knew the patients whose stories Dr Patricia Kullberg tells from her time working as a family physician and medical director for indivduals on the fringes of society in Portland, Oregon. I could not decide if her book was a warning, chastisement, or celebration of her practice with those who have been shunned by the health care system and society. Compelling and tender, she allowed me to laugh and mourn. From the dialogue with a hypomanic patient who was the first patient that she ever fired, to the friendship with the allegedly antisocial patient who “licked” alcoholism and tuberculosis to come to her retirement party, she clearly treated her patients with as much empathy and humor as she exhibits in portraying them in this short collection of patient stories. “It is written in remembrance of all those folks, brave and imperfect, who entrusted themselves to our brave and imperfect care,” she reflects in her author’s note.

I was hoping Dr Kullberg would tell us how to fix the broken system or avoid being frustrated and exhausted, but instead she celebrates with humor and reminds us why we do the work we do. The preface opens with a description of her walk to the clinic. She remarks on the scenery and the possible places to sleep among the buildings in a way that changed how I view my own city. She describes how her patients amaze her—“funny, insightful and caring in the midst of destitution…resilient and incredibly resourceful” (p. 3). The same could be said of Dr Kullberg and other doctors like her.

Those who have practiced, as I have, in an underserved setting may recognize faces and shortcomings that feel surprisingly familiar. Work in underfunded community health centers can feel isolating. I have wondered if other physicians are affected as I am—if they absolutely love witnessing the quirks and resilience of patients and are as devastated by the ways in which they have fallen short as a doctor. It was surprisingly comforting to read of Dr Kullberg’s joy in retiring from patient care as well as her joy in providing care. The opening quote from her 13-year-old son says so much: “My mother is a doctor at a homeless clinic in downtown Portland. Because of the stress she experiences at work, she is sometimes edgy.” Those who have practiced in similar settings or are considering a career in medicine will find both warning and inspiration here. Those who are reflecting on our health care system will be shown many compelling ways we can improve.