Dr. Patricia Kullberg joins us today to give a sneak peek at her new book, On the Ragged Edge of Medicine, available March 2017. Dr. Kullberg has served as Medical Director of the Multnomah County Health Department as well as a primary care doctor for people living with physical, mental, and addiction issues in Portland, Oregon. On the Ragged Edge of Medicine invites readers to take a deeper look at the world we live in, especially at the lives of the dispossessed among us.
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If we still thought of certain women as spinsters or old maids, Carla would have been one. That's what my mother would have called her six decades ago: a woman whose longing had fled before the impress of time. Carla was middle-aged, crumpled and dowdy, no shape to her skirts and blouses, no color either. She wore old lady underwear, like white cotton short shorts and full, white nylon slips, gray with age. You couldn't even buy a full slip anymore without going to an online specialty store, where, I was certain, Carla did not get hers. I was her doctor. I knew these things about her. I thought of her as someone who would never precede anyone through a door, who would not even complete a sentence if the signals looked wrong. She was well practiced in backing away. A woman peeping out from under a rock.
What I didn't know about Carla was this: she harbored a secret passion that would erupt with tragic consequences, ones that would implicate me in ways I had never anticipated.
I knew doctoring would be difficult. But not like this. Forty-two years ago as I sat in the lecture hall trying to absorb the principles of pharmacokinetics or glucose metabolism, I thought challenges would evolve from the science: understanding it and applying it with sufficient care and finesse More often the science was the easy part. The hard parts were these:
- Accepting the limits of medical science.
- Battling the self-sabotage of mental illness and addiction disorders
- Caring for patients who were hateful, manipulative, contrary, or hostile.
- Challenging bureaucracies that places rules over human welfare.
- Facing up to my own lapses of judgment or knowledge.
- Cultivating a sense of humor and agency against an irrational system of care.
- Bearing witness to the unnecessary suffering of a sick society.
- Placing band-aids on the wounds of poverty, racism, and abuse.
- Embracing the mysterious and unknowable.
- Making peace with uncertainty.
- Coping with failure.
- Struggling to do something when there was nothing to do.
Writing about it helped. I first put fingertips to keyboard during the second year of my two-decade practice among the dispossessed in downtown Portland. My patients were homeless or marginally housed. They suffered all manners of acute and chronic physical and mental health disorders. Many had fled war and repression in the countries of their birth. Or abuse within their families of origin. Or conditions in their American home town that deprived them of safety and economic security, only to land in yet another place that would treat them scant better. They were not necessarily innocent, but they never deserved the nastiness of what was dished out to them.
The patient who inspired my first writing was, like Carla, white and middle-aged. She suffered all the ill effects of massive obseity, like diabetes and arthritis and social isolation. What is most seared in my memory about her was her unrelieved grief over the death of her only child some decades earlier. At the time my own son was a toddler and I was simply unable to contemplate her loss. It was too painful to imagine. Still, we had a good relationship I thought, until I unintentionally breached her trust. I was never quite sure what had upset her. One day she became furious with me for not attending properly to her problems and never came back. It was confusing and disheartening.
Putting words to paper forces you to elaborate, clarify, and crystallize. If you enter into the process with an open mind, you can discover things you didn't know. The act itself can enable you to acknowledge, to forgive, and let go. I employed the writing process often in the years to come. I had many opportunities, as so many times things did not go as planned. I had lots to sort through. On the Ragged Edge of Medicine: Doctoring Among the Dispossessed is a collection of fifteen stories I wrote. They are snapshots of fifteen lives as seen through the lens of ill health and the struggle to survive. Too many of these patients did not.
The stories include these:
- A woman who tested my loyalty, found it wanting, and chose to forgive.
- An elderly man who repeatedly, wittingly or unwittingly, sabotaged efforts to fix his problem and still emerged with a good outcome.
- A modern day hermit who cultivated a large garden on forbidden green space smack dab in the middle of town and got away with it.
- A fellow who crashed his own lifeboat by refusing his medicine, but managed to survive.
- A young woman who could endure most anything but loneliness.
My stories ask a lot of questions. They don't provide a lot of answers. They are an invitation to look into a corner of the world that usually escapes the public gaze, precisely because what you will see is disturbing. We should be disturbed.