>> booktv is on twitter and facebook, and we want to hear from you. tweet us, twitter.com/booktv. or post a comment on our facebook page, facebook.com/booktv. [inaudible conversations] >> ladies and gentlemen, i am tonya, i want to thank you ever so much for coming in this evening. we have a great lineup of different authors throughout the year. we do upwards of 400 events, so ubookstore.com or this handy little flyer will tell you more information about different can events that are coming up. but right now we're so happy to welcome a new northwest author, we'll claim her as long as we can with no apparent distress,

rachel pearson. [applause] >> all right. thanks so much, tonya. can you guys hear me? nope? can you hear me? wonderful. yeah, thanks so much for coming out. really excited to share a little bit of the book with you guys and hear your questions if you have any. and so this is a book that i wrote primarily based on experiences i had in medical school working in texas where i cared for folks in pretty marginalized communities, so at a free clinic, at prison clinics, at some border clinics and in county hospitals in central texas. and the experience was eye-opening and life-changing. and, yeah, i'm excited to share

a little bit of it with you guys tonight. one thing to know about the book is it deals with really heavy things. so it deals with the problem of lack of access to care, it deals with the sad political fact that people do die for lack of access to care. at the same time, it has stories about my family, stories about my friends, and there's a lot of different tones within the book. so i'm going to read from a couple of different sections. i'm going to start out with a section that i think is funny. and then i will read from a section that's a little bit more serious. okay. so this is based in west texas in a tiny town where i did my

family medicine rotation, a little town called fort davis. and in this story, i'm riding into town with the family doctor who takes care of patients in that town. we pulled into fort davis, a little strip of a town with 1,000 inhabitants nestled at the foot of the mountains near the mcdonald observatory. the clinic is in a stone building at one end of the town, and we walked right into the waiting room. the doctor said hi to everybody, then sent me off to see the first patient. ooh, it's mr. housen, he said, talk him down for me, rachel. talk him down. mr. house p was a rancher in his 60s with sun-weathered skin and strong arms. i think i -- excuse me. i think i tore myself, he said, picking up a hay bale. his wife nodded significantly. yes, he did, she said, down there. [laughter] i understand, i said.

this was bread and butter for me. on my surgery rotation, i'd helped repair a bunch of hernias and learned how to do a good exam in cling. mr. housen told me the story, he picked up bale and felt a sudden pain in his groin. go ahead and pull your jeans down and i'll check you for a hernia. sure enough, when i pressed my finger up against the opening of his ayoural canal and had him cough, a bulge came down against my fingertips. yep, i said, that's a hernia. well, heck, he said. looking down at his genitals. yep, i repeated. i stood up and took off my gloves. well, heck, mr. housen said, it's broken. [laughter] yes, ma'am, i said. but it's not too broken. i mean, we can fix it. [laughter] dang it to heck, mr. hawzen

said, putting his hands on his hips. i sure as heck hope y'all can fix it. that's right, mrs. housen said, nodding vigorously. you can go ahead and pull your shorts up, i said, we'll have the doctor take a look. i stepped out and found the doctor in his office. how's mr. housen, he asked. he has a hernia, i said. my goodness, the doctor said. it's a left-sided indirect hernia, i said. you checked him for it? i sure did. i did a lot of hernia exams on my surge call rotation, i said. well, good for you, the doctor said, blushing a little bit. back in the exam room the doctor had mr. housen pull his jeans down again. yep, the doctor said, that's a hernia. well, heck, mr. housen said. the doctor turned to me, you sure did learn howed to do a hernia exam, i said. yes, sir, i said.

she did a real good job, mr. housen said. yes, sir, she sure did. well, thank, y'all. oh, you can pull your jeans up now, the doctor said. i reckon we're going to schedule you for some surgery. up in alpine, mr. housen asked? up in alpine, the doctor said. well, heck, said mrs. housen. then she pointed to mr. housen's genitals, will it still work, she asked? [laughter] yes, ma'am, the doctor said. don't let him fool ya, it'll work. [laughter] all right then, she said. then the doctor kissed them both on the top of the head, and we stepped out. [laughter] so that was a really lovely place to train with a doc who just cared so much about his patients out of west texas. you know, out there we also cared for a lot of folks who didn't have regular access to primary care. is some of the stories that came out of that experience are, you

know, a little bit more difficult. but i wanted to start off with something light. okay. and then i guess this story is more from the heart of the book. so i went to medical school in south texas on an island called galveston island, and the year before i started med school my island was hit by a hurricane. hurricane ike. it devastated the town, and in the aftermath of hurricane ike the hospital, which had historically been a cherry hospital that -- charity hospital that cared for all comers, the kind of hospital where a doc in texas who couldn't get care for her patient could literally buy them a bus ticket and send them to galveston and know they would

get care there. that hospital changed. very abruptty we stopped doing -- abruptly we stopped doing any charity care, and the patients who were on the rolls of the charity care program at galveston were sent form letters that said, for example, due to the devastation caused by hurricane ike, dr. susan will no longer be your doctor. and that included patients who had cancer, patients who had chronic kidney disease, patients who had complicated room to logical decide and what happened after hurricane ike very much defined my experience as a medical student and the kind of doctor that i'm becoming. so this story is about the head

and neck cancer surgeon, and she refused to abandon her patients even when they were dropped from the rolls at utmb. so this is about her and what she did. what is a surgeon without her operating room? whatwhat does a good doctor do n the institution she works for compels her to abandon patients who obviously need her help? susan began to find her own answers to these questions by driving up the coast. her galveston patients were scattered, but many lived farther up the coast in areas that had had not been flooded by ike. these patients, too, had gotten the form letter. in the weeks after hurricane ike, she began to climb into her little volkswagen and drive out to find them. she was unaccustomed to all the

free time, and she began to fill it with the practice of medicine. the weather was beautiful then; sunny and cool, the most perfect october you could dream of after your town was destroyed. it felt almost like a vacation for a while, leaving the wreckage of galveston behind and driving through the seaside towns listening to box goldberg variations or his sonatas and harpsichord. these town toes were startlingly -- towns were startlingly intact compared with galveston. the restaurants were open, people had lawn chairs and swing sets in their yards. susan would find to the nearest point she could find listed as her patient's address. if she couldn't start find the house, she would start asking around until someone knew where her patient lived. susan's patients spanned the width of american poverty. some were in houses, some were

in trailers, some were in garage apartments with dirt floors where the electricity came from an extension cord and running water could be an issue. they welcomed her in, and she began to learn any little house, no matter how humble, could feel just like home. susan would duck through the low door of a trailer, and someone would offer her a cup of tap water. the sick bed took up most of the space, so she would be invited to sit in the folding chairs out front. she was conscious of her own comparative wealth and grateful for her modest car that was not too shabby to seem doctorly but still wouldn't stick out in any neighborhood. oddly, susan's patients did not seem surprised to see her. it was as if they had been sitting at the edge of the bed waiting for her to walk in. there were people at every stage of treatment, people who had just been diagnosed to whom weeks before susaned had explained that they -- susan had

explained that they had a great chance of surviving. there were people who were belled ridden with feed -- bedridden with feeding tubes in their stomach and those in between, some who had gotten surgery already and some who had not. so what are we going to do, doc? they would ask her. what's our plan? that's when the easy autumn feeling grew thin and shaky, because the truth is that susan did not know exactly what to do. some of her patients were convinced that the interruption in care was a temporary thing and that utmb would take them back as soon as it could. others had already begun to seek care elsewhere. still others were too sick to do anything at all. she had to tell them that it was true, she would no longer be able to treat their cancer. susan's patients would ask her what would happen to them if they didn't get care, and this was even worse. ..

you'll debuts of this. i said you had a 70% chance of being alive five years from now but that was with treatment. without treatment, your mortality rate within a year will be 100%. this is not an easy thing to say, and sometimes she failed. she would dance around the issue, talking about care plans and applications to medicaid even when she knew the plans

weren't going to work. the sometimes were circuitous sometimes. she tried to force herself to say it strongly, you will die, and that was awful also. it was too much. sometimes the conversations were arduous, two are hour long affairs with the patient saying tell me again how it is i'm not going to get care. so she would try to repeat it. a time or two she arrived at the patient's house and sat silently in her car and then drove back to gavel stan to heartsick to have the conversation again. so, she thought these conversations also happened face-to-face. she could not fathom the form letter, the innocuous language that in fact meant bleeding, suffer indication. her patients deserved at the very least to hear it in person to have it made plain so she returned to their homes and to

these impossible conversations. susan was in unfarm territory. beyond the guidelines how physicians discussed death. as a surgeon she had been train to confront bad diagnoses and knew how to tell patient that a treatment wasn't working and how to tell a patient her disease could not be cured. many on her patients have died before because cancer patients do. but this felt different. she could not blame the cancer itself, that disease that humbles all of medicine. the situation felt unnatural. and she wasn't sure who to blame. the insurance system, the states, the hurricane, other employs? she felt implicated in withdrawal of care so at times she blamed herself. she felt like it was a novelty, super who could not operate, a

cancer doctor who could not cure. she had some idea however, that she could stand by her patients. she could go to their houses and lay on her lands and comfort them. she could clean their wound, change their tubes, write prescriptions for pain, even encounter began with the washing of hands, and sometimes to wash her hands, susan had to begin by washing the dishes in the sink and then putting them away because her patients were alone and sick and things like dishes had been forgotten. how strength as this was it was also deeply familiar. the same old rituals of doctoring acted out in a taylor park outside beaumont. clean hands, vital sign, history-taking, care. sometimes a anybody or neighbor's kid would be sick and susan would into -- see them, too. some of her patients did not

want this. they did not want her comfort, the laying on of hands or a doctor who follows the egg cal imperative of patient nonabandonment. they wanted surgery, raidation, chemotherapy and cure. they wanted to live. [applause] >> has there been a time -- okay. one more story and this is about a time when -- undocumented lady

was super sick and a volunteer managed to push and push and push and push until she got the care. the volunteer's name was jacqueline, and when i start in the story, we have already diagnosed her patient, gloria, with cervical cancer. working in galveston, we all too often encounter the stigma where we were able to diagnosis patients with cancers by getting biopsies and read by a surgeon but we were not able to get them treatment. so too unfrequently can't do chemotherapy, can't do surgery, couldn't do radiation, and when there's not a robust safety net, patients me a die of diseases you know are treatable.

but at this point doesn't end like that so bear with me. jacqueline was in south texas and was gloria was ray raised in el salvador. jacqueline was from a family of doctors. father's father was ophthalmologist in coup and then residency in detroit to become a american general practitioner. jacqueline's own fathering was an oncologist. her mother refused to port arthur because, quote, it smelled. jacqueline, just laughed. she had nanny whom she loved. a catholic shrine in the entryway to the house, and jacqueline's mother tells her to pray. her father says she'll need god as a physician. when she stopped living in the world of black and white and lived in the gray areas, she told her you need god.

gloria, the patient, had a husband and a chauffeur in el salvador but after she and her husband both lost their jobs gloria promised to pay $300 to bring her north to work for a while in a shrimp factory in virginia, saving money to bring her daughter. the daughter married an american citizen and doesn't involve herself much with gloria. certainly not enough to pay for gloria's sons, her brothers to come north. as for gloria's husband, well, qiin sabe. came to work in a hotel custom. she made the skin of her hand crack, and one day she arrived at st. vincent and jacqueline met her. and then there's a part here which i'm going to pass over for brevity stake and talk about the data around cervical cancer. you may know cervical cancer is

one of the cancers that the u.s. government has committed to funding diagnosis and treatment for, so in general, even at st. vincent, if we diagnosis cervical cancer we can get them treatment. gloria was undocumented, and latino women and undocumented women and women living on the border in texas are not only more likely to get cervical cancer and more likely to die from it if diagnosed. so, it was a dilemma because gloria was undocumented, couldn't get her into the -- for treatment. so started caring for glory razz cancer. living piecemeal for the diagnosis and staging and trying to find charity care for gloria. jacqueline was present at each of gloria's appointments. if jacqueline wasn't the student in charge she would translate.

gloria took to helding her, holding on to her hands and saying, -- [speaking spanish] , gloria was rejected by three hospitals in the area. every time she was reejected, jacqueline gave her the bad news. jacqueline was no longer a practicing catholic. but sometimes after these encounters she would call her father, it will work out, jacqueline, he would say. this is why you saould go to church. it doesn't work out, jacqueline thought, i'm going to need to pray to somebody. jacqueline and gloria began booking up more elaborate plans to get gloria the cancer care she needed. somehow, jacqueline convinced st. vincent that $3,000 for a ct scan to find out if gloria had cancer in the rest of her body. one of the doctors got on

jack rein lynn's case for dedicating so much to this one patient. do you think she's trying to play you, he asked, or what? jacqueline thought, when the scan came back negative, showing the cancer had not spread, the statement doctor asked jacqueline why, then, they needed it. jacqueline was just silently grateful to see the cancer had not invaded gloria's organs. this took time and some ways felt like they were stalling, killing time, while we scratched around for someone to offer surgery and chemo. if gloria had been admitted to a hospital, all of these things, the biopsies, the scans, beginning treatment, could have been done in a day or two. but at st. vincent, weeks turned into a month, then two months. the cancer was growing. over the course of a work day, blood seeped through gloria. jacqueline does not particularly

believe in being well-around as a doctor. she pressures to treat medicine as a job to leave it at the hospital. her father never left his work at the office. he was always on call. always thinking about heirs -- his patients. part of me doesn't want medicine to be the way dereich meaning from life, but that's just the way it's going to be. why is so it bad that it want my life to have meaning for my work. some part of me wanted to stop, jacqueline thought to tell her life was full of meaning and we don't have to take all of it from medicine. i couldn't stop myself. she chose medicine. she drove gloria into houston. gloria's application for charity care was rejected by the md anderson cancer center. gloria told jacqueline to trust in god. faith is a must, jacqueline told

me. the worst day came when they were trying to figure out if gloria could move to houston, take an address in hewitt to get indigent care coverage under the hospital district. but gloria had nothing, no bills no paystubs, nothing that showed her address at all. main we can get you in a study, the doctor at sin vincent said, lightly patting gloria's back. jacqueline translated and gloria burst into tears. are you telling me i won't get care? i'm not sure i want to go on. want to go back to el salvador to be with my family. i want to go back to el salvador to die. jacqueline went home and felt guilt but lick a miracle, the answer came the very next day. floarea called jacqueline on her cell phone. thanks in large part to jacqueline's advocacy si, gloria had been accepted to houston

methodist for charity care. she would be treated in a few weeks. she went on the floor and jacqueline went again. gloria would stay and live. sometimes medical students and doctors do get too involved with our patients. sometimes we sacrifice our family lives, our art, the things that keep us human, but sometimes when you push and push and push, and you don't give up, you become one of a doctor who can think of nothing else, you actually save your patients' lives. jacqueline and gloria still talk on the phone sometimes. even now that gloria has her own doctors and no longer needs to come to st. vincent, gloria prays for jacqueline, and jacqueline meditates. medication doesn't feel quite full enough, to though. and sometimees the prays in a vague, earnest way. she's not quite sure whom she is

praying to but sometimes she just needs to pray. [applause] >> thank you so much. if y'all have questions i'd love to chat with you. >> margaret? >> thank you for the reading. why do you think it is that people need to hear stories that turn out well and have such a hard time tolerating hearing stories that haven't dead endings? >> that's such a good question. actually i've noticed on this -- as the book has started moving out into the world, i get asked

to tell the miracle stories, and for me the miracle stories are thester of routine care, where a baby is born and they do fine, where somebody's blood pressure is completely controlled and they don't have a stroke. i think that there is a healing power in the stories of suffering. i think that people who struggle with the healthcare system, who have been denied access to care, need hear of those stories and be reassured their experience is real. that suffering happened and not -- can be put into words. at the same time, we all have to hope, myself as much as anybody,

and in contemplating the whole situation i found myself saying, over and over, there's so much good in the affordable care act that we can build on. right? there's so much we should be proud of. and i myself, even having been through experiences like this and carrying for folks in rough situations, turn towards those over and over. i think it's human. >> considering the current heated, insane political climate, where liberal versus conservative is like clashing into n a way it has not in a long time, and the healthcare

issue, what are we going to do as a country, is up there, people who are pro life or pro choice are more adamant than ever in their discourse. are you concerned or have you yet caught any flak for your sort of -- you want everybody to have care, and specifically you are pro choice, and you have worked in an abortion clinic and all these things. are you experiencing -- are you worried about experiencing any flak? >> that's also a very good question. i do write in the book about working in an abortion clinic and share stories about women

who got care there, and i try to do it in a way that feels real to me because i don't identify particularly with either side of the political debate. what you see as a provider is women who are struggling and women for whom that kind of care is painful and difficult and challenging. i think i probably will be trolled on twitter by some people, and that is happening already a little bit and that's okay. sometimes you have to speak out about things. i think the thing i was most worried about actually getting pushback about what none of the overall charges the book makes, which is medical -- preying on the poor and mind of color and

that mean wiz learn from those communities, that means we make our mistakes on those communities and that means that when i now see a private doctor, with my wonderful private insurance, i see a doctor who made her mistakes on the poor, and i think that's hard for docs to face honestly because we think of charity work and we think of working in public hospitals as something that makes us good, something that ensure we are moral. it's a lot harder to think about the ways we benefit from a system that denies care to some americans, so that it's harder to think about the fact that i trained seeing people who would have preferred to see a doc but because they were denied

comprehensive care they had to see me. i had a very gentle and generous intellectual home for a long time, but a lot of the graduate -- speak out on the hard truths. but the docs who don't have that space and time and gentleness, those hard truths are hard to look at. >> that was beautiful. i'm curious as the book is out there, have you reconnect with anybody that the part of the story, whether it's a patient or cowork center. >> yeah. that's actually been one of the great joys of the book getting out there, doctor campbell was good friend of mine and she invited my to galveston to read from the book, which was lovely. especially because the book -- you know, critical of policies

at ucmb but the community has been really helpful and generous with their response. i think most of the doctors there are mission-oriented people who are deeply dedicated to the care of the most vulnerable, and themselves feel a lot of pain about the policies that fake -- affect so many. also been in touch with a couple of patients and just been one of the great joys of writing the book. there's a patient -- just such a cool person. in the book i just write how she evacuated from hurricane ike with all of her animals and it's like dogs, cats, a macau, some abandoned baby squirrel she found, a whole lot of animals.

she is just like such a tender-hearteddadey and she told me -- feels really nice to know you told someone's story in way they recognize it and felt true to them. >> what will your relationship be like with utmb in the future? are you going to work on changing something together? >> that's such good question. i hope my relationship will be one where i'm a pediatrician there. but who knows. that is, again, super reassuring and gratifying and -- about possible utmb responded because there's obviously, like it's not a surprise to them it came after

some articles that came out of a lot of pain from not being able to get my patients what they needed. and what i see there is doctors and nurses and -- everybody really wanting to do their best at feeling -- but feeling themselves stuck in the system. it wasn't utmb per se. it was the state, texas not extending medicaid. like 18 other states. it was deliberate denial of resources to vulnerable communities at a state level, and then there's the doctor component which you can't overlook. so i tried to be fair to utmb, and it's a place i love, that

i -- before i became who i am, and i think i'm all right. so, i really hope it's ongoing conversation with them. >> yes. well, turned 80 in december so i've been doing a lot of thinking about death and dying, and it's my observation that those people who are able to get palliative care and/or hospice care, who truly believe that they will be reunited with their loved ones, who have passed on before them, or go to heaven and meet jesus or meet god, those people who truly believe that, i think it's a lot easier but for those people like me who believe that after death, it's just oblivion, like it was before i

was born, the thought of death is a very frightening experience. >> boy, i am with you on that. find it very frightening, and susan became a palliative care doc as well as a surgeon, and she got the palliative doctor about doing a fellowship because some of her patients dieter died. she never thought that was an company thing ship thought every patient should have a chance to try to live and that their preventible death was a tragedy. i do not know what lies beyond this life, but i certainly want to make the effort to try to make as much meaning as i can while we're here because whatever is after is, if anything, this is finite and it's very beautiful stuff, and

happy birthday. >> that was in december. >> well, still happy birthday. >> i was curious when you got asked the question about the political divide, if you would be willing to talk about your experience talking with more conservative folks on your am radio tour. >> thank you so much. the am raid your tour hand been a source of constant delight. eve enjoyed it so much. think it works because i'm a carpenter's doctor from a small town in texas, right? so the book puts forth -- it's not explicitly here's what we need to do politically but the arguments are from my bleeding liberal heart. and i have been really delighted

to find that folks across the political speck truck president -- spectrum pretty much believe everybody deserves to the a doctor whole they're ill, suffering, or worried about their kid. have been asked some -- what i would characterize as whack whack-a-doo questions. when that comes up you acknowledge the question and talk about access to primary care, which is all you ever have to do, and the am radio tour has been cool because i hear the agency send offered people from across the country talking about issue is loch and care about, and i even got invited to go fishing with the dudes at the radio station in kenai, and i'm going to try to do it. i would love to do that. it's been a pleasure. it's been cool to get out there and talk with other folks.

slow. >> we, thank you for coming out tonight. [applause] >> here's a look at books being published this week: ...

>> should we wait for -- should we sit or should we -- [inaudible conversations] >> welcome, everyone. thank you very much. we're delighted to have you at this event. tonight we're featuring steven sloman, co-author of the new book, "the knowledge illusion: why we never think