the second place prize of $1500 went to classmate, mary sire for her documentary on mandatory minimum sentencing and mass incarceration. there place winner won a prize of $750 for her documentary and gender inequality. there is a honorable mention price for the documentary and the relationship between the police and the media. thank you to all the students who participated in the 2017 student can video competition. go to student can.word. the theme for next year's the constitution you. asking students to choose any provision of the u.s. constitution. create a video illustrating why the provision is important. >> physician, rachel pearson writes about how the u.s.

medical system treats the poor. she tells about her education at medical school in galveston, texas. she talks about her book at university bookstore in seattle. >> is and gentlemen, i'm tonya, i want to thank you for coming in this evening. we have a great lineup of authors throughout the year. we do upwards of 400 events. so new bookstore.com will tell you more information about events coming up.tore.c right now were happy to welcome a new northwest author, will claim her for as long as we can with no apparent distress,

rachel pearson. >> thank you so much. can you hear me? wonderful. thank you for coming out. i'm excited to share the bookk with you. good to hear your questions if you have any. this is a book i wrote primarily based on experiences i had a medical school, working in taxes where i cared for folks and marginalized communities at a prison clinic, and a border clinic in the county hospitals. it was life-changing. i'm excited to share it with you tonight.

one thing to know about the book, deals with really heavy things. it deals with the problem of lack lack of access to care. the same time, and has stories about my family, stories about my friend and there's different tones within the book.t tones so you will hear from a couple of different sections so start off with something that i think is stunning. and then i will read for onene that's a little bit moremo serious. >> this is based in west texas in a tiny town right of my family medicine rotation.

the little town called for davis. the story i'm writing it into the town with the dr. who takes care of patients in that town. there's a little strip of theli town, nestled at the foot of the mountains near the mcdonald conservatory. the clinic is in a stone building at one end of the town. we walked into the waiting room. doctor said hello to everyoner and set me up to see the first patient. mr. house and he said, talk him down for me. talk him down. he was a rancher in his 60s with then skin a strong arms. i think i heard myself picking up the abo. his wife nodded. yes, he did, down there. i understand, i said.

this is bread-and-butter for me. , surgery rotation helped repair hernias and i try to do good hernia examine clinic. he told me the story about how he picked up the hill bill and felt the sudden pain in his groin area that didn't go away. go ahead and pull your genius down and i'll check you for hernia. he shrugged his shoulders said well okay and unbuckled his belt. enough, when i press my finger up against the opening of his canal and had them cough of bolds came down to my fingertip. yes, that's a hernia.eck he s well, heck he said looking down at his genitals. yes, i repeated. i stood up and took my gloves up. well, heck misses house and said. it's broken. >> yes, ma'am i said. but it's not too broken. we can fix it. dang it to heck, mr. house and said putting his hands on his

hip.s i sure is hope you can fix it. that's right the mrs. said. you can play your shorts up, i said will have the dr. take a look. i found the dr. in his office. how's mr. house and he has questioned he has a hernia i said. he got it picking up a hill bill. my goodness the dr. said. it's a left-sided indirect in all hernia i said. you checked in for? i sure did.u i i said. well good for you. blushing a little bit. back in the exam room he had mrs down again and yes, that's a hernia. well hack mr. house and said. he turned to me and said you sure did the how to do a hernia exam. yes, sir he said. thank you.. she did a real good job mr. house and said. yes, she sure did.

well thank you. i said. oh, you complete your genes up now. i reckon we will schedule you for surgery. up and out time. well, hack said mrs. thousand. then she pointed to his genitals. will it still work she asked? yes, ma'am. she said. don't let them fool you. it will work. alright then she said. then doctor kissed them both on the top of the had me steppedf e up. it was really a lovely place to train with the dr. who cared so much about his patients. out there we also checked folks who do not have regular access to primary care so some stories that came out of that experience

-- it wasn't more difficult but i wanted to found out with something like -- i guess the story is more from the heart of the book, so i went to medical school in south texas and an island called -- island in the year before i started mid- school mile and was hit by a hurricane. hurricane ike. in the aftermath of the hurricane the hospital which had historically been a hospital the cared for old comers, the kind words i can texas who couldn't get care for patient could literally buy a bus ticket and go to galveston another get care there.

the hospital changed, very abruptly. we stopped doing any charity care and the patients who are on the roles at galveston were sent form letters that said for example, due to the devastation caused by the hurricane thehe ds dr. susan will no longer be your dr.. that included patients who have cancer, or patients who had chronic disease, patients who had chronic disease. what happened after hurricane ike very much to find my experience as a medical student in the kind of dr. that i wasr becoming. so, this story is about doctor

who is the head head of the cancer surgeon. she refused to abandon her patients when their drop from the role. this is about her and what she did. the institution she works for told her to abandon patients susan began to find her ow answers by driving up the coast. her patients were scattered but many look further up the coast in areas that had not been flooded by ike. these patients to have gotte form letter. susan cannot reach them byd fure telephone, so the weeks after hurricane ike should begin to climb into her volkswagen and drove off to find them. she began to fill it with the

practice of medicine. the weather was beautiful, sunny and cool the most perfect october you could dream of after your son was destroyed. felt like a vacation for a while, leaving the wreckage of galveston behind the drivinger through the seaside towns listening to variations. these towns were startling intact to compare to galveston. the oak trees were alive, the restaurants were open, people have launchers and swing sites in their yard.ns w susan would drive to the nearest point she could find for patients address. if she can up in the house should start asking corner stores and churches until someone new where her patientlyc somewhere in houses, summon trailers, summon garage apartments with dirt floors were

electricity came from an extension cord and running water could be an issue. they. she learned that every little house, no matter how humble cann feel like home. someone would always of her cup of tap water.. the sickbed usually took up most of the space inside so should be asked to sit in the folding chairs out front. she was conscious of our comparative wealth. grateful for her modest car but not too shabby to see doctor lee but wouldn't stick out in any neighborhood. it wasn 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 are people at every stage of treatment, people had just se been diagnosed two weeks before

susan had explained that they had a great chance of surviving. there are people bedridden, with feeding tubes and there's dominic send tracheotomy's into their throat. and then those in between. some surgery already in somewhere not. the so what are we going to do.they would ask? what's our plan? that's when the easy oddly feeling grew grim is shaky. the truth is, she did not know exactly what to do. some of her patients were convinced that the interruption and care was temporary and that you can still take of them back as soon as i could. others have begun to seek care elsewhere. and others were too sick to do anything at all. she had to tell them the truth.e she would no longer be able to treat their cancer. susan's patients would ask whatt happen if they didn't get care. this was even worse, had and that cancer if untreated it can

grow into your brain or the roads into an artery. you can hemorrhage out of your mouth and nose drowned in your blood. susan began forcing herself to tell the truth. not all the details, but the truth. you'll die she would say. you'll die because of this. i know i said he had a 70% chance but that was with treatment.say he will without treatment, your mortality rate within a year will be 100%. this is not 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 those planes were not going to work. e the conversations redact she

would say very strongly, you will die, and that was awful also. it was too much.she forc sometimes the conversation were too long affairs with the patient saying tell me how it is that i'm not going to get care. she would try to repeat it. a time or two she arrived at the house and sat in her car for a few minutes, then turned around a joke back, too heartsick to have the conversation again. so, she felt these conversations had to happen face-to-face. she could not have the form letter, the inaccuracy languag that meant bleeding in suffocation. her patients deserved at the very least to hear it in person, to have it made playing. she returned to the home and had

the impossible conversations. she was an unfamiliar territoryo as a surgeon she had been trained to confront bad diagnoses. she knew how to tell patients treatment wasn't working and hoy to say that a disease cannot be cured. many patients had died before, because cancer patients do, but this felt different. she couldn't blame the cancer itself, the situation felt unnatural when she wasn't sure who to blame. cancer the insurance system, the state, the hurricane, susan fell -- with care. a time she blamed herself. she felt like a useless novelty, surgeon who cannot operate, a cancer dr. who could not cure.

she has some idea however that she can stand by her patients. she could go to the houses, land hands and cover them. she could clean their wounds and write prescriptions for their pain. each encounter began with the washing of hand in some time to wash her hand she had to begin by washing the dishes in the sink and putting them away because her patients were alone and sick. strange as it was, it was deeply familiar. the same old rituals of doctoring acted out in a trailer park outside of beaumont. clean hands, vital signs, history taking care. sometimes a neighbor neighbors kid would be sick and she would see them too. some of her patients did not want this. they don't want her comfort or

the laying on of hands or a dr. who follows the ethical imperative of non- abandonment. they want surgery, radiation, chemotherapy and a cure. they wanted to live.aban [applause] >> how are we on time? i will read one more story. this is about a time when the undocumented lady was super sick and a volunteer managed to push

and push until she got care. the volunteers name is jaclyn. and where i will start in the story, we have already diagnosed for patient gloria was cervical cancer. at the clinic where i worked in galveston we all too often were able to diagnose patients with cancer by getting biopsies and having them read by pathologists. we are not able to get them treatment. so at his free clinic you can to chemotherapy, surgery,o radiation. and when there is not a robust safety net, patients died that are untreatable. but this one doesn't like that,

so bear with me. jaclyn was raised in south texas and gloria was raised in el salvador. jaclyn spirits immigrated from cuba and hers was a family of doctors. her father's father was in ophthalmologist. they repeated a residency in detroit to become a practitioner. jaclyn's own father became an oncologist. her what mother once refused to move to port author because quote, it smelled. jaclyn and the taxes just left. jaclyn had a nanny she loved. in jaclyn's mother often tells her to pray. her father says she will need god is a position. stop living in a world the back lack in white. you'll need god. gloria, the patient had a

husband and's chauffeur in el salvador. after she and her husband both lost their job gloria promised to pay $3000 to bring her north. she worked for a while in a factory in virginia saving enough money to bring her daughter north. the daughter married an daughte imaginary services. certainly not enough to pay for gloria's sons and her brother's to go north. as for his husband she moved to galveston to live with enough you work in a hotel kitchen. she wore gloves that made the skin of her hands cracked. one day she arrived in jaclyn met her. and then there's the part which i'm going to talk a lot about the data around cervical cancer. you may know several cervical cancers one of the cancers there

committed to funding diagnosis and treatment for. so if you're diagnosed you can get treatment. gloria was undocumented. a latina woman and undocumented women and women living on the border in texas are more likely to die of it if they arediagnose diagnose. dilemma t there was a dilemma. because gloria was undocumented we can get it or into any programs that fund her treatment.g was started caring for her. try this meant diagnosis and staging while we tried to find charity care for gloria. the cervical biopsy, jaclyn was

in charge to translate. she held onto jaclyn's hand and her own saying, make a blessing. meanwhile, gloria was rejected by three hospitals in the area by the time she was rejected, jaclyn gave for the bad news.r r jaclyn was no longer practicing catholic, but sometimes after they would encounter should call her father it will work out he was say, this is why you should go to church. this doesn't work out she thought, i'm going to need to pray to somebody. jaclyn and gloria began looking at more elaborate plans to get gloria the cancer help she needed. somehow she just met with $3000 to find out of glory had cancer in the rest of her body.

one of the doctors got on her case for dedicating so much for this one patient. to think she's trying to play you hear this? for what jaclyn thought? the scan came back negative showing the cancer had not spread the same dr. asked why they hadn't needed it? jaclyn was silently grateful to see that it had not abated gloria's organs. it took time and in some ways it felt like we're stalling,,were killing time always scratch run for someone to offer surgery and chemo. if gloria was admitted to a hospital all of these things, the biopsy, the scan in treatment could have been donene in a day or two. weeks turned into months and then two months in the cancer was growing. over the course of a workday jaclyn does not believe in being

well rounded as a dr.. she's under pressure to treat medicine as a job, to leave it at the hospital. her father never left the work at the office, he was always on call thinking about us patients. part of me doesn't want medicine to be what i devry from light. but that's what it's going to be. why is it so bad that i want my life to have meaningful work? some part of me wanted to stop her and tell her life is full of meaning and we don't have to take it all. but i can no more stopper than i could stop myself. she chose medicine. glorious application for charity care was rejected by the cancer center. gloria told jaclyn to trust in god.

the day came in jaclyn and gloria were trying to figure out if they could get coverage under houston hospital district. glory had nothing, no bills, nothing that showed her address at all. maybe we can get you enrolled in the study the dr. said jaclyn translated and gloria burst into tears. are you telling me i won't take care she say? i'm not sure i want to go on. i want to go back to el salvador and be with my family. want to go back there to die. jaclyn went home but like america, the answer came the next day. gloria called jaclyn on her cell phone, thanks in large part to jaclyn's advocacy glory had beec accepted for charity care. should begin treatment next

week. she wept on the phone and jaclyn wept again, gloria would not go back to el salvador, she would stay and live. sometimes medical students and doctors get too involved with their patients. sometimes we sacrifice our family lives, or art, the things that keep us human. but sometimes we push and push and you don't give up. and you become the dr. can think of nothing else and you actually save your patient's life. jaclyn gloria still talk on the phone sometimes. even though glory has her own doctors and no longer needs to come. gloria praised for jaclyn. meditation doesn't feel quite full enough and sometime she prays in a vague, honest way.prn she's not quite sure who she's praying to but sometimes she

just needs to pray. [applause] thank you. if you have questions i would love to chat. >> think you, why do you think it is that people need to hear stories that turn out well? and have such a hard time tolerating stories that have bad ending? that's a good question.es i actually have noticed on this as the book has snowballed, i

confess to tell the miracle stories. for me the miracle stories others stories a routine care. were a baby is born and they do fine. where somebody's blood pressure is imperfectly control and they don't have a stroke. i think there is a healing power in the story of suffering. suffe i think people who struggle with the healthcare system and have been denied access to care need to hear those stories and be reassured their experienceshearo real.s that the suffering happened in matter date can be put into words. at the same time, we all have, myself as much as anybody in

contemplating the current political situation i find myself saying over and over, there's so much good in theuch d affordable care act that we can build on. there's so much that we should be proud of.yself when myself even have been through experiences like this and cared for folks in roughitun situations i turn towards hope over and over. i think it's human. >> considering the currents heated comments saying political climate where liberal versus conservative is flashing in a way that has had a long time healthcare issue what are we

going to do as a country is upae there, people who are pro-life, pro-choice are more adamant than ever in their discourse, are you concerned or have you yet caught any slack for you want everybody to have care and specifically you are pro-choice and you have worked in clinics, are you experiencing, are you worried about experiencing any slack? >> that's a very good question. i do write in the book about working an abortion clinic. and i share the stories of those

who got care there.nd i try to do it in a way that feels real to me because i don't identify politically with either side of the debate. what you see is a provider woman who are struggling and for women who that kind of cares painful and difficult and challenging. i think i probably will be told on twitter by some people, that's happening already a little bit it's okay, sometimes you have to speak out about things. when i was most worried about and getting pushback about was one of the overall charges was that the training on the poor,

whether from those communities, we make our mistakes and that means that when i now see a pria private dr. with my private insurance i'm seeing a dr. who major mistakes. i think that's hard for docs toe face honestly because we think of charity work and we think of working in the public hospital is something that makes us good, something that ensures that we are more open it's harder to think about the way we benefitwe from the system that denies care to some americans. it's harder to think about the fact that i trained seen people who would have preferred to see a fully qualified dr.. but because they were tonight comprehensive care they had to see me.

i had a very gentle and generous intellectual home for a long time in the medical community it allowed me to gradually look up on those hard truths, but for docs who don't have that space and time and gentleness it's hard to look at. >> with the book that's out there have you reconnected witht anybody weather as a patient or co-author? >> that's 11 of the great joys about getting out there, so doctors a friend of mine, and she came from the book and it was lovely especially because the book is critical of policies

that you can be. but the community has been very thoughtful and generous.most of i think most of the doctors there are mission oriented people who are deeply dedicated in themselves feel a lot of pain about the policies that have denied charity care for so many. i've been in touch with patients and that's really been the great joys, there's a woman in the book named vanessa who is a cool person. she has all these animals, dogs, cats, call, some abandoned baby squirrels she found. she told me that -- and that

feels really nice to tell someone story in a way that they recognize it. it feels true to them. >> what will your relationshipbe like in the future. are you going to work on changing something? . . [inaudible] but who knows. what is again super reassuring and gratifying has responded and is not a surprise to them that came after some articles that

came out with a lot of pain from that not being able to get my patients what they needed and what i see there aren't the doctors and nurses and respiratory therapists, everybody wanting to do their best but feeling stuck in a system. it was the state of texas not expanding medicaid. it was a denial of resources to the vulnerable community at a state level and then there's the natural disaster component so i try to be fair.

i feel like it is an ongoing conversation with them. >> they've been thinking of death and dying and it is my observation those people that are able to get care truly believe that they will be reunited with their loved ones who've passed on before then or believe it's a lot easier for those that believe me that after the oblivion like it was before i was born, it is a very

frightening experience. >> i'm with you on that. i find it very frightening. i do not know what lies beyond this life but i'm certainly with you to do as much as we can why we are here because whatever is after this if anything this is finite. and happy birthday.

>> that was in december. [laughter] >> asking the question about the political divide if you would be willing to talk a little bit about your experience and the conservative fold on your radio to her. >> it's been a source of constant delight. from a small town in texas the book puts forth its not explicitly like here's what we need to do politically when they

had been worried about their kids and what i would characterize as these greasy questions that even when that comes up you just acknowledge it and talk about the access to primary care that is all that we have to do. we talk about issues that we we loved and cared aboulove and can got invited to go fishing with the dudes at the radio station and i started to try, i would love to do that.

thank you for coming out

in his book healing children, he writes about his kooky or as a pediatric surgeon and gives advice to parents on how to find the best health care for their children. he recently talked about his book at politics and prose bookstore in washington, d.c.. >> [inaudible conversations] >> if i could have everybody's attention.d have e good evening. i'm the co- owner of politics and prose and on behalf of the entire staff,