she talked about her book at the university bookstore in seattle.

>> ladies and gentlemen, i am tonya and 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 at the bookstore.com or this handy little fire will tell you more information about different events coming up. right now we are so happy to welcome a new northwest author. we will claim her as long as we can. with no apparent distress, here is rachel. mark. >> thank you so much. can you hear me? can you hear me? wonderful. thank you so much for coming up. we are very excited to share the book with you guys and

hear your questions. this is a book i wrote primarily based on experiences i had in medical school, working in texas where i cared for folks in marginalized communities, at a free clinic, at prison clinics, at some border clinics and county hospitals. the expense was eye-opening and life-changing. i'm excited to share a little bit with you tonight. one thing to know about the book as it has this really heavy things. it deals with the problem of lack of access to care and people die due to lack of access to care. at the same time and has

stories about my family and my friends and there are a lot of different tones within the book. i will read from a couple different sections. the 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. >> mrs. bates lives in a tiny town where i did my family medicine rotation. the little town called port davis, and in the story i am riding into town with the family doctor who takes care of patients in that town. people and to fort davis, a little town with 1000 inhabitants nestled near the

mcdonald observatory. the clinic is in a stone building at one end of the town and we walked through the waiting room. after we said hi to everyone they sent me off to see my first patient. two. talk him down for me rachel. he is a rancher in his 60s with a strong arm. i think i tore myself he said, picking up a hay bale. his wife nodded. yes he did she said, down there. i understand, i said. on my surgery rotation i had helped prepare lots of hernias and i learned how too do a good hernia exam. he told me the whole story how he picked up the hapeville and the pain didn't go away. go ahead and put your genes

down and i'll check you for hernia. he shrugged his shoulders and said all right and unbuckled his belt. sure enough, when i press my finger up against the opening of his renal canal and had him cough, yep i said that's a hernia. well heck he said, looking down at his genitals. yep i repeated and i stood up and took my gloves off. well heck she had said, pointing at his genitals, it's broken. yes, ma'am i said, but it's not too broken. we can fix it. thing it to heck he said putting his hands on his hat. i sure as heck hope you can all fix it. that's right she said nodding vigorously. you can go ahead and pull your shorts up. we'll have the doctor come take a look. i went down the doctor and his out office but how is he asked. he has a hernia. he got it from picking up hay bale.

my goodness the doctor said, it's a left-sided indirect hernia. he said you checked in for it? i said i sure did. i did a lot of hernia exams in my surgery rotation. good for you he said blushing a little bit. back in the exam room, he had his pul him pull his jeans down again. yep, that's a hernia. well heck he said he turned to me and said you sure did learn how too do hernia exam. yes or i said, thank you. she did a real good job he said. will thank you all i said. you complete your genes up now he said. i reckon we will schedule from surgery. up in alpine? >> yes. >> well heck and she pointed to his genitals.

will it still work. >> yes, ma'am he said. don't let them for you. it will work. alright then she said. then the doctor kicke kiss them both on the top of the head and they went out. it was great to train at a place where doc cared so much about his patients. :

was hit by a hurricane. it devastated the town and in the aftermath the hospital that had historically been a hospital that cared for alzheimer's are the kind of hospital where she couldn't get care for the patient. the hospital changed very abruptly and stopped doing any

care and the patients that were on the walls of the programs were in four letters that said due to the devastation caused by hurricane ike, doctor susan will no longer be your doctor and that included patients that had cancer, chronic kidney disease, and what happened after hurricane ike very much defined my experience as a student and kind of student that i'm becoming so this story is about the head surgeon and she refused to her abandon her patience and

this is what she did. what is a surgeon without her operating room and wha would dor do when the institution she works for obviously need her help. susan begin t began to find hern answers to the questions her patients were scattered but many would further up the coast. these patients. susan couldn't reach them by telephone to in the weeks after, she began to climb into her volkswagen and drive out to find them and was unaccustomed to the time ike granted her a. sunny and cool the most perfect october.

adult almost driving through the seaside towns listening to variations of the harpsichord. of these towns were intact compared with galveston. the restaurants were open and people have swingsets in their yards. susan would drive to the closest place but if she couldn't find the house she would start asking around corner stores and churches until someone knew where her patients lived. some were in houses and trailers and dirt floors where the only electricity came from an extension cord and running water. they welcomed her in and she began to learn every little house no matter how humble feels just like home.

susan would go through the door of the trailer into someone would offer a cup of tap water. the sickbed often take up the space so afterwards she would be invited. she was conscious of her own competitive golf and it wasn't too shabby to seem doctor lee. oddly her patients didn't see surprised to see her and it was as if they had been sitting at the edge of the bed to walk in there were people at every stage of treatment people that have been just diagnosed and to whom weeks before susan could explain they had a great chance of surviving and there were people with feeding tubes in their stomachs and of those in between some who'd gotten surgery and

some who had not. so what do we want to do, they would ask her, what is the plan. that is when the easy autumn healing became shaky because the truth is susanne didn't know exactly what to do. some of her patients were convinced that it was a temporary thing and that they would take them back as soon as they could. others had already began to seek care elsewhere but still others were sick to do anything at all. she had to tell them it was true she would no longer be able to treat the cancer. patients would ask her what happened if they didn't get care and this is even worse. it's often inexorable if untreated it grows back to an rac suddenly bleed to death and

drowning her blood to put in a tube that would block the blood from going into the lungs. not all those details but the truth you will die if she would say he will die because of this. i know there was a 70% chance but that was with treatment without treatment for mortality rate will be 100%. this is not an easy thing to say and sometimes she failed to talking about the plans with medicaid even when she knew that they were not going to work they were sometimes circuitous seven she forced her to say strongly.

the patients they 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 and sat silently in her car for a few minutes and turned around and drove back to galveston to have the conversation again. still she felt the conversations thaconversationshad to have bee. she couldn't fathom the innocuous language but they deserved to hear it in person and have it play out playing so she returned to their homes and to these impossible conversations. she was in an unfamiliar territory. as a surgeon she had been

trained and even had to tell a patient treatment wasn't working and how facilitation of the disease wasn't sure. many have died because cancer patients do but this felt different. she couldn't blame the cancer itself that humbles all of medicine. the situation felt unnatural and she wasn't sure who to blame. as an employee susan felt implicated in drawled in tears sometimes she blamed herself and felt like a novelty a surgeon that couldn't operate and cancer dr. who couldn't cure and have some idea however she could stand by her patients.

sometimes to wash her hands susan have to begin by washing the dishes in the sink and then putting them away because the patients were alone and sick and things like dishes have been forgotten. of the same old rituals acted out in a trailer park clean hands in vital signs history taking and care sometimes a neighbor's kid with th would bed susan would see them. some did not want her comfort or a doctor that follows the imperative beyond the abandonment they wanted

radiation, chemotherapy and care. they wanted to live. [applause] hell am i doing on time? okay. i'm going to read one more story and this is about a moment when a woman was a volunteer and managed to push until she got care. the volunteer's name was jacqueline and they had already

diagnosed. we often encountered this dilemma that we were able to diagnose patients with cancer but we were not able to get him treatment. so those that can't do chemotherapy you can't do surgery or radiation and when there is not a robust safety net patients die of diseases that are not tradable but this one doesn't end like that. she was raised in texas. jacqueline's parents emigrated from cuba and hers were the family of doctors. her father's father was an optometrist in cuba and they had

a residency to become an american journal practitioner. her own father began an oncologist and her mother wanted to move to port arthur. she had a nanny whom she loved and in the entryway to their house her mother often tells her for all the time in the areas of. a chauffeur ergo there is [inaudible] to bring her north. she worked for a while in a factory in virginia saved money to bring her daughter north. it's a daughter married an american citizen and didn't involve herself much with gloria

certainly not enough to pay for her perverse to come north. as for her husband she moved to galveston to work in a hotel kitchen and made the skin on her hands crack and one day she arrived and met her. cervical cancer is one of the cancers that they've committed to funding diagnosis and treatment for so in general even if we diagnose more, we can get the treatment. gloria was undocumented and latina women and undocumented women and women of the border in

texas are not only more likely to get cervical cancer but more likely to die of it if diagnosed. so it was a dilemma they couldn't get her in the programs that would fund her treatment. so, they started caring for her and this went moving piecemeal to trying to find charity care and jacqueline made sure to be present at each of gloria's appointments. if she was not the one in charge, she would translate. she was holding onto her hands saying may god bless you. meanwhile she was rejected by three hospitals in the area and by the time she was rejected, jacqueline gave her the bad news and is no longer a practicing catholic but sometimes after these encounters, she would call her father.

it will work out. if this doesn't work out, i'm going to need to pray to somebody. as the reactions kept rolling in a begin cooking up more elaborate plans to give her the care she needed. somehow to find the ct scans to find out if she had cancer in the rest of her body. one of them got in th into caser dedicating so much to this one patient. do you think she is trying to play you? when it came back negative showing that it hasn't spread, the same doctor asked why they needed it. she was just grateful to see that the cancer had not invaded glory as organs.

this took time and felt like we were stalling. they always scratched around for someone to offer surgery and chemo. if she had been admitted into the hospital, all of these things, the stands, beginning treatmenscans, beginningtreatmee in a day or two but weeks turn into months and the cancer was growing. over the course of a work day. she doesn't believe in being well-rounded as a doctor. she has the pressure to take medicine as a child, to leave it at the hospital. her father never left his work at the office. he was always on call, always thinking about his patients. jacqueline said, but that is

just the way it is going to be a [inaudible] she chose medicine so the application for charity care was rejected by the cancer center. this is amorphous, she told me. when they were trying to figure out there are no bills, no pay stubs maybe we can get involved in the study.

i'm not sure i want to go on. i want to go back to el salvador to be with my family. she went home but like a miracle they answer came the next day and she called her on her cell phone. thanks in large part to the advocacy correa has been accepted for charity care and would begin the next week. she went on the phone and jacqueline wept again. gloria wouldn't go back to el salvador sometimes they do get involved with our patients and sometimes they sacrifice the things that keep us human.

when you become the effective doctor that can think of nothing else, you actually save your patient's life. jacqueline and gloria still talk on the phone sometimes. she prays for jacqueline and she meditates. it doesn't feel quite old enough and sometimes she prays and isn't quite sure whom she's praying to sometimes she just needs to pray. [applause] thank you so much. if you all have any question i would love to chat.

>> thank you for a lovely reading. why do you think it is people need to hear stories that turn out well and have such a hard time tolerating your own stories [inaudible] that is a good question. i've noticed as the book started moving out into the world i get asked to tell the miracle story and for me they are the stories of routine care where a baby is born and if they do fine.

there is a healing power in the stories of suffering. i think the people that suffer in the health-care system and have been denied access to care need to hear those stories and be sure that their experience is real but it can be put into words. at the same time, we all have to cope. myself as much as anybody. and in compensating the current political situation i found myself saying over and over, there's so much good in the affordable care act that we could build on. there is so much that we should be proud of and i am myself even having been through experiences like this and caring for folks in rough situation turned

towards folks over and over i think it is human. >> considering the current political climate where liberal versus conservative what we are going to do as a country is up there and those that are pro-life and pro-choice and more adamant than ever that you caught any flak you are

pro-choice and you've worked in the clinic and all these things aren't you worried about experiencing any flak? >> that is also a very good question. i do write in the book and to share that story and i try to do that in a story that is real to me because i do not identify with either side of the political debate. what you see as a provider is women that are struggling and for whom that's kind of care is painful and difficult thing.

i think i probably will be told on twitter by some people and that is happening already a little bit and that is okay sometimes you have to speak out about things. the thing that i was most worried about getting pushback was one of several charges that took me. when i now see a private doctor with my wonderful private insurance ica dot her that made her face on and i think it is hard for any to face honestly

working in public hospitals about something that makes us good and ensures that we are moral it's harder to think about the ways that we benefit from the system that denies care if a little harder to think about the fact they would have preferred to see a qualified. it allowed me to gradually speak up on those hard truths but for those that don't have that space and time and gentleness those are hard to look at.

have you reconnected with anybody that is a part of the story. she invited me to galveston to read from the book. they were so critical of the policy but that the community has been really thoughtful and generous. most of the doctors are people who are deeply dedicated to the care and feel themselves a lot of pain about the policies that

have denied the charity care to so many. there is a line in the book. there are the innovative squirrels and she found and a lot of animals. that feels really nice to know they recognize it and it feels true to them. >> what will your relationship be like [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

book in washington, d.c.