41 pages • 1 hour read
Rachel PearsonNo Apparent Distress: A Doctor’s Coming of Age on the Front Lines of American Medicine
Nonfiction | Autobiography / Memoir | Adult | Published in 2017A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Themes
Depression in Medical Care Providers
Frank’s suicide does not seem related to his status as a medical student, but when Pearson later presents statistics on the prevalence of depression and suicide among medical students and physicians, the connection is plausible. Male physicians are 1.4 percent more likely than non-physicians to die by suicide. For female physicians, the number is 2.3 percent higher. Pearson writes about the all-consuming nature of medical school and 24-hour trauma shifts as periods that block out the world, including the good things that might bring joy or relieve the pressure of academic of professional expectations.
When Pearson is depressed, it is a profound despair to the point that she doesn't even recognize it as depression. She sees it as an integral part of herself, this lifelong desire to die. She feels “doomed” (93) to be a medical student. Although depression distorts her thinking, she still pushes forward in a field that will require her to be close to death for the entirety of her career. To Pearson, the rigor required for elite medical practice sounds like it must almost exclude other interests, hobbies, and cannot allow for other passions. Her remedy is to encourage physicians to strive to maintain a life outside of work.
Dehumanization in the American Healthcare Industry
The theme of dehumanization first appears in the section about the anatomy lab. Pearson worries that dissecting bodies that were once living people might disturb her. However, she finds that she is fascinated. She can treat the bodies as objects and useful tools that can help her learn. She says that to dissect a body is literally to make the body less sacred—to desecrate it—but it is what is required for her to gain the skills she needs.
Dehumanizing a cadaver to learn, or to override squeamishness, is one thing, but detaching emotionally from living patients under her care is more difficult. Doctors—and particularly cancer doctors—are continually required to give bad news and to be present for people who are desperate, terrified, stricken with pain, and in need of emotional comfort. Pearson believes in comforting patients when she can but is not always sure of how to do it. It is emotionally safer for the doctor to view the patients as subjects, or problems to solve, rather than people, but that makes the patients feel as if they don’t matter.
She reconciles the tension between caring too much and caring too little with the story of Cicero, who managed to literally detach himself from society in order to feel what he needed to as he mourned his daughter. But it was while he was detached—while he was free of human contact—that he did some of his most influential work. Pearson believes a doctor must be able to feel for their patients, and to experience professional dehumanization or detachment at times, to protect themselves and do their best work.
The Responsibility of Doctors and Patient Abandonment
Many of the patients in the stories Pearson tells feel that they don’t matter to the doctors. This is illustrated in the woman in the dermatology lab, who has been on the wrong end of several medical student mistakes: “This is what it’s like when no one gives a shit about you” (206). Many of the poor who come to St. Vincent’s feel that they have been abandoned by the medical system, which ignores them if they are uninsured. Pearson sometimes feels the same way, as does Jacob.
Dr. McCammon is literally forced to abandon her patients, who will die without her, when she is no longer allowed to treat them. She feels as though the medical system as abandoned her as well. She poses the value of a surgeon without a surgery room. The broken system has caused her a crisis of identity.
In a sense, Frank abandons Pearson in medical school when he takes his own life. In turn, when Pearson is too focused on medicine, she realizes that she is abandoning many parts of her life, including romance, writing, and relaxing. In the Epilogue, she realizes that it is part of her job to always be there for those who suffer, and she is committed to non-abandonment as part of her identity.
