Note: Some details have been altered or omitted for patient privacy.
Port Aransas, my hometown, is so small that one day the local Rotary Club just called me up to ask if I wanted to be an exchange student. I was sixteen. They bought me a ticket to Spain, gave me fifty Texas flag lapel pins to share with the Spaniards, and sent me off for a year. Only later did I learn that this is a rare gift for a carpenter’s daughter from an island off the coast of Texas. At the time, it simply seemed natural, as if the life that fit me perfectly had finally begun.
During that year in Spain, I began to write for the public. Specifically, I wrote for the reading public of Port Aransas by way of a regular column in the weekly Port Aransas South Jetty. When, in Madrid, I hauled my suitcase up the stairs after my very first subway ride and nearly got hit by a taxi; when I saw a stranger’s testicles through crystalline seawater at a nude beach; when I ate a pig’s ear—all these wonders became stories to tell my hometown.
Through the column, I stayed connected to Port Aransas. Along with my fellow writers Francois Zen Monk Poet, Tony Amos, and Taddy McAllister, I became a shaper of the Port Aransas discourse. Francois Zen Monk Poet lived in a wrecked boat way down the island, and he would mail his handwritten poetry to the Jetty. Tony Amos rescued sea turtles and documented the trash that washed up on nearby islands. Taddy McAllister wrote scathing letters to the editor on local and national politics, signing each with her name and her three cities of residence (Port Aransas, San Antonio, and Washington, D.C.).
Francois Zen Monk Poet seems to have died, but the rest of us are still writing. In fact, I kept writing that column for twelve years. I wrote through college, through a long romance with a British man that carried me all over the world, through the deaths of both my and my brother’s childhood dogs.
Then came medical school. When I decided to train as a physician, other writers (and even some doctors) warned me against making such a move. They said I wouldn’t have time to write. That I would lose my creativity and begin to think only in algorithms. That I would no longer see people as people—I would see them as bodies, and a body as nothing more than a collection of parts.
My first act as a medical student was to receive my white coat, in a ceremony that my parents attended. My father, who was so proud of me, wore his nicest cowboy boots, and they pinched his toes so badly that he hobbled. It still hurts to remember him dressed in strange clothes and limping along the Galveston sidewalk. He served a brisket in the yard of my house that evening to celebrate.
My second act as a medical student was to dissect a human body. Anatomy lab trained me to do the very thing that I had been warned against: to see people as objects.
To write honestly about anatomy lab is always to betray medicine. If people knew how completely we chop and saw and scrape apart those bodies, few would choose to donate theirs to science, but good medical education depends on those donations. So I did write about it for the Jetty. But my piece was strained, and a bit saccharine. I didn’t want my hometown readers to know what I was really doing.
It was when I started taking care of patients as a third-year student that I finally gave up my column. By then, all the best stories I knew were hospital stories. And I had no right to violate my patients’ privacy, and was too shy to ask their permission.
Furthermore, medical school was changing how I saw myself: what I once would have accepted in myself as quirks now seemed like flaws. An uptight hospital administrator set up a broad desk in my subconscious, tallying these flaws until the accumulated evidence would prove I was unfit for the profession. Writing honestly would reveal far too much. I was not, in fact, a perfect, professional doctor but an imperfect woman with an ill-behaved Labrador and a Honda so messy that I once had to roach-bomb it. I wasn’t going to quit medicine, so I quit writing.
During my training, I found that the skills I had begun to learn in anatomy lab would serve me well. I could laser-focus on a single problem during surgery. I could feel my way through the living muscles of a person with a shoulder injury to tell exactly what body part was causing the pain. I didn’t always zoom back out and get to know the person as a person, but often the patient didn’t need that from me. My role in his or her life was limited. I was just a medical student.
Needless to say, when I stopped writing for the Port Aransas South Jetty, I fell out of touch with my hometown. But then, in the final year of my absurd seven-year M.D./Ph.D. training, I went home for an extended stay. Specifically, I went to live in the lower level of my parents’ house, in an enclosed bedroom among the creosote-soaked pilings that would hold the rest of the house above flood level in the event of a hurricane. For four weeks, I would train in the office of Bruce Russell, a family doctor who had moved to Port Aransas several years earlier.
I was, at this point in my life, 32 and recently divorced. My brief and unfortunate marriage had failed to produce the grandchild that my parents coveted. I felt, in Port Aransas terms, like a successful failure: a bright young woman who had succeeded in her career but who had proved unable to sustain a marriage or bear a child. I hauled my two bags into the downstairs bedroom, had a brief cry on the bed that was already sandy despite my mother’s best efforts, and prepared to avoid everybody’s questions.
Small-town people tend to be suspicious of our doctors. We assume that anybody who gets sent off to work in a little town must have been banished from a city hospital. I remember thinking this myself: if he has to work in Port Aransas, he must be a quack.
Dr. Russell’s office is among a cluster of shops on Cut-Off Road. He chose that location because of its proximity to his home and to the water: he can walk there from his house, and then for lunch, he can walk over to Taqueria San Juan, and after work he and his wife, Janey, can walk on the beach.
On my first day, I was delighted to join the rest of the team for lunch at the restaurant that the locals call Juan’s. My brother and I used to get breakfast tacos at Juan’s after early surf sessions, and once we saw a police officer there, alone, eating a large bowl of guacamole with a spoon. It was the lonesomest thing I ever saw.
During lunch, Juan himself—the proprietor—came over to say hello to Dr. Russell. Their conversation didn’t get medical, but often enough, Dr. Russell explained to me, such conversations did. People would stop him in the grocery store and ask for prescription refills, or catch up with him on the beach to see if their blood tests had come back. To some patients, he was always a doctor no matter where he was. To others—those he knew as friends—he was always Bruce, even in the exam room.
Yet he didn’t seem to mind the town’s scrutiny too much. If he’d ever had a judgmental hospital administrator lodged in his subconscious, that guy had long since retired.
It turned out that, in Dr. Russell’s office, I was also Rachel—not just a medical student, but that gal who used to write for the Jetty. Patient after patient recognized me, got up to hug me, asked after my family. These folks knew me: they remembered the time I got smacked in the face with a basketball and my braces stuck to my lip, and they recalled my epic tale of the mango harvest in Mexico. They knew I had roach-bombed my car! Even so, they allowed me to help with their medical care. I had never felt so completely known, and so accepted, in my life.
As a kid in a small town, you see a lot of the grown-ups as distant legends: that couple that runs the shrimp boat, that guy who got injured in Vietnam and now picks up litter and flashes the peace sign, that Zen monk poet who lives in the shipwreck. In the doctor’s office, many of my childhood legends couldn’t remain so distant and legendary. I had to really look at them and get to know the problems they hoped most of the world wouldn’t see.
At some point in every visit, Dr. Russell would say, “We’ll get you taken care of.” And I came to believe that statement absolutely. Dr. Russell was not, in fact, a quack. He had been a national leader in family medicine as a program director at Georgetown University. Working with him, I learned that a few of my childhood legends had serious pathologies—advanced autoimmune disease, complicated diabetes, a dizzying array of illnesses. I would go home to my parents’ basement and marvel at something I had never realized: people in my hometown were really suffering. They were sick.
My last week with Dr. Russell, I walked into an exam room to find a lady I’d been familiar with since I was small—one of those characters from childhood, one of those legends. She stood up gingerly, leaning on one leg, and we hugged. Then I crouched on the floor to take off her shoes, as you do when your patient is having some pain and can’t move around as well as you can.
There, under her sock, was the wound I was afraid of: a diabetic ulcer, red and oozing, the harbinger of a future amputation.
“I knew it was there,” she said. “But I can’t feel it very much, and I can’t see it. Is it bad?”
Tears had come to my eyes. I knew we would have to send her for an X-ray. I knew that if that X-ray showed infection in the bone, she might lose her foot. And I knew I would never again see her with the same comfortable distance of legend.
I had seen this problem dozens of times before, but in that office in Port Aransas, it was impossible for me to see it as only a medical problem, or to imagine this friend of mine as only a foot, a body in parts. Small-town medicine simply does not permit it.
“I can tell,” she said, “from your face.”
She smiled at me, generously, trying to help me feel better. I got up and sat next to her for a minute and squeezed her hand.
“Let me get Dr. Russell,” I said. “We’ll get you taken care of.”
Rachel Pearson is a resident physician in Washington State and the author of No Apparent Distress: A Doctor’s Coming-of-Age on the Front Lines of American Medicine.