Two weeks ago, our book was released into the world. I’ll admit, I was a little nervous that this project of two years was leaving the comfort of trusted reviewers and friends for readers across the country. While I was apprehensive about the first negative review or an interview question I couldn’t answer, I was more concerned that simply no one would read it. But two weeks later people are reading it. Friends, colleagues, strangers, and interviewees have read it and responded with thoughtful comments and questions.

At our book release party, someone asked if it was difficult or painful to recount the stories of suffering in our neighborhoods and clinic. I realized as I answered that the process of writing this book has been an outlet for me to address the hardest reality of my job as a health care provider: I haven’t always brought healing. Each story in the book, while carefully tweaked to protect patient identity, is a longer narrative of a person I knew well. When I write I see their faces, remember our conversations, and mourn the pain they experienced. I often find myself feeling like I owe them an apology.

I am sorry to the young man who sat quietly while his brother paced around the room as I delivered the news that he was in renal failure. At barely 20 years old, a congenital renal disorder was the likely culprit and he already needed dialysis. The brothers had fled severe poverty for the chance of work in the U.S. There was no dialysis in their small rural hometown in Mexico and there was no hope for a transplant without legal status in the U.S. Did you survive?  

I am sorry to the gregarious man who brought bear hugs for everyone and wore brightly colored purses and heels to each appointment. We worked on your diabetes and blood pressure control but a stroke took your life. I didn’t think about the impact that discrimination due to sexual identity and race likely had on your life. I was focused on your numbers but you lived with that chronic stress every day.

I am sorry to the teenage girl who told me she was raped by a guy staying at her house. I remember driving you to the ER with your mother because I didn’t think you would get there any other way. She didn’t believe you and she couldn’t risk loosing the only place you had to live. I walked you in and waited until the ER took over but never saw you again. Did you have to go back to that house that night? Are you someplace safe right now? 

I am sorry for all of the patients whom I asked about symptoms but didn’t ask about your housing. I’m sorry for the women who cheerfully talked through their annual check-ups and I never asked you if you were experiencing abuse. I’m sorry for all the ways racism, poverty, oppression, and homelessness have robbed so many of my patients of their health and life.

While I can get better at asking the right questions and connecting my patients to good resources, for each success story there is one marked by pain, loss, and grief. The truth is that no matter how well I do my job, health is shaped outside of the clinic walls.  It’s too late to change the story for some but maybe by sharing these stories we can right a little of that wrong. For me, writing our book was a way of offering solutions to problems I can’t solve in the clinic.

Sometimes in health care running the right lab test uncovers a problem moments before it’s too late. Sometimes the right medication can significantly improve the quality of someone’s life. Sometimes previously untreatable illnesses can be cured. What if the same is true in our neighborhoods? A few new donors keep a local non-profit from downsizing services. Parent advocates increase resources for the local public school. Church members open a free daycare service so single parents can look for jobs. Voters pass an ordinance to increase affordable housing units in their city. You don’t need a clinic to increase the ability for people to live healthy lives.

The book will have its lifespan and the interviews will dwindle but the conversation must keep going. Let’s tell the hard stories. And let’s do something about it.

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