Out of Patients by Sandra Cavallo Miller (Fiction)

Story: 4/5 Characters: 5/5 Writing: 4/5 Enjoyment: 5/5

Norah is the tending-toward-cynical but unfailingly caring and dedicated family practice doctor in the Arizona desert. In her 50s, she thinks of retirement almost every day, but can’t get herself to pull the trigger.

With a jaded but humorous and never bitter tone, Miller brings to life the modern family doctor. Forget Marcus Welby, Norah and her colleagues are beset with endless regulations, condescending specialists, arrogant medical students, health insurance battles, and a plethora of patients who don’t always (ie hardly ever) advance their own cause. On top of this, the practice seems to be losing money despite a full waiting room, and someone is leaving nasty-notes on car windshields. Norah had to kick her do-nothing boyfriend of three years out of the house for … continuing to do nothing, and she has nearly daily calls with (possibly my favorite character) her 86-year old mother who has a crush on the elderly, but well-built mailman and gives detailed instructions on what to do if she doesn’t answer the phone (wait several days to make sure she is dead!). While too grumpy to even consider dating, Norah does come across some potential love interests — an even grumpier vet and a shy radiologist who suffers at her side during endless student admissions committee meetings .

I loved the tone, loved the characters, and appreciated the peek into a real doctor’s life by someone who a) has lived through it themselves and b) translates her knowledge into a highly self-aware and comical story. Some very interesting medical tidbits and asides as well…

Some good quotes:
“To give your life more purpose, for what that’s worth. I’m not sure anyone has ever convincingly proved that human life actually has a purpose. Evolution just does its thing. Sunrise, sunset.”

“I guess when your spirit pales to a washed-out shadow, you grow tentative.”

“Once upon a time we became physicians, but now we also must perform as secretaries and transcriptionists and file clerks and coding authorities and billing experts ad regulations enforcers.”

“And I wondered how anyone can eat baloney, that mash of pig snouts and ears and genitals. You can feel gritty little bits of bone.”

“That made me sad, but why should it? Why should I impose my arduous overdrive, my endless quests, on a quietly contented person?”

“No, apparently my ego needed to analyze and try to fix them. Make a difference in their lives. Maybe I worried that my failure with Grace, a previous student, might repeat itself. I may have mentioned how doctors often obsess about doing things right.”

“Nobody listens. Sometimes I feel like a tiny squeaky voice in a wind tunnel, about to be blown away.”

“And even before I say this next sentence, I’m aware it isn’t fair, because I know tons of great physician men, smart and intuitive, generous and wise. But between Jeremy Newell and Carter Billings, I’d drink my fill of medical males that day.”

“A long afternoon, but mostly rewarding. Nothing easy, nothing cut and dried. Everyone needed to talk. Mostly good patients, all with real problems. No one surly or defiant, no one acting like I owed them good health because they demanded it, no matter how unwilling they might be to earn it. Every now and then those petulant people stayed home and I felt in my element, listening, sorting, treating. Come on, Norah, I told myself, settling in with my charts after everyone had gone.”

“What would fix me would be better healthcare systems, not spending hours grappling with a convoluted computer program. Where I got more than ten minutes with an addict. Consistent medical billing and affordable insulin. Free insulin, Where medical students didn’t lose their glittering idealism in a few short years, while a handful of ego-besotted attending physicians badgered them into despondency. Until some students lost themselves under the crushing demise of their dream. The statistics on physician suicide are dreadful — every day, at least one physician or medical student is lost forever. What an unforgivable waste.”

Thank you to University of Nevada Press and NetGalley for providing an advance copy of this book in exchange for my honest review. The book will be published on August 16th, 2022.

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