On the Ragged Edge of Medicine

On the Ragged Edge of Medicine: Doctoring Among the Dispossessed

by Patricia Kullberg, MD, MPH

Available at Oregon State University Press


A remarkable account of a shadowed part of Portland that we generally do our best to ignore and forget; a deft and honest account of a doctor’s years among the poor and broken and forgotten of Oregon’s biggest city; an admirably unadorned and un-egotistical book of witness and even celebration of Oregonians dealing with terrible illness, loneliness, and duress.

—Brian Doyle, editor of Portland Magazine and author of the novel Mink River and many other books

“A compelling portrait of working with people whose stories cry out to be told.”

—Paul Collins, author of Not Even Wrong: A Father’s Journey Into the Lost History of Autism and Edgar Allen Poe: The Fever Called Living

On the Ragged Edge of Medicine offers a unique and personal glimpse into a medical practice for the homeless and urban poor in Portland, Oregon. Told through fifteen patient vignettes and drawn from the author’s decades of experience on the front lines, this revealing memoir illuminates the impact of poverty on the delivery of health services and the ways in which people adapt and survive (or don’t survive) in conditions of abuse and deprivation. Kullberg’s stories show the direct and sometimes devastating effects of poverty on personal health, poignantly demonstrating that medicine is as much a social enterprise as a scientific one.

This collection of narratives is filled with questions about the realities people face in their everyday lives and the inadequacies of medicine to remedy them. A life-saving procedure is refused without explanation; an agoraphobic woman suffers silently and fails to cope; an accidental overdose takes another life. Delving into her daily interactions with patients, Kullberg muses on the impact of scarce resources, the ways she managed to succeed, the fall-out of her own mistakes, and the strategies she used to keep her sanity.

Written for anyone interested in the limits and possibilities of medicine within a context of social inequity, On the Ragged Edge of Medicine draws the reader into the big tragedies, small victories, and everyday mishaps of medicine when ministering to the destitute.

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About the Author:

Patricia Kullberg, MD, MPH, served more than two decades as Medical Director at Multnomah County Health Department and primary care doctor for persons living with physical, mental and addiction disorders. She has written award-winning articles about health and medicine, and in 2015 published her first novel, Girl in the River, about the intimate life of a working girl in mid-twentieth century Portland. Kullberg and her husband live in her home town, Portland, Oregon, where she facilitates writing workshops for incarcerated women through Write Around Portland and volunteers as radio engineer at Portland’s community radio station, KBOO.

Dr. Kullberg with patient, Leonard Lewis (photo courtesy of The Oregonian)

Dr. Kullberg with patient, Leonard Lewis (photo courtesy of The Oregonian)

Dr. Kullberg at her retirement visiting with Barry Mattern, whose story is featured in Ragged Edge

Dr. Kullberg at her retirement visiting with Barry Mattern, whose story is featured in Ragged Edge

Start Reading On the Ragged Edge of Medicine

All too often a day at Burnside Health Center would begin with a melancholy tramp through the heart of Portland. I would leave my car in the cool of early morning near the river that slices the city in two. The parking lot spread out in the shadow of the Morrison Bridge, one of ten […]