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.