Heart in the Right Place

/ posted in: Book ReviewReading Heart in the Right PlaceHeart in the Right Place by Carolyn Jourdan
on June 15th 2007
Pages: 304
Genres: Nonfiction, Personal Memoirs
Published by Algonquin Books
Format: Hardcover
Source: Library
Setting: Tennessee

Carolyn Jourdan had it all: the Mercedes Benz, the fancy soirees, the best clothes. She moved in the most exclusive circles in Washington, D.C., rubbed elbows with big politicians, and worked on Capitol Hill. As far as she was concerned, she was changing the world.
And then her mother had a heart attack. Carolyn came home to help her father with his rural medical practice in the Tennessee mountains. She'd fill in for a few days as the receptionist until her mother could return to work. Or so she thought. But days turned into weeks.
Her job now included following hazmat regulations for cleaning up bodily fluids; maintaining composure when confronted with a splinter the size of a steak knife; distinguishing between a "pain," a "strain," and a "sprain" on indecipherable Medicare forms; and tending to the loquacious Miss Hiawatha, whose daily doctor visits were never billed.


At first glance this is a funny memoir of life in a small town medical office.  Stories of men who try to operate on themselves or get injured doing ill advised things abound.  There are also heart breaking stories of the deaths of beloved patients and friends.  If you like stories full of small town characters, this would be a great read for you.

On a deeper level though, I found it quite disturbing.  The author’s father is a doctor.  He has a practice with one nurse and his wife is the receptionist/office manager.  His wife is unpaid for this more than full time job.  She also has a doctorate but has spent her life doing unpaid work to support her husband’s job.  When she gets sick her daughter comes home to take over her job.  Her daughter is a lawyer working for a Senator and is an expert on U.S. nuclear policy.  She gives up that job to become her father’s unpaid helper.  The reason they can’t hire anyone else is that the practice doesn’t make enough money to support a paid receptionist.  So now you have two highly educated women who have given up their careers to support this practice and you are denying a job to a person in the community who could be a fine receptionist if the job was paid.

The reason the practice isn’t making any money is because the patients are too poor to pay for healthcare.  Now we get into the failures of the U.S. health care system.  Unfortunately, that isn’t what people tend to take from memoirs like this.  They see a fine doctor who cares enough not to charge for services if people can’t pay.  That’s admirable but not sustainable.  If you can’t pay to keep the electric on, then the community loses its only health provider. 

(This is a touchy subject for me.  I work in a low cost, walk in veterinary clinic in a poor area.  I am basically living this doctor’s life in the veterinary world but with better staffing and hours.  People come in and regale us with tales of TV shows they’ve seen where the vet cares so much about animals that they don’t charge people.  The implication being that if we do charge, then we don’t care.  We just nod because no one wants an economics lesson or to hear about my massive pay cut to work here or the fact that the owner isn’t getting paid yet because the clinic just opened…)

The answer for communities like this is to find a better way for people to afford health care, not to emulate this model.  It isn’t possible moving forward.  Student debt is too high for newer doctors to be able to afford to live on what a practice like this makes.  I looked at buying a practice like this once.  The vet was making about $100,000 a year being on call 24/7.  I wasn’t willing to do that because that type of stress will kill you and once you figured in paying back a loan to buy the practice and doing some way past due maintenance to the building, I would have almost been paying to work there.  I had been out of school long enough not to have any student loans left.  If I had had the debt of today’s graduates, I could never have even considered it.

So, yeah, the book is cute and funny and sweet as long as you don’t look too closely at why a practice like this is needed.