For 20 years, Dr. Patricia Kullberg was the medical director for the Multnomah County Health Department. She worked directly with those living on Portland’s utmost margins: undocumented people, people dealing with abuse, living with mental illness and experiencing homelessness.
Now retired from the health profession, she published a book in August about a girl fleeing to Portland from her small Oregon hometown. She is forced to seek shelter under a bridge, in a shantytown, under the wing of a deceptive pimp and eventually in the sex trade – living the reality of many of the people Kullberg met in her clinic. The difference is her novel, “Girl in the River,” is set in the mid-20th century, in the heyday of rampant police and government corruption and of the famous abortionist Ruth Barnett.
For almost 50 years, women in need of abortion services traveled from rural communities in Oregon, California, Washington and Idaho to access Ruth Barnett’s hygienic, skilled and illegal services.
But while law enforcement looked the other way during World War II, the sociopolitical economy of the postwar era required women to leave the workforce and return to the home, freeing up jobs for veterans and cementing the U.S.’s vision of the nuclear family. And with this tightening of morals and increased control of women’s independence came Barnett’s arrest and the end of her practice.
Kullberg, a Portland native, is fascinated by stories like Barnett’s and other aspects of Portland’s history that have been underrepresented. Through this historical lens, she tells stories that continue to ring true today – stories of homelessness, desperation, the necessity for reproductive rights and the many barriers women face in achieving independence and success.
In addition to “Girl in the River,” she has written one unpublished work, “Out of the Iron Lung,” and is working on a fictional work about Vanport, Portland’s public housing project that was destroyed by flood in 1948. This new novel will deal with health care services, racism, women’s issues, political conflicts, wartime and postwar life.
Kullberg has also written for numerous news publications, sometimes operates the board at KBOO FM community radio, and facilitates writing workshops with Write Around Portland at Coffee Creek Correctional Facility.
Sarah Hansell: Your career as the medical director is quite different from the path of a fiction writer. What inspired you to start writing?
Patricia Kullberg: I mostly started writing because it was a way to work out the troubling things that happened mostly in my medical practice. Coming to terms with things that didn’t go the way you wanted it to go, which often happens in medicine. And then I would write about those things and use that as a way to understand them, and delve into them and kind of settle them in my mind.
S.H.: You use fiction to draw on your own experiences and the experiences you witnessed as a medical director. Are there any specific experiences that stand out to you, ones that were especially troubling that you really needed to work through with fictional writing?
P.K.: Well, a couple things. One is, just to back up a little bit maybe, is that medicine is really about telling stories. It’s basic to the enterprise of what I think of as the encounter between a practitioner and a patient — that duality, that pair. And it’s about coming to an agreement about what the story is here. That’s the first thing that you have to do: You have to get the patient’s story and you have to reframe that, or rework it, within the paradigm of medicine, and then tell it back to the patient in terms of how you understand it. And you can’t really get to first base in terms of crafting a plan to go forward to help this person until the person and you have a story that you agree on.
I think in terms of going to my fiction, I think the thing that probably inspired me most was the population that I was taking care of in the clinic. You know, this was at Burnside Health Center first, and then Westside, and these are all downtown. I saw a lot of people living on the streets, a lot of people with chronic mental illness, with addictive disorders. I saw a lot of undocumented (people). I saw immigrants and refugees, people with disabilities.
But particularly the people who were really kind of at the bottom of the heap, if you will, they’re people who are surviving on the streets. I came to have a tremendous amount of respect for those folks and their resourcefulness, and their resilience, and their lack of self-pity – for the most part – their acceptance, often, and their ability to just deal with things and come back. Most of these people never ever had a chance.
When you see what I saw in my practice, there were not a ton of working-class or upper middle-class people who’d fallen. It was usually people who came out of poverty who never really had much of a chance at life, and had been kind of hardscrabble all their lives. If it was people who came out of wealthier backgrounds, it was usually because they had bad mental illness of some sort or another. I think I tried to recreate some of those characters and those characteristics in my novel, and in other fiction pieces that I’ve written. Because I find them so interesting and fascinating.
S.H.: In “Girl in the River,” Mae is temporarily homeless. So, how have your own experience working with people experiencing homelessness informed your depiction of Mae’s struggles?
P.K.: Women being preyed upon in the streets is very, very common. And I would encounter it all the time in the practice. Women who would hook up with men, either pimps – not always pimps – but men who would protect them and with whom they would enter into a kind of contract, providing sexual favors and companionship in exchange for safety. A woman by herself on the street does not do well, and she really needs to hook up with someone. And that’s usually a guy.
It’s often, for the women in particular, a relationship of convenience. They endure a lot. There’s a lot of abuse of women that goes on in the streets. When you’re with a guy on the streets and he’s abusing you, but he’s your source of protection from other men who would abuse you, it puts you in a very tough spot. I would witness these dynamics a lot.
S.H.: Planned Parenthood and reproductive rights are being attacked by anti-abortion advocates and legislators, and Dr. Barnett is similarly attacked for providing these services, by law enforcement and by the media. So, how have things changed and how have things stayed the same?
P.K.: During Dr. Barnett’s heyday, of course, abortion was completely illegal, although a white upper-class woman could always get an abortion, and always will be able to get an abortion. And that will likely never change. But even though it was nominally illegal, the practice flourished, particularly in Portland.
And today you have something that’s nominally legal and highly standard, and particularly in Portland, fairly accessible. But you have this eating away at it at the margins. So for women in rural communities it becomes less accessible. For women of color it becomes less accessible, primarily because they tend to live more in poverty. You have these restrictions that chip away at what should be a legal activity. So in a way, the accessibility, for some women, is less than it was at those times.
S.H.: Why are women’s sexual health and reproductive rights so important to you?
P.K.: I had a lot more female patients than my male colleagues sometimes. And I think that range of issues is so fundamental to the basic health of a woman and is so fundamental to her well-being and to her relationships in a way they aren’t for men. I mean, when you talk about childbearing and control over your own reproduction, and what that means for your life and your relationships, it’s just a very different story for women than it is for men.
S.H.: Besides your work as a fiction writer, you also serve as a workshop facilitator for Write Around Portland at the Coffee Creek Correctional Facility. Tell me about your experiences working with people who are currently incarcerated and why this is something that’s important to you.
P.K.: Writing is a really powerful tool for looking inward and examining your life, as well as for looking outward. But in terms of sort of personal growth and development, and also for building community and bringing people together around writing, it’s a very powerful tool. When I became involved with them I sort of gravitated toward working in corrections partly because not very many people want to go into a prison. People are intimidated by it.
I had done some medical work in the jail as part of my job at the county. And I didn’t have an issue with that, and I certainly didn’t have an issue working with people who were incarcerated. I found that working with the women at Coffee Creek, you know, these were basically the same women with the same issues, the same fears and concerns and hopes and desires as the women I worked with in the clinic. Except now it was a lot more fun because we were doing writing instead of working on health issues.
I think the one thing that bothers me a little bit about working in that environment is that the whole recovery process within a prison setting – at least down at Coffee Creek – is really focused on people looking inward to solve their problems, to make different choices, to become better people somehow in the world, without any kind of – or very little, that I could tell – acknowledgment of the extremely difficult circumstances these women find themselves in and the precipitance of their criminal activity, which is so often poverty and abuse.
They may come out of prison being able to make better choices and being stronger and more resolute or having a better, repaired relationship with their family or communities but they’re still going to be thrown back into poverty. Some of those same issues are going to come up. It feels like it’s that classic trying to fix the society by fixing the victims. It just isn’t a good long-term strategy.