Can the Subaltern Speak at the Free Clinic? 

The road to Rowan County curves like a question that never quite gets answered. U.S. 60 eastward, out past where the signs for Lexington give up and the trees get bold again, where the hills start tucking in tight like they're guarding something. It’s a stretch of Kentucky I once knew only in outline – a map memory traced in childhood, shaped by news stories about flooding, addiction, coal, and the long road between my grandparents’ house in Kentucky and our home in West Virginia. But I moved here for medical school, into a program with “Rural” in the name, which in this state means something more complicated than small towns or pickup trucks. It means legacies. It means glaring gaps in care.

When I tell people I’m studying in Morehead, they usually nod like they’ve heard of it – maybe from the college, or the storytelling festival, or that time Kim Davis made national news for opposing marriages like mine. But usually, they don’t really know Morehead. They don’t know the way Main Street smells like bar food and forest breeze by midafternoon, or the way the air stiffens around the VA clinic just up from Triplett Creek. They don’t know the kindnesses – quiet ones – that pass between people who’ve been through some things and don’t make a show of it.

Most Wednesday nights, I drive past the Dollar General and the BP, turn onto Flemingsburg Road, and park behind Gateway House. That’s where the CATS Clinic lives. We call it a clinic, but it’s a couple of packable exam tables, a well-used vitals station, and a set of laptops that work on the hospital network. We’re co-located inside a shelter for people experiencing homelessness – not beside it, not affiliated with it, but inside, intentionally. Built into the same space where housing is not a guarantee – because that’s where care belongs. That part matters. There’s no hallway buffer between “patient” and “resident,” no white-walled neutrality. When you’re here, you’re with people, not above them.

The first time I met Glory, she was holding her toddler on one hip and trying to keep him from licking the doorframe. I remember thinking: There’s something radiant about her. Her posture was tired, sure, but proud in a way you don’t often see from someone three months out from a psych admission.

“Can I come back here?” she asked me when I brought her a new WIC form.

“You mean like next week?” I said, not sure what she meant.

“I mean, like, again. Y’all are good people.”

Glory was 23. Black. A single mom with a son named Kayon who had a developmental delay – speech at least, maybe global. The paperwork was a mess. He was eighteen months but hadn’t yet said “mama.” He loved stacking the tongue depressors we kept on the side table. Glory had tried to take her life the winter before, when the baby was sick and she’d been living in a Nissan with no heat. She told me this the way someone else might mention a grocery run – factually, but with distance. Like she had walked out of a burning house and didn’t want to look back too long.

“Nobody ever told me I was allowed to feel done,” she said. “I thought you had to keep going till you dropped.”

I didn’t have the right words for that—none of the ones I’d studied, anyway. Medical school had taught me how to chase lab values, how to find a swollen spleen, how to translate symptoms into diagnoses. Still, I knew enough to stay in the room. To tell her I was glad she had kept going and got the help she needed when life stretched her so thin there could be no stretching further. To ask, gently, if she wanted me to check on her son’s Medicaid referral.

Out here, medicine looks different. It’s not just listening to lungs and writing notes. It’s pulling double duty as social worker, therapist, and sometimes just someone who sits down and listens without a clipboard. It's handing out Pedialyte and Tylenol and a flyer for free pediatric dental at the health department. It’s knowing that your patient’s chief complaint – “sick” – might mean anything from depression to hunger to custody court.

We don’t wear white coats at CATS. Not because it’s policy, but because it would feel like dressing up to play doctor in a place where what people want is help, not hierarchy. There’s a kind of honesty in a folded-up card table and a donated blood pressure cuff. I’ve come to love the lack of polish. It reminds me that trust isn’t built with gloss. It’s built with time, with follow-through, with being there again next week like you said you would be.

Glory came back. Every week, for a while. Sometimes to pick up a prescription we could finally fill, sometimes just to talk. Once she brought me a cookie from Root-a-Bakers and said, “I figured you hadn’t eaten.” She was right. I’d skipped lunch that day because we were backed up with patient intakes.

We always sat in the lobby to do triage, and Kayon played with a plastic dump truck someone had donated. She told me about her old job at the Hardee’s in next town over and how she wanted to go back to school but didn’t know where to start.

“Folks look at me like I should be grateful for what I got,” she said one day, “but what I got ain’t where I’m meant to end.”

She said it with no bitterness, only a deep sense of direction.

I think about that sentence a lot.

What I’ve learned in Eastern Kentucky wasn’t printed in my syllabus. It came from people like Glory, from the way she could make you feel like the sun was trying again, even on a cold Wednesday night. It came from conversations over clipboards, from watching Kayon grow more curious, from learning how to say, "I don’t know," in a way that built trust instead of eroding it.

I came into medicine with a background in public health, in research, in big-picture thinking. But out here, the picture’s made of faces. Of people who might be counted as outliers in a dataset, but who are the very center of the story when you sit with them long enough. In Morehead, I’m learning how to practice a kind of medicine that doesn’t always have a billing code. Where the most important work might be a bus pass. A call to a case manager. A moment of shared quiet when someone tells you they’ve survived something you can’t fully understand.

I think about Glory when we talk about “compliance” in class. About “non-adherence” and “health literacy.” I think about the impossible calculus she performs each day – balancing Kayon’s therapies with a job search, housing applications, and the specter of returning to drug use. She isn’t failing the system. The system just never showed up for her in the first place.

Sometimes I wonder who gets to be heard in medicine – not just listened to but understood on their own terms. Spivak’s question, the question we’re rarely asked, but should be, echoes in my mind: Can the subaltern speak? Not always in the rooms where decisions are made. But in places like the clinic inside the shelter – if we stop narrating over them, if we stay quiet long enough – they already are speaking. And yet, I am the one writing this essay. And you are the one reading this essay.

What stays with me is the way Glory said goodbye the last time I saw her – Kayon's hand in hers, her other hand resting on the doorknob like she was holding two futures at once.

“You’re gonna be a good one,” she said.

I hope she meant doctor. But maybe she meant something else. In that moment, I’m not sure it mattered. She was speaking. Whether I’ve truly heard her – that’s the work ahead.