Medical memoir dramas, especially those centered in the emergency room (ER), are often met with the anticipation of top-rated medical shows portrayed on TV, in which there is nonstop blood-and-guts action and sizzling tensions between shouting doctors and nurses. In her recently published memoir, The Beauty in Breaking, emergency room physician Michele Harper, MD, brings readers into the reality of her world, one that has meditative pauses between the scalpel and the defibrillator.

BOOKMARK

Title:The Beauty in Breakinge
Authors: Michele Harper, MD
Publisher: Riverhead Books
Publication Date: July 2020
Price: $27.00, hardcover, 304 pages

As chief resident at Lincoln Hospital in the South Bronx and later as ER staff in inner-city hospitals in Philadelphia, Dr. Harper has been knee-deep in life’s worst traumas: gunshot wounds, car crashes, tenement fire victims, and domestic violence.

Yet it is the intimate slow-burn stories about her patients and the lessons shared and learned that give this book its page-turning momentum and human gravitas. Dr. Harper writes in the introduction: “I am the doctor whose palms bolster the head of a 22-year-old man with a gunshot wound to the brain. I support the baby as she takes her first breath outside the womb. I hug the wife whose husband is dying of advanced liver disease…. Most of my job is to keep death at bay. When I’m successful, I send the patient back into the world; when not, I’m there as life passes away.”

Tough Childhood

The Beauty in Breaking is organized into 11 chapters. Aside from Dr. Harper’s own compelling story, each chapter is a case study of a patient encounter in the ER, which run the gamut of experiences when people are seriously injured, both physically and emotionally. Unlike primary care or oncology, the doctor-patient encounter in the ER is transitory, a hands-on meeting in the midst of fear and pain; then it is over.

Dr. Harper shares her own challenges and triumphs. Brought up in Washington, DC in an abusive family, Dr. Harper recalled one of numerous descents into darkness when her teenaged brother was fighting her father to protect her mother. Dr. Harper had no choice but to dial 911 because she did not feel safe.

“The job of my youth had been to get out of that house and out of that life,” Dr. Harper writes. She was bright and ambitious, finally escaping her troubled home in DC for the rarified lecture halls of Harvard University, where she met her husband.

Dr. Harper excelled in medical school, deciding to pursue emergency room medicine as her specialty, due largely to the immediacy of fixing broken bodies. The title of her book is derived from her childhood: “From childhood to now, I have been broken many times.” She also has an affinity for the Japanese art of Kintsukuroi, where one repairs broken pottery by filling in the cracks with gold, silver, and platinum. “The previously broken object is considered more beautiful for its imperfections. In life, too, even greater brilliance can be found after mending,” writes the author.

On Her Own

As medical school graduation approached, Dr. Harper was accepted to join the ER staff at a hospital in central Philadelphia. At last, her dream was materializing, but her celebration was short-lived. Two months before she was scheduled to join the hospital, her husband seemingly out of the blue told her he couldn’t move to Philadelphia with her. Her marriage at an end, Dr. Harper took stock, pulled up stakes, and began her new life as a single woman and a rookie ER doctor in a strange city.

Moreover, being female and Black, Dr. Harper also faced the challenges of entering a profession that was overwhelmingly male and White. Although racism and sexism present itself, they remain largely in the subtext of her daily operations. Already battle-scarred by a tough upbringing, Dr. Harper, deals with social adversity much as she does her job: Fix what you can and don’t let what you can’t fix hobble you.

Everyone in the ER Has a Story

Chapter 6, Jeremiah: Cradle and All, is a strikingly good story, which captures the harsh violent reality of the inner city, written in delicate but firm prose. Dr. Harper treats a shy, intelligent 13-year-old who has come in with head trauma, the result of vicious schoolyard bullying. It takes a good bit of sharp-witted cajoling for Dr. Harper to break the code of the streets and get the boy to talk. After relating the humiliating beat down, the boy confesses that he owns a handgun and has every intention to use it on his accoster. While she awaits word from a social worker, Dr. Harper drifts back in time and wonders to herself: “Why, in all my growing-up years, had no physician ever spoken to me alone, to ask if I was safe, knowing that I wasn’t.”

“Most of my job is to keep death at bay. When I’m successful, I send the patient back into the world; when not, I’m there as life passes away.”

— Michele Harper, MD

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Readers of The ASCO Post will take special note of chapter 8, when Dr. Harper must deal with a patient infrequently seen in an inner-city emergency room: a patient with cancer. When a patient presents with severe chest pain, Dr. Harper orders a computed tomography scan; upon reading it, despite the lack of a pathology report, she “had to introduce the word cancer into the discussion.” What follows is a textbook discussion with a nervous, overwhelmed patient that is riveting in its humanity and honesty.

Clearly, a hospital ER is not for everyone, but it’s where Dr. Harper was born to be: “The truest part of me has always known and just now understands that this is where healing happens, and this is where healers abide.” This fine and compassionate book is highly recommended for readers of The ASCO Post.