#5 Review: The Beauty in Breaking
The following review first appeared in The DO magazine.
The Beauty in Breaking is the true story of Michelle Harper's journey toward self-healing as she embarks on a career in emergency medicine. Her story begins with an introduction to her dysfunctional family, her childhood of physical abuse, and her inspiration for becoming an emergency physician. The completion of her emergency medicine residency in New York City coincides with the break-up of her marriage which leaves her emotionally “broken.” The ensuing chapters tell of her move to Philadelphia to work as an attending physician and to heal the wounds in her personal life. As an African-American female physician, she brings her often unique perspective to her recounting of multiple patient encounters at various community, university, and Veterans Administration hospitals. Each chapter recounts the story of a patient or two who expose broader societal issues of systemic racism, sexism, child abuse, and the many problems with caring for veterans, the poor and underserved. Each patient teaches her something important about her own life.
The lay public will find a lot to like about this memoir. For the scads of viewers of TV medical dramas, Dr. Harper’s detailed patient case vignettes paint dramatic portraits of suffering and pain. Given the nature of episodic care delivered in the emergency department, some readers may yearn to know what finally happens to some of the characters and like the physicians, we will never know the outcomes. Her retelling of the patient care scenarios is quite strong. In several chapters, the drama of cases juxtaposed with each other, serves to heighten the contrasts.
For example, in one chapter, a toddler presents after prolonged seizure activity at the same time an elderly nursing home patient presents in the midst of active cardiac resuscitation. Another chapter introduces a drug-user who elects to leave the emergency department against medical advice and juxtaposes his resistance to a gentle man who seems to accept the diagnosis of metastatic cancer. The wonder of a shift in the emergency department is not just the variety of people and presentations we see but the shear improbability of the life’s extremes occurring nearly simultaneously.
Dr. Harper introduces the trials and tribulations of being a complex human being, while becoming a better physician. As an injured child who acutely feels the pain of a physically and emotionally abusive father, she carries scars well into her adulthood. As a resident she suffers the end of a storybook marriage that she dreamed would someday bring her beautiful curly haired children. As an attending, she hesitantly forays into dating and love once again.
The author adroitly shares the ache and empathy that she feels with each patient encounter. Physicians are assumed to be objective, rational beings, easily able to detach as they guide patients and families through some of life’s most challenging moments. In reality, doctors’ emotional responses to the life-and-death dramas of everyday practice have a profound impact on medical care. Dr. Harper shows us that in addition to the highly trained minds and methods of the medical professionals who save our lives, our physicians have real and raw feelings. Precious little has been said about their emotions.
The author is a thoughtful and curious woman who is just as affected by her patients as she affects them. From children to the very old, from people of dignity and control to addicts, alcoholics, and malingerers, each encounter she describes causes her to tie the patient's struggle to something happening in her own life at the same time: love, divorce, loneliness, self-care, and job insecurity. The lessons she learns from listening to and treating her patients are reflected back to herself in ways that are admirable but occasionally strained. The story she relays about the death in the emergency department of seemingly perfect infant segues into a missive on her own wish to become a mother and find an eligible partner.
Another of goal of the memoir is to highlight the issue of physician wellness. Dr. Harper has a strong interest in complementary medicine, yoga, Buddhism and nutrition. The book chronicles her own spiritual journey as she pines away for the loving supportive family and devoted husband that she believes she deserved. She yearns to start a a complementary health clinic within the Veterans Administration Hospital and applies for advancement in administrative positions. The chapters progress though the movement out of victimhood into the state of acceptance. Her early life was never going to be the way she imagined. Ultimately, this is a story of Harper's ability to forgive and recover, stronger, from the many times she was broken: by her parents, by her ex-husband, by a system that promotes bureaucratic compliance and masculinity, by despairing patients bent on self-destruction, and by her yearning for a different sort of practice.
Physicians reading the book will find a lot to identify with. Many of us have found ourselves in exactly these same clinical situations and have butted our heads against stubborn rules and policies. We have held the hand of those who are dying. I trained in Philadelphia, probably in the very hospitals she cloaks in the pseudonyms Andrew Johnson and Montefiore. Many of us have trudged physically and emotionally though the long nights on call or in the overnight emergency department shift, just hoping that no new patients would come in during that last hour. My fellow physicians will likely nod in agreement as Dr. Harper does a fair amount of explaining and preaching about the problems in the medical field.
In a most timely way, Dr. Harper introduces the concept of bias and white privilege that pervades our society and our medical system. In the chapter “Dominic: Body of Evidence,” she tells the story of a young black male who was brought to the ER by police after suspected ingestion of bagged drugs. The patient refuses the exam and Dr. Harper refuses to comply with the police officer’s request to examine him against his will. She pulls in several historical incidents of black people and prison inmates being treated unfairly and inhumanely. Dr. Harper’s resident questions her about her stance after the resident has seen other attendings force treatment during previous similar encounters.
Dr. Harper writes, “ I sat still at my computer, attempting to… dampen my disgust and my anger mounted - anger that my resident, my highly privileged, highly educated white female resident, had felt comfortable being so disrespectful as to dismiss my judgement on this matter; that she felt she had the right to invoke what she deemed to be a higher authority: older white doctors who’d done the police’s bidding in the past or whatever voice happened to be on the other end of the line from Hospital Ethics.” (P. 108) Of course the young resident does not recognize the biases of the system in which she was trained and was immersed. The author uses this patient case to speak about larger issues of white priviledge and patrimony in a very personal way.
Don’t we want our trainees questioning what they are told? Dr. Harper just wishes the resident would have questioned the old guard’s approach that violated the patient’s autonomy, not the latter which questioned Dr. Harper’s own judgement.
Physicians reading the book will identify strongly with the anecdote Dr. Harper tells about being called out and humiliated while on patient rounds as a resident. Who among us has not felt that hot burn of shame? The raw emotions and fatigue of the patient encounters inevitably occur during the long and sleepless nights that we all know too well. The author makes a concerted effort to take care of herself and advocates wholesome food, yoga and meditation. Fortunately, she must have found the time to keep a journal that must have become the fodder for this book.
Dr. Harper relentlessly searches for perfection in her romantic life and her professional life. Like many perfectionists in the medical profession, she never feels done or satisfied with her life because in her own mind, she can never achieve perfection. By reflecting on the lessons learned in the emergency department back to her own life, she wrestles with disappointment and disillusionment. She ultimately chooses to keep pursuing a richer life for herself and encourages the reader to do the same. She says "I knew that after letting go, there is forgiveness; after forgiveness, there is faith."
Dr. Harper’s adds a fresh new addition to the crowded field of medical memoirs. She tries to cover a lot of ground on many issues we are reading about and seeing on the news. Her new voice can be heard on how female doctors are mistreated and how hospitals have thwarted her promotion because she was both black and a female. She provides ample historical context for the systemic racism she sees in the emergency department. She dabbles into self-help and spirituality. The first step in addressing the many problems identified in the medical system is first, to become aware of them. Dr. Harper’s first book is an admirable effort to open the eyes of her readers to the problems in medicine and to heal her own broken places.
