‘The Beauty in Breaking’: ER doctor on domestic violence, survival, and spiritual healing

There’s not always a lot of hope in the emergency room. Patients arrive desperate, vulnerable, and frightened. Some are clinging to their lives, not knowing whether or not they’re going to die.

Others come to the ER because it’s the only place they can go for medical care, even for minor things like refilling a prescription.

For the doctors who treat these patients, bearing witness to all that desperation can affect them deeply.

Dr. Michele Harperhas spent her career as an ER physician at hospitals in the South Bronx and Philadelphia. In her debut memoir, she shares stories from the field, and how healing patients taught her to care for herself. The book is called “The Beauty in Breaking.”

KCRW: You witnessed a lot of violence growing up. Your dad beat your mom, and your brother would intervene. There's one part in the book where you break down and cry after treating a little girl. You wrote that you never really cried when you were young — how did you learn to stifle that?

Dr. Michele Harper: “I think it's really common in those situations — for me and I've seen that with a lot of patients and children in traumatic situations — where the energy goes to survival. … I feel that in many ways I was groomed to go into emergency medicine because all we had when I was little was a snapshot in time. It’s this situation where in this moment, would I survive it? Would my mother, brother, sister survive it? Is it likely to blow over? Or do we have to intervene immediately?

I remember one day when my brother was trying to protect my mother. My brother restrained my father, and during that restraint, my father bit my brother's thumb. And it was a significant wound. To this day, I'm struck by the brutality of that act, that someone in your own family could inflict such savagery upon a family member and his son.

That was one of the moments I learned that there was no safety here. So what I had to do, and what I put all my energy into, is survival and doing what I could to look out for myself and my family. So tears could wait.”

In that instance, you drove your brother to the ER, and that set you on your path to where you are today. Can you read a passage from the book where you come to the conclusion that the ER is a magical place?

“'As my brother and I left the ER, I marveled at that place, one of bright lights and dark hallways, a place so quiet and yet so throbbing with life. I marveled at how a little girl could be carried in, cut and crying, and then skip out laughing. At how a bloody brother could reappear with stitches in his repaired hand.

At how the family of a man who had presumably been fine that morning could manage to leave without him to start a new stage of their lives, one in which he would no longer play a part.

At how the man without a home could find somewhere to rest until he, too, would have to go back outside to figure out the rest of his day, the rest of his life.

And how all of us had converged in these hallowed halls for a chance to reveal our wounds, to offer up our hurt and our pain to be eased. If my brother's body could be patched up, then certainly in its own time, his spirit could mend too. If we looked, if we named the problem, identified and examined it, then there was the opportunity to fix it. The chance for us to walk out under the stoic pines healed, or on our way to being so.'”

That passage is really a description of spiritual and emotional healing. In the ER, which is all about business and getting from one patient to another, that is a really interesting way to look at it.

“For me, it's the most accurate way of looking at it. I mean, sure, there are dramatic instances of someone [who] comes in with a gunshot wound to the abdomen. And we stabilize them medically, they're rushed to the OR, and then they're fixed. But most of the time, that's not what healing looks like. It's much more subtle, and it has to do with the inner aspects of healing.

Like the middle-aged woman who comes in with a dull aching headache. She's worried about her blood pressure — and the blood pressure is high, but just not ER high. I evaluate her and speak to her and ask her, 'We're going to check your labs and get a CAT scan, make sure you're okay. And I think you're okay. But I feel like something is going on. Like maybe you're a caretaker.’ And she hadn't told me that.

She was looking at her phone and was concerned about the time she had to spend there. But she mentioned, 'You know what, I am.' And she told me how her husband was battling cancer, and she was taking care of her granddaughter with special needs. So she was under a lot of stress, and didn't get to take care of herself.

We talked about strategies that might help her, and she mentioned how she used to do martial arts, and a really helpful part of that was meditation. So while we waited for her results, she said she was going to meditate, just to see if it would make a difference. All her tests were fine. And it did make a difference.”

How often do you get to spend time with someone and really find out what is going on, versus treating the immediate problem and moving on?

“So much of it depends on what's happening in the department that day … the acuity of the illness they're presenting with. But I would say … at least several times a shift it happens.”

A young patient had a gunshot wound to the head, and you wrote that as you looked in his eyes, you saw a far deeper pain than what the bullet produced. When you were looking at him, did you know he was going to die?

“As he's rolled in, blood splattered, we're getting him undressed, we’re trying to evaluate where's the blood coming from, what's the nature of the injury? I didn't know, not initially. He was talking, he was moving. His vitals weren't terrible.

But there was a moment when he was screaming out, crying out for help, for his mother, and when he cried out that he was going to die, that shifted something. And I looked at him, and I knew he knew.

We did everything we could. I intubated him, the OR team was already mobilized. He was rushed up to the operating room alive. But then we got the notification that he had passed away. So then it was a homicide. But it wasn't until he was close to me, speaking to me, that I got the sense of how that case would end.”

As an emergency room doctor, you have to learn to compartmentalize the tragedy of human suffering and death. How do you do that?

“There's [sic] many strategies I utilize now. And I will say that I learned to compartmentalize at a young age to survive. Now [as] I get older, that strategy, it's no longer healthy.

So other strategies I've used is [sic] meditation. I really like walking meditation, where I can clear my mind and hold a space for my own feelings, and recognize there was a time in my life where it was important to not feel.

But now it's important to feel and to move through whatever my experiences are. To embrace, accept and understand them. So that's one of the reasons why I love meditation.

The physical practice of yoga is really helpful for me also. Being in community, especially during this time of coronavirus where we're all socially distant. …

I wrote these stories because I really believe that, and I want to amplify these voices, and especially voices that are traditionally silenced. And I want to show that in choosing to heal ourselves, we can be a support system for healing others.”

You wrote this book right before the pandemic. You don't talk about that specifically in the book. But you did write a Medium essay recently about your experience with COVID in the ER. The headline is “When this war is over, many of us will leave medicine." Does the “us” include you?

“No, I don't feel like my time in medicine is done. My path is shifting. I want to do more with writing and other projects. With that [Medium] piece, I do mean that. I see the toll it has taken on so many of my colleagues. On the message boards, on the physician social media groups, [there’s] increasing discussion about how to leave medicine, the strategies people are employing, what they're doing because it's feeling untenable.

What people are saying about the lack of protective equipment, the pay cuts, the furloughs, the working understaffed. It takes a toll on a health care provider, on these frontline workers.”

Are you afraid that you might catch COVID when you go to work?

“It is concerning. But I think that the only thing that's really helped me in this is just developing peacefulness around uncertainty. I never want people to get depressed by what I'm talking about. But in these discussions, I think coronavirus, for example, is just laying bare weaknesses in our society and in the health care system. … The fact that health care in this country is treated as a privilege and not a right. So I feel like in highlighting these issues, we can mobilize to change them.”

Maybe you were referring to yourself, your patients, or America with the book title “The Beauty in Breaking.” This is a pretty broken place right now.

“It is, and I believe it. What you mentioned is true. I was referring to myself, and my patients, and all of us. I see amazing potential, should we choose it, for us individually and as a society to rebuild stronger and better.”

Read an excerpt from chapter 1:

With the final DC home, house number three, we had arrived on the “Gold Coast.” Areas colloquially referred to as the Gold and Platinum Coasts of Washington, DC, were so named because they were historically home to Washington’s black elite. I landed there in the fourth grade with a new status, at a new private school for girls, the National Cathedral School. Like all elites, we didn’t expose our private, upper‑middle‑class shame to the public sphere. Why would we have? After all, we had worked too hard to get here to risk a crack in the fragile façade that fronted our legitimacy. All elites knew the code: Take your pills with your cocktail, use your cosmetics to cover the blemishes and bruises, clean up quickly, whatever it takes so you can present a smiling, perfectly coiffed and clad self to the world.

— Written by Erin Senne and Amy Ta, produced by Brian Hardzinski