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 Harper has 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.”
In “The Beauty in Breaking,” Dr. Michele Harper shares stories from the field, and how healing patients who’ve trusted her with their lives taught her to care for herself. Photo courtesy of Penguin Random House.
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.
I broke this code of privilege only once. I was a tween when, one Saturday afternoon, I fled the melee in the s econd‑ floor master bedroom where my teenage brother was fighting my father to protect my mother and as my mother was fighting my father on the periphery to defend my brother, and my sister was somewhere unidentifiable but not visibly in the fray. I ran downstairs to the phone docked on the wall outside the kitchen. Tucked in the dark where no one would see me, I desperately dialed.
I heard: “ Nine‑one‑one. What is your emergency?”
“I’m at home. We’re not safe. My father is hitting my mother. He’s fighting with my brother. We’re not safe here!” I whispered into the phone.
“Where are you located?” the voice asked.
I looked around and, with my hand over my mouth, stealthily told them where I was calling from and what was happening.
“We’ll send a unit right out to you,” the operator said.
“Please, please hurry,” I begged before hanging up.
I ran upstairs to my parents’ room. As my father and brother fought and my mother swatted my father with her shoe, I managed to yell out, “I’ve called the police. They’re on their way!”
This was my leverage. The beating stopped, but the threats continued to fly. My father threatened to have my brother arrested. My mother retorted that she would never allow such a thing and that it was my father who should be arrested.
They were still arguing when the doorbell rang. I ran downstairs to open the front door. Two male DC police officers were standing there. They adjusted their gaze down from the iron grate peephole to see a little girl framed in the doorway. One officer had a hand on his holster; the other officer stood with his arms crossed. As if in stereo, they fired off rounds of questions at me.
“Did anyone here call nine‑one‑one?”
“What seems to be the problem?”
“Is there a disturbance here?”
“We received a call about a domestic dispute.”
I opened my mouth to reply, but standing on the doorstep looking out into my quiet, placid neighborhood, I found the answers hard, so hard, to utter. I saw the police car parked on the street in front of my house. I wondered if the Fraziers, next door, were home. I wondered if Sammy, my crush who lived around the corner, would ride by on his bike and see the police car and me with my side ponytail and favorite striped dress. At least I was well dressed, I thought, for my unexpected guests and any unsuspecting onlookers.
“Miss,” the police officer on the left said, jolting me back to attention. “Did you call the police?”
It was as if he had asked me to recite the complete value of pi. I could have given him a basic idea of its beginning, but I had no idea in what order it unfolded and no clue about how it might end. I could feel my breathing accelerate as I thought about what I might say, but then the adults rushed to the door, whisking me aside.
I stood in the corner of the foyer as my mother, brother, and father spoke to the police. As far as I could hear, each of them was frantically interjecting his or her version of the story. Emboldened by the police presence, my sister and I chimed in to corroborate our team’s account.
The police listened quietly and with little patience. Finally, they said, “Well, if you all want to stay with your stories, we’ll just have to arrest you both,” indicating both my father and brother.
I could feel my sister’s heart sink with my own. How had these officers parsed the blame to dismantle justice in this way? How did my father’s account equal the collective account of us four? How had my call yielded their indifference instead of assistance, which was yet another punishing blow?
My mother spoke up right away, her voice filled with dread. “No, no, no, I don’t want my son arrested”—and because she couldn’t risk my brother being jailed, she then said she didn’t want to press any charges against my father, either.
And that was the end of the police involvement. The two officers looked at my parents and, without saying anything else, turned and went back to their cruiser.
After they left, I realized that there really wasn’t anyone we could turn to. There was no law here. No help. When assessing the danger, the police had not differentiated between my father and my brother. They had not asked me or my sister if we were safe. Without so much as a verbal censure to my father, they had simply abandoned a woman and her children to a clear danger in their house.
Worse perhaps, I had broken the code of how “good” families behave, only to find that traditional avenues would neither protect nor serve me.
We never spoke of the 911 call—no one ever mentioned it—and I never dialed those three numbers again. When my parents f ought—and they continued to—I just prayed to my angel that it would all end well one day. And one gorgeous fall day years later, it did end—in a way. Or maybe it is more accurate to say that on that gorgeous fall day to come, I was able to see a way out.
Years after I called the police, the usual battle was raging as I cowered in my room, contemplating, once again, what I might use as a weapon to protect myself and my family against my father. Then I heard someone leave the house, the door slamming shut. My father had stormed upstairs and thrown clothes in a bag. He then got his car keys and left the house without saying a word, driving away for what all of us hoped would be forever but collectively knew would be for only a few days.
I hesitantly emerged into the hallway. My mother stood there holding my brother’s hand; he was bleeding from a deep wound in his left thumb. Our father had bitten him while John had had him pinned to the floor.
As my mother ripped the hem of John’s frayed shirt to man sat at the other end of the room, his hair disheveled and his skin creased from what even at my young age looked like a lifetime of hard living. He had pulled his heavy brown trench coat over him as he slept in the unyielding waiting room chair, his head bobbing with each big‑bellied breath. For long moments at a time he would stop breathing altogether, and I found myself watching anxiously until he took another breath. I figured that if the next one didn’t come, at least he was in an ER.
A young man was sitting in a chair toward the middle of the room with his discharge papers, an inhaler, and a bottle of medicine. He kept looking out toward the parking lot, and I gathered he was waiting for a ride. The ER doors slid open, and a father hurried in carrying his little girl, who had a nasty gash on her leg just below the hem of her purple dress.
All of us were there, I realized, because we were damaged in some way. Wounded. Broken.
A few minutes later, my brother was called into the inner recesses of the ER. I watched him disappear into a triage area and then out of view. I settled in for the wait.
Flashing lights and high‑pitched beeps pierced the lull, announcing the arrival of an ambulance backing up to the ER doors. The vehicle parked, and then the crew proceeded to unload a portly older man lying on a gurney. A medic held up a bag of fluid that dripped into the man’s arm. He secured it to a metal pole and then continued to pump air into a tube that went into the man’s mouth. Another medic performed compressions on the man’s chest, but the man did not move, save for the intermittent involuntary jerking of his body in time with the thrusts to his chest. At one point, an ashen arm dangled off the gurney as they rushed the patient into the emergency department.
Moments later, what appeared to be a family flooded into the waiting room: Women and men came in crying, asking about their father, husband, son. The clerk at the intake desk quietly asked them to wait. I picked up a magazine and tried not to stare as wounded people came in, nurses arrived to call out names, patients walked or were wheeled into rooms, and curtains closed around their beds. The wounded little girl, the old man, the f amily—the whole gamut of life seemed to be converging in this space.
All of us sat there waiting, nervously averting our eyes from one another. At one point, a burgundy car pulled up outside and the young man with the inhaler and discharge papers exclaimed, “Finally! Thank God!” gathered his belongings, and rushed for the door. The old man under the overcoat, who I decided must be homeless, continued to sleep. The family members, still crying, eventually were ushered into an interior room. The little girl with the gash on her leg skipped out, hand in hand with her father, wearing a brand‑new pink Band‑Aid and clutching a lollipop; she was smiling as if she’d just been to the circus.
I glanced at my watch: It had been slightly over an hour and there was still no sign of my brother. Later, the family of the man who’d arrived by ambulance came out one by one, arm in arm, shaking their heads and wringing their hands. As they headed out into the night, there was talk of arrangements and who would call Aunt Jo.
Now it was just me and the Sleeper. Dusk set in as I continued to wait. Finally, my brother emerged, his hand bandaged in thick white gauze. He was ready to go.
“How is everything?” I asked
“Fine. They just did an X‑ ray and cleaned it up. I have to have it checked in a couple of days to make sure it’s healing all right. They said something about how they could only put a couple of stitches since it’s a bad bite wound, and I have to take these antibiotics.”
As my brother and I left the ER, I marveled at the 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 bloodied 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 play no 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; at 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.
On the drive home, my brother and I assumed our usual silence. The city at dusk was cloaked in shadows, and the full moon played mischief among the clouds. I pulled my Toyota into our driveway behind my mother’s Lincoln Town Car and alongside my brother’s sports car. We went into the house, and John headed up to his room and turned on his music—this time A Tribe Called Quest. I went into the kitchen and poured myself a glass of orange juice, then sat at the kitchen table and thought about how I wanted to leave this haunted house and fix people. I figured that if I could find stillness in this chaos, if I could find love beyond this violence, if I could heal these layers of wounds, then I would be the doctor in my own emergency room. That would be my offering to the world, to myself. Unlike in the war zone that was my childhood, I would be in control of that space, providing relief or at least a reprieve to those who called out for help. I would see to it that there was shelter in the spaces of which I was the guardian. The formless angel with a voice as clear as my own had told me the secret many years ago. Let it be so.
— Written by Erin Senne and Amy Ta, produced by Brian Hardzinski