Emergency medicine

The DO Book Club, October 2020: The Beauty in Breaking

Emergency physician Michele Harper, MD, writes candidly about systemic racism and gender bias in the health care system through the lens of her own experience.

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

Welcome back to The DO Book Club!

For October, Joan Naidorf, DO, read “The Beauty in Breaking” by Michele Harper, MD. Dr. Naidorf is board-certified in emergency medicine and has practiced at community and military hospitals for over 25 years in Alexandria, Virginia.

If you’ve read this one, please share your thoughts in the comments below. And if you’d like to write a book review for a future month, please email Andy Brown at abrown@osteopathic.org.

“The Beauty in Breaking” is the story of Dr. Harper’s journey toward self-healing as she embarks on a career in emergency medicine. It 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 end of her marriage, which leaves her emotionally “broken.”

The ensuing chapters cover 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 a unique perspective to her retellings of multiple patient encounters at various community, university and Veterans Administration hospitals. Each chapter highlights patients whose stories expose broader societal issues of systemic racism, sexism and child abuse.

Dr. Harper’s detailed 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 but, as is often the case for emergency physicians, we will never know the outcomes.

The wonder of a shift in the emergency department is not just the variety of people and presentations we see, but the sheer improbability of life’s extremes occurring nearly simultaneously. Each patient teaches her something important about her own life.

Dr. Harper also struggles with the trials and tribulations of being a complex human being while trying to become a better physician. She still acutely feels the pain of a physically and emotionally abusive father, carrying scars well into her adulthood. As a resident, she suffers the end of a storybook marriage that she dreamed would someday bring her beautiful children. As an attending, she hesitantly forays into dating and love once again.

Ultimately, this is a story of Harper’s ability to forgive and recover, stronger each time, from wounds inflicted by her parents, her ex-husband, a system that promotes bureaucratic compliance and masculinity, and despairing patients bent on self-destruction.

Interesting tidbits for DOs

Osteopathic physicians reading the book will find a lot to identify with. Many of us have found ourselves in similar 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 pseudonyms.

Many of us have trudged, physically and emotionally, through 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.

The author also adroitly shares the ache and empathy that she feels with each patient encounter.

Physicians are presumed to be objective, rational beings, able to easily detach as they guide patients and families through some of life’s most challenging moments. But doctors’ emotional responses to the life-and-death dramas of everyday practice have a profound impact on medical care.

Dr. Harper shows us that beyond their highly trained minds and methods, physicians have real and raw feelings.

Notable quotes

Dr. Harper touches on the bias and racism that exist in our society and medical system through the story of a young Black male who was brought to the ER by police after his suspected ingestion of bagged drugs.

The patient refuses the exam and Dr. Harper refuses to comply with an 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, having seen other attendings comply in similar situations.

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 judgment 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)

Using this anecdote, Dr. Harper speaks to larger issues of racism and patriarchy personally, expressing that she wishes the resident would have questioned the old guard’s approach that violated the patient’s autonomy, rather than questioning Dr. Harper’s own judgment.

Dr. Harper also grapples with never feeling satisfied by her romantic or professional life because she is a perfectionist. By reflecting on the lessons learned in the emergency department, she works through disappointment and disillusionment, ultimately choosing to keep pursuing what she wants out of life rather than wallow in what she doesn’t have.

She says:

“I knew that after letting go, there is forgiveness; after forgiveness, there is faith.” (p. 47)

Takeaways

Dr. Harper adds a fresh new addition to the crowded field of medical memoirs, attempting to cover a lot of ground on many current issues. She tackles these obstacles head-on, from how female doctors are mistreated to how she believes hospitals thwarted her promotions because she was both Black and female. She provides ample historical context for the systemic racism she sees in the emergency department.

The first step in addressing the many problems identified in the medical system is to first 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 wounds.

November’s book

For November, The DO Book Club will be reading On Immunity by Eula Biss. We encourage all who are interested to read along! If you are unable to get out to a local library or bookstore due to COVID-19, we recommend checking out eBook options for rent or purchase.

As a reminder, if you read “The Beauty in Breaking” or any previous Book Club selection and want your reflections to be shared in future posts, or want to write your own book review for a future month, please leave a comment below or email abrown@osteopathic.org.

Happy reading!

Related reading:

The DO Book Club, September 2020: Fallible: A Memoir of a Young Physician’s Struggle with Mental Illness

The DO Book Club, August 2020: The Immortal Life of Henrietta Lacks

1 comment

  1. I’m a W female DO board certified Child, adolescent &adult psychiatrist-have seen &suffered most of the same issues &abuse as Dr. Harper. Not only was I a young “yankee”(in Alabama) female, DO (which aren’t real dr, so can’t park in the doc parking lot); I appeared to be a much younger, blonde model so cant be a doc; “competition” to RNs for Docs (really? I’m a dr. I don’t need a dr), in most places treated worse by female staff. &“reverse racism” in Detroit & AL
    I’ve also been the patient, twice. 1: had motorcycle accident=>several hairline fractures around knee that were not visible except via MRI (that were found later) & an obvious fracture of the distal end of the fibula that the Dr “wasn’t sure if it was a new or old fracture” I wouldn’t remember breaking that bone? wasn’t even asked despite being a doc & should know if I broke that bone or not. on top of that, ER dr gave me a tiny dose & only a few pills of a narcotic, not even enough to allow me to sleep that night from the excruciating pain. because what? Do I look like drug addict who is faking the swelling &blood to get pain meds?
    2-missed steps &fell a full story ~ 13’ from moms kitchen into basement &suffered burst fracture @L1, Contrae-coup injury Rt frontal lobe w/sl. blood, crushed trachea,etc. Hosp in WV, poor area, (they didn’t realize I’m self employed doc/can’t afford insurance)couldn’t speak at first/cc: fell down steps. In room w/lady w/good insurance=>minimal care, no MRI of head, neglected esp by RNs

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