Michele Harper: Beauty in the Breaking
Emergency Rooms are the theater of life itself. For ER Dr. Michele Harper, work has become a calling—to bear witness to people’s problems both large and small, to advocate for better care, to catch those who fall through society’s cracks, to stand up against discrimination, to remind patients that the pain they have endured is not fair… it was never supposed to be this way. In this episode, Kate and Michele talk about the importance of radical honesty when it comes to advocacy as well as the racial and socio-economic disparities that keep people disproportionately affected by the pandemic… and the anxiety and stress that follows. And still, even after all she has seen and all she has walked through, Michele finds great hope in being broken. Yes, we are shattered, but yes, we will be made into something new.
CW: domestic violence, a doctor discusses a patient’s experience of sexual assault and a patient’s suicidal ideation, racial discrimination
Michele Harper has worked as an emergency room physician for more than a decade at various institutions, including as chief resident at Lincoln Hospital in the South Bronx and in the emergency department at the Veterans Affairs Medical Center in Philadelphia. She is a graduate of Harvard University and the Renaissance School of Medicine at Stony Brook University. The Beauty in Breaking is her first book.
You can connect with Michele on her Instagram, on her Facebook, or on her website. Michele’s first book, her memoir entitled The Beauty in Breaking, was published earlier this year. You can find The Beauty in Breaking, here.
Kate Bowler: Hi, I’m Kate Bowler, and this is Everything Happens. Look, the world loves us when we are good, better, best. But this is a podcast for when you want to stop feeling guilty that you’re not living your best life now. We’re not always celebrating a zen like mindset. I used to have my own delusion of living my best life now. I’m a Duke professor, wine and cheese enthusiast, wife and mom. Instagram gold. Then I was diagnosed with stage four cancer. That was four years ago and I’m still here. And now I get it. Life is a chronic condition. The self-help and wellness industry will try to tell you that you can always fix your life. Eat this and you won’t get sick. Lose this weight and you’ll never be lonely. Believe with your whole heart and God will provide. Keep this attitude and the money is yours. But I’m here to look into your gorgeous eyes and say, hey, there are some things you can fix and some things you can’t. And it’s OK that life isn’t always better. We can find beauty and meaning and truth, but there’s no cure to being human. So let’s be friends on that journey. Let’s be human together.
Kate Bowler: People always say, find your center, find your center as if you were a seesaw and you didn’t know you were supposed to balance, but right now there is no balance. There is no normal, there is no pretending that life is staying on course. We are living through a season of intense and prolonged uncertainty and fear and unknowing. But sometimes we meet people who know how to keep their feet under them. They aren’t lucky. They haven’t been spared pain and heartache, but they have figured out something about pain that still lets them grow. What is it? Dr. Michele Harper has worked as an emergency room physician for more than a decade at various institutions, including as chief resident at Lincoln Hospital in the South Bronx and in the emergency department at the Veterans Affairs Medical Center in Philadelphia. She’s a graduate of Harvard University and the Renaissance School of Medicine at Stony Brook University, and she just released her first memoir, The Beauty in Breaking. Michele, hello. Thank you so much for being here.
Michele Harper: Thank you. Thank you. It’s a pleasure and an honor to join you and and your community here today.
K.B.: I think that there is something deeply magical about you, she said, having just met you, but I just want to tell you straight off, I think it is so powerful. You’ve endured like chaos and pain and transition and fear. And I want to ask you all about your story in a minute. But there’s like there’s such a sense of grounding people get in your account, like your feet are right under you and it allows you to give incredible gifts.
M.H.: I do. I wasn’t joking when I write about doing yoga, I do a lot all the time.
K.B.: Yeah. Yeah, this makes sense, I’m totally tracking. I think it’s just like part of a hope that we all have is that even now in the midst of this, we can find a strength like that.
M.H.: I appreciate that. I don’t always feel grounded. And I think that what I’ve tried to cultivate over time is, is an honesty about how I feel and what I’m going through and really being present with it. And I think in that act of of presencing, that’s what gives me grounding. Radically honest if I’m in the face of death or pain or suffering or the end of relationships, being present is what keeps me grounded and rooted in the moment.
K.B.: It sounds like you kind of got hooked on honesty. Where you’re like, oh, we can tell the truth about this. I guess I could tell the truth about a lot of things.
K.B.: Your ability to manage chaos seems I think that it’s very it might be intimidating to people who don’t who don’t think they have something like that in them. But you have like a long history with managing and experiencing chaos. Would you mind, like, starting at the beginning and telling me a little bit about your childhood and how maybe you were forced to learn that kind of grounding at such a young age?
M.H.: Yes. And this does come up a lot. And then now when I look back on my childhood growing up in an abusive household where my father was a batterer. So, at any moment, we never knew what would happen, it could just erupt in violence. As I got older, as my brother got older, he was often our protector, thank God. And I I learned at that time that anything was possible. And I think back there’s a moment that one story it could be could be any story, but one where my brother was trying to protect my mother. In his effort to restrain my father, my father bit his hand and it was this terrible injury to his thumb. And I remember I was a young teenager and I remember looking at his hand and it looked like he had been bit by an animal. And I remember feeling the horror and the terror and knowing that if this person in my home could do this to someone that I loved, cared for, my protector could do this savage, brutal act to him that anything could happen and we weren’t safe and that somehow I had to manage. We had to manage. To find our own safety and way through that and in many ways, that cultivated for me, well honestly, being an E.R. doctor, because all we have is a snapshot in time, I have a moment to look at a situation. Is this immediately life threatening? Is it likely not immediately life threatening? Is it something we can get through and blow over or is really nothing very dangerous going on right now and I just have to be vigilant? So those were skills that I developed early.
K.B.: That hyper awareness, it sounds like, turned into the ability to like, hyper interpret and live almost at the speed at how quickly things are happening.
M.H.: Yeah, and, you know, it’s a it’s a process, of course, because that was a survival strategy when I was young. And one cannot continue to operate like that 24/7. It’s not functional, it leads to burnout and so much deep suffering and even kind of a dissociation in order to get through it. And so that’s something I had to work on as I got older and when I saw that another life was possible, you know, and I remember when I went to the emergency department, when I was still a young teenager and seeing all manner of life converge there, seeing people come in hurt, battered, just looking for shelter, like a homeless man who just needed respite from the elements or a little girl who needed her booboos stitched up, someone coming in and coding and EMS working on it and pumping on his chest, all kinds of people met there looking for some kind of healing. And often somehow many of them found it. I mean, that homeless man had maybe an hour or two to rest. That little girl skipped out with her father, that family, the family with the man coding, we don’t know if he made it or not, but somehow in that space, they were going to have to find a way through it to find their life forward with or without that family member. And so when I saw, getting a glimpse that there are these spaces of potential and hope, I knew that I wanted to be that for other people, that I wanted to be some kind of support for them. And I also knew that there was more to life that was possible.
K.B.: Man, and the way you’re describing it, I know I mean, I am not in medical world, but I know they call it like the surgical theater. But like the way you’re describing it, it sounds like these spaces can sort of just be like the theater of life itself, like everything. This whole spectrum of humanity and possibility can happen inside there.
M.H.: You know, that’s one thing I wanted, I’d read so many different books and books where people are telling their life story and it’s wrapped up with a bow and maybe it’s their journey to health, and at the end of the book, you know, they lost 200 pounds and now they feel beautiful and they’re like.
K.B.: Yeah, well, I’m so happy for you.
M.H.: Exactly. And in fact, they’re a supermodel. And so it just all ends perfectly. That’s not my take on life. I don’t feel that life is perfect. I don’t feel that the reward at the end of a struggle is that now we have the life of our dreams that we might see in a Disney film. That not real. I feel like the deal of being human is that there will be challenges, there will be struggle. And for me, the reward is to find inner peace. That’s the part that I think is immutable. That’s the part that will that will give some sense of joy, because everything else in this material world, it comes and it goes like just in the E.R. When I see patients, I can’t promise a family necessarily that their loved one with end stage heart disease is going to make it. I can’t. But I can promise that we’ll do what we can and that we’ll try to get them the support that they need so that they can manage no matter the outcome.
K.B.: Yeah, and the way you describe witness, it’s very similar to um, because I’m in divinity school land where there’s, there is like a big emphasis on like an account of witness, like part of what it means to, like, accept the weight and meaning of suffering as part of that hard work of staying present. It sounds like you like part of the gift that you’re determined to give, regardless of the circumstances, is something like I see you. Yes, it happened. I’m right here. I’m right here.
M.H.: Tara Brach talks about radical acceptance and I feel so strongly about radical honesty. And I feel like that is the only way through a situation. I, will never forget an interaction I had with a young woman who I saw I met in the psychiatric part of the emergency department when I was working at the VA hospital, and it’s not uncommon for veterans to come in at this hospital seeking medical clearance, just a doctor saying they’re medically OK to go on to their sober house or then the next part of their job. They just needed a quick medical blessing so they can go on. So I was meeting her there, it was the end of my shift. I had to get home because I was running over. I was pretty much staying late to help the other doctor who was overburdened and she was fine, so I could have been in and out of there in five minutes. But just something was pulling at my heart and soul and gut. She had mentioned she was recovering from a trauma, we glossed over it though, but as I was leaving, I just felt that I needed to ask her. I felt like if I didn’t, I would be complicit. I didn’t have any information. I didn’t have anything to base it on. But I just felt you need to ask her because if she’s willing to talk about it, you need to acknowledge this. And when I did ask her, she revealed that she was raped in the military by not only her colleague, a fellow soldier, but also her supervisor. And she was overseas when it happened. Meanwhile, her grandmother died. They conveniently messed up her paperwork so she couldn’t go and pay her respects to the only support she had in this world. And so not only had they committed this crime against her body and her spirit and then emotionally tortured her on top of all that, but then they had tried to take away her livelihood by ruining her record so she wouldn’t have a way to support herself or a career at all. So I’m meeting her at a space in the E.R. where, you know, thankfully, she had been reassigned. Her new team was helping restore her record, helping her with her career. And she had a new therapist who was helping her so that she could maintain sobriety and help with her depression, anxiety, PTSD. Well, I listen to her, I felt it was important to listen to her and I said to her what they did to you was wrong, it was just wrong. And we continue to speak. And I remember she said that it felt good to speak because she had never told the whole story to anyone like that. And I could see her just feel lighter in that moment, her whole countenance transformed and, you know, this wasn’t, this was for her I mean, a byproduct of it was that I felt a deep sense of fulfillment because that’s what I was there to do to help her and not just sign a paper, but I hoped this was part of her healing. And and, yes, I also write about it because while she’s struggling to survive, to thrive, to have the life she deserves, people like me were there to help her who aren’t in the midst of that acute struggle. Should be there to not only bear witness, but to amplify the story and be part of accountability because we, I feel I have to change the system so this doesn’t happen to other people.
K.B.: Yeah, that is so powerful when someone in the role like say you’re not, you know, like you’re not playing the role of friend, you’re playing the role of trusted medical professional. It really does feel intensely validating to be able to have someone in an official capacity be able to say like this is injustice. Because I think especially when something happens to you, you start to feel even when you know you were right, you start to feel a bit confused until until you can feel sort of like that bubble around you is remade by trust. And just to offer that trust, that’s a powerful thing.
M.H.: You’re right. And so much even though I work in the emergency department and people come in who have been shot or who are having strokes and heart attacks, so much of what we do, it’s not an acute medical emergency. It’s a different kind of spiritual, mental, emotional urgency.
K.B.: I really like the kind of existential bravery you’re talking about. So it makes me wonder, other than a complete badass, like what kind of person do you think it takes to be an E.R. doctor?
M.H.: I think there is a certain amount of comfort you have to have with uncertainty because anything and anyone can come in any time. I feel also there has to be a certain I mean, I have to tell you, part of the reason I love doing it is in this country where we don’t have access, equal access to health care. I needed to know I was going into a profession where I could see anyone where I wouldn’t and couldn’t, like I love the fact that it’s mandated, I can’t turn someone away just because they can’t pay like I needed in our system, it’s at least a spiritual privilege, because for me this is a calling. It’s a privilege. I want to know that the system will allow me to take care of anyone and to the best of my ability. So that is really important to me. And given that, you know, in the hierarchy of specialties, there are many specialties that pay more, I think that there has to be a certain amount of generosity of spirit to want to be in that setting and then cognitive flexibility. Then you have to be a little there’s a certain amount of masochism that goes along with the scheduling.
K.B.: (Laughter) Totally, no, I didn’t want to sleep. I don’t remember self care.
M.H.: Yeah, I know, I know. That part of it is wearing thin, though. I got to make some adjustments.
K.B.: Yeah, yeah, yeah, yeah, yeah, yeah, yeah. Oh.
M.H.: And I hope I still hope. And you know, that being said about access to care, I mean truthfully it’s that’s one of those things I’m increasingly vocal about and I hope I become super famous so I can use this platform because we got to make some changes. Like everybody deserves health care, everybody deserves a living wage. Everyone deserves to be treated fairly, equities. Like I want to be part of getting rid of these disparities. I mean so these are the reasons why I do what I do.
K.B.: I love that you’re describing like a sub category of that profession, which creates justice as part of its, like it has to be part of that process. I love that. Like, there’s such a vast and important body of literature about how African-Americans and other people of color will receive unequal treatment as both patients and also medical providers. And I know it is a huge topic, but we both know it’s so especially crucial right now when a pandemic means that some people are disproportionately effected. So as a doctor, like, what are some of your fears for folks that you’re seeing come through? How do you feel like justice is being meted out at that at that level?
M.H.: Well, that’s one of the things that I feel that this pandemic has laid bare. So much pain and suffering. And a lot of it just needless, because this should have been handled appropriately with so much pain and suffering from the pandemic one, what I hope will be a positive outcome is that it has laid bare these disparities. I mean, so many of our essential workers, people, people who are always essential, people who are teachers, people who work in sanitation, our grocery store clerks, but people who also haven’t traditionally been valued in society. Now we depend on them. And so often they are women and people of color. And given the nature of the professions are not the highest wage earners either. And we’re seeing them disproportionately affected, getting sick, being ill, you know, in an economy where so many people work in what’s called the gig economy. Or people with, record unemployment. And underemployment, the fact that people don’t have health insurance during a pandemic, blows my mind like I the people, you know, so many patients I see now, I’m seeing people coming in because they’re having panic attacks, because they’re depressed, because like this middle aged woman said, well, I lost my job, I can’t find a job, I was kicked out of my housing because I can’t pay my bills. Sure, we’re not supposed to have evictions, but real facts on the ground are that we are being evicted and I can’t get into a shelter because of the pandemic. And she doesn’t know what to do and has nowhere to go. And so she’s depressed. Of course she’s depressed. And I have no resources like I’m seeing this increasingly. So these are some of the impacts. And I, it is heartbreaking because there’s so little like in that in that instance, I mean, I can make sure she’s medically OK, I can try and give her resources. But truthfully, there’s so little I can actually do for her. So what I try to do is continue advocacy so that we can change structures so that people can have help and support and that they can work one job and be able to survive.
K.B.: Yeah, for health care to be tied directly to the economy and people’s employment status is so deeply immoral that, like I, I imagine that it is constantly exhausting to be to be seeing like the people with so little to lose being the first to be impacted.
M.H.: It is. And one thing I always try to be a little positive.
K.B.: And I love it also and it will probably, I just like as a Canadian, I just can’t understand this part of it, I can’t. On the topic of fundamental justice, it does seem, bananas.
M.H.: I totally yeah. I totally agree. And that’s honestly why I mean, I’m glad I’m there. I’m glad I’m in the E.R. to try and do something like at a time when people still can’t get into clinics. And I mean, even if, like the patient I just spoke about, what could I do? I offered her a meal, you know, like even if just for she could have one more meal in that moment or there was a young black woman who she was like 20 but not, you know, now at my age, 20 year olds look like 12 year olds. And so she looked like a little girl.
K.B.: (Laughter) Hey now, she was a fetus. She crawled in straight from her cradle. Please continue.
M.H.: Exactly. And so she also was depressed. And, you know I, in the ER we have to decide if someone’s suicidal or not. Do they need to be admitted to hospital or not? Like that is part of, that’s the ER job. We’re not going to do management of chronic anxiety and depression. So we just spoke and as she was coming in, the nurses were about to put her in the like, using layperson’s term like the psychiatric safe room and have her undress and put on the psychiatric scrubs, like getting ready for admission. I just, when I saw her walk in, I was like, this is this is not, she doesn’t, this is not where she’s going to end up in the psychiatric floor. I just felt that. So I spoke to her and she told me that she was feeling depressed. She doesn’t want to hurt herself or anyone else, but she is a is a front line worker working as a clerk in a grocery store. She feels immense stress and anxiety because the patrons who come in are mean to her. One of the people who where she works is sexually harassing her, and her boss won’t do anything about it. But she can’t afford to leave that job because she has to pay bills and she doesn’t have any family who can help her and she doesn’t have any support and she doesn’t have any friends. And now with the pandemic, the few people she could speak to, she can’t even, she has increased isolation, so of course, I did my screening and of course, you know, I made sure that she had a safe place to live and go. And she asked me, she’s like, do you think I’m crazy? And I said, no, I don’t think you’re crazy. I believe everything you’re saying. And I said, and it’s wrong. I said, and I don’t often talk about myself, but I just I felt like she needed to hear it. So I said, I face rude people also and discrimination and it’s not fair. How you’re being treated is not fair. And if you’re able to if you’re able to find a way through this, I was like, you know, me, you people like us, we have to find a positive way through it. And she just looked at me and I said, is there something else we can do for you today? And she said, I just wanted someone to talk to. And she said, like I talked to you and I, I feel, I feel better. And I was like, well, do you think you you’re going to be OK? She’s like, I think I can make it. I think I can do this. Like, I have faith and I have goals for myself and I feel like I can do this. I’m OK. I can go now. I was so happy and if it wasn’t like coronavirus I would have hugged her, but we can’t do those things anymore. And I discharged her, but like this is what’s going on. And this is why it’s important for me to be there, because we need to be there. Like we need more women and people of color and different backgrounds, different socioeconomic statuses and disabilities, because the patients we see need that. They need to feel seen and heard and understood. So that they can go on.
K.B.: Yeah, that’s right. I never even thought of you’re an emergency room doctor trying to decide what’s an emergency when right now everything is an emergency. Like people’s regular anxiety and sexual harassment complaints just like, the stakes of everything become an emergency, which means you’re just there like seeing all of, all of life. You’re like the big temperature taker of society. Yes. You’re a giant thermometer.
M.H.: Yes, we are. We are. We are. The canary.
K.B.: No, no don’t be the Canary, be my thermometer.
M.H.: Yeah, unfortunately, yes.
K.B.: You just you’ve managed intense transitions you have made. I mean, right before huge moments in your life, you’ve had to begin again in a new city, in a new job, as a newly single person and like and then remake your life. There’s a lot of, I don’t know in my experience, sometimes missing the life I could have had is really… while still wanting to be like to be the person that gives the gift like that is hard work.
M.H.: And that’s, that’s one thing that that I realize even when I got divorced and I knew that and I really grieve that. And that divorce happened right as I was moving to a new city for new job, for this new phase in my life that was supposed to be fantastic. We were going to be in this together just making this storybook life. But it didn’t happen. And we were close, I mean, to this day, I think he’s a good guy, but clearly it wasn’t meant to be. And, you know, he told me he was into documentary film. He said, you’re on your path and you’re doing well, but I, he didn’t feel he was doing well. So he couldn’t be with me if I was successful and he wasn’t. So, you know, I think if someone doesn’t want to be with me for whatever reason.
K.B.: For being awesome is my reading of that. Is my reading of that.
M.H.: Exactly cut it and move on, but I knew I was going to I knew I was going to be terribly sad and terribly depressed. And my only hope was that I would get through it. And um what I grieve the most and what I knew, like I knew he could go. It wasn’t losing him. It was losing my story of what I wanted for myself and not knowing if I would ever get that story and being OK with the fact that, you know, I finally decided that, I’m going to be I’m going to have to be open to the life that is intended for me. And then, you know, here enter like magic, I do believe in magic in that I think it can be I do think it can be better than we even anticipate.
K.B.: I think about this all the time. I really do. I do. I like totally obsessed with this topic because I think we both don’t believe that things are always better, but that things can still really be beautiful. And you give a great pitch for like, beauty. I mean, OK, so. When I am at the next barbecue and I’m trying to convince other people what is beautiful about being broken?
M.H.: What’s beautiful about being broken is the possibility of rebuilding better and stronger and more resilient, in a deeper way. You know, I talk about this, my analogy is and I’m sorry I’m going to mispronounce this, but the Japanese art of kintsukuroi where pottery has it’s broken. And so it’s rebuilt then with an amalgam of precious metals. So now you have this piece where the cracks are highlighted by gold or platinum, because the thinking is we’re not going to pretend this this art hasn’t been through something, hasn’t been broken, hasn’t been destroyed. No, it has been. And now look at it, for the cracks. It’s worth it’s worth more. And I don’t mean that a financial sense.
K.B.: No, I like it. That’s hard won wisdom. It is.
M.H.: It’s more precious. And so, you know, I don’t romanticize trauma, but I do think that our experiences can take us to a deeper, more meaningful way of being.
K.B.: Yes, I agree, and I can only hear it in you from second one where you think your job is to find possibility in the midst of it and just to and to bear witness to it in yourself and other people. And I honestly just find that absolutely gorgeous to be around.
M.H.: Thank you.
K.B.: Thanks for saving people’s lives every day. But but also existentially being yourself. It’s a treasure.
M.H.: Thank you so much. It’s been so fun spending time with you.
K.B.: Michelle writes so beautifully about the precarity of life. She says it’s human nature to want to bind ourselves to the parts of life we hold dear, whether those parts are actual people, events, items or dreams. We want to fasten them to us so they’re safe and near us forever. But this type of binding frays and tears, until even when we fight the awareness, we’re forced to see how illusory the reliance on permanence is. What we have in all its glory to hug and hold, to caress and learn, to feel and grow is simply right here and right now. If we’re lucky, the bond holds in the moment and the experience of it shines and breathes and expands. Thank you, Michele. Yes. It is not trite to say that what we have is right here and right now and when our lives have shrunk to the rooms we’re in, may we find the treasure of gratitude here in the now. A little bit of gratitude for this gorgeous, fragile life. This life that will demand everything from you, but right now, let’s just take a moment to say, thanks. Thanks to our bodies that give us a place to call home. Thanks to the simple moments of delight, a long stretch, that delicious sip of wine, my son’s evil, evil laugh. Thanks to the caring professionals and essential workers who are asked to give so much right now. Thanks to friends who know us better than we know ourselves sometimes. Thanks to first snowfalls and familiar prayers and family traditions. And thank you, dear listener, that we get a minute to do this together. When our lives get small, may we grow deep.
K.B.: This podcast wouldn’t be possible without the generosity of the Lilly Endowment. Huge thank you to my team. Jessica Richie, Keith Weston, Harriet Putman and J.J. Dickinson. Ok, so it’s the season of Advent. It’s the season of almost. Almost Christmas, almost a vaccine. Still the night but we need the light and I have an idea for how we can spend this together. We need gentle ways right now to find hope and beauty and love. So, join me on instagram and facebook to find out more. This is Everything Happens with me, Kate Bowler.