1. Brown, Theresa PhD, RN


Michele Harper's striking memoir contextualizes racism in health care.


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A few years ago, I spent an afternoon in Atlanta visiting the Martin Luther King, Jr. Center for Nonviolent Social Change. An exhibit there detailed the history of J. Marion Sims, the so-called "father of modern gynecology," who developed a way to surgically repair vesicovaginal fistulas by operating on unanesthetized, enslaved women in the American South. In her memoir, The Beauty in Breaking (Riverhead Books, 2021), Michele Harper offers Sims's story as one explanation for why Black Americans may feel they do not own their bodies. Harper, a Black ED physician, draws on Black history to show how Black Americans have suffered from racism. She also argues for the power of healing, regardless of the difficulties any one person has faced.

Figure. Theresa Brow... - Click to enlarge in new windowFigure. Theresa Brown

Harper's childhood was marked by trauma. Her father regularly beat her mother; in striking prose, Harper captures how alone and terrified she felt following one of these beatings: "I went into the foyer and sat on the bottom step of the staircase. I waited in the event my father returned. I waited in case my sister cried. I waited for my fluttering heart to be still." Her family told no one about the abuse. Their DC neighborhood was "historically home to Washington's Black elite," and maintaining "the fragile facade that fronted our legitimacy" was paramount.


From this description of Harper's childhood, the book proceeds along two parallel tracks, alternating portrayals of Harper's clinical work with her personal work to heal from trauma. While she doesn't foreground her race as a nexus of workplace conflict, she shows how race can become an issue given the history of racism in the United States and specifically in U.S. health care.


Harper personally experiences racism in the workplace. In one instance, she is denied a promotion because she is Black and a woman. Although she's the only applicant and well qualified, the hiring committee chooses to leave the position open rather than hire her. Harper recounts the department chair's expressions of regret and then points out how the hospital's racism affects her: "He had spoken with the heavy heart of a longtime liberal white man. . . . His part was done. I was the one left to live with the limitations of that bigotry."


Black patients also have to live with that bigotry. In the chapter titled "Dominic: Body of Evidence," Harper references the notorious Tuskegee syphilis experiment that ran "for forty years" (italics Harper's) in the mid-20th century. This project run by the U.S. Public Health Service recruited Black men with syphilis; the men were lied to about their diagnosis and denied treatment so that researchers could study the effects of syphilis over time. Harper is reminded of this when she encounters Dominic (a pseudonym), a Black man caught in the crosscurrents of racism and health care, much like the men in the Tuskegee experiment. But as the ED physician in charge, she's able to make a difference for Dominic.


Four White police officers have brought Dominic to the ED, accusing him of swallowing bags of drugs. The police want him examined and the "evidence" extracted, but Dominic refuses, saying he's done nothing wrong. A White resident physician intends to examine Dominic against his will, until Harper steps in. She tells them all, "It is against the law to force a medical examination on a competent adult human being." The indignant resident calls the hospital's ethics board, only to be told that Harper is correct about the law.


This was just one of many difficult situations that Harper has navigated at work. She describes suturing deep cuts on the hand of a man with psychosis who may have committed murder just before coming to the ED and comforting a female veteran who was raped twice while serving overseas. Throughout, Harper ruminates on the meaning of healing. "There is tremendous release in speaking . . . in the heroism of being willing to heal. It is only in speaking of abuses that we can address them."


While I do not share Harper's optimism that all people can be healed, her assertion that healing takes time and effort rings true. And while a contemporary memoir might seem an odd choice for Black History Month, I chose it in part because the book documents that, for Black Americans, health care has too often been about hurting, not healing. At the same time, The Beauty in Breaking portrays patients' humanity as uniquely theirs, comprising much more than their race or history. Clinicians would do well to take both messages to heart.