Michele Harper’s breakout memoir, The Beauty in Breaking, was published in July of 2020. In it, she describes a life dedicated to healing and advocating for people in a US health system still searching for equity, and how her own process of healing has taught her to be a better doctor. Her surgically wrought prose weaves together her phoenix-like evolution, the complexities of emergency department patients, the patriarchy of medical culture, and the effects of racism in medicine. The Beauty in Breaking points out how far we have to go to ensure every patient is seen and heard, regardless of race, gender, class, age, or sexual orientation, and that every provider of color and every minority provider feels safe in the healthcare workplace. Her book has garnered acclaim from the mainstream press, and despite the challenges this year has presented her as a physician and as an author, she has made the virtual rounds for interviews. Harper’s gentle but firm commitment to practice daily what it takes to be the change we wish to see in the world is inspiring, and I am grateful for our memorable conversation. She is everything and more that she appears to be on the page.

PLEASE SEE ME: There is so much to unpack in your book, so many themes that resonated personally on many levels. I’d like to start with health equity and disparities and Dominic’s chapter. You describe the inequity in the way he—a handcuffed, nicely dressed Black man—was treated by police officers and ER staff when they assumed him guilty of charges made against him. You close the chapter by resigning from this position after being passed over for a deserved promotion.

This chapter feels like a call to action. You’re advocating for Dominic, and others like him, by revealing that an ER physician would perform a procedure against the will of a competent patient. You’re also advocating for yourself, and physicians like you, to refuse to accept the norms of white male privilege run medicine. The fact that others stand by and facilitate both is infuriating, yet sadly not surprising. You write: “While practicing medicine was feeling increasingly crucial personally, between the hospital bureaucracy and the colleagues who brought limited perspectives to work—they were, after all, only human—the prospect of it being a sustainable career path for me was diminishing.”

The resident’s dismissal of your authority is one of many details in this chapter that is troubling to me, alongside the fact that it’s long overdue more Black physicians become integral parts of our healthcare workforce and administration. We can’t afford to lose you and others like you because of the systemic racism in the healthcare environment. What keeps you coming back?

MICHELE HARPER: Financial considerations aside, such as the fact that I have to pay my bills and take care of myself, I’m not ready to leave because I resonate more with being a healer than any specific title. My work in medicine is not done. For me, it’s not just a job; it’s a calling in that way. It’s an expression of how I fulfill my purpose on this earth. That’s why I haven’t left, and that’s why I’m not leaving now. I’ll have to determine moving forward what my life will look like, the balance between clinical practice and writing, but I don’t want to leave it now. I want to make a difference. There’s so much for us to achieve in medicine. And when I say that I mean—everybody’s talking about the problems in policing, which are real and true—the structural bigotry, the suffering that has been exacted upon communities, the murder, quite frankly. We have those parallels in medicine. We just do. People are not seen or heard as a result of what people like to say is implicit bias, and which I think in many ways is quite explicit as a result of the structural bigotry in medicine. People are literally not taken care of. It has resulted in worse outcomes in terms of morbidity and mortality. So I am not ready to walk away from this field because I know it can be better, and because it’s part of my purpose. I won’t walk away from my purpose either.

PSM: How do you personally manage, and I’ll use the term microaggressions but it bothers me to do so because they’re obviously blatant dismissals. It’s ridiculous that we continue to sugarcoat things in words, so if you have a better word for this I’ll use it, but how do you manage those microaggressions in your environment when they’re all around you?

MH: Honestly, that’s the thing. It literally is the environment. Residency was a special time; it was a different environment. In many ways there were issues, certainly, but I was working with physicians who were women from all around the world, doctors of different colors. It wasn’t uncommon when I saw patients, and so they assumed I was the doctor. Racism in that way was less prominent during residency. That’s the only time that I’ve had that kind of experience in my medical career to date. It’s literally in the air that we breathe, the water, everything.

In instances like the one I talk about with Dominic, I just try to maintain my integrity. If I need to intervene on behalf of the patient, then I summon the courage to do so. I discussed in that chapter that it takes a lot of courage to go against so many people and systems at the same time. It takes a lot of courage and quite frankly, energy, to go against the racism and aggressive behavior of the police, the nurses I’m working with, and of fellow physicians. So part of me navigating it is being willing to take action because I wouldn’t be able to sleep at night if I didn’t operate with integrity. In that way it’s replenishing.

Apart from that, there’s the self-care that I do. I have to take care of myself, so I do yoga. I do meditation. I’m not religious but I’m spiritual, and I listen to spiritual leaders like Eckhart Tolle, who is much wiser than me, on my ride to work. That self-care, the spiritual work I do is a daily practice because this work would be too hard otherwise. It wouldn’t be possible, but then I also find it really rewarding. That’s a big part of why I wrote the book. It’s an extension of this healing work. In the ER I can interact with one patient at a time, one family, maybe one community, but with a book, depending on how it does and who reads it, I connect with and can be part of a support system for people around the world. That for me is deeply restorative practice. I’m rarely accused of being an optimist but I am hopeful, and I couldn’t do this work if I didn’t believe in the potential of change. I do believe there’s a way for us to practice and be better. If I didn’t believe that then I would do something else entirely, and just focus on making bags of money.

PSM: That hopefulness does come through in the book. The spirituality does too. In fact, it’s incredible. So, next big question: How can we recruit more talented Black STEM students to the healthcare workforce?

MH: Part of it is just doing the recruitment, and then the other thing is that when you get people into a system, they have to be supported in that system. People can’t be recruited to a hostile environment and then turn around and wonder why they’re not thriving and why they don’t want to be there anymore. The only thing we have to do is really easy. The only thing we have to do is not be racist. What goes into that? There’s redlining in communities. There’s lack of access to healthcare, access to quality education. These things should be made right. These are questions of who we are as society. What is it we value? Do we feel that everyone should have access to education and healthcare? Or do we feel that only if you look a certain way or have enough money, that those things would be accessible to you? Those are the questions. I know this is big, but it’s true. And real. Those are questions that each of us as individuals have to answer if we want to live in an equitable society. I feel that everyone deserves education and healthcare. Everyone deserves a living wage. Everyone deserves a chance to achieve their dreams in life. I think there’s at least a majority of the population would say that too.

The other part is the courage to act because it doesn’t really matter if we think this, if we’re not willing to do something about it. Academic institutions, hospitals, healthcare systems in general have to act first. I’ve worked at hospitals. There may be a consensus that racism exists. There’s not a consensus, though, that it is a problem. A system will have to decide if racism exists and then, if so, if they care to do something about it. Which means they’re going to need to recruit people of color, recruit Black people into the sciences and medicine and then hire them and then promote them equitably, pay them equitably, and be invested in a fair environment that is not hostile to them. If systems don’t do those things, there need to be penalties. There has to be accountability. I was listening to NPR while driving, and someone from California said that there aren’t enough women heads of companies. There should be, and clearly this illustrates a disparity, a problem. It’s structural sexism. So they enacted penalties. If you don’t hire women, you’re going to lose funds. Magically, all of a sudden, women were hired. They found a solution because they had to, they were forced. It didn’t come down to, are you a decent person? Are you willing to live with integrity? Do you care? Do you have a moral compass? They said, this is a problem, do something about it, or if you decide not to we’ll just cut your resources. In medicine there has to be the same accountability.

PSM: While systemic racism is clearly the root cause of many of these behaviors, do you have any ideas that can be rolled out to mitigate the implicit/explicit bias, the microaggressions, and the systemic racism in the healthcare environment? Have you seen any tools or anything that is functional or useful?

MH: Apart from having an environment, a culture change within the institution, there’s nothing else that’s going to be useful. There has to be commitment from the institution, and that commitment has to be actualized with actions. There was one hospital I’ve been to that felt different in that respect. I feel like everything comes down to the hallways. In probably every professional building, certainly every hospital, there’s a hallway with pictures of their leadership over time. Invariably they are portraits of, maybe with a few exceptions, white men. Usually white men of varying degrees of old, who do their masculinity in the traditional way. Every day, you walk by that hallway and that hallway tells you many things without saying a word that this is who that institution values, and who they promote. That is who they consider the stakeholders there.

Imagine what that feels like to anyone who is not a white male, or who hasn’t internalized oppression to the extent to feel like that is okay. When people ask me, what will it take to change medicine? It will require people taking all the steps so that this is not what the hallway looks like, because no matter where you are in the country at least 50% of the population are women. As is, that hallway will never be representative anywhere in this country, no matter the demographics of the community.

Apart from my experience in residency, which was really diverse in terms of the healthcare providers at that time anyway, there was one hospital that I went to where we were talking about diversity, and the director was telling me about the values of that institution, and he stopped and said, “Let me take you somewhere.” He took me to their hallway. There were pictures of women, people of different shades. Looking at them, I couldn’t tell how they did their gender. It was such a spectrum of all of these parameters. And then he told me, “We don’t only value diversity, we live it. We have taken action. We said, this is what we believe in, and we prove it.” It almost brought me to tears. Even when I talk about it, it moves me to tears because that is what it will take. Until that happens, we’re not going to have equity in healthcare or anywhere.

PSM: That is a fabulous example. Your ability to paint a picture like that comes through in your writing too. Examples like this are so important to bring to people’s attention.

Jeremiah’s and Gabriel’s stories are portraits of the socioeconomic determinants of health. With Gabriel, the 13-year-old who presents with head trauma sustained in a playground fight and vowing revenge, you asked the tough question: Do you have access to a weapon? In comparison, after losing Jeremiah, the 19-year-old, who presents with a gunshot wound to the head, you wonder if having asked Gabriel about his plan for revenge, you might have altered his life path for the better. You also ponder why no physician ever asked you if you felt safe in your environment. I’m not sure enough healthcare professionals address these needs in the moment for most patients, let alone those with critical needs in the moment like Gabriel. How would you advise young medical students or residents to consider the importance of addressing the social determinants of health in the patient encounter?

MH: That’s an interesting question because we can teach protocols and we can teach procedures, but we can’t teach people to care. They care, or they don’t. Is it important to ask the questions, like “If I write you this prescription, will you be able to fill it? Should I write a less expensive medication so that if you don’t have insurance, or if you can’t pay your copay you’ll be able to get something. Do you have access to food? Are you being abused at home?” Abuse at home or potential injury involving a firearm are a little different. For certain kinds of injuries we legally have to ask about firearms. For certain kinds of abuse, we legally have to ask about it. But those details aside, it is important to ask all of those questions because if we want to take care of the patient, we need to know that information and then tailor our treatment plans accordingly. I can teach that to someone all day long. Whether or not they do it well comes down to whether or not they’re a thorough physician. It’s also going to come down to whether or not they care. That comes down to character. That gets back to who we are recruiting into medicine.

PSM: What would you say to hospital administrators still not convinced that health disparities need to be a number one priority in the delivery of care?

MH: This gets back to what it means to be an advocate. We have so many studies about how it affects morbidity and mortality using our outcomes in care—all of these measures. But I’m going to be honest. Healthcare is set up to prioritize reimbursement. It is a business model that’s based on finances. What really needs to happen is that we have these discussions. Healthcare providers, administrators and the public, because we are still accountable to the public, need to decide what we care about, what we stand for, and what we will tolerate. And then we need to make some hard decisions. If we work in a system where the administrators or the head of the hospital doesn’t care, then people like the public and their providers need to take actions. That’s where we come into accountability. If a person doesn’t care about this, then they are not appropriate for their job and they should find something else to do, and that can be facilitated. It’s not a lack of knowledge. It is a lack of interest in addressing the problem of racism, and you can’t make people care. You can remove them from their position. You can’t change them if they don’t want to change.

PSM: We need Black leadership in place who feel empowered to be able to do that, because there has to be leadership at the table who do not feel like they’re going to get fired if they speak up because they’re the only person at the table with that opinion.

MH: I will also say that yes, we do need Black leadership, but also the people who are there who aren’t Black need to look at themselves and ask who they want to be in this world. For example, I have advocated for queer patients. I’ve had a patient who was transgender and I heard a colleague making fun of the patient. It wasn’t relevant to their care. It didn’t make sense why they were making jokes about them, and so I said something. I don’t have to be queer to know that’s wrong, and I don’t need to be queer to advocate for that person’s humanity. So I expect people to be decent and against bigotry, no matter their orientation or color. That is the expectation. And so absolutely we need more Black physicians and we need physicians of every color to not be racist.

PSM: Great point. This is where courage comes in. Everyone in the room needs to speak up when they feel something’s wrong, even if they feel just as oppressed by the predominantly privileged or largest voice in the room.

MH: Right. Who has been given that, but he doesn’t have to be given that, and it can be taken away. And that’s the right thing to do. I gave a presentation in November, and although anxiety provoking, I was enjoying preparing for it. I’ve been reading all these studies, including a recent study that looked at Black babies taken care of by white physicians and by Black physicians, and then looking at what the factors are that influence this huge disparity in infant mortality with Black babies dying at alarming rates. This particular study looked at concordance between the race of the patient, the baby, and the provider, and found that the mortality of Black babies cared for by Black physicians was decreased by over half. That was the one variable they looked at. However, if a Black baby was taken care of by a white doctor, they died over twice as much. I feel like we all just need to sit with that, because it is so horrifying and alarming. We cannot ignore the role of racism in medicine, or in outcomes. It’s costing lives, in this case infant lives. So that is a call to action. What’s also so sad about it, is that when I read it, I wasn’t surprised because so many of us already know how dangerous racism is.

PSM: Let’s move on to Vicki’s chapter. It’s more of a craft question, though it’s a rich chapter for many reasons. You are able to make this strong yet damaged military veteran, raped by her superior officer, come alive from the page during her visit for psychiatric clearance. You start by noting the similarities between the two of you, and how strange it feels to meet behind the locked doors of the emergency department in the psychiatric unit of the VA Hospital versus a yoga studio or 5K fundraiser. This is my favorite chapter because of the growth that you described for both of you as a result of your meeting. Again, you asked the important questions. In this case it was simply: May I ask what happened to you in the military? It’s another hopeful message that a strong patient-provider connection is healing for both parties. Is Vicki an amalgamation of more than one patient?

MH: This was specifically about the interaction and her, and I changed her name. The crazy thing about her name, and of course I can’t say what her real name is, but her name was so perfect for what we were discussing in this chapter. It was nominative determinism. As a result, I had to make up a name that would approximate the poetry of her name. It was almost impossible.

PSM: How much do you feel your patients teach you?

MH: I learn a tremendous amount from my patients. Part of it is how much people in general teach each other. I’m of the opinion that I can learn from every interaction, or at least 95% of them. That’s my goal anyway, but honestly, it’s my life philosophy. I demonstrated that with these different patient interactions, but it is truly how I live my life.

PSM: It also seems like you’re incredibly present with your patients. Is this true, or truer on the page, after time to reflect?

MH: I would say it’s true, but it also varies. For example, when it’s really busy in the ER and we’re getting slammed, do I have time to sit with Ms. Honor and talk for 40 minutes? Definitely not; it’s just not possible. So it depends on the circumstance and situation. There have been times when it’s really busy, and I’ll spend time talking with a patient because it’s equally as important. I’ve been working on the book for six years, so I had the benefit of picking salient cases over time. It’s a memoir, so it’s curated, but I’m glad that in many of the cases I was writing from that I did have that time with those patients. My job pre-pandemic was so busy I didn’t have that time. Things have kind of slowed down with the pandemic, so right now I do have more time. That being said, I wrote a new essay where I speak about having to intervene and speak out to protect a patient against abusive behavior by a police officer. So is that how I am with patients, and how I am in the world? Yes.

PSM: The relationship between fathers and daughters, as well as forgiveness and gratitude, are big themes that run throughout the book. I understand the internal struggle and the resulting sequalae of having a complicated relationship with a volatile father figure. The book opens with you at seven years old witnessing your father, Morris, assaulting your mother yet again while your brother tries to intervene and you and your sister try to stay out of harm’s way. While Morris is absent most of the book and your adult life, you return to the relationship when you receive his letter of repentance, asking you to call him. The fact that you didn’t hesitate to call him, to me, is both brave and hopeful. It also reveals the craving for a father’s love. I don’t think we, as daughters, can deny that there’s a need for it. In what ways has that relationship shaped you into the person you are for the better, and what do you struggle with because of it?

MH: I will start by answering the ways in which it shaped me for the better. However, I do want to say first and foremost that his behavior was wrong. That I would never want anyone to be in an abusive household. It’s not healthy, and it is wrong to put a child or anyone through that. If they’re a batterer, then they’re battering other people too. I also believe, and I believed this at the time, that if I survived I would go on to help people as a consequence of my resilience and growth. From that experience…well, I’m really independent, and I think that’s a good thing. I feel like my perspective on relationships is really healthy too. I feel that I’ve learned, over time, the difference between love and codependence, and that real love is caring for another person. I start my book with the dedication that love doesn’t need anything. It’s loving in a way that creates freedom, which means that a relationship can last for as long as it’s supposed to last and that’s okay. There is no bondage of any kind, no manipulation that is involved in real love. I also realize that probably is not common for most people’s relationships, but I know it’s possible to have if a person is brave enough to not settle for something less than that. I’m extremely happy about that insight.

How else does it help me? Resilience. I feel like the insight in that, not to romanticize trauma or struggle, but knowing that if something is stressful for me, I’ve been through worse and I can survive. It gives a certain amount of perspective. I’m grateful for that insight into my own life because it’s easier to get through situations like racism at work. I can persist. And when I’m working with patients who are going through traumatic experiences, it may not be the time in that interaction to say, “You know what, it’ll get better one day.” But sometimes it is, and I feel like the energy of knowing that the person can get through it, just even bringing that energy to the interaction, it’s been my experience that that is healing. So I’m grateful for that also.

What have I struggled with? I talk about it with some of my past relationships, like Colin, for example, where I realized that I had slipped into a pattern that was codependent because I think it was familiar. Once I verbalized that to myself, then I had to make a choice, and I did. Like I said in the book, I was a warrior already, so I left. That was a challenge. I don’t feel like it’s a challenge anymore, but even up until my recent history it was a challenge that remained in my subconscious. And then for a long time, trust, and this is a tricky one. Trust is so tricky because of experiences I’ve had in my childhood, but then also being a Black woman in this country. We have a lot of reasons to be distrustful that are valid. That’s been a tricky navigation.

PSM: You had some closure because Morris came back and essentially said, “I heard you. And I’ve been trying to do better.” Many people don’t get that kind of closure. Forgiveness can be a real struggle when you’ve lost a part of yourself as a result of another’s behavior. In Dominic’s chapter, you write:

What we had just experienced had offered an opportunity for all of us to recognize that America bears not just scars, but many layers of racial wounds, both chronic and acute. In order to move beyond them, we need to look at them for what they are, diagnose them, treat them, heal them, and then take care not to pick at the scabs…I write about these moments so we always remember the power of our actions. So we always remember beneath the most superficial layer of our skin, we are all the same. In that sameness is our common entitlement to respect, our human entitlement to love.

This is another beautiful passage with a powerful message. There are so many of us that need to heal as a result of our past. It takes a lot of work, and it’s easier to blame others. Our society is in so much pain as a result of some really tough generational wounds related to deep-seated racism. How do we teach everyone that despite these wounds, accountability, respect, and love for one another are necessary to heal as individuals and as a healthy society?

MH: When I was writing the book, it’s true that I got the letter, but it took me awhile to read it. After I read it, I called not knowing what the discussion would be, or where he was. I believed a couple of things at the time: I knew I deserved an apology, and I also felt, and feel, that everyone deserves a chance at redemption. I meant it when I said forgiveness certainly doesn’t mean condoning behaviors. It also doesn’t mean that a person should have access to my life, be in my life, or deserve a role in my life. It simply means that I recognize part of their humanity. That I forgive who they were at the time, and the pain they have caused—whatever brought them to that point to do it. I forgive that and want to liberate us both so we can go on with our lives however that looks. I meant that, but I purposely didn’t tie it up in a bow. Yes, he did apologize in his way. It was satisfying to hear that he actually heard me at that time, and it stayed with him. Are we close now? No. Have I talked to him since then? Barely, because there’s so much more work he would need to do in order for him not to be toxic in my life. And I will not allow anyone to be toxic in my life. I am not willing to have someone be trauma and drama in my life at any time. But this practice of forgiveness, this practice of not picking at the wound, whether or not they’re problematic or abusive family members or bigotry in society, it’s all the same. Allowing ourselves to heal without adding to the trauma, it’s not a one and done. It’s a daily practice.

PSM: Almost everybody is wounded from something. It’s our responsibility, if we want a good, productive life, to do the work. How do we teach or coach people to understand this?

MH: Tara Brach calls it “radical acceptance.” And I get that, and that’s true. But I feel like first we need radical honesty, where we’re honest about what is going on. We say: this is racist, this is sexist. We say: you were wrong. What people do with that, and this is the radical acceptance part, we don’t necessarily have control over. I feel like another part of being radically honest is being open and honest about past and present situations. Then it gets back to courage, having the courage to act, and being honest about the fact that this will be a daily practice.

I think it’s fantastic, all the marches that are happening. I hope all these people marching know that the action they’re taking is a lifetime of work—their lifetime and the lifetime of generations to come. If we know that, then we can behave accordingly and practice the self-care needed as we work on the structural changes forever. I would offer that I think this is very worthwhile. I think that is an honorable way to live, an honorable way to dedicate one’s life. To me, it makes sense. But we have to be honest about that so people don’t get involved in a situation—whether it’s fighting for antiracism, or getting a certain job, or getting a certain relationship—without understanding that this relationship is not going to make you happy. This job is not going to make you a good person. That’s your work; that is part of a life’s work. I talk about doing yoga. I do yoga all the time—remotely now—but I log in and do the practice. I can’t say I did yoga for six months, now I’m good. I have to do it all the time.

PSM: In the first chapter, you mention a presence or a guardian angel telling you that everything will be okay. What or who did you attribute that voice to as a child? Has that voice changed over time? And do we conjure that voice or that guardian angel, or are we just open to hearing it?

MH: At that point in time, I was about seven years old, sitting in an area of the house that we called the fish room. I was alone, playing with my little ponies, and the house was quiet. It wasn’t always quiet, but at this particular time it was. I heard a voice, but didn’t see a form, letting me know that I would be okay, that I would survive, and the people that I cared about would survive. I was young and didn’t have the language, but I knew I was scared. At the time, I knew there was no certainty that any of us would make it. So hearing this message, I was elated. There was another part of the message that I couldn’t fully understand when I was young, but it sounded cool. The message said that I also had to survive, because I was supposed to go on to help many people. Of course, I didn’t really know what it meant, but I was so full of joy in a way that was not accessible to me before that. I ran upstairs and told my mother what I had heard. In my family, especially with grandparents who were Black and from the South and who have since passed away, there was always this sense of spirit and angels. I knew that was possible. It’s just how I was raised. It was part of our culture, but I hadn’t had an encounter like that, at least that I could remember. I don’t feel like at that age, I could have conjured that voice. Maybe a person could say it’s your inner knowing—but I was seven, so I don’t know. It really felt like the message of an angel, and it was a message that carried me through my childhood and through difficult times in college and beyond. I’ve never forgotten that.

Subsequently I have received other messages. That’s a different discussion, but I wanted to mention it because I do feel there can be times in life when, even though I didn’t have the childhood that I wanted or deserved, and I didn’t have the support that I needed or deserved, I feel that if we’re open to receive it, if we are receptive, there are points in our life where we will get the assistance that we need, at least in that moment to get us to the next moment. It can take different forms. It could be a family member or a friend, it could be a stranger on a sidewalk. It could be the message of an angel. But I do feel that there are points in life where we will be buttressed to keep us going.

PSM: In Baby Tally’s chapter, you write:

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…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 are lucky, the bond holds in the moment—and the experience of it shines and breathes and expands. Then our story can change in an instant, and we may never be given the gift of why.

How did you come to this realization, this way of being in the world?

MH: I’ve had a lot of practice. Honestly, I guess I didn’t have a choice. I didn’t have the appropriate parenting. I didn’t have the story of the life that I wanted that’s told on TV and in movies. So I have to let that go. That is a huge process. I feel that if I can let that go and allow who I am, allow the life that is meant for me…then with practice, I can let go of anything. I can allow for grace, and I can allow for opportunity and possibility in other aspects of my life.

PSM: Does that come with a lot of therapy or is that just who you are?

MH: I think none of this is inevitable and part of it is personality, but it takes practice. Like when I talk about yoga being a daily practice, this is a daily practice too. And I feel like it’s still work. It’s just that the turnaround time is quicker. It’s a little less devastating every time I have to do it. It becomes a habit, a really good habit. And it’s easier for me to remind myself of that.

PSM: Does working in the ER provide perspective in this regard?

MH: It’s so much harder to do this in my personal life than in the ER. I say I was groomed to do emergency medicine because I am used to and can relate to this. I’m used to just having a snapshot of information and having to decide in the moment if it’s dangerous, if it’s likely to pass over, or if it’s benign given the circumstances. And there’s a certain amount of dissociation that is developed to be able to do that. I largely mastered that when I was young. So when I’m in the ER, and people are dying around me or someone’s trying to die and I’m trying to prevent it, I can do that. But transferring that and the integration of the parts of my psyche so that I can feel and be present, and not just remove myself took a lot of practice. I had to develop that skill over time. Being able to do that in my personal life in a functional way was a lot harder. Like when I was writing the chapter about Colin—that’s more recent history. So that took a while. I feel good now. I feel I have expert status on how to do that in my personal life.

PSM: Do you believe we end up where we’re supposed to be?

MH: If we work at it, yes. There’s nothing that’s inevitable. All things being equal, if we put aside the numerous people being in positions they don’t deserve and haven’t earned because of their privilege. If we put aside certain people not being able to access those positions because of structural bigotry. If we equalized everything, then there’s so much choice that enters into it. What are we willing to fight for? What are we willing to work for every day? And I don’t use the word work in a pejorative way. I think it’s a positive thing to dedicate oneself to a mission. For me, that’s the whole point of life. What are we willing to work for? If we do that, if we move from a space of insight and alignment, then yes, we will be living our purpose.

PSM: It’s such a hopeful message. Moving on…Erik’s chapter was difficult to read. Not only because his chart was flagged with a “Violent Behavior Alert” after assaulting a female physician three years earlier, but also because you revisit the statistics that healthcare and social service workers are five times more likely to be victims of nonfatal assault than average workers in all industries combined. The irony that you had been put through so much growing up, and then he arrived with a trigger warning yet you had to treat him, seemed like such a challenge to your own well-being. Yet this happens frequently in emergency rooms, right? I’m sure you have to treat people who have done terrible things, but his case also put you at risk at the same time. You write:

If I were to evolve, I would have to regard his brokenness genuinely and my own tenderly…. My choosing to care about his welfare, my decision to hold in my heart the best intention for another human being no matter who that person is or what they have done…despite my disgust at his previous behavior and the possible moral decay that led him to it, was a social action.

How did you come to this wisdom, this inner strength? And how would you use this experience as a teaching moment for young doctors just starting out?

MH: It really comes from my spiritual practice and how I feel about humans, their essence and their potential. That’s just how I have to operate. By the same token, there are times that the most loving thing I can do for a person is to have boundaries, is to be curt with them and to get them out of the department as quickly as possible provided they’re medically stable, and to not enable their abusive and dangerous behavior. That is loving as well. For trainees, I find it’s important to move from the space of self-inquiry. It helps me to understand why I’m feeling what I’m feeling, and if it is useful in that moment. Yes, his behavior was heinous, and it turned out I had to monitor the situation. But he wasn’t presenting with that behavior now. He was presenting with a surgical emergency, so my feelings about his past behavior were not relevant and could only be a hindrance to me doing my job. I had to look at that if I want to evolve. So I would encourage all of us—we talked about racism before—that’s how people decide if they want to be better than their racist behavior too. It’s the same—this willingness to have self-inquiry, and then to act, to change, to evolve and grow.

The thing about medicine is, we have to be very careful because everyone deserves care. If we’re not comfortable with treating every human being, then we should work in a different field. That’s another important point I would make. In Erik’s case, yes, it’s important to take violence against women seriously, to take misogyny seriously. And there’s a way to handle that. I don’t know what the hospital did to address it. I hope that they did because this provider should have been protected, and I hope that she was. This man needed to have been held accountable for his actions. And that’s how it should be addressed in the moment. When he could die of a surgical emergency, and he’s not being aggressive or violent, it’s not the time for me to exact justice upon him for his past behavior. That’s inappropriate.

PSM: And yet it happens frequently.

MH: I specifically wanted to give this example because the disgust at his behavior is appropriate and it’s righteous and yet it didn’t have a place in the moment. There are countless times when people are discriminating against other people. In this circumstance where one could find it reasonable, it’s not appropriate. So all those other times when you have ill will towards someone, when you have a negative impression about someone and the behavior is questionable, it certainly doesn’t have a role.

PSM: It was clear that this was an example for the larger biases or discriminations that aren’t justified. If you can find it in your heart to treat someone who has done something like this, how come we’re having issues simply because of someone’s race or gender? This really gets into the structure and strategy of the book, and how you laid it out, and why you pulled these stories. Did you pick the themes that you wanted to touch on first, or did you pick the stories because of the importance in your career and let the stories drive the arc of the book?

MH: Initially I picked the stories I was really passionate about, and then I did a loose outline or arc for the book. Then a couple of them were removed and a couple were added, depending upon the themes I wanted to highlight. I tweaked it a little based upon what I decided would be the arc of the book. What is interesting to me is that people often say this is so personal, and I make the point that I don’t actually think it’s that personal. For me, the personal is the same as the political. We’re all connected as humans. These are common struggles, common themes in our lives. So in that way it doesn’t feel personal; it feels universal to me. There was less about me in the book to begin with, and my editor forced me to put more about me into the book. It was so hard—like pulling teeth. I think people in general, but specifically Americans, need to feel a connection to the writer. I cursed my editor at the time. However, I love my editor and I’m really thankful because it’s a better book for having done this. They understood this was a passion project for me, but I was reminded it’s also a business. It was also this amazing spiritual process for me to work through my recent breakup that much more. To work through the part with my father that much more. I knew I had done so much work, but this development happens in layers. There were more layers that I uncovered as I was writing. So it was a blessing.

PSM: I’m so happy that you’re having the success you are, because it’s a gorgeous, layered book with so many messages. What made you decide to write the book in the first place, and did you do an MFA program to help with the process?

MH: People might guess that I was a psychology major and did premed along with it. I didn’t major in literature. In fact, because medical writing does not count, I lost all my writing skills through my medical training. The last time I really wrote a paper was as an undergrad, but there were stories that stayed with me. And again, serving this purpose of healing that we spoke about earlier, that’s why I had to do it. That’s when I started looking around online to enroll in a writing course. Of course I couldn’t do that because I work shifts, and knew I would end up missing half of the classes. So instead, I hired someone to work on my writing with me. A of couple of sessions in, I knew I wanted to write a book. With his help, I decided to develop the arc of my book and write a chapter and have him edit and tell me where and what to expound upon. I learned how to write while I was writing the book.

PSM:  Your book is a memoir written by physician that weaves in patient stories showing how your patients affect not only you as the provider, but also mirrors the health inequities—our social justice failings—in the healthcare environment and the community. This approach feels new. Is this something your editor designed, or did you sketch it out yourself?

MH: I take credit for that. But I will say that because I don’t have a writing background apart from going to school, I was a little scared after I wrote the book. Part of the reason I followed up with writing the essays I mentioned—one on topics related to COVID in March, and then this summer, another one around police violence and racism in the hospital—was that I had to prove to myself I could actually write and it wasn’t a fluke.

PSM: Who were your mentors? Your medical mentors, or just mentors in general for that matter?

MH: There’ve been a couple physicians along the way who’ve been really helpful. I’ve never had one mentor. I’ve learned different skills from different physicians. I learned the importance of history taking, the importance of listening and putting together information so I could understand what has happened to a patient and how to make a treatment plan from one physician in particular. She was pretty mean, but I learned that invaluable skill and I speak about it because it was life changing. In that way, she was a critical mentor for me. There have been other attending physicians from whom I learned empathy. I had an attending in medical school who was heavily involved in intimate-partner violence prevention and did a lot of educating on it because of his experience with it as a child. He was a great deal of support for me during medical school. When I faced racism during medical school, he was someone I could just talk to. So there’ve been different people along the way. I also draw a lot of strength from people who I’ve never met, but who I’ve modeled after from their teachings—like Audre Lorde and James Baldwin, which gets back to the spiritual practice. These are people who I feel all along the way energetically have been mentors. But I’m open to different people who I can learn from as I go through life.

PSM: Who and what are you reading right now?

MH: The next book I will read is Caste by Isabel Wilkerson. It’s blowing up everywhere; I have to read it. I was also reading a book of poems by the poet laureate Joy Harjo. That was easier because I could read one every night. It was a really stressful time, and I was having to keep a lot of balls in the air. And I was also rereading The Alchemist, which I love.

PSM: Along those lines, what books would you suggest people read who are interested in working to resolve systemic racism in the world or removing bias of any type in the healthcare system in which they work?

MH: There are many good books out there, and I think all of them are important to help educate ourselves and to support authors of color, but making the switch to caring and acting is a different process. For example, there was a problem in our ER. People were making racist statements, and a student overheard them. She was distraught and had to leave her shift early. Somebody in ER leadership asked me, “Can you help me? What are your ideas? What should we do to make people less insensitive?” I gave her suggestions about how there’s leadership in these areas who can help develop a training program, different educational resources, whole books written about the topic, and I provided some  additional ideas. Her response was, “I don’t really have time to do that.” So if it’s not important to educate yourself and to reach out to the appropriate people, then there won’t be change. And that’s the point.

PSM: Yes, it has be a priority.

MH: She was making the larger point, unbeknownst to her, that it wasn’t a priority and she wasn’t willing to put in the work. Part of the reason I hesitate to give a list of books is that I don’t want to overwhelm people. She spoke a lot of truth when she said that was not a priority to her. What’s required is that a person cares and that it’s important. It’s always wonderful to have a reading list in schools, or for people’s daily lives, but it can also feel overwhelming. Even if you’re a good person who cares, it can feel overwhelming if it means in order to understand racism, I’m going to have to read seven books. I don’t necessarily think that’s the case. I think it’s a matter of being open and receptive, because this is stuff we can see in our daily lives. Is it important to read if a person has never thought about it? For example, if it’s a white person and this hasn’t affected them in their daily lives, and they mainly hang out with white people in a white area and they’ve never thought to branch out or educate themselves? Then yes, in that case, you should read something. And then just open your eyes because it’s all around you, all the time. The question is, do you want to see it? Are you willing to do something about it? In the end, it doesn’t matter if you read 15 books if you don’t want to see it, and you’re not willing to do anything about it.

Tracy Granzyk is the editor in chief of Please See Me.