The Beauty in Breaking

Harper alludes to Complementary and Alternative Medicine (CAM) in the context of treatment for veterans, for whom this approach often works well. CAM relies on a group of internal medicine doctors, social workers, and psychiatrists to provide treatment and wellness practices beyond conventional ones. In working with veterans, Harper at times hopes for alternative treatment methods because veterans often have unique mental and emotional needs. Despite CAM’s potential for assisting her in her work at the Veteran Affairs Hospital, she was unable to reap the benefits of a CAM program, be it for funding, timing, or logistics. 

A “CHFer” is the abbreviation that doctors use for patients experiencing congestive heart failure, which occurs when the heart is unable to pump blood with normal efficiency. In her work as an emergency room doctor, Harper saw countless CHF patients and often relied on a bilevel positive airway machine (BiPAP) machine to bring a patient back to stability. Through exams and EKGs, Harper monitored her CHF patients to help ensure that their symptoms didn’t worsen. Heart failure, combined with chronic heart disease, are the leading causes of death in the US. 

This term refers to activity that happens primarily during the daytime, which for many doctors is a luxury. Harper contrasts her self-admitted diurnal tendency with the challenges of working night shifts. For Harper, the physical recovery from a night shift is akin to recovering from a bad hangover and is more difficult with age. However, as much as Harper prefers to work during the day and sleep at night, she also qualifies night shifts as a “refuge” (45). As she reflects on her work and responsibilities as a doctor, the importance of working during either the day or the night significantly affects her life and the way she organizes her time. 

Emergency Medical Services (EMS) provides urgent treatment before a patient is admitted to a hospital and often includes ambulance and paramedic services. In Harper’s world, EMS acts as a bridge between the outside world—removed from the immediate reality of the emergency room—and the constant turmoil of the hospital. In Chapter 11: “Jenny and Mary: What Falls Away”, for example, Harper details the key role that EMS plays in facilitating her treatment of an elderly woman named Mary Giannetta, as they perform CPR and place an IV into Mary’s body.

Harper describes medical internships as “the year of residency that nearly everyone in medicine programs hates” (33), a year in which doctors who have completed medical school anxiously await their primary programs. During their internship year, these physicians in training are not yet allowed to practice medicine unsupervised. Many doctors end up working in programs that do not align with their future aspirations, but internship is nonetheless a formative, necessary part of any doctor’s experience. Harper’s internship experience was overseen by a forceful, blunt physician named Dr. Jaiswal, who habitually corrected her interns during rounds, even in front of patients. 

Kintsukuroi is the Japanese art of repairing pottery with precious metals, such as gold, silver, or platinum. Harper uses Kintsukuroi as an analogy for her life, where brokenness is perceived as beauty. In other words, an object—or life—becomes more beautiful because it has been broken. As Harper alludes to Kintsukuroi in the book’s introduction, she centers the thematic premise of her memoir in this image. Just as in the practice of Kintsukuroi, Harper highlights what was broken rather than ignoring it or sweeping it under the rug. 

Mercy Hospital, in the South Bronx, is where Harper completed her emergency medicine residency. She describes Mercy as “one of the busiest hospitals in the country” (81) and “one of the highest-volume trauma centers in the country” (81). She recalls the Mercy Hospital community—and by extension the EMTs, firefighters, and police officers that regularly frequented the hospital—as a tightknit community, where people worked hard and developed meaningful relationships: Mercy may not have been fancy or innovative, but its staff cared for patients with love and dedication.  

Montefiore Hospital, in North Philadelphia, is where Harper pursued career mobility after leaving Andrew Johnson Hospital. She describes Montefiore as very similar to Mercy Hospital. However, with a patient volume of approximately 95,000 a year as compared to Mercy’s 145,000, Montefiore was not nearly as hectic or busy as Mercy. In Harper’s position as one of the assistant medical directors, she oversaw program improvement at the hospital.