“Most of the time my job is to keep death at bay. When I am successful, I send the patient back out into the world. When I’m not, I am there as life passes away.” 

Harper emphasizes the stakes of working as a physician as often being someone’s one and only hope to survive. For a doctor, a razor-thin line separates success and failure, which often translates to life or death, and Harper’s personal connection to these stakes are undeniably real. 

“As a black woman, I navigate an American landscape that claims to be post-racial when every waking moment reveals the contrary, an American landscape that requires all women to pound tenaciously against the proverbial glass ceiling, which we’ve since discovered is made of palladium, the kind of glass that would sooner bow than shatter.” 

Harper embraces her identity as an African American woman, navigating not only the delusion of a post-racial America but also the constant expectation to batter the glass ceiling that exposes the income and opportunity gaps for women across virtually all professions.

“The previously broken object is considered more beautiful for its imperfections. In life, too, even greater brilliance can be found after the mending.” 

Here, Harper compares her life to the Japanese art of Kintsukuroi, which consists of repairing broken pottery with precious metals, such as gold, silver, or platinum. The philosophy behind the practice equates brokenness to value. For Harper, her personal brokenness, through the complicated landscape of both her childhood and adult traumas, is in essence an act of Kintsukuroi. 

“Security was perhaps the only thing I ever wanted, and up to that point it had remained a long-ungranted wish.” 

As Harper chronicles her childhood experiences with domestic abuse, she highlights how she craved security, which seemed to her a mere fantasy, a luxury that her life and circumstances would never afford her. 

“There was no law here. No help. When assessing the danger, the police had not differentiated between my father and my brother.”

Harper expresses her disillusionment with the police as a system, one that failed her family by not protecting them from the violence her father inflicted upon them. During her childhood she was overwhelmed with a feeling of helplessness. If she, her mother, and her brother were to escape her father’s violence, it would have to be through their own devices or a miraculous, sudden change in her father.

“I figured that if I could find stillness in this chaos, if I could find love beyond this violence, if I could heal these layers of wounds, then I would be the doctor in my own emergency room. That would be my offering to the world, to myself.” 

Here, Harper recalls the first moment she knew she wanted to work as a doctor. Back home following a visit to the hospital after her father injured her brother, she reflected about how her own gift to the world would be a response to the violence she experienced herself—not retaliation or vengeance but an open-hearted gift to her future patients. 

“It wasn’t at all how I had pictured graduation from my emergency medicine residency at Mercy Hospital in the South Bronx would be, but it certainly was a blistering end.” 

After four years of medical school and then another four years of residency, Harper hoped to celebrate alongside her husband. Instead, her mother was her only guest at graduation, and Harper’s experience of the occasion was bittersweet without her husband by her side. Her marriage over, she would be a recently divorced woman as she started her medical career in a new town. 

“The breakup of my marriage was stoking in me the deep sense of abandonment that had lain dormant during my marriage, the loss of the home life I had craved but never had. I knew on some level that this was the real source of my grief.”

Harper reveals that although she was sad that her marriage had ended, the center of her grief was an accumulation of emotions that made her feel a sense of abandonment and loss. She could make sense of her divorce, even heal from it, but she would have to confront these cumulative feelings of abandonment to truly heal from her past. 

“As far as I was concerned, the title of ‘father’ had to be earned, and I began to define ‘family’ for myself, concluding that inclusion in this group could be forfeited.” 

After the pain that her father had inflicted on her throughout her life, Harper no longer felt that she could refer to him as family. Family became more of a construct, regulated by her sense of safety and belonging rather than a merely biological tie.

“It is better to be left with a ghost than a ghoul, so his disappearance from my life was an acceptable outcome.”

Here, Harper refers to her father’s abrupt departure from her life and his “ghosting” her intermittently. She reveals her own indifference toward his absence, reasoning that she’d rather he disappeared from her life for stretches at a time than be haunted by him on a constant basis.

“I fancied that all things happened for a reason, so there had to be a reason I had been stripped to my core and was sitting here on a warm carpet, in the blazing reflected light of an unknown city.” 

After moving to Philadelphia from New York, Harper contended with the significance of her personal crisis—fueled by the collapse of her marriage—right at the end of her medical residency. Here, she reveals that she was broken and welcomed the opportunity to find meaning in that season of her life.

“Night shifts are always inconvenient and much like hangovers: the older you get, the harder they are to recover from.” 

In this passage, Harper expresses the physical toll that working all-night shifts in a hospital can take on doctors, particularly as they get older. The implication is that a doctor’s entire lifestyle is oriented around their work schedule, which can feel like constantly recovering from a hangover. 

“Resuscitations can be brutal: Ribs are broken with chest compressions, skin is contused, mouths bloodied, even teeth knocked out for God’s sake.” 

Harper provides a glimpse into the ruthlessness of trying to revive a patient during CPR, as chest compressions and artificial ventilation are often used in an urgent, harrowing effort to manually preserve the brain function of a patient in cardiac arrest.

“Parents know. They know the way we know life is gone as the gurney is rolled through the ambulance doors. Parents know because these angels whisper their last words in their ears and butterfly-kiss them good-bye.” 

Here, Harper compares the prescience of doctors to that of parents, who know when their child’s life has left them. For doctors, the knowledge is based on professional expertise, whereas for parents, as Harper articulates, the knowledge comes through a more spiritual language.

“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.”

Harper finds herself in a unique position as an emergency room doctor. On one hand, she is in the business of changing lives. On the other, she also witnesses death on a frequent basis. This passage articulates how she leans into this tension by naming the natural human tendency to hold onto the people and memories we hold most dear. 

“If I were to evolve, I would have to regard his brokenness genuinely and my own tenderly, and then make the next best decision.” 

After dealing with a particularly difficult patient, one with a violent history, Harper reflects on her role as a doctor, as a healer. She defines her responsibility as one that requires care to all, one broken human being preserving the life of another.

“We are not yet at a time in America when the attributed or perceived actions of a brown or black or queer or Muslim ‘wrongdoer’ are considered singular. Instead, such accused are seen as emblematic of an entire demographic, one labeled guilty before charged.” 

Harper laments the American tendency to generalize the actions of someone who belongs to a non-white demographic. She does not believe that America has somehow reached an enlightened post-racial reality. 

“We can’t force parents of children to allow immunizations that prevent epidemics of devastating pediatric disease; we can’t force a hemorrhaging Jehovah’s Witness to accept a blood transfusion; we can’t force someone having a heart attack to go for a life-saving cardiac catherization if he refuses it.” 

In context, this quote is a conversation Harper has with a fellow doctor as she justifies a patient’s decision to refuse an examination after being brought in by the police. Ultimately, a patient has a right to refuse treatment, no matter how incomprehensible or controversial this decision may be. 

“I choose to witness the tortured flesh. I support it in my hands and cleanse the wounds as gently as I can.”

The “tortured flesh” here refers to the brutal history of America’s racism and the scars it has left in the American psyche, both past and present. Harper’s choice is to confront every brutal reality, contributing to America’s healing in her own way, as a doctor navigating multiple identities and contexts.

“I knew the pain of the kind of violence that happens privately, at home; the violence that’s not reported, much less discussed; the violence you can’t escape because it’s where you lay your head, until you can manage to pack up and secure a safe place to bathe, to eat, to sleep, to be.”

Harper identifies a fundamental difference between the private violence of domestic abuse, a kind of violence that happens out of public view, and the violence of the streets. Whereas she frequently treats victims of public violence, she has experienced only the kind of violence that happens behind closed doors.

“Strange how police officers frequently find the wackadoos. I suppose it’s just like ER physicians, psychiatrists, social workers, and all of us in the helping fields: We all nurse that same Achilles’ heel of cleaving to the damaged.” 

Here, Harper muses about the tendency that people in the “helping fields” have in choosing a romantic partner—specifically, the tendency to find partners she calls “wackadoos,” who may be experiencing emotional or mental instability. The term “wackadoo” is unconventional for a doctor, but in this passage, she is expressing herself outside the immediate context of her profession.

“Timing can make or break the best of us, and for reasons that may be yet to be revealed.” 

This passage illustrates Harper’s belief that all things happen for a reason and events happen at a meaningful time. Someone can be broken or renewed depending not only on what happens to them but also when it happens. 

“In my life, I chose a different pattern from the one I was born into, so I would not replay my past trauma with anyone. It was worth creating good with the right person at the right time. I am worth being healthy with a person who also chooses health.” 

Harper highlights her choice to break with her past, a choice rooted in pain and personal heartbreak. She reveals her determination to not replay her past with anyone else, instead choosing to seek out people—or in this case a potential partner—to mutually pursue health within the context of a relationship. 

“I knew that after letting go, there is forgiveness; after forgiveness, there is faith.” 

In this passage, Harper accentuates the process of her personal journey out of trauma and into healing: first, letting go; then forgiving; and finally, faith, or the assurance that our traumas will not dominate our lives any longer.