Click "Read Online" at the top of the mail for a better reading experience.

Midnight does not arrive in the emergency department.

It slips in unnoticed,

like a diagnosis

delivered too late

to matter.

A number changes.

The room does not.

A young man

lies beneath a sterile towel,

his twenties still clinging to him

like an unanswered prayer.

Alcohol swims

in his blood,

not enough to save him from pain,

not enough to drown memory either.

He fell forward.

Gravity finally remembered his name.

His chin is split open.

The inner lining of his lips,

that soft, intimate place where words are born

and lies learn to sound sincere,

is torn apart from the inside.

Local anesthesia.

Because here, pain is negotiated, not abolished.

I inject.

The tissue tightens, then yields.

My resident everts the inner lip,

turning the mouth inside out

the way truth sometimes is -

raw, wet, humiliating.

A clean field of vision.

Nothing hidden. Nothing spared.

We remove fragments of his broken tooth

embedded in the wound.

The nurse stands close,

scissors poised like punctuation,

ready to end

each sentence I begin.

I stitch.

Fourteen times the needle enters living flesh.

Fourteen small violences

disguised as mercy.

Inside the mouth,

that restless cave that refuses stillness,

healing feels temporary,

almost dishonest.

Blood mingles with saliva.

Speech dissolves.

The body

takes over the narration.

Behind a curtain

thin enough to lie,

a man with heart failure

borrows breath.

NIV breathes for him,

its hiss steady, bureaucratic.

Each breath sounds uncertain.

Each pause threatens

to become permanent.

Life here is not sacred.

It is conditional.

It survives

on renewals.

Then,

obscenely,

a voice

cuts through the machinery.

“Happy New Year!”

The words land wrong.

Like a smile at a wake.

Like hope in a room

that has outgrown it.

We say it back anyway.

Because ritual

is how humans pretend

they are not completely alone

inside systems that do not love them.

Under the towel, the young man hears us.

He raises both hands,

fingers twisted into defiance,

and makes

the rock sign.

A childish blessing.

A celebration of still being here.

His mouth pulls into a careful grin.

A stitched joy,

measured in millimeters

and restraint.

He does not know

how close the night

came to swallowing him whole.

The spared never do.

They mistake

chance for destiny,

survival for approval.

The room holds its contradictions without comment:

a boy laughing through sutures,

a heart being bullied into rhythm,

three clinicians acknowledging midnight

as if it were anything more than a clerical update.

No fireworks.

Only nylon and steel.

No rebirth.

Only repair.

The year does not begin.

It continues, unbothered.

Then the doors burst open.

A man is wheeled in on a stretcher, gasping -

wet rattles tearing from his throat,

each breath ripped from him

like a confession extracted by force.

The right side of his head is cratered open,

skull fragments splayed like broken porcelain,

hair matted into a dark, sticky map

of blood and bone dust.

Brain visible,

not as metaphor,

not as thought,

but as naked, glistening fact.

The mind,

exposed.

Unarmored.

Bleeding.

There is no silence for this.

No time to feel horror bloom.

Only the metallic tang of blood in the air,

the wet suck of suction tubing,

the low hiss of oxygen,

and the soft, irregular throb of living tissue that should never see light.

Hands move

before the heart can object.

Before the soul has time

to flinch.

An Ambu bag appears.

Squeeze.

Release.

Air forced into lungs

that no longer remember how to ask,

while someone else

packs gauze around the edges.

Not to stop the bleed,

but to keep the brain from falling further,

to cradle the quivering mass as it rises and falls

with each stolen breath.

A jaw pried open,

teeth clacking against the blade,

a tube slid in, right there on the stretcher,

because time has revoked the privilege of preparation.

The laryngoscope light

catches the glistening folds,

a brief, impossible glimpse of cortex

before the tube disappears down the throat.

Numbers shouted

like coordinates in a burning city.

Clothes cut away

as if dignity were an obstacle.

Someone cradles the head,

gloved fingers slipping on bone and meninges,

as though what is spilling out

might still be persuaded to stay.

This is not heroism.

This is reflex.

This is what repetition

does to fear.

It turns revulsion into routine.

Turns the sight of a man’s thoughts

leaking onto linoleum

into just another Wednesday midnight.

Outside,

people are kissing,

promising themselves forgiveness

they will postpone.

Inside,

the year walks forward -

over exposed brain,

over failing hearts,

over stitched mouths

and gasping chests.

Life does not pause to be understood.

It does not wait

to be mourned.

It demands motion.

And so our hands move -

again,

and again,

and again.

If this made you pause, forward it to someone who might need it.

WhatsApp, Facebook, or X - one click away.

More soon.

Another moment.

Another reminder that we are still, somehow, human in all of this.

Yours,

Dr. Adarsh Nath,

Letters from the ER

Disclaimer:

Patient details have been changed to protect confidentiality. This is a personal reflection, not medical advice or substitute for professional care.