- Dr. Adarsh Nath | Letters from the ER
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- Coffee at 150
The Quiet Arrival
61/M
He didn’t arrive like an emergency.
No sirens.
No clamor.
No breathless rush.
Just a thin old man,
walking in at his own pace,
with a heart racing
at 150 beats per minute.
“Mild breathing difficulty…
and palpitations…”
as if introducing two old friends.
Years of paroxysmal atrial fibrillation
had taught him the dance.
Only today,
they had overstayed their welcome.
The ECG confirmed it:
“AF with FVR”
His heart, a trapped bird,
fluttered wildly between 140-170 beats per minute,
wings frantic,
directionless,
defiant.
In the ER, some emergencies come loud.
Others come quiet but urgent.
Like a fuse burning in another room,
just out of sight.
The Tense Stillness
We moved quickly,
but not in panic.
This was a fight to be won by patience,
not force.
The IV slid in cleanly,
veins still generous despite the years.
We pushed a bolus of Amiodarone,
that bitter, dependable friend
who doesn’t work swiftly but works well.
Then came the slow drip of infusion,
each drop a plea for calm,
each drop a whispered negotiation
with a stubborn heart.
The monitor traced jagged green lines,
like a stubborn sky
refusing to soften.
“140.
136.
142.
156.”
Unyielding.
We checked his electrolytes,
ruled out thyroid flares,
debated beta-blockers.
This wasn’t a sprint.
This was a stroll beside him,
hoping his heart would remember
how to keep its own time.
The Request
He had been watching us work.
Quiet.
Patient.
Eyes following every movement as if studying a play.
And then, without warning,
he leaned toward me.
“Doctor… could I have some coffee?”
I blinked.
“Coffee?”
“Yes,” he said, perfectly serious.
“Just a small cup.”
The Laugh We Couldn’t Contain
In that moment,
the ER became a theatre of the absurd.
Coffee.
Caffeine.
The spark that could send his heart flying faster,
undoing every deliberate step we’d taken in the last hour.
We were coaxing the storm to sleep.
He wanted to hurl lightning into it.
It cracked the room open.
The nurse bit her lip,
trying not to laugh.
My resident turned his back,
shoulders shaking.
I caught my own grin
in the monitor’s reflection.
We refused, of course.
He only smiled.
As if he’d known the answer all along,
but asked anyway,
just to watch us squirm.
For a moment,
the ER wasn’t a place of failing hearts.
It was a stage for their mischief.
The Cup We All Crave
Some patients fight their illnesses.
They meet them with sharp edges,
every test result a battle to be won or lost.
Some bargain with them.
One more year, one more trip,
one more wedding to attend.
And some, like him,
share a quiet truce.
His heart wasn’t a crisis to him.
Just an old friend, restless again.
The coffee wasn’t rebellion.
It was familiarity.
A nod to living on his own terms.
A spark of normalcy
in the sterile, beeping air of the ER.
His request made me think
about the rituals we cling to
when life feels most uncertain.
The things we know might hurt us,
but keep us feeling human.
The Slow Descent
By dawn, his heart rate eased
from the 150s to the 90s,
a slow descent
like a storm clearing the sky.
We arranged his transfer to Cardiology.
He left sipping water instead of coffee,
but the mischief in his smile told me
the idea of that cup was still very much alive in his mind.
In the ER,
we spend our days taming chaos,
slowing what races,
quieting what rages.
But his coffee request reminded me:
not every storm wants to be tamed.
Some are meant to be danced with.
And maybe that’s why we all keep asking
for our own cups of coffee.
Knowing it might make things worse,
but certain it will make us feel alive.
“We must laugh in the face of our troubles,
lest they devour us before they kill us.”
If this letter made you pause, forward it to someone who needs a reminder that not every storm must be tamed.
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More soon.
Another moment.
Another reminder that we are still, somehow, human in all of this.
Yours,
Dr. Adarsh Nath,
Letters from the ER
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