Dear Readers,
Letters from the ER will take a short pause until the second week of February.
In the meantime, we’re quietly working on something long dreamed. An idea that will come to life once we reach 50 letters. Something to hold in your hands, to keep beside you, and to revisit whenever the ER whispers its stories.
Thank you for waiting. When we return, the nights, the patients, and the truths of the room will return too, perhaps a little closer to the heart than before.
Time.
It refuses linearity.
In here, it arrives already damaged.
I enter a night shift and leave in morning light, but the hours in between refuse the name.
A clock with blue borders hangs above the nurses’ station. Round, official, well-meaning. It keeps time for rosters, for administrators, for people who believe minutes stack neatly and can be trusted.
It has never met a dying man.
In bed seven, time bleeds out.
In the waiting room, it simply waits.
On the monitor, it flashes red, then flat, then irrelevant.
They ask me how long. Everyone does. How long for the scan. How long for relief. How long before we know. How long before you do something.
I am expected to translate chaos into duration, to make time legible. I say soon, a little while. Language becomes anesthesia; tone buys minutes.
Inside, I count what cannot be counted: how much time this body still owns, how much suffering is acceptable per hour, how many lives can be held open by an exhausted pair of hands.
When time runs, it runs viciously.
A man arrives clutching his chest and the room obeys. Hands move. Orders land. The clock turns sharp, surgical. Door-to-balloon. Numbers that pretend death respects benchmarks.
We move fast enough to feel clean. Fast enough to believe.
And then time slows.
A woman waits for a head CT that will not save her husband, only rename what is already happening. A man breathes just well enough to remain deferred. These hours do not announce themselves. They erode.
I walk past carrying urgency elsewhere, promising myself I will return. Time sits with them faithfully, doing its quiet work.
There are moments when time stops completely.
The fraction of a second before I speak the sentence that will split a family’s life in two. The room stills. Machines lower their voices. Even the clock hesitates, aware it has no standing here.
Then I say it. Clearly. Professionally. And time resumes. Crude, unmoved. I announce the time of death as though naming it gives it authority, as though precision might dignify the theft. Later, I wash my hands and notice the clock has advanced without reference to what was lost.
This is what emergency medicine teaches you, slowly and without ceremony: time is not a resource. It is a verdict. Some are given it generously. Some are stripped of it abruptly. And some of us are stationed in between, tasked with distributing loss as judiciously as possible.
I give my time away in fragments too small to defend: missed meals, delayed sleep, conversations postponed into absence. Years pass disguised as shifts. I used to think I was saving lives. Now I know I am negotiating with time, and most days time sets the terms.
When my shift ends, nothing feels finished. I step outside and the world moves at a speed I no longer trust. Somewhere between the sliding doors and my car, I try to remember how to live without measuring it.
I almost never do.
“The trouble is, you think you have time.”
If this made you pause, forward it to someone who might need it.
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More soon.
Another moment. Another reminder that we are still, somehow, human in all of this.
Yours,
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.
