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

A moment so small it should’ve passed unnoticed.

Not in the middle of a code.

Not while holding pressure on a bleeding artery.

Not during one of those nights

when the whole ER tilts toward madness.

No.

It came between patients,

a sliver of stillness

wedged like a skipped beat

inside the machinery of the shift.

The monitors silenced their alarms.

And into that fragile silence

rose a thought

I had no right to think.

What if God is not watching?

It hit me

like a pulse that flatlined.

Wrong, disobedient,

unsettlingly honest.

I tried to push it away.

But it clung,

hot and septic,

like a truth that’s waited too long to surface.

You’re not supposed to question God in the ER.

You’re supposed to move. To fight.

To drag bodies

back from the cliff

with whatever’s left in you at 3 a.m.

But the question stayed,

circling like a predator

that has finally memorized

the scent of your fear.

What if the universe is indifferent?

What if suffering has no witness?

What if prayer is a ritual meant to soothe humans,

not summon heaven?

I’ve seen too much randomness

to call it plan,

too much grief

to call it divine design.

Every time I whisper to a dying patient, “I’m here,”

I feel a fracture tear through my chest,

the truth I want to believe,

and the truth I fear is real.

Not all lies wound.

Some save.

Some keep people alive long enough

to die with dignity.

Sometimes

mercy

is a lie

spoken softly.

Sometimes I think God must exist.

When a mother grips my hands after we save her son.

When a pulse returns after 30 minutes of cracking ribs.

When a patient says thank you

in a voice so fragile it feels like a prayer.

On those nights, something moves.

Something deeply human, not divine,

as if meaning is a creature we create together

to keep darkness from swallowing us whole.

Maybe God is not a being.

Maybe God is the name we give

to the part of us

that refuses to look away.

If so,

every suture is a scripture,

every shock a hymn, and

every life saved is an act of worship

in a temple made of white walls and flickering lights.

And yet,

in the stillness after the last pulse fades,

when the ER returns to its strange emptiness,

the thought returns, heavy as guilt.

It returns unannounced, the way old wounds ache before rain,

a slow, philosophical dread that tells you,

that the darkness I fear “out there”

is merely the echo of the one I tend “in here.”

I’ve watched enough souls walk their final steps

to understand that suffering

isn’t an event.

it’s an inheritance.

A language passed from one life to another,

spoken in silences, in half-remembered nights,

in the way a man knuckles the bed rail

when he realizes that no one is coming to save him.

Maybe that’s why this question rose in me tonight.

A reminder that the human spirit

is not a flame or a shadow,

but a trembling axis caught between both.

Spinning,

always spinning,

trying to make meaning

out of a universe that refuses to reply.

And still,

despite everything I’ve seen bleed, break, collapse, and vanish,

despite the whisper that the dark is not a place I enter

but something I’m made of,

I choose,

with whatever part of me remains unruined,

I refuse the dark.

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.