- Dr. Adarsh Nath | Letters from the ER
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- The Boy in the Dinosaur Shirt
The Exit
The ER never sleeps.
It hums with monitors, stretchers, and lives
held together by threadbare systems,
where we stitch moments into meaning.
I had just punched out of my shift.
Home was still.
The fan hummed like a memory.
She was already curled up on the sofa,
scrolling through Netflix.
My blue blanket tossed over her knees.
Hair messy from waiting.
She’d picked the movie.
I’d ordered dinner.
My phone buzzed:
“Your order is 22 minutes away.”
And then it rang.
A colleague.
His voice stuttered between breath and adrenaline.
“Mass casualty.
A company bus hit a car.
Multiple injured.
They’re routing all ambulances to us.”
The air shifted.
The room, just moments ago filled with hard hunger and soft love,
grew thin.
Weightless.
Distant.
She didn’t speak.
She only nodded.
A silent contract we’d signed
the first time she kissed me goodbye before a night shift.
“I’ll be back soon,” I said.
“Please eat.”
I walked out.
Not into a war zone,
but into something crueler.
A system stretched thin,
understaffed, overworked.
It doesn’t explode.
It bleeds.
Slowly.
Quietly.
Predictably.
The Storm Before the Silence
They arrived in waves.
Fractures. Lacerations.
Broken spectacles. Bent ID cards.
One man cursing his shattered phone screen.
Another chuckled nervously at his dislocated finger.
Pain, when diluted across twenty-two bodies,
becomes theatre.
A grotesque ensemble
of moans, blood and bureaucracy.
Triage.
Vitals.
X-rays.
Reassure.
Repeat.
The air smelled of iodine and fear,
monitors beeping their warnings.
But somewhere between patient seven and patient eight,
I looked up.
And saw my team,
All listening for something that hadn’t arrived yet.
And then,
he came.
The Smallest Body in the Room
He was six.
Maybe seven.
His stretcher rolled in with unnatural quiet.
No wails.
No chaos.
Just the silence of impact.
Unconscious.
Blood across his temple like a closing curtain.
He wore a colorful dinosaur shirt,
now soaked in red and dirt.
His father limped behind,
face bruised, wrist cradled.
He whispered:
“He was in the front seat.
He wasn’t wearing his seatbelt.”
Eyes brimming with tears.
And guilt.
Then, the spiral.
GCS 6.
Sluggish pupils.
Breathing ragged.
Sats dropping fast.
We tubed him on the spot.
Bagged.
But his chest -
it wasn’t rising the way it should.
Barely any air entry.
Hyperresonant to percussion.
The bedside ultrasound confirmed it:
Bilateral pneumothorax.
His lungs weren’t just collapsing.
They were retreating,
as if his body had grown
weary of the fight.
Bilateral chest tubes went in.
Sharp steel. Blunt forceps.
A hiss of air,
like death exhaling.
But the mind -
the mind was another story.
We started mannitol and levetiracetam
to protect his brain.
The CT lit up like a curse.
Multiple facial bone fractures.
Subarachnoid hemorrhage.
Micro-tears.
Hemorrhages like constellations.
?White matter shearing.
Features suggestive of Diffuse Axonal Injury.
A brain not destroyed,
just slowly unplugged from itself.
Like Kafka’s Gregor,
he was present, but unreachable.
The Absurd Theatre of Hope
His mother arrived,
crying.
Her phone clutched in her hands,
still open to missed calls.
She found her husband among the chaos.
She didn’t scream.
Didn’t ask.
Didn’t accuse.
Her eyes searched for her boy
and found him.
Found his feet and held them.
Two small feet, battered with abrasions and antiseptic.
She rubbed them
gently, rhythmically,
as though this were any other day,
as though school was starting late and he’d overslept.
She whispered his name.
Again.
And again.
And again.
Like she was begging God
to rewrite the script,
to rewind time by an hour,
to trade her breath for his.
The Curtain Call
Twenty-one people walked out that night.
Some for follow-ups with the orthopedics team the next day.
Some admitted for fracture fixations and wound debridements.
Some booking Ubers.
Some bandaged.
Annoyed.
But alive.
And one child…
floated upstairs.
Intubated.
Tubes in place.
Brain swollen.
No voice.
No goodbyes.
Later, when I finally sat in my car,
my girlfriend asleep at home,
food gone cold,
the night long behind me -
I looked at the passenger seat.
Empty.
And I asked myself,
not as a doctor, but as a man:
“What if that had been mine?
What if that boy,
so small,
so silent,
was the one I kissed goodnight?”
And as I was about to drive back home,
I thought of her,
asleep at home,
oblivious to the boy who might never wake.
Her voice, soft from a morning long past,
echoed in my mind,
a fleeting anchor to a world
untouched by this night.
“Death is the wish of some, the relief of many, and the end of all.”
- Seneca
If this letter stayed with you,
if it reminded you of life’s fragility, or beauty, then stay with me.
I write every week from inside the ER, to make sense of what most people never see.
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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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