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He was eighty.

An age that no longer

hurries toward anything,

least of all illness.

Two weeks earlier,

he had danced at a wedding.

Music, laughter,

the brief sanctioned excess of joy.

He returned

carrying a word

that travels lightly through families.

Gastritis.

A diagnosis

that promises forgiveness,

asking only

for time.

Food withdrew first,

as preference, then as effort.

Solids departed

without farewell.

Liquids lingered,

a fragile treaty,

until even thirst

lost its voice.

“Nothing has changed,”

they said.

That is how neglect always speaks

before it learns its own name.

Speech failed first.

Words unraveled in his mouth,

meanings slipping their moorings,

sentences arriving

like refugees without papers.

Thought

may have remained intact,

but expression

was refused entry.

His son brought him to the ED,

holding confusion

like a fragile inheritance.

Careful, apologetic, afraid of exaggeration.

The machines

found nothing to alarm them.

Monitors slept.

Numbers behaved like obedient citizens.

Glucose steady.

Blood gas unremarkable.

Sodium: 145,

precisely compliant.

Yet confusion in the elderly

is never solitary.

It always travels

with silent accomplices.

I pictured

blood moving slowly,

injuries too small to be remembered.

Age teaches trauma how to hide.

The head CT scan

almost

sent us home.

Almost.

A softening of borders,

a hesitation

where firmness

should reign.

A thin, bright line

in the right parietal lobe.

Not loud enough to accuse,

but too precise to ignore.

Doubt stood

beside me,

not as uncertainty

but as insistence.

We looked again.

Deeper.

MRI Brain.

Venogram.

And there it was:

a vein

that had forgotten

how to be a river.

A channel thickened by stillness,

blood stalled,

like traffic in a city

that no longer believes in departure.

Cerebral venous thrombosis.

Not the violence of rupture,

but the quiet tyranny of obstruction.

A slow starvation

of thought.

The labs

arrived last,

almost embarrassed

by their simplicity.

Sodium: 147.

Creatinine climbing,

the kidneys

quietly resigning.

Dehydration.

Not catastrophe.

Just absence,

repeated often enough

to become perilous.

Less food.

Less water.

Less insistence

on living.

A body

can forgive much,

but not

being forgotten.

We poured fluid into his veins.

Slowly, deliberately,

as if coaxing a desert

to remember rain.

Anticoagulants followed,

slipping into the stalled river

to loosen the grip

of stillness.

I explained the diagnosis.

its rarity, its treatability.

They listened, faces easing

from terror into cautious hope.

Emergency Medicine trains us to fear floods.

Hemorrhage, rupture, explosion.

That night it taught me to fear drought,

and how close we had come.

He had drifted

to the very edge,

language already slipping away,

the body poised to follow into silence.

We caught him

just in time.

Hours later, in the ICU,

his eyes opened wider than before.

He turned his head toward the nurse,

searched the room with sudden intent,

and with a voice still cracked, still thin,

offered one deliberate word:

“Water.”

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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

Disclaimer:

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