The Emergency Department is not a room.

It is a tribunal that never adjourns.

Lights hang low like interrogators.

Beds stand as silent exhibits.

Every arrival arrives already convicted,

of wasting time, of inflating pain, of delaying the inevitable.

And you,

you do not enter as healer.

You step in as the accused

who happens to carry a stethoscope.

Eyes latch on at once.

Hungry.

Desperate.

Prosecutorial.

They do not ask

whether you are skilled.

They ask only

whether you will break.

They read

the angle of your spine,

the half-second your gaze hesitates before meeting theirs,

the weight of your silence more than your words.

Here language is secondary.

Your body speaks first.

And it must never

confess fear.

Truth, spoken naked, is violence in this place.

Say “he will most likely die” too soon

and the room collapses inward

like a tension pneumothorax.

Say “I don’t know” with an unguarded face

and your authority bleeds out onto the floor.

So you learn the calibrated lie,

continuous,

titrated,

administered in safe doses.

“Let’s observe for now.”

“Still stable.”

“Nothing immediately alarming.”

These are not falsehoods.

They are restraints.

Tourniquets.

You are not concealing the truth.

You are metering its detonation.

Yet after years, the lies migrate inward.

You rehearse certainty before you feel it.

You choose the defensible path

rather than the one that might survive scrutiny by God.

Is that being dishonest?

No.

It is survival.

Because being witnessed in doubt

has become more dangerous

than being wrong.

Patients lie too,

but theirs

are the lies,

of the already condemned.

They minimize pain

because quiet agony is dismissed.

They edit timelines

because blame cuts deeper than disease.

They deny fear

because fear here is treated as moral failure.

“I’m fine.”

“I can handle it.”

“I don’t need to stay.”

Meanwhile their bodies testify against them.

Sweat beads like perjured evidence,

Pulse racing like a witness cracking,

oxygen saturation drifts downwards,

slow, treacherous, undeniable.

The body does not care for dignity.

It tells the truth anyway.

This is the obscene symmetry of the Emergency Department:

everyone lies,

everyone smells the lie,

and still the watching never stops.

The junior studies your face,

learning which uncertainties are permissible.

The nurse reads your tone,

deciding whether urgency is real or theatrical.

The family watches your eyes,

hunting for the moment the performance fractures.

There is no sanctuary for doubt here.

Only brief recesses.

Emergency medicine does not make you cruel.

It makes you split.

One part of you carries the unfiltered truth,

heavy, lethal, unspeakable.

The other part performs control

so the room does not descend into panic.

You learn

to pace reality

like a death sentence

delivered in installments.

Too much honesty,

and you destroy people before the disease does.

Too little,

and you become complicit in the lie.

So you stand there,

watched, assessed, mirrored,

holding the raw truth behind your ribs

while your face offers calm.

This is not compassion.

It is containment.

You absorb the panic

so others may keep breathing.

You split yourself into roles

because someone must remain upright

when the truth finally enters the room.

And when the eyes finally turn away,

when the shift ends

and the lights release their grip,

the most honest truth settles in:

No verdict is ever delivered.

Only adjourned.

Tomorrow

the tribunal will reconvene.

The lights will lower again.

The eyes will return.

And you will step back under them,

carrying truths too heavy to speak,

lying just enough

to keep the world

from tearing itself open.

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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