Two months since I last put anything down in paper. The emergency room had not gone quiet. God, no. Shifts blurred into another. Noise, bodies, spilt-second calls. But somewhere, writing started to feel like I was packaging the mess, turning blood and confusion into something neat. Like I was lying by making it readable. So I quit.

The work never did.

They brought him in, sometime in the afternoon. Late twenties, IT guy. His friend gave us the rundown: two months of pulling away, skipping work, going quiet. Nothing flashy. Only that slow fade you see too often.

Something that only screams for help once it’s too late.

The friend had found him conscious in his apartment. Still talking. Sitting there surrounded by the damage he’d done to himself.

Vitals stable when he had arrived. No wild agitation, no obvious fog in his thinking. He answered questions with a straight face. What got under my skin wasn’t the blood. It was how calm he seemed.

“There’s a voice,” he said.

His delivery, perfect. It had been there for weeks, he muttered. Steady. Reasonable, almost. Convincing him there was something inside, a separate soul, rotten, dead set on ending him.

“I tried to get it out.”

He laid it out flat without any drama. Started at the forehead. Figured that’s where the mind sits. When it only gave him pain and seepage, he went lower, to the gut. Still nothing. So the logic turned cold.

“So I decided to kill myself instead.”

Said it bluntly. Like the next item on a check list. Then, as polite as you please, he asked if I could point out a good vessel in his arm. He’d given it a go. Angle was off, apparently.

That’s the part that crawls under your skin later. It’s not just the cuts themselves, but the way everything fit together so neatly in his head.

We’re drilled hard for the body failing. Pressures tanking, airways clamping, blood you can see and stop. Nobody quite prepares you for a mind that’s rebuilt its whole wiring around a death warrant. And yet hums along without a glitch.

You can’t argue him out of it. Can’t nod along either. So you wedge yourself in that tight, suffocating space between the two and fall back on what your hands know.

We didn’t suture. The wound was too extensive, covering his entire forearm. Jagged, deep, already heading toward infection. Instead we irrigated and dressed it carefully under strict aseptic precautions, gave him tetanus toxoid and a solid dose of IV antibiotics. It needed proper debridement in the operating room, not a quick repair in the bay. His body we could stabilize for now. His mind needed psychiatrists.

Every so often he’d circle back to the question.

Waiting like I might eventually see the sense in helping him finish.

We did what we could with dressings. The voice, the certainty, we passed that to psychiatry.

In time there would be a label, investigations, procedures, a diagnosis, meds, eyes on him round the clock. The slow machinery of trying to pull his map of the world back into line with ours.

But even that wouldn’t keep me awake at night. It’s the way he asked. He was quiet, courteous, and almost collegial. A man who could no longer trust the only instrument he had for sorting what was real, yet had no choice but to keep living inside it.

The voice he heard hadn’t drifted in from the corridor or the vents. It had been forged in the same wet gray matter we all rely on to draw the line between self and other.

He believed something buried deep inside him wanted him dead.

In a way, he wasn’t wrong.

And sometimes, late at night, when the department finally goes still, I wonder how thin that line really is. How easily it could shift. And how little it might take.

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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