Some nights in the ER

feel like hallucinations dressed up as work.

The walls stretch and contract like muscles around ribs.

Time slips, folds, repeats, contradicts itself.

The ER feels

less like a department

and more like the inside of a dream

God forgot to finish.

And in that dream, louder than an alarm,

one truth keeps echoing:

The only thing that’s permanent

is impermanence.

I used to think impermanence was a poetic idea,

something philosophers toyed with,

because they had the luxury

to suffer in leisure.

But the ER doesn’t philosophize.

It exposes.

It undresses illusions naked

with the tenderness of a knife.

Outside these walls,

people worship permanence.

They name it love.

They call it forever.

They tattoo it on their skin.

They swear “this time it’s different.”

But here?

Every certainty carries its own quiet expiration.

Every identity has a hidden crack.

Every moment contains the seeds

of its own disappearance.

Even the self is slippery.

You’re a different person at 7:03 PM

than you were at 7:02 PM.

A slightly more fractured version,

a slightly more rewritten edition.

Nothing stays.

Not even you.

And then she came,

tearing through the dream.

73/F.

Chest pain.

Breath collapsing in

on itself.

She entered the ER

like a scream given human form.

Her fingers clutched my sleeve

as if reality itself were dissolving around her.

I swear the room itself paused

when she said it.

As if death had stopped

mid-step to listen.

ABCDE.

NIV. Oxygen.

Pressure building.

Breath returning.

Trop positive.

NSTEMI.

The heart confessing its sins.

And then, the surreal shift.

Her panic softened.

Her chest opened.

Her gaze steadied.

By the time they wheeled her to the ICU,

she offered me

a smile so delicate

I was afraid the air would break it.

A smile born in terror,

dipped in relief,

wrapped in the fragility of someone who knows

she borrowed a few more hours of her fleeting life.

And in that moment,

a seam I didn’t know existed

split clean.

Not because she almost died.

Not because she lived.

But because she reminded me

of something I try hard to forget:

People leave too.

Even the ones who swear they won’t.

Even the ones who promise they can’t.

The ER may show

impermanence in bodies,

but life shows it

in relationships.

One day someone laughs with you,

their presence as warm as a candle in a dark room.

The next, they’re a stranger

with a voice you barely recognize.

One day someone texts you every hour,

filling your world with meaning.

The next, your phone is quiet

and you’re left trying to understand

how “forever” became “no longer.”

People drift.

People vanish.

People become memories

while still breathing in the same world as you.

And maybe that’s the cruelest version of impermanence.

Not death, but distance.

Not endings, but slow dissolves.

Not loss, but transformation into someone else.

We lose people

long before

we actually

lose them.

The ER forces you to watch it up close.

In the sheets wrinkled by bodies that were there an hour ago,

in the smiles that evaporate as fear takes over,

in the fear that dissolves when oxygen returns,

in the goodbyes no one plans for.

And you start to understand:

Nothing we love is ours to keep.

Not the people,

not the moments,

not the versions of them we carry in our heads.

Even love has seasons.

Even closeness yellows and curls at the edges.

Even the warmest hands

eventually let go.

It’s terrifying.

And it’s holy.

Because if people stayed unchanged,

we would never learn to see them fully.

If moments lasted forever,

we would never feel their weight.

If relationships didn’t fracture,

we would never understand how deeply we needed them.

Impermanence is not the thief.

It is the sculptor.

It shapes us

through what it takes away.

It teaches us

through what it refuses to let stay.

It blesses us

through what it breaks.

Her smile still lingers in my mind.

A reminder,

a warning,

a gift.

Not because she lived,

but because she showed me

that even survival

is temporary.

Everything is temporary.

And that’s why every fleeting thing

cuts so deeply.

And shines so brightly.

And matters so unbearably much.

If this made you pause, forward it to someone who might need it.

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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.