I work 8-hour shifts. Sometimes they go long. They always end. I walk into each one ready and trained to handle just about anything. It’s hard to impress me. I’ve seen a lot. I’ve heard more.

One thing I try to convey to my patients who have to wait for a bit. “It’s good to be bored in the Emergency Room.” They normally smile when I say that. They don’t understand. Its okay. I don’t expect that they do, it’s a luxury that they don’t. But it’s one of the most blatant truths that I speak: You do not want my full and undivided attention, or the reason for it that lingers behind its need…

I spent a decade of my life training to see the dying. See them before they die. The “art” of Emergency Medicine. Save the dying.

Patients cycle through the Emergency Department. I am responsible for them all. I am aware of them all. It’s a focused blur, a synchronized hum, a well-oiled machine. I sip my coffee and quietly center myself. I answer yours, and a dozen nurses’ questions. I smile. I analyze complex labs and reports. I don’t miss a beat. Not. One. Heart. Beat.

You are pushed past me in a wheelchair. Our eyes meet across the room. Your very being declares its need. For you, I pause. For you, my orchestra of madness is silenced.

It’s as if a sense I cannot label knows that Death lurks behind you, challenging me not to notice. My brain, humming through constant input all day long, pauses… everything slows… I see only you… the color of your skin, that fine laced purple hue no one else has yet noticed, your vital signs… blue, green, red on the monitors… not yet drastically alarming… but I see you. I see your posture. I hear the sound of your heart. Your lungs, quietly pulling for oxygen yet failing… why… But it’s the look in your eyes…

Many patients scream and cry in the Emergency Department, it’s the quiet ones who die. You are silent. Your wife is blissfully unaware. Some protective feature of panic has not allowed her to register that you are the only patient for whom four nurses, two techs, a Physician Assistant and a quiet and thoughtful Attending have gathered… My team knows me… They instantly register my silent cues, my posture, my intensity, my tone… They heighten… They scramble…work quick, quiet, efficient, flawless. They watch me. They do their job and they do it well. They are your heroes.

I do not panic. I won’t. Not here. That’s not how this works. Your wife chatters. She nervously tries to answer my questions. She holds your hand. You’re awake. You look at her, at the nurses, you look at me. You do not talk. Our eyes lock. Souls meet. Silent communication of words not defined. Patients know when Death is near, they feel Him. You’ve recognized me as the one in charge of if you live or die, and even if you don’t consciously know it, your soul calls out, declares its need. I feel it. I can’t say it either, I don’t have the words, but I feel the urgency, and my decade of training, the additional years of experience, they answer… I don’t need tests to tell me what will kill you. I get them, because my job also does not allow for arrogance… but they only confirm what I already knew… what I’ve already treated… This is Emergency Medicine, this is what I have trained for… where I excel, where I cannot be replaced…

You’re improving. Red. Green. Blue. They trend in the direction of life, Death takes a bow, takes a step back from the bedside.

I have other patients. I round through them. They too are cared for. “Bored”. But I always come back to you. I touch your skin. See the color rebound when I push a finger against it. It’s strange I don’t ask permission to touch you… Death invites an intimacy that forgoes formality…  I listen to you breathe. I look in your eyes. Souls speak silently. I draw you to my side of the fight. Back to the light.

“No one dies that wasn’t meant to.” It’s one of the goals and expectations that I set when I work with the resident training physicians. I tell them that at the beginning of every supervising shift that I work. It allows for the fact that there are battles I cannot win. People die. Death is a foe that when truly lays claim, I cannot compete. But Damn… the combination of all my team is, all that I know, and all the resources that I have access to make me one Hell of a competitor… “No one dies that wasn’t meant to.” If there is any chance that today is not your day, for you I am your champion.

The ambulance is here to rush you to another, bigger, hospital. You need things that my ER cannot provide. You’re sitting up a bit better now. Red, blue, green, better. Your eyes are focused now. You see me from across the room. Of all the people that closely surround you, you look past them to me. You don’t have words either, but you know. I give you a thumbs up, my gesture one of question, you raise your hand the same, answer. Your eyes never leave mine. Souls.

Three days later you walk out of the bigger hospital. You lived. I don’t remember your name, names are so trivial… I remember the color of your skin under my finger, the accents in the blue of your eyes, my soul still feels yours… You lived.

Many patients have since been seen, since been “bored”. But you lived. I played a part in that.

And I wish you well.

Signed,

Your ER Physician