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Hi - and welcome.

If this letter found its way to you, thank you.

This is the beginning of Letters from the ER - a space for the kinds of moments we carry long after the shift ends.

They’re not always dramatic. Not always tragic.

But they’re always real.

And they’re rarely written down.

This one stayed with me. 

“I want to stay a little longer.”

It was during the peak of the COVID-19 pandemic.

He was an elderly gentleman.

On non-invasive ventilation, maxed out on oxygen.

Still desaturating.

Beginning to slide into shock.

He looked at me - past the mask, past the noise - and said,

And then:

His grandkids were on their way.

They lived far, but they were coming.

He just wanted to see them.

I told him everything was going to be okay.

But I knew I was lying.

He knew I was lying.

And somehow, we sat in that lie together.

He was going to crash, we could sense it.

We proceeded to secure his airway.

It felt like a line we crossed together -

a silent agreement to try, even when we both knew how the story would end.

I stood there, helpless.

There was nothing more to escalate, no drug that would reverse time.

Just the quiet feeling that I was witnessing something precious fade away.

He coded about twenty minutes later.

We did everything.

He didn’t make it.

And I’ve thought about that line, hard and long, more than I can explain.

“I want to stay a little longer.”

There’s no checkbox for what that moment does to you.

No textbook for how to carry someone’s last hope.

But these are the things we carry -

not in case sheets, but in the quiet.

Things that stay.

In the silence after the shift.

On the drive back home.

In the middle of your life.

At 03:00 a.m., when the world is asleep and your mind is not.

Letters from the ER is where I’m choosing to put them.

Real. Raw. Honest. Unfiltered.

What You Can Expect

Some letters will be like this -

unfinished and heavy.

Others might feel like poetry.

Some might simply leave a question behind.

If you’re in medicine, I hope you feel seen.

If you’re not, I hope you feel closer to what this work actually is.

If you’re still reading - thank you.

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

Or invite them to join here:

More soon.

Another voice.

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 a medical advice or a substitute for professional care.