13 Years in the ER: From Chaos to Bearing Witness (A Farewell in Two Acts)

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Prologue

I thought I’d prepared myself.

My last shift in the ER, after 13 years, landed on Friday the 13th - the most infamous day on the calendar. It felt like a joke the universe was playing, so I leaned into it. I imagined the absurdities, the chaos, the dark humor that define life in a pediatric ER. I even wrote about it preemptively, anticipating the madness.

But the universe had more to offer. What I thought would be a final hurrah of irrationality turned into something far heavier. A father, a family, a tragedy that echoed through time.

This is my farewell to the ER in two acts.

  • Act I – The chaos I expected.
  • Act II – The weight I couldn’t see coming.

 

~ Act I ~

13 Years, Friday the 13th, and the Madness of the ER

Coincidence or predestiny? After nearly 13 years of adrenaline-fueled chaos, sleepless nights, and a steady diet of chai and calamity, my last ER call lands squarely on the unluckiest day of the calendar. I could’ve chosen to laugh, but let’s be honest - when you’re signing out on Friday the 13th, in a low-middle-income country pediatric ER, it’s the universe laughing back: a celestial warp or a celestial chuckle?

The pediatric ER is a kaleidoscope of irrationality and raw emotion. Over the years, I’ve witnessed everything from first-time parents convinced their colicky, overfed baby needs imaging to ‘rule out badness’ to a suited, booted grandfather declaring, “You’ll be hearing from the CEO!” because I refused to order unnecessary blood tests for his mildly anxious teenage granddaughter. This is a place where emotions, biases, and egos converge, often with comical and baffling results.

Human behavior takes center stage here. The parents of a child we’ve just placed on a ventilator will ask, “Abhi toh behtar hai, na?” (she’s better now, right?). Their hope is heartbreaking, their denial almost admirable. Then there’s the anti-vaxxer mom, clutching her unvaccinated toddler with measles, furious that we don’t have a luxury suite-level isolation bed available for her. My ER, resource-strapped and overcrowded, feels like a war zone at times, with dengue and chikungunya (previously COVID-19) leading the charge.


There’s a kind of gambler’s logic that permeates the ER. "It’s been quiet so far; we’re due for chaos," a nurse mulls, tempting fate like a poker player with a bad hand. Chaos obliges. You can count on a child in cardiac arrest landing up in the ‘resus’ just as we’re starting a surgical procedure under sedation on another child or an ambulance arriving at 3 a.m. with a febrile baby whose fever started, of course, 15 minutes earlier.

Working in Pakistan after years in the U.S. has felt like moving from a symphony orchestra to a jazz improv session. One moment you’re calmly explaining to a family why their toddler doesn’t need antibiotics for a runny nose, and the next, you’re restraining a child mid-seizure while translating medical advice into three languages to five or more family members simultaneously. Here, medicine is part improvisation, part resilience, and a whole lot of duct tape and prayers.


Confirmation bias is alive and well in the pediatric ER. Parents walk in with pre-diagnoses courtesy of a relative, Dr. Google, and now ChatGPT. “It’s definitely malaria,” insists one father while we’re preparing to send a dengue test. Another swears his child needs a CT scan because “my cousin’s son had similar symptoms, and that turned out to be appendicitis.” As always, they’ve solved the mystery before we’ve even examined the patient.

And then there’s the heartbreaking absurdity of this world. The child who’s been broken:
“…it is the stories of darkness, in darkness,
that reveal the beauty of the fifty shades.
Whether of a child raped in mind, body or spirit…”

“…a morning in turmoil, a boy of ten, his innocence questioned,
Brought under harsh lights, a story of rape, starkly laid bare.
It's not the first tale of darkness I've heard,
Nor, I fear, the last, each narrative a heavy burden.”

The specter of child abuse…sadly we have to see those kids in our ER and try to start the process of healing them in minds let alone bodies.

Or the father not realizing that the baby brought to me is already dead; in fact, has likely been so for perhaps several hours given the rigor mortis set in. Or the teenager who has come in yet again after ingesting several paracetamols, or the young woman with huge potential who chugged bleach: albeit a stark expression of self, yet defiantly her way of showing the world a middle finger.

Amongst all that chaos, the parents who demand an ultrasound for a toddler with gas pains are the same ones who don’t understand why their sick child isn’t immediately ‘dischargeable’ after stabilizing on a high amount of oxygen. In those moments, you see humanity at its most paradoxical - frustrating yet achingly tender.


As the clock ticks closer to my final shift, I wonder: Is this a full-circle moment or just cosmic trolling? Thirteen years, capped off by Friday the 13th. It’s a setup Shakespeare would envy. I imagine myself standing in the center of the ER, surrounded by a chorus of wailing toddlers, ringing monitors, and distraught parents, delivering one last soliloquy to this nuthouse of miracles and madness.

This isn’t just about Friday the 13th or the absurdities of pediatric emergency medicine. It’s about reflection. About what these 13 years have taught me. That life is as fragile as it is ridiculous. That irrationality isn’t the enemy; it’s the spice of human existence. And that the pediatric ER, for all its chaos, is a mirror of life itself: unpredictable, absurd, and deeply, undeniably human. So, here’s to my final call. May it be filled with the same irrational hilarity, profound exhaustion, and improbable miracles that have defined these years. And if I survive Friday the 13th unscathed, I’ll consider it proof that the universe, for all its quirks, has a sense of humor after all.

from Narrative Medicine

References:

·       https://www.dawn.com/news/1110534

·       https://anitinerantobserver.blogspot.com/2015/05/fast-medicine.html

·       https://anitinerantobserver.blogspot.com/2017/12/jack.html

·       https://tribune.com.pk/article/51851/the-shared-experience-of-being-tampered-with-as-a-child/

·       https://tribune.com.pk/article/49056/13-reasons-why-hannah-lives-and-dies-in-all-of-us

·       https://tribune.com.pk/story/2460335/code-blue-and-contemplation

 


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