The Nativity in the Emergency Department; my December EM News column

Merry Christmas!  This is my December column in EM News.  The Nativity in the Emergency Department.

https://journals.lww.com/em-news/Fulltext/2012/12000/Second_Opinion__The_Nativity_in_the_Emergency.9.aspx

I once wrote a story for Christmas in which the nativity happened in an old, beat-up hunting trailer behind a man’s store, somewhere in the South on a cold winter night. From everywhere and all around, rough people and businessmen and politicians found their way to it, situated as it was in a cluttered backyard of a poor but compassionate store owner. Mary and Joseph had a car that broke down, you see, and they were stuck. I doubt if it’s that original. I suspect Hallmark or someone has done this story over and over.

Image… Image Tools

Image… Image Tools

Yet it still resonates; it still bounces around inside my mind. I envision that cold night, and the star, and the people in my neighborhood, camo-wearing hunters and bearded bikers, the guy with the meth lab that blew up (no kidding), the men in the garage across the highway. I suppose it’s because the story fits everywhere.

As you might expect, I have this image of the manger scene set in an ED. I think back over my patients, and it makes perfectly good sense to me. I can’t decide if it’s a busy night or a slow one. But there are Mary and Joseph, maybe homeless. We do see the homeless, don’t we? And certainly the poor. “Doctor, we don’t have any money or anywhere to go. Can we stay here tonight?” We might try social work, but face it, they probably went home already. The poor are always among us.

If it’s a slow night, the nurses are stricken with a kind of magic. They fluff Mary’s pillow, and one of them (who used to do OB) notices the way Mary is breathing and holding her belly. “She’s going to deliver!” (For the purpose of the story, Labor and Delivery is full to capacity.) All of the nurses are hovering, getting ice for Mary and coffee for Joseph, who has not so much as the change to buy one.

If it’s a busy night, everyone is frantic, and when Mary says, “I think the baby is coming!” the staff roll their eyes, as if they needed one more thing between the overdoses and the chest pains, the weaknesses and the demanding daughter in the hallway insisting on endless attention for her aging mother.

But they do the right thing, don’t they? They almost always do. We almost always do. Before you can sing “O Little Town of Bethlehem,” the baby is there. He’s crying because they do that. And Mary nurses him immediately after the nurses clean him off. But the nurses, and the doctor who caught him (fumbling, frightened … he hates delivering babies), all of them are somehow breathless. The hair on their necks and arms rises up, chills run along their spines. It’s not fear; it’s wonder. Inexplicable. Another poor baby. So what? Everyone is crying. Nobody knows why. Mary just takes it all in as Joseph wraps his arms around both of them, still in the same dirty sweater, still disheveled.

Of course, there are no animals. And yet. If it’s slow, the sleeping drunk in the next room wakes and stumbles in to see. Looking down, he cries, too. He understands something so deep he can’t express it. Something he forgot about hope and love and parents and forgiveness. He reaches into his pocket, pushes $100 into Joseph’s hand, and goes to lie down again. He sleeps in lovely dreams.

If it’s busy, things suddenly move slowly. Things happen. The mumbling, confused lady with dementia (whose daughter is so demanding) speaks for a few minutes with utter clarity, and finds her way to the door of the baby’s room. She holds her daughter’s hand and laughs, and recalls the details of her own maternity. The meth addict, tweaking and rocking back and forth, sits on the floor and just watches. He is calm. He does not scratch or scream. He is transfixed by the inexorable wonder he always hoped to find in drugs, and by the possibility that he might be whole again, that he might have his own wife, child, and delight. The man dying of lymphoma, passing the room as he is wheeled up for admission, asks the nurse to stop so he can look, and the child fixes its tiny eyes on him. He still dies, but he does it in peace.

The cardiac patient’s chest pain resolves, and the febrile infant in the hall-bed (the one who looked so sick) begins to laugh, cackling, breathless laughter. His fever is gone. Only the babies can see the angels swooping round, touching, healing, encouraging.

I can imagine all sorts of things. An angry mayor, searching for the child. Or professors and priests and ambassadors looking for him later, giving him gifts.

But all I see now is the dawn. Mary is strong. She has no time to be admitted. Joseph says they have to go. They are loaded with formula and money, with snacks and blankets (and diapers). They are hugged and kissed by strangers, and everyone waves goodbye.

The next shift asks, “What was that all about?”

“Don’t know,” is the answer, “but I’m glad I didn’t miss it.”

And the chaos descends again, tempered by inexpressible hope, washed in love.