The world of the emergency department is fast paced, full of uncertainty, suffused with suffering.  There is never enough time, never enough information.  We go from social crisis to mental health issue, from heart attack to stroke, head injury to fracture and back again from hour to hour.  In the background plays the soundtrack of crying children, confused senior citizens calling out for help or for loved ones long gone.

A phone always rings.  We speak to another physician, a family member, call for a transfer, ask for an ambulance or helicopter.  Silence is rare.

Sometimes the noise is the babbling of schizophrenia.  Other times the frenetic beeping of monitors and the unmistakable sound of many persons in one small room shuffling around the body of a dying patient. It is a discordant chorus of orders and dropped packages, opened syringes, occasional profanity, a bed creaking with CPR and sometimes later, the sobs of a loved one.

Stillness is rare, as we move, and move, and move.  In the chair, out of the chair, running, walking, lifting, suturing, typing.

And yet, between the madness, the confusion, the almost Brownian motion of people and things, there are times for rest.  Tiny Sabbaths.

Lately, it has been my cup of hot water and lemon.  My wife suggested it as part of a diet plan, as I have been trying to lose weight.  Like any hot drink, there is rest in the preparation.  After a frustrating phone call, a confusing patient encounter, a stressful intubation, or just too much time spent sitting, I pick up my cup and lemon juice and go to the staff lounge where there is  (wonder of wonders) a hot water dispenser attached to the coffee maker.

I lift the red handle and steam rises from the stream of water, onto the lemon juice I have put into my styrofoam cup first.   The very act of walking the thirty feet from chair to water, and thirty more back to chair, is a time to rest my brain and focus on something tangible and comforting.  Certainly, it may also be coffee or tea (or the diet pause of a donut).

It may be merely to go to the quiet of a restroom down the hall, in the doctor’s lounge and to then sit for just a moment; maybe five glorious minutes during which I flip channels on the television.  That wee respite is a wonder.  The last time I did it, just yesterday, I picked up the remote and heard ‘Code Blue, ER, ambulance bay.’

On nights it may be thirty minutes on a bed in the call room.  On snowy days it may be a chance to just walk outside and see the powdered sugar trees across the valley; or in the Summer, to look up at stars vaguely shrouded by Southern humidity.  these are restful as well.

Others it is the sweet voice of my wife, or a chance to chat with my adult children.  The restful delight of connection.  The reminder that out there, beyond the distorted view I have of sickness and injury, there are normal things happening to people moving at a normal pace through wonderfully pedestrian activities.

Small joys.  Bright joys.  Healing joys and necessary joys.

There are too few times of rest in a busy emergency department.  And they must be seized whenever they are available.

However brief or small they may be.


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