ACEP ID:

Second Place: Eligio S.V. Maghirang MD, FPCEM

Untold Stories in the ER: Faith, Hope, and Love

The emergency room was bustling and pulsing with activity, its walls standing both as a witness and vessel of stories. Figures clad in their scrubs rush past the room, briskly and perpetually in motion--it was a scenario no different from the other days, saturated in familiarity, except in the heartbeat of a second, it suddenly wasn’t.

An 87-year-old hypertensive female patient arrives through the doors, coming in due to dizziness and loss of consciousness. Prior to her consult, she was complaining of dizziness and vomiting, but by the time she was on her way to the ER, she was unresponsive. With a BP of 230/120, HR of 110, and GCS of 5, the signs and symptoms point to one clear thing: a cerebrovascular accident. Eventually intubated, managed, and seen by the Neurology service, a CT-scan of her brain reveals a massive intracerebral haemorrhage. The patient’s family received the news and stayed in the ER while the Neuro-ICU had no vacancy. The outcome seemed bleak with very little legroom for optimism.

The clock’s hands point to midnight and it has been more than twelve hours since the patient came in at 10 am. Closed off from the frenzy of worry surrounding the room, the patient remains in the ER, her eyes shut tight and oblivious. But amidst the passing blur, an elderly man comes into the view--back and forth, restlessly watching as an observer. He hovers close to the patient’s gurney, speaks to her as if she were awake, and talks to her with palpable gentleness. Anyone watching him could only imagine the exhaustion he must have been grappling with, but this does not deter him and doesn’t convince him to leave. He spends between five minutes to an hour beside her, a cycle of holding her hand, letting it go, and walking slowly back into the emergency room waiting area--a stubborn persistence to hope even if the odds are stacked against him.

By two o’clock in the morning, the ER is quieted by a gentle hush. My eyes follow the elderly man still lingering closely to his wife and in the hours that passed, my curiosity only grew. I observed the man, within a few feet of distance, intrigued by his persistent efforts despite the long hours and the difficulty of his mobilising in and around the ER. It was a compelling sight to behold, made even more extraordinary by his unrelenting devotion.

Finally deciding to approach him and give him an available seat, I opened the conversation by asking how he was because I have noticed him around the ER since the patient arrived. The elderly man tells me that he’s the patient’s spouse. Eventually feeling comfortable as the earliest hours of daybreak wore on, the man began to share with me their love story, starting with telling me that the two of them were high school sweethearts.

Theirs was a story that is often the stuff of romantic myths and movies. They were 19 when they eloped-- like lovers embarking on a great adventure-- and got married. It was young love that remained even in the face of several decades and maturity. They were married for seventy years and I can’t help but ask him that after all the time they spent being together, it must be very difficult that the love of his life will soon be gone and leaving--their years of marriage, slowly and inevitably, reaching its end. It’s a mystery with an elusive answer: how do you endure when the witness to all the most wonderful, and even worst moments of your life, will be gone?

The old man lets go of his wife’s hand for a while, returning it gently back to her chest, and placed his left arm on my shoulders.

“What is the average lifespan of a person nowadays?” he answers my question with another.

“Around their seventies,” I respond tentatively.

“And well, we’re already past that number.” A smile spreads across his face as he replies, aware that even in brevity, he has proven his point. ”Each day that we wake up? We just count that as a bonus,” he continues. “ We have long been in the pre-departure area.”

I look at his face, still a portrait of unexplainable lightness even if the situation looked grim. There was something about him that remained at ease. He wasn’t conforming to the default response that the situation demands. The lines of his face that outlined the grin reaching the corner of his eyes remain.

“Sooner or later, we’re all going to die,” he expounds further. But the gravity of what he meant is separate from his tone. He offers this insight in a voice saturated with warmth, like a father talking to his son. “It’s just a matter of who’s going ahead of who. Clearly, my wife is going first, but give it a couple of months or a year...it will be my turn, too.”

The old man doesn’t shy away from the topic of death and neither does he show any fear about the concept of imminently passing, he simply proceeds to continue the conversation casually. As if the weight of his words were just strings of letters he can casually toss, as if the topic only took as much heaviness as a feather. His perspective is nothing short of surprising, but he doesn’t seem to be quite aware of it.

The elderly man continues to speak about the future fondly, and in his eyes, he sees it in a lens full of hope instead of fear. “Even if my wife gets to part with me in this life within a couple of hours...with love and faith, I am sure we will see each other again,” he says. “We’ll be together again. And when that happens, it will be forever.”

There’s an optimism you’d find rare to expect from a man facing great loss. But there he was, confronting it head-on. There he was, with some of his best days flashing before his memory--remembering it without regrets, like a man emerging from the homecoming of a fulfilled mission.

The hours trickle by, each second dragging us to the inescapable. The Neurology service did their rounds and both the patient’s husband and her family have already decided for the request of a DNAR. Before the end of my shift that morning, it was then that the patient went into cardiopulmonary arrest.

While her body was prepared to be brought to the morgue, the husband approached me again, this time in tears, his face is painted with a visible trace of agony and grief.

“Thank you,” he says with a bow and shook my hand. A tiny smile disguises his sadness, tugging at the small corner of his lips.

It was a fleeting encounter that lingers in your memory long after it happened--a kind of experience that any manual can’t offer, any textbook cannot match anywhere else. Life- changing in several ways, for both the elderly man and I, it was an affirmation that commitment as a doctor in the ER is never misplaced. To witness resilience trump over defeat, to witness humanity’s choice in clinging onto faith even in the unmistakable face of loss and fear are invaluable gifts.

The Hollywood happy ending has a particular template that’s not always matched with reality. In a more real dimension, the director doesn’t always yell “Cut!”, the end is not always confirmed when the credits roll, and a meaningful conclusion isn’t boxed in a singular form. Because other times, the ‘ever after’ we’re looking for is simply the profound consciousness that great love--no matter how unexpected or tragic it slips from your fingers--is never truly lost. And sometimes, it’s in awakening to the realization that you’re in the right place, doing the right thing--aligned with your divine calling and purpose.

(As edited by Ms. Danielle Arcon)

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