To know that even one life has breathed easier because you have lived. This is to have succeeded. -Ralph Waldo Emerson

Easter Sunday, another chaotic shift. I held a woman’s head gently as she vomited into a bucket, while her 80-year-old mother pulled her hair back from her face. I watched a family weep for not one but two losses, a mother and her daughter. The emergency room was packed. And tragedies always seem even sadder on a holiday.

In light of all this, I realize that I have reached a different vantage point this month. First was the climb, which began slowly in year one. Then I began to climb faster, and faster still, covering more and more mileage in year two. Efficiency, skills, technique – these I have developed and polished over the last three years. But now I have reached another, entirely new vantage point – the higher I climb, the more I see as I look out below me. The emergency room lies in a valley, and I watch the ever-changing landscape with vigilance, calm, and still a slight bit of fear – fear out of respect for what I know can happen here. I envision my patients all there in the valley, and surrounding each of them in my mind’s eye are their illnesses, their perils, and the possible paths that we may tread down together over the next few hours.

The metaphor may seem abstract, but it is not. Each patient occupies a distinct territory in my mind  – and the physical equipment surrounding each of them pertains to what I perceive their needs to be in the next few hours. The people around each of them are families and friends. And the boundaries separating these patients are minimal – mere curtains between one and the next. These patients and their families, strangers outside these walls – here, in this landscape, they have become neighbors. They hear and view the suffering of one another. They share a common path today.

As the guardian over this landscape, I watch my ever-changing valley over the course of my shift; I watch these patients’ stories unfold. I can smell forest fires and hear distant thunder from miles away, and sometimes I can even predict their exact location and nature before they occur. Other times I am caught off guard, but only for a fraction of a second until I compose myself and begin to react. And although these are my grounds, I too – like my patients – have become part of the landscape.

My patients’ suffering, the pathophysiology of disease, the hope of their families, and the waiting – all of these realities are entwined together in my mind as I watch this landscape unfold before me. It is a breathing, living being. And I am watching it all, but also sculpting it in my very palms – trying to change people’s paths, trying to readjust things to make for a better picture, trying to create health from sickness. Trying to help people live. And I am doing this with the nurses, the technicians, the chaplains, the social workers. We are all doing it together. Creating and recreating a landscape. Trying to paint a more beautiful picture.

We only have a small hand in this, though. We can only offer our intellect, our sweat, our compassion, and our skills. But even this – how much does it really change people’s paths? Less than we might hope.

Even so, I still hope. Maybe my presence, or spirit, or efforts – maybe they will make the difference. Maybe they will be just enough to change one destiny, to paint one or two strokes on this landscape that lies below me, to leave one sculpted mark on this world. Maybe one frail mother will keep her petals a little longer in the wind with my palm shielding her. Maybe the umbrella I cast beneath the clouds will save one small boy who lost his raincoat.

Maybe not. But maybe…. And it is the maybe that makes me keep coming back. It is this maybe that makes me not want to give up, in spite of how difficult and trying this journey has been. It is this maybe that makes me want, more than anything, to be an emergency room doctor.

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