Why do you laugh in the ER?  This is not a place for joy.  There is no joy as we drop you into Trendelenberg, trying to improve the circulation to your brain even though your systolic blood pressure hovers just below 80.  There is no joy as we race to get epinephrine, albuterol, ipratroprium into a nebulizer to open your airway before the tissues of your trachea swell up completely and close the door to your lungs.  There is never joy in a chest compression.

But, goodness, we laugh so much.  There is so much joy.

The wife of the elderly patient walked to the bathroom…and then got lost trying to get back to his room.  Their son poked his head out the door and said, “Why is she going that way?”  I jogged over to re-direct her.  She and I walked back in the room.  “She tried to escape.  I caught her, though,” I say.  A friend in the room laughs, says, “I knew she was trying to run away from us.”  Says her husband, “I knew she was trying to run away from me!”  Says I, “Don’t worry, I have a tech standing by to tackle her if she tries that again.”

He’s been in an ER room for three hours with terrible, searing abdominal pain.

The room explodes into laughter.

Later, in another room, a son holds his mother’s hand as she lies on the cot, tubes protruding from every part of her body, the machine breathing for her, the intravenous drip forcing her blood pressure up to a reasonable level, the monitor beeping cautiously as she tries very hard to die.

It’s her time; they all know it.  She’s relatively young, but has lived very hard her whole life, and her self-abused, self-neglected body has finally given up.  We have tried to save her, and we’ve failed.  We’ll transport her up to the ICU in a little while, where the ICU nurses (bless them, they are amazing people) will pull all the lines and the tubes and drips and needles and allow her to finally let go.

But at this moment, as the son holds her hand, and family and friends gather around, someone begins to tell a story.  As I imagine the majority of her life stories to be, it involves a lot of cursing.  “Remember…remember when you took her car?  And she ran out the door as we pulled away, wearing nothing but her bra and those nasty sweatpants, screaming, ‘I will fucking kill you when you come home!  I brought you into this world and I will goddamn fucking take you out again you little shit!'”

People begin to smile.  Someone half laughs.

And then another story emerges.  It involves alcohol, more swearing, people being stupid, and this mother telling the world and the people around her exactly what she thought of them.

Now everyone grins.

Someone adds another comment, an unexpected memory.

Through tears and tissues, the room explodes into laughter.

And standing at the bedside, tinkering with the dopamine drip, as they laugh and smile down at her, though she’s far away from hearing them, I think, so this is joy.

How grateful I am to be here.