Cross and Caduceus: Emergency Room Nativity

I have this image in my mind of the manger scene, set in an emergency room. As I think about it, and think back over my patients, it makes perfectly good sense to me.

Edwin Leap

I can’t decide if it’s a busy night or a slow night – God is present in either. But there are Mary and Joseph, maybe homeless. And certainly poor. “Doctor, we don’t have any money, or anywhere to go. Can we stay here tonight? It’s so cold, and the car stalled.” We might try to call social work, but they probably went home already. The ER is the last hope.

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 purposes of the story, the labor and delivery unit is full to capacity). So all of the nurses are hovering, getting cups of ice for Mary and a cup of 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 starts to say, “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 next hallway insisting on endless attention for her aging mother.

But they do the right thing. And soon the baby is there. He’s crying – because babies do that. And Mary is nursing 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 up, chills on their spines. Not fear, but wonder. Inexplicable. Numinous.

Another poor baby. So what? Everyone is crying. Nobody knows why, but tears roll down their faces. And Mary just takes it all in as Joseph wraps his arms around both of them, still in the same dirty sweater, still disheveled, still gentle.

Of course there are no animals. 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 and pushes $100 into Joseph’s hand and goes back to lie down. He sleeps in lovely dreams.

If it’s busy, things suddenly move slowly. Things happen. The mumbling, confused lady with dementia (whose daughter was 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, might have his own wife, child and delight. The man dying of cancer, 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. The man still dies, but he does it in peace. They’ll meet again, soon enough.

The cardiac patient’s chest pain resolves, and a febrile infant in the hall-bed who earlier looked so sick begins to laugh and laugh – cackling, breathless laughter – his fever gone. Only he and the Christ child can see the angels swooping round, touching, singing, praising and encouraging.

I can imagine all sorts of things: an angry politician 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,” someone on the night shift whispers. “But I’m glad I didn’t miss it.”

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


– Leap is an emergency physician and columnist who lives with his wife and four children in Walhalla.