Zen and the art of emergency medicine

The hospital is new. Everything gleams.

The corridors are long and white and perfectly straight, the sort of corridors that seem designed less for walking and more for moving things efficiently from one place to another.

The floors are spotless. The lighting is bright but oddly bloodless. Doors open and close with a soft pneumatic sigh.

Walking through it for the first time, I couldn’t shake the feeling that I had stepped into an episode of Severance.

In the television series, the employees of Lumon Industries wander immaculate hallways performing tasks they only half understand, their lives neatly divided into compartments — work self, home self — each version of the person knowing nothing about the other.

Emergency medicine runs on categorisation. It has to. Every shift brings a stream of patients with different complaints, risks and levels of urgency. Without some way of sorting that complexity, the entire system would collapse.

Patients quickly become shorthand.

The chest pain in Bed 6.

The appendicitis in cubicle 4.

The ankle waiting for an X-ray.

This language is not intended to be cruel. It is cognitive survival. The emergency department is a place designed to manage uncertainty and volume at the same time.

Most of the time, the system works remarkably well. Patients are assessed, investigated, reassured, admitted or discharged. The rectangles slide up and down the screen as the shift unfolds.

But somewhere between triage and discharge, something subtle happens.

A person becomes a problem to be solved.

This transformation is not just something that happens to patients. It happens to doctors as well. When every encounter becomes a task to be completed, curiosity begins to fade. The work becomes transactional: gather the history, examine the patient, order the tests, decide the disposition, move on to the next rectangle on the screen.

Medicine risks becoming a sequence of problems rather than a series of human encounters.

Hospitals are not supposed to feel like that.

And yet modern emergency departments depend on a similar kind of compartmentalisation. The electronic tracking board that dominates the department wall reduces each patient to a coloured rectangle. Each block carries a small bundle of information — a presenting complaint, a triage category, a scattering of tiny icons. At a glance, it tells us everything we need to know to keep the department moving. Throughout the shift the rectangles slide around the screen, rising and falling as patients are assessed, admitted or discharged.

Pieces in an endless game of Tetris played with human problems.

A moment of zen

Zen philosophy describes a similar shift in perception. When we approach the world entirely through labels and categories, we stop seeing what is actually there. Instead, we see the idea we already have about it.

Zen teachers sometimes call the opposite state beginner’s mind — the ability to look at something as though encountering it for the first time. In practice, it is simply a form of attention.

The emergency department does not always encourage that kind of attention. Its rhythms push us toward speed, decisiveness and throughput. None of these are bad things; patients depend on them. But they can make it easy to forget that the coloured rectangles on the tracking board represent lives far larger than the complaint listed beside them.

Every now and then, though, the system pauses long enough for the person behind the rectangle to reappear.

One of my patients had been in the department for eighteen hours by the time I saw him. His blood tests were normal, his chest X-ray clear, his oxygen levels reassuring while he was awake. Clinically, there was nothing that required admission. The most likely explanation was sleep apnoea - something for outpatient investigation rather than emergency treatment.

The department, meanwhile, was full. Ambulances were ramping outside. The tracking board behind me glowed with its coloured rectangles, each one waiting to be moved along to the next stage of the puzzle.

Everything in the system pointed toward the same conclusion: he could safely go home.

But the man sitting in front of me looked terrified.

He watched my face closely as we spoke, searching for clues, hopeful that I might be able to fix whatever was happening to him.

“I keep waking up gasping for air,” he said. “I think I’m going to die in my sleep.”

From the system’s perspective, the case was straightforward. The investigations were reassuring. The plan was clear: outpatient investigation, follow-up with a sleep study, reassurance and discharge.

But the man in front of me wasn’t worried about blood tests or radiology reports. He was worried about the moment in the night when he woke choking for breath, convinced that his body had forgotten how to breathe.

So I told him that what he was describing sounded frightening. Anyone waking suddenly unable to breathe, would feel the same. We talked for a few minutes about sleep apnoea and why it can feel so dramatic without being immediately dangerous. As the conversation unfolded, his shoulders settled, and the tight lines around his eyes softened.

Nothing about the medical plan had changed. The tests were still normal. He was still going home.

But for a few minutes, the rectangle on the tracking board had become a person again.

Then I stood up. Another patient needed review. Another form needed signing. Another small bureaucratic crisis waited somewhere down the corridor.

So I moved on.

Paying attention to the human qualities

In Zen and the Art of Motorcycle Maintenance, Robert Pirsig wrote that “the real cycle you’re working on is a cycle called yourself.” At first glance, the book appears to be about engines and carburettors, but its real subject is attention — the quality that emerges when someone is fully present with the task in front of them.

Medicine, of course, runs on procedures. We measure waiting times, length of stay, time to antibiotics, time to imaging. The electronic board quietly tracks all of it.

Yet the most important part of the encounter is something we rarely measure at all: whether the patient felt seen.

The paradox is that the best emergency physicians often understand this instinctively. They pause just long enough to grasp what is really happening in front of them, and the rest of the encounter unfolds with surprising ease.

Modern emergency medicine will always depend on systems. The corridors must stay clear. The tracking board must keep moving.

But the work of medicine is not simply to move rectangles across a screen. Patients arrive as stories.

In a hospital built for speed, the most radical thing a doctor can sometimes do is slow down long enough to see who is sitting in front of them.

A/Prof Andrew Tagg is a Paediatric Emergency Physician at Western Health in Melbourne. He is Deputy Chair of the ACEM Workforce Wellbeing Network and a strong advocate for mental health in medicine.