***Justin Millan is a writer and registered nurse working***

Before I was a nurse, I worked as an EMT, and maybe that's why Collin Mulcahy's elegant "Scrap of a Story" resonated with me.

Emergency medicine can be a relentless onslaught of emotionally-charged cases; most clinicians I know have techniques of "not reacting" and "not feeling," just to get through each shift. But some cases get to you—often by sneaking up on you, like the situation in Mulcahy's piece. After an introduction, Mulcahy gets into the patient encounter that is the impetus of his story: a car crash victim lying in the trauma bay, the prognosis bleak. Note the tone here. As Mulcahy writes it, all is clinical, grounded, fact-by-fact— there is little, if any, of the narrator's feelings in that initial survey. Isn't that how most of us process time-sensitive events like this at work? Focusing on the objective? Following decision trees? It is only when resuscitation efforts are stopped that the narrative shifts and a little bit of the narrator's interior life pokes through: "That was the first time I really looked at the patient."

It doesn't stop there. Now Mulcahy carries the reader out of the trauma bay and into the narrator's head and heart. He's getting to know the patient, looking at him as a human character, an individual—the kind of thinking we don't bother with in an emergency. The clinical is replaced, little by little, by the personal. As a testament to Mulcahy's skill as a writer, this all happens in a subtle way; as the reader, I didn't really see it coming, didn't realize it had happened, until I was deep into it. And just when we think we've reached the climax—the sad text message on the victim's phone—there is another shift: Mulcahy reveals that the night has passed and the narrator is off-duty, on the street. And like the reader, he is still thinking about this patient. He has gone to see the crash site for himself. ( I wager that venturing out into the community and visiting locations relevant to our patients is a practice which is probably more common than we may let on.) Here, with an abruptness perhaps meant to mirror the suddenness of this tragedy, the titular "scrap" is finally disclosed. In short time, and with grace, Mulcahy has taken the reader on a linear journey: from practical, to personal, to cathartic.

Justin Millan is a writer and registered nurse working in long-term acute care in New England. His non-fiction essay “Edentulism” appears in the Spring 2019 Intima: A Journal of Narrative Medicine.