This is pretty obviously an unpolished excerpt from a letter home. It may or may not merit further examination someday, but the matter is so entirely depressing that I'm not sure its worth it.
I wrote this part way through my third year of medical school. At that point, I didn't understand the flow of clinical practice terribly well and had trouble imagining that I ever would. That being granted, this piece marks one of the many epiphanies that continue to strike me in the course of my job: we see all sorts of truly terrible things, and sometimes there's just not a damned thing we can do about it other than hurt inside.
One of the things that struck me most during the entire grim episode was seeing extraordinarily jaded, hard-core inner-city e/r nurses completely broken up, men and women alike. The department was busy, as it always is, and there was no time or place for anyone to mourn.