The place where you don't have to belong to belong

What the ER taught me about belonging

Today I am thrilled to share the space of Designing Connection with a fellow Substack writer that I hold great respect for: Dr. Landon Eggleston.

She has been in my dear circle of writers for a while, so this is a wonderful treat. Please welcome her warmly and enjoy as she shares how the emergency room and belonging go together naturally.

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People assume that I went into the ER because I’m drawn to the drama and chaos of it all. Maybe in some ways that’s true. I do think my upbringing and the trauma I experienced as a child made environments like a shift in the ER feel familiar—like a version of home. There’s a part of me that understood how to function in that kind of energy without needing to be taught. And if I’m being honest, a piece of me resents that that’s even partially true. Because now, after spending so much time healing my inner child, I can see with clarity how much that chaotic energy interrupts the peace I work so hard to create outside of work. So yes, maybe that played a role in the decision—but it was never the whole truth.

The bigger truth is that I fell in love with how inclusive the ER is. I loved that anyone and any situation could show up at any time. I loved that patients couldn’t be turned away and that we would treat anyone regardless of whether they could pay or not. I loved the diversity of patients that would come through the door—how that diversity shifted depending on the neighborhood the department was in, not the building itself. As if the community surrounding the building crafted the culture instead of the other way around.

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When I was in undergrad, still trying to figure out what I wanted to do with my life, I took a job as a medical scribe in the ER. I shadowed physicians and documented their patient encounters, which gave me the unique privilege of being in the room while people shared some of the most vulnerable moments of their lives. Even as a young and very naive undergraduate, I recognized how much of a privilege that was.

I was drawn in by how unique every person’s story was, but also how similar they all felt at the same time. Different lives, different circumstances, different paths that led them into that room—but underneath it all, the same human need to be seen, to be understood, to be helped.

I remember my first encounter with a patient in a psychiatric crisis, in full delusional psychosis. At that point in my life, I told myself I couldn’t have been further from that experience. There were no obvious similarities between us. And yet, when I looked at them, I saw the same humanity in their eyes. Not their story, not their behavior—but something deeper that felt familiar. I felt with a deep sense of fear in my gut how close the line was between where I was and where they were. It felt real and tangible and like I could slip off the edge at any moment.

That moment stayed with me.

Maybe I would have gone into a different specialty if I had spent more time somewhere else, but this was what drew me in. And when it came time to decide years later, I never seriously considered changing course.

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Now, years into practicing, I still see that same thread running through the work. The ER is chaotic. It’s imperfect. It’s stretched thin in ways that can feel unsustainable. But it is also one of the last places where belonging is not something you have to earn. You don’t have to prove anything to be there. You don’t have to fit a mold. You don’t have to have the “right” kind of problem. You just have to show up, and we will meet you there.

And I think there’s something we can learn from that.

Not because the ER is perfect—it’s not. Every person who works there brings their own biases. Doctors, nurses, techs, administrators—we are all human, shaped by our experiences, our assumptions, and our limitations. The ER is not exempt from that.
But the structure of it is different.

The laws that govern it don’t allow us to turn people away. They don’t allow us to decide who is worthy of care and who is not. No matter who walks through the door, we are required to meet them where they are. (But I mean, don’t show up and be an asshole). And because of that, it creates something rare—a space where, despite all of our imperfections, access is not conditional.

A space where belonging isn’t something you have to earn.
And maybe that’s the lesson. Not that we can eliminate bias entirely—we can’t. But that we can build systems, environments, and communities that don’t rely on individual judgment to determine who gets to belong. Spaces that are designed, at their core, to include rather than exclude.

The ER does this imperfectly, but it does it consistently.

And in a world where so many doors require you to prove yourself first, there is something deeply beautiful about a place that simply says: you’re here, so we will care for you.

Thank you, Matthias Biehl for the opportunity to connect with your beautiful community. It has been so lovely collaborating with you. And to all of his subscriber base, thank you for reading and please keep your eyes out for his contribution to my ‘The Art of Staying’ Series coming in the next several weeks. You won’t want to miss it.