Do they know it’s Christmastime at all? – Band Aid

Snowy Wreath

This is for all of the doctors and nurses. For all of the police and firefighters, EMTs and paramedics. P.A.s and N.P.s, techs and aides. You know what I’m talking about.

We are the “essential personnel”, the ones whose work includes nights and weekends and holidays. The ones who go out in the storms, even when everyone else stays home. “Stay off of the streets, except for essential personnel.” Schools close, businesses and banks and government close. Hell, even Dunkin’ Donuts and 7-Eleven close. But no closures or cancellations for “essential personnel.”

We essential types work lots of holidays. Correction, all holidays. Our friends and families miss us, learning over time to make the adjustments and accommodations for the holiday schedules. We hope they understand. If we are all very lucky, we can sneak in an early or late celebration. We sometimes miss it all completely. I think our families get a raw deal out of this; they don’t have the work responsibility to justify the interruptions and cancellations. They sacrifice, too, maybe more.

When Christmas and the holiday season come to the hospital, the atmosphere is festive. Nursing stations and the various hospital departments are decked out in often creative holiday regalia, depending on how Hospital Administrators may be interpreting the latest rules and regulations at the moment. The nurses are clever, though, a step ahead of the regulatory caprice, and the decorations cheer staff, patients, and family alike.

The nursing lounge is the Mother Lode, the place where an abundance of various holiday treats and sweets are sequestered, showered on the staff by appreciative physicians and patient families, sometimes making it out to the nursing station itself to be shared among the staff. Calories and diabetes be damned: Cookies and chocolates rule, a quick sugar rush to get through the shift.

On the actual holiday, there is a different vibe. There is quiet, a peace around the hospital, the usual energy buzzing in the air is muted, dampened. Staff levels are minimized,  many departments are closed, others only open if on-call staff need to be brought in for an emergency. In contrast to this, those staff members who are present really step up, and they are more warmly celebratory than ever. Pot luck meals together, even carry-out on occasion if there is a place open to deliver. All of those who are working, regardless of whether they celebrate Christmas themselves, are included. The EMTs and Paramedics passing through, as well as the police and firefighters who turn up. The doctors on their rounds, the nurses and aides and techs coming on shift or going off. All together, we become a family (of sorts) for this holiday.  We become a surrogate family for each other, as we share this holiday in the hospital. We share with each other, because all of us there are sharing the responsibility of being essential, being essential together.

We all know, and it goes unsaid, that we would rather be at home. We don’t need to dwell on the sacrifice we have made to be there. Instead, there is a sincere cheer in the air, an appreciation for each other as we are all there together, and all in it together. The world and its celebrations are going on without us, most places are closed, but we are there, we are open, and we make our own celebration. Every effort is made to get patients home for Christmas. They don’t want to be in the hospital if there is any chance that they can safely continue their recoveries at home. So those who remain in the hospital are the sickest, both in degree of illness and numbers. Very few of the “easy” patients remain.

This spirit is also echoed in the Emergency Room. No one wants to spend Christmas Eve or Christmas day in the E.R. or in the hospital, so they hold off as long as they can, wait until they are absolutely sure they are getting worse, before they come in. Sometimes a little longer if they are deciding for an elderly parent or a young child. Usually they shouldn’t have waited so long. Each person with each condition, even the common conditions, seems much sicker than usual. There seems to be the worst possible version or presentation of every illness or injury. Maybe it is because they waited, maybe it is because it is colored by seeing their holiday ruined. But there it is. Trauma, car crashes, violence also punctuate the holiday. The night is not so silent, no heavenly peace.

Despite our attempt to keep things quiet and the census down, it is often very busy. Of course, because we now have the sickest patients and more pressing emergencies at a time when we have kept staffing so low.

Some of these sick patients are dying. We hope they hang on, we help them hang on just that one more midnight, so the family won’t have the joyous Christmas clouded forever more by the loss of their loved one. Despite our efforts, we are not successful, forces more powerful than our will and skills prevail.

Surrounded by a world awash in the holiday glow and celebration, joy and cheer, we turn to provide sympathy and solace to try to comfort the family and loved ones. If there are any there. Or at least take a quiet moment, a pause, for that patient who departed this world alone at Christmas.

There are these contrasts and conflicting emotions in the hospital this time of year. It is it’s own special cognitive dissonance. It binds us together, doctors, nurses, patients; all of the essential personnel in and around the hospital during the holiday.

All of us wishing to be somewhere, anywhere, else. But making the best of it for ourselves and each other, together.

Yes, I am on call for Christmas this year. I will be with other essential personnel making our own cheer and celebrations here in the hospital. Keep all of us in mind among your gatherings, and know we are here for you, even at Christmas.

It is quite a time, Christmas in the hospital. Working Christmas.

Merry Christmas.