For the past 28 years, Phillip Harter, MD, has worked every Christmas Day but one in Stanford Hospital's Marc and Laura Andreessen Emergency Department. This year proved unusually busy, and when I spoke with him that morning he didn't have time for more than a cup of coffee for lunch. But he had big plans for dinner.
"We get a free meal!" he told me, grinning as he reached into the pocket of his blue scrubs for the free meal voucher provided to hospital staff on Christmas Day. "Look, dinner and three sides -- plus dessert! This is really why we are all here," he joked.
Elsewhere, the normally busy Stanford Hospital was subdued. Hallways decorated with wreaths and ribbon were almost empty. The pace slowed enough that sidewalks were cordoned off for power washing. The gift shop was dark.
But in the hectic emergency department waiting area, the only obvious sign of the holiday was the tinsel-and-light-trimmed elf hat worn by one of the nurses.
The lobby, crowded with all ages and backgrounds, is arguably the most egalitarian division in health care. The Emergency Medical Treatment and Labor Act, passed in 1986, requires anyone coming to an emergency department to be stabilized and treated, regardless of insurance status or ability to pay. Thus, every Christmas, there are patients who are simply trying to escape a life on the streets for a short time, to have what so many have on Christmas Day -- a warm place to stay and some attention.
However, this is the exception rather than the rule.
"Most people only come in on the holiday if it is serious," Avinash Patil, MD, told me. He has worked every Christmas since his internship fourteen years ago, and he estimated 2017 to be the busiest yet. Nationally, emergency rooms often see an uptick in heart-related ailments during holidays, and Patil and his colleagues had already seen a number of stroke patients by that morning.
Patil's colleague Laleh Gharahbaghian, MD, noted additional holiday triggers. "People, especially the elderly, forget to bring their medication when they visit family. Or, maybe the medication makes them sleepy, or it has a side effect that would somehow limit their enjoyment of the day, and so they decide not to take it." Gharahbaghian has also seen several cases where a family member picked up a relative at the airport, could tell at a glance something was wrong, and brought them directly to the emergency department.
Gharahbaghian opted to work the holiday shift as a favor to colleagues who celebrate Christmas. Not every preference can be accommodated though, and those who cannot adjust their work schedule simply adjust their festivities. Hanna Linstadt, MD, a resident in the class of 2020, celebrated with her family two days prior. Deborah Kimball, MD, and her husband planned to hold Christmas in a day or two. "Our kids are so young, they don't really get it yet," she explained. "My husband's also a physician so when I'm working, it means he gets some good one-on-one time with them. And I get to feel like I'm here for something good, to support the community."
Nurse Vasiliy Rodin was also missing Christmas with his two children, ages 10 and 5. He was going to fly to New York later in the week to celebrate New Year's with them, and he looked on the bright side. "The hospital, to me, feels like a family. We laugh together, cry together... These are close relationships. Could I have picked an easier job, an easier part of the hospital? Definitely. But this is immensely rewarding. And look at the friends I've made." As if on cue, a coworker leaned across a desk to give him a high five.
These work-families provide much-needed support, particularly on holidays. Emergency room physicians have among the highest burnout rate of all specialties, in part because they treat high-acuity patients in short, intense visits. There is rarely opportunity for patients to express gratitude, and so colleagues draw closer together to provide that support and affirmation.
On this day, as on every day, small gestures meant a great deal to the staff, whether it was a meal voucher, or a candy cane, or words of encouragement from an administrator who took time to stop by late on Christmas Eve. Many of the residents sported socks they received in a gift package from an anonymous attending "Secret Santa."
At the end of the day, there was no end of the day, at least in this department. Patients continued to come through the front door or off of ambulances. New shifts arrived to relieve coworkers from 8-, 10-, and 12-hour shifts. By Robert Frost's definition, it is a home of sorts - when you have to go, they have to take you in. But according to each staff polled on Christmas Day, it is also a family.
Photo by Susan Coppa
