Intended for healthcare professionals

Careers

Doctors working at Christmas

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d8176 (Published 20 December 2011) Cite this as: BMJ 2011;343:d8176
  1. Kathy Oxtoby, freelance journalist, London, UK
  1. kathyoxtoby{at}blueyonder.co.uk

Abstract

Kathy Oxtoby speaks to six doctors about their experiences of working on Christmas Day in the United Kingdom and other countries

Omar Bholat, associate director of trauma, Bellevue Hospital, New York

Omar Bholat served as a military surgeon in Iraq on Christmas Day 2008. He recalls how this experience has had a lasting effect

On 11 September 2001 my wife, a surgeon, called me to say that a plane had flown into one of the twin towers of the World Trade Center. We lived 60 blocks away. I was off duty that day, but I immediately put on my scrubs and headed down town to help.

I was assigned to a resuscitation area on the west side of New York. None of the patients taken there had survived. I then went to the South Ferry Terminal, where I helped run a triage facility, treating rescue workers who had been wounded.

My experiences that day made me so angry. Our country had been attacked, and innocent civilians had died. I decided to volunteer for the army and in 2003 was deployed with a surgical team to Iraq.

After my first tour in 2004 I continued my work as a surgeon, most recently at the Bellevue Hospital Center, New York. But as an army reserve I can be called on to offer my services as a surgeon at any time.

In December 2008 I was back in Iraq treating trauma patients. I was working with Major John Pryor, an eminent trauma surgeon based at the Hospital of the University of Pennsylvania.

John’s wife and one of my best friends went to medical school together, so I’d spoken to him while we were preparing for our next deployment. John, a father of three, had also become a reservist as a result of 9/11—his father had been involved in the building of the twin towers. We had a lot in common and spent time together before going out to Iraq, talking about how we’d get our families together on our return.

After we arrived in Iraq that December we provided combat medical care for one of the hospitals, which included treating patients with multiple wounds sustained from bombings.

On Christmas morning John and I met up as usual to run through patients’ details. At 1030 am John said that we should get together to celebrate Christmas, and we arranged to meet an hour later. I saw my patients and went to the emergency ward. While talking to colleagues I looked at the clock, noticed it was 1130 am, and remembered that I needed to meet John. Then I heard a massive explosion about 20 feet [6 m] from where I was standing and about 10 feet from the main operating room. A rocket had dropped outside the hospital.

I went to help the injured and directed them to our trauma section. A large man who was severely injured was carried in. We began trying to resuscitate him. Then I realised it was John. I knew that his injuries were so devastating he wasn’t going to survive. Despite our best efforts, there was no response. One of my colleagues asked permission to cease resuscitation, and John was pronounced dead.

I found out later that he had been coming back to the hospital having attended a Christmas service at church with some colleagues. While they stopped to chat he had carried on walking to the emergency room, when a rocket landed two feet in front of him and went off.

The rocket only partially detonated, otherwise many more people would have died. Two doctors were wounded, whom we successfully treated. Any interest in festive activities had gone. My ability to call my family had gone.

I witnessed the ceremony where John’s coffin was loaded onto the plane to fly him home. I then went to my room, crawled into bed, and tried to sleep.

My wife was at home with two children and eight and a half months pregnant. On 29 January 2009 I saw, on Skype, the birth of my little boy. I wanted to name him something unusual—my wife wanted something traditional. We called him John.

There have been times since then when my wife has asked me to leave the army, but she understands why I will continue to serve. Next time I go to a combat zone it will be as a commander.

What happened that Christmas changed me in so many ways. Dealing with devastating events has made me a more confident and competent doctor. I’m not the bravest man, but I won’t run away from this fight. I want to look after injured soldiers and make sure that doctors and nurses know how bad things can be if they serve in the military; that even as a medical unit in a relatively fortified position, where the worst shouldn’t happen, it can—and to friends. And I want to make it easier for others to cope with such situations.

The first year after John’s death I took my family to see his grave. The second year I visited his grave with my military colleagues. This year I won’t be going, because my family want me to spend time with them. I won’t mention John—but I will be thinking of him.

Christopher Tranmer, retired general practitioner, London

Christopher Tranmer has been involved in several missions for the independent humanitarian medical aid organisation Médecins Sans Frontières (Doctors Without Borders). This work involved him being away from his family on Christmas Day. He says that the work was testing but also hugely rewarding

I have always felt it was important that as a doctor I should use my experience to try to help extremely disadvantaged people living in deprived areas in other countries.

I have always admired the work of Médecins Sans Frontières (MSF): the organisation seems to be the first to send people to help in difficult situations, and I thought their standards were incredibly high.

I retired as a general practitioner in London in 2007; and in 2008, on the advice of MSF, I took a three month diploma course in tropical medicine and hygiene at the London School of Hygiene and Tropical Medicine. I then volunteered my services to MSF. My first mission that July was to the Central African Republic, where I spent six months doing general medicine and teaching my skills to other doctors.

The Christmas I spent in the Central African Republic was an incredibly basic but unique experience. Some foods were difficult to get hold of. But while jogging around Birao—the town I was based in—I happened to see some guinea fowl and managed to negotiate the purchase of one for Christmas Day. Along with helpers from MSF and other aid organisations that were based in the town, I cooked a great Christmas meal.

Having returned to England in February 2009, I felt I needed to do more missions, so that July I went to Malta to support the healthcare needs of refugees arriving in the country. At that time there were disturbances, which continue, in Somalia and also in north Africa, which meant that people were leaving these areas for a chance to make a new life in Europe. One of the shortest crossings to Europe was by boat from Libya. Many refugees would try to get to Italy, but they could get caught up in storms and end up in Malta. From September 2009 to March 2010 I took part in an MSF mission to try to improve the circumstances of these refugees.

My remit was to provide basic healthcare for refugees in detention camps and also to supervise healthcare workers. Men and women were separated into large rooms. There were about 40 to 50 refugees to a room; some had scabies or worms.

One area of healthcare that became increasingly important as the mission went on was the refugees’ need for psychological care. These people were often severely traumatised. This trauma may have happened before they left their homes, but often it would occur during their journey when they were abused by those smuggling them to Europe. There were frequent incidents of women being beaten and raped. We realised during the mission that those who were being detained in these camps for up to two years were experiencing psychotic disturbances.

As field coordinator I liaised with government officials to draw their attention to what was happening to these people and to try to improve their situation. I also had the support of a psychologist and a psychological coordinator.

On Christmas Day we had personal celebrations, but at the same time we needed to go to the camps, see people, and continue to care for patients. The psychologist was away, so I needed to cover their duties. My experience as a GP doing psychotherapeutic work was suddenly required. I assessed patients and established what the priorities were for treatment and whether patients needed to be referred.

I visited a girl that day who was suicidal. She was from Ethiopia and had been raped and abused there. Having been in a detention centre in Malta, she needed to be sectioned and was admitted to an institution, where she experienced further sexual abuse. When I saw her I was concerned about her safety, and I highlighted my worries to staff. They then took her to another ward, where she received the necessary support.

The MSF team in Malta was looking forward to Christmas Day. I cooked a turkey, and we had a great evening together. MSF gives mobile phones to volunteers so I was able to speak to my family that day. I came home in March 2010 and have since been on missions for the organisation in India and Russia.

Taking part in these missions has meant leaving my family behind. My wife, a retired doctor, has been incredibly supportive, as have my three children. Some of the places I have visited have been dangerous, but my family and I had confidence that I would be supported by MSF.

These experiences have been incredibly rewarding but also testing. Working and living with a team, and seeing huge suffering, you learn a lot about healthcare and also about yourself. It’s extremely hard, the hours are long, you’re very tired, but at the end of a mission the satisfaction is immense. However, this year I’ll be at home for Christmas, and I’m looking forward to being with my family—though I’ll still be doing the cooking.

Dario Archille, general doctor, Haiti

Dario Archille, who works with cholera patients in Haiti, says that although working on Christmas Day can be difficult for healthcare workers, some experiences can be rewarding

I qualified in medicine in 2009 and began working as a general doctor in 2010. I work as the head of the cholera treatment unit in Cité Soleil, an impoverished community on the northern outskirts of Port-au-Prince, overseeing the functioning of the unit and collecting epidemiological data each week.

Haiti is a poor country. On 12 January 2010 we were devastated by an earthquake, worsening our poverty levels, and eight months after the earthquake we were struck by a cholera epidemic, which we hadn’t had before in our country.

Almost 7000 people died from cholera in Haiti in 2011, and almost 522 000 people were affected by the condition; the prevalence is about 2%.

The biggest problem with cholera is that it affects Haiti economically, preventing investors from coming to the country and diminishing the workforce—all contributing to the country’s increasing fragility.

We also have more patients in hospital. With respect to cholera our role as doctors is to train medical staff in its treatment and show the public how to deal with the disease and to make them aware of the risks.

Cholera is a condition that needs to be treated as an emergency, and you have to react rapidly to save the lives of people affected by it. When patients arrive at the clinic they are assessed to find out how dehydrated they are as a result of watery diarrhoea and vomiting. They are then given oral or intravenous rehydration salts, and we keep a watch on the state of their health.

I decided to work for Doctors of the World (Médecins du Monde) in 2010 to help combat cholera in Haiti. People here were not really aware of the illness before. When I realised how many people in Haiti had died from the disease, I wanted to give a helping hand through this international aid organisation, which provides medical care for vulnerable people all over the world.

Christmas Day is a special day in Haiti, and as in other countries many employees don’t want to work. It’s hard if you’re called in to work when you have made other plans, but you also have to remember that no one chooses when they are going to be ill, and they certainly don’t want to be ill on Christmas Day. Sometimes there will be an emergency situation and you need to have a medical team to deal with it.

On Christmas Day 2010 I was leading a team working on cholera cases. Some of the team were frustrated at having to work, and I had to explain to them that it was important because we needed to save lives.

Ordinarily we don’t really celebrate Christmas in our hospital—all we do is put up decorations on a Christmas tree. Last year Doctors of the World gave us sweets and toys to give to patients, and we wished each other a merry Christmas. Even those children who were very ill were smiling, because they knew that Father Christmas hadn’t forgotten them.

At around 2 pm on that day a woman was brought in who was close to death. She was almost unconscious, had sunken eyes, dry buccal mucus, poor skin turgor, a very fast pulse rate, and cold extremities.

We rapidly gave her two drips. We then gave her 3 L of lactated Ringer’s solution. She gradually regained consciousness. Several days later she returned to the hospital to thank us for saving her life, and we replied, “It was not us, it was Father Christmas.” It gave us great satisfaction that on Christmas Day we had saved someone’s life. Those people who were frustrated about having to work that day said that if they had not been there they would have regretted it.

I have learnt so much from this experience. Although Christmas happens every year, any day someone can lose their life. If doctors have the opportunity to make a small sacrifice for just a few hours to save lives, they shouldn’t hesitate to do it.

Gal Dubnov-Raz, paediatrician and sports medicine specialist, Israel

Gal Dubnov-Raz works at a hospital near central Israel. As a Jewish doctor he says that Christmas is a normal working day for him, but he understands the sacrifice involved in spending time away from family on important holidays

Being of Jewish faith I don’t celebrate Christmas—25 December is like any other day at the hospital. I go to work, do the morning rounds, where I see young patients, write up notes, and visit community clinics. There are no decorations and no special food and drink. It’s just a normal day.

When I go home and see my three children they sometimes remember that it’s Christmas Day—they see how it can be great fun and enjoy Christmas TV shows. My daughter once asked if we could celebrate this holiday because of the presents. I understand why it is a special holiday: as a child I experienced how Christmas was celebrated in the United States, where shopping malls were filled with pine trees decorated with ornaments, and there was lots of candy and, of course, Santa.

Although working on Christmas Day doesn’t mean the same to me as to some clinicians, having been a doctor for 10 years I understand the sacrifice of having to spend time away from your family on major holidays. When it comes to working on those days I believe it’s important to make my family understand that their dad has to help other children, some of whom are very sick in hospital.

I regularly work on important holidays that celebrate the Jewish faith, including the Jewish New Year in September; Yom Kippur—when we fast and visit the synagogue to pray; and Hanukkah, when we light candles, spend time with our family, and sing songs.

Doctors at our hospital are of different religious faiths, so we try to help each other to celebrate special days by offering to work their shift on their festive days.

We try to ensure that children on our wards, many of whom have been hospitalised for long periods, don’t miss out on holidays such as Hanukkah. We also want to help children in our care understand the value of different religious festivals, such as important Muslim holidays. For example, staff in the paediatric department create educational posters giving information about such special events, which they display in the children’s ward.

When I work special holidays I isolate myself from what’s going on at home and concentrate on being a doctor. Usually I’m in the emergency room treating children. While none of us are having a holiday, at least I can help these children to feel better and hopefully ensure they are well enough to go home as soon as possible.

One particular holiday I remember working in the emergency room was on Yom Kippur, a day when tradition dictates that no one drives their car, and the custom is for children to ride their bicycles in the streets. A child who had been riding his bicycle was brought in by ambulance because he was experiencing chest pain and dizziness. An electrocardiogram showed that he had a heart condition. Being a sports medicine specialist I was immediately able to identify the problem—it’s something you look out for when doing pre-participation examinations for competitive athletes.

As it was a holiday, the boy needed to wait a day or two to see a heart specialist. My experience meant that I was at least able to reassure his mother and emphasise that her son would be able to live a normal life with this condition. To see the relief on her face reminded me that it doesn’t matter if I have to work at holiday times—what counts is being there for patients. The experience also made me value the fact that my family was celebrating at home and healthy. And even though I was working, it felt good to be doing an important job—for there is no other job like it.

Angela Burnett, GP, Hackney, London

Angela Burnett, who works at the Greenhouse general practice in Hackney, says that her experiences of working for a Christmas charity inspired her to work with homeless people all year round

I first got involved with Crisis at Christmas, a charity that supports homeless people, in 1982 when I was a medical student. I decided to volunteer to help out that day as I believed that I should be doing something more at Christmas than just sitting around, eating a lot, and opening presents. Christmas, to me, seemed more important than that.

I saw an advertisement for Crisis at Christmas and contacted the organisation to offer my help. For 10 years I volunteered to help out on Christmas Day, serving meals and looking after people.

Often the centres that homeless people visited would shut down over the Christmas period, leaving them with nowhere to go. To fill that gap the charity worked from makeshift centres. My work took me all over London. Sometimes I would be working in a disused bus shelter, other times in an old warehouse or any big space that the charity could obtain.

This work involved providing people with hot meals and, importantly, companionship. Volunteers were on hand to give people advice about healthcare issues, housing, and training opportunities.

The charity now aims to establish much smaller, less intimidating sites for the 2000 people or so who need support at Christmas in London. These smaller spaces cater for specific groups, so now there are women only shelters and those that accept pets.

The kind of people the charity helps has also changed since I first volunteered. Back then it was mainly middle aged men needing support. Now there are many more women, young people, and people seeking asylum—some of whom are survivors of torture—who need help.

In 1989, after a few years of volunteering for Crisis at Christmas and having qualified as a doctor, I became more involved in dealing with the health needs of those who visited the centres. I worked in makeshift clinics—rooms that were partitioned off from the main space designated for visitors to offer as much privacy as possible.

I then went on to coordinate these health services. This involved recruiting other healthcare workers, organising shifts, and making sure that there were dressings and a supply of drugs such as antibiotics and simple pain killers to support people’s health needs during the Christmas period.

I also liaised with the ambulance service, making them aware of the work we were doing. Sometimes I would need to call on this service at Christmas, as people living on the streets can become very sick. Many have alcohol dependency and some are substance misusers.

While working for Crisis at Christmas I was struck by how becoming a homeless person can happen to anyone. I remember one Christmas seeing a man in his 50s who had been living on the streets for about a year because he had lost his job, his home, and his family. Having had a fairly secure career, he had lost everything.

He was very down and withdrawn and appreciated the opportunity to talk to me about his problems. As well as giving health advice about what was a potentially infected ulcer on his foot, I talked to him about the housing and welfare support that was available. I didn’t see him again, but that is the nature of working with people experiencing homelessness—it’s quite hard to have any degree of continuity with those you advise. But I hope I made him aware that help was available to allow him to move on with his life. I just hope that this Christmas he’s somewhere warm with family and friends.

Women living on the street have a particularly hard time at Christmas, with many of them having had their children taken into care. One woman I came across, who was in her 40s, was affected by alcohol addiction, which led to her being separated from her children. As well as treating her chest infection I also worked with colleagues to arrange long term accommodation for her.

I’ve been fortunate that having done a morning shift on Christmas Day for Crisis at Christmas I could go home to my family and friends and, when faced with particularly distressing experiences, I would talk to other volunteers for support.

My time at Crisis at Christmas inspired me to do work that supports homeless people. I work three days a week as a GP for the Greenhouse practice in Hackney, which was set up to support people who are homeless or vulnerably housed. The rest of my week is spent working for Freedom from Torture, which provides care for survivors of torture.

Working for Crisis at Christmas taught me not to make any assumptions about people and to look beyond first appearances. I also enjoyed working with a team of committed individuals who, by creating temporary shelters, managed to build something out of nothing over Christmas, offer support to homeless people, and signpost them to more permanent sources of help that would hopefully have a positive effect on their lives all year round.

John Heyworth, emergency department consultant, Southampton

John Heyworth, a consultant in the emergency department at Southampton General Hospital and immediate past president of the College of Emergency Medicine, says that working on Christmas Day can be a combination of festivity and tragedy

In my 22 years as a consultant I’ve worked many Christmas Days. The prevailing atmosphere in the emergency department is seasonal, and staff members work hard to embrace the spirit of the day. We decorate the department, and the team will often don reindeer antlers and the like to cheer up patients and ourselves.

A surfeit of food is essential, and any emergency department is always stocked well with cakes, chocolate, and nibbles. While the traditional days of the consultant dressing up as Santa and carving the turkey—see the 1950s Doctor series of films—are sadly long past, the occasional consultant-delivered “ho, ho, ho” can never be ruled out.

We try to sustain the Christmas spirit, although sometimes this is difficult as the day progresses, when the very sick and injured arrive. It’s sad but true that illness, injury, and death do not stop for Christmas.

On Christmas Day the department is one of the very few areas patients know will provide urgent and emergency care, so we always expect it to be busy and are never disappointed. The day tends to follow a pattern: reasonably quiet first thing in the morning as people are busy opening Christmas presents, but as the day progresses we see the whole range of injuries and illnesses. Usually during the course of the morning some very seriously ill patients, such as those with chronic obstructive pulmonary disease and stroke and some celebration related injuries, seek emergency care.

By the time it’s the Queen’s speech there will be many more ill and injured patients: the elderly, children with fevers, those who have proved incompatible with wheel based gifts such as bikes and skateboards, and usually a turkey related choking event.

Sadly, most years two or three people will die in the department on Christmas Day, which is particularly poignant. Inevitably such events affect staff. We debrief afterwards and attempt to rationalise. These events do not get any easier—which is probably a good reaction, no matter how experienced we are—and they are particularly difficult on Christmas Day.

Although I have been doing this work for many years, this palpable sense of loss remains as powerful as ever. That sense of loss is a reminder of the importance of Christmas and the need to be with family—for part of the day at least.

So there is no trench-like Christmas Day truce in the emergency department, and then there’s the alcohol fuelled celebration of New Year’s Eve still to come.

As ever, the maxim of the department is that it should, and will, provide care for all patients of all ages, all injuries, all illnesses, and at all hours, and this applies equally during the Christmas and New Year period. A fundamental role of the department is the universal safety net for those people who are unable to access other parts of the healthcare system during holiday periods—for example, those who are not registered with a GP, are away from home, or are simply unable to navigate the complexity of the somewhat fragmented urgent and emergency care system.

The department over Christmas will, therefore, be a true Christmas stocking mix of unexpected delights tempered with real life.

Further information

Footnotes

  • Competing interests: None declared.

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