For most people, the festive period conjures up images of twinkling lights, family gatherings, and the warm fuzzy glow of over-indulgence. For the doctors and nurses on my A&E ward, it presents a rather different reality: one defined by constant fatigue, poignant tragedy and, on one occasion, a patient who decided to stick a jar of Marmite up his anus.
The chaos begins at the start of December, as Britain’s party season swiftly takes its toll. And as a physician, it’s the time of the year that I really feel like I’ve earned my stripes. Christmas is tough on the public and staff alike and my A&E will be an absolute fairground of drunken activity. Alcohol-related admissions rocket. I remember one year treating a rather self-important, high-profile barrister who arrived intoxicated and belligerent, treating us with the same contempt he might reserve for his opposing counsel. Fortunately (or not, as it would soon transpire), that quickly changed when, slouching in a three-piece chalk stripe suit, his nostrils enjoying a “white Christmas” of their own, his bowels got the better of him. A&E has a habit of being a great leveller.
Over the festive season, however, it also has a habit of witnessing Christmas in its cruellest incarnations. As any paramedic will tell you, alcohol consumption makes the roads increasingly treacherous; what’s often forgotten is that it can make life at home more dangerous too. According to police data, domestic violence incidents surge during the Christmas period. And frequently that spills over into A&E. Last year, on Boxing Day, a woman presented on our ward with a broken nose and an indentation in her cheek that bore a striking resemblance to a large signet ring.
It’s not just alcohol abuse that takes hold over Christmas; the grim consequences of drug-taking — from cocaine-fuelled acts of violence to accidental and intended overdoses — also increases. One of the worst cases I’ve ever seen took place a few years ago, when a heroin-addicted couple brought their baby into A&E just before Christmas. They were beside themselves with anguish. After injecting themselves the night before, they had come around to find their child rigid, cold and lifeless. An examination revealed that the baby, only a few months old, had choked on his own vomit. The parents could hardly speak; my colleagues and I ended our shifts numb. Nobody felt festive that year.
More often than not, it’s Christmas Day itself when the true essence of emergency medicine reveals itself. The patients who come in on the 25th generally need to be there. And treating their conditions is not for the faint-hearted. I’ve seen everything from massive heart attacks to brain haemorrhages — often in patients who’ve been putting off symptoms for days because they didn’t want to “spoil” the family’s Christmas until it’s too late.
I’ve also seen those who succumb to the rituals of Christmas itself. Burns from hot fat or blistering pans and falls from step ladders while hanging decorations are par for the course, as are small children swallowing Lego bricks. Some years ago, I had a patient who, while preparing the family turkey in flip-flops, slipped on her kitchen floor and sustained a severe ankle fracture. The result: six days in hospital waiting for the swelling to subside before surgery.
Away from the mundane, Christmas Day is also when we witness the most poignant festive phenomenon — a practice so common it has its own unofficial medical and sociological terminology: “Granny dumping”. I saw it first-hand a few years ago, when the treatment of two elderly women in adjacent beds told very different stories about family and festive priorities.
The first patient was surrounded by her grandchildren, from a nearby council estate, who were eager to take her home for Christmas dinner. Despite their limited means, there was warmth and genuine care. In the next bed lay a woman from a wealthier area, whose well-heeled daughters adamantly refused to take her home, despite her being medically fit for discharge. The contrast in the patients’ expressions said everything — one beaming with pride, the other bearing the weight of shame and rejection at her adult children’s callousness.
Boxing Day, meanwhile, brings its own unique challenges. While Christmas Day typically sees genuine emergencies, the following day is marked by a host of “celebrations gone wrong” — from gastroenteritis due to poorly stored leftovers to respiratory problems from overindulgence. By the time New Year’s Eve comes around, we often start to wonder if there’s anyone in the community we haven’t seen.
Yet amid the chaos, there are moments of profound meaning on the ward over Christmas. Once, I dealt with a young man who was brought in after an assault on Boxing Day. He had suffered a catastrophic brain haemorrhage due to a severe isolated head injury, and died some days later. In this darkest of moments, the coroner made special arrangements to allow organ donation below the neck — ensuring that while one family’s Christmas was forever marked by loss, others received the gift of life. On the ward, whether or not you’re a believer, that is how the spirit of Christmas often becomes clear: those moments when you’re faced with the fragility and generosity of the human condition, when you can’t help but ruminate on the meaning of life in all its weird and wonderful ways.
For those who choose to work these challenging shifts, yes, there’s an element of sacrifice. But this sacrifice isn’t a burden. It’s a privilege, even if it means getting up at 3am on Christmas morning and putting in a 14-hour shift. Once you arrive on the ward, bleary-eyed and longing for home, you swiftly discover that Christmas in A&E serves as a microcosm of life itself — joy and tragedy, hope and despair, all playing out against a backdrop of tinsel and trauma.
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Source: UnHerd Read the original article here: https://unherd.com/