23 December 2006

Holidays in the ER

I am lucky enough this year to be more or less off on the holiday. I work tonight, the 24th, from midnight to 8AM (technically the shift starts on the 23rd at 11:59PM, for clarity in scheduling). So while I am theoretically working christmas eve, I am actually off for the real eve of christmas. I am also off on christmas day.

The holidays are different in the ER. There's usually plenty of good cheer and decent food. The staff traditionally flagrantly violates JCAHO standards and brings in a sort of spontaneous potluck which gets set up at the nursing station or in the break room if there is space. There is a sense of camaraderie, in that all of us who are there are kind of pissed off that we have to be at work and not home with our families, but since it is a shared burden we don't get too openly bitter, but sort of refocus on trying to make the best of it and have a marginally festive time where we are. And there is a weird feeling of insularity (especially on the night shift), that we are set apart from the other 99% of the population, being at work when the rest of the real world is on hiatus. More than a little pride in that fact.

The holiday clientele is also a bit different from the usual mix. Fair to say that alcohol related presentations increase, though not so much for christmas as New Year's or the Fourth of July. The nursing home patients come in regardless of the day. Old folks overindulge and go into CHF, young men get kidney stones, young women get gall stones, and plenty of people develop acute illnesses. Many (or most) of the trivial or recreational visitors simply don't come in -- it's the one time of the year when everybody has something else they would rather be doing. But there seems to be a corresponding uptick in the psychiatric visits, and the chronic pain exacerbations seem to increase. Last night I saw six migraineurs -- triple or more what I would average. I wonder how much of this is due to the stress of the holiday season and how much is due to the fact that all the doctor's offices are closed. And since all the clinics are closed, the ED volume is about 30% more than on an average day. The acuity is higher than average, and the waiting room becomes an ugly place indeed.

Aftercare is a huge problem. There is a five day gap when all the clinics are closed and you cannot get anybody in for an urgent recheck or consultation. But (for once) patients are incredibly resistant to being admitted to the hospital -- as I said, they all have something else they would rather be doing. The worst thing is the relatively rare holiday tragedy -- be it a fatal MI or motor vehicle accident. Knowing that someone's holidays have just been ruined forever casts a pall over the entire ED. Fortunately, in the dozen or so christmases I have worked in the ED, I have seen only a few of those. Maybe I am just lucky.

Well, off to work. Happy holidays all.


  1. May your shift tonight be quiet, and your holidays fun. Merry Christmas, doc.

  2. Merry Christmas! I hope your shift's quiet, too. I've decided to do a volunteer shift in my ED on Christmas evening, since people who are there then may be more than usually likely to appreciate a visit from a chaplain. I'm curious to see what it will be like, and I'm praying -- even more than usual -- for no deaths!

  3. Merry 'Hoikey' Christmas and all the very best for 2007 :)


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