January 2nd, 2024

Reflections on Working in the Hospital During the Holidays

On-service ID team, December 25, 2023

For the zillionth year in a row, I spent the Christmas holiday working in the hospital. For me, it’s not much of a sacrifice — we don’t celebrate Christmas, and my kids are long out of school so the strict limits on when we can take vacation are a thing of the past. But it puts me in a notable minority, as around 90% of U.S. workers have the day off.

So what do we 10%-ers get in exchange for working? Here’s a secret — we get plenty. A brief rundown:

Camaraderie. This is one of the best things — the immediate recognition among those in the hospital that we’re in this together. Take a look at that picture of the faculty and fellows on call. Do those look like unhappy doctors? Importantly, a couple of the members of this quintet do celebrate Christmas, yet made the sacrifice to come in. To them, an especially big thank you!

Continuity. Sadly, illness doesn’t take a holiday and neither do hospitals — they’re a 24/7 business. The patients who must be in the hospital over Christmas are mostly quite sick, or socially disadvantaged, or both. They’re usually pretty upset about having to be there, quite understandably. So they very much appreciate that some of the doctors who were following them before the holidays know them during the holidays too.

Barter. Working Christmas allows us to trade this important holiday for others. For example, I haven’t worked Thanksgiving in years and almost always find a way to get coverage for Passover. Already I’ve blocked off Christmas 2024 as a time both my wife and I will be working — you’re welcome, happy to do it.

Bonus. Several years ago, our division adopted the policy of providing a small bonus to the on-service faculty for working certain important holidays. (Apologies to our residents and fellows who don’t get this. Maybe that will change now that they have adopted a union?) Note that for most salaried workers, it’s typically 1.5 or even 2 times the hourly rate. Believe me, it’s appreciated.

Golden Citizenship Award

Citizenship. Some of the crew on call over Christmas volunteer to do so nearly every year. As the person in charge of clinical scheduling, I hereby give them the Golden Citizenship Award. Mike, Eric, Amy, Anna — you know who you are — thank you! Place this award in a prominent place, it’s quite valuable.

Sustenance. The hospital president every year sends around an email wishing us happy holidays and announcing that lunch and dinner in the hospital cafeteria are free. This year’s entrees were pretty good, both the chicken and vegetarian options, though I wasn’t a big fan of the dessert. But if it’s sweets you’re after, no worries — hospitals are replete with goodies, homemade and otherwise, practically everywhere you go. This year, I arrived on one hospital unit to find gorgeous homemade chocolate chip cookies invitingly set out on a tray with a sign saying, “Take One”; another unit had a huge basket of assorted Lindt truffles. Noticing my rapt attention to the chocolates, a kind nurse insisted I not leave the floor until taking a few. Yum.

Appreciation. If you work over the holidays, you can pretty much guarantee that plenty of people will thank you. Patients, doctors, nurses. Hey, note that even I am thanking people (see “Camaraderie” and “Citizenship”, above).

Learning. Medicine is a lifetime of education! No reason this needs to stop over the holidays, right? Cryptosporidiosis, vascular graft infections, bacteremia as a complication of appendicitis, drug-induced vasculitis — summarized these topics and others in an on-line thread. Plus, one of the fellows shared an interesting paper on antibiotic-associated neutropenia. Much appreciated, Carlos!

Pace. Hospital census used to drop dramatically in the week before and after Christmas, leading to a delightfully slower pace in what is usually a very busy environment. While that effect is much less dramatic with the post-pandemic bed crunch, there are still fewer elective surgeries and admissions. So it’s still not quite as busy as during the rest of the year, a welcome break. And if you’re worried that I’m going to jinx this effect by even mentioning it, I refer you to a classic paper.

Diversity. Here’s a wonderful thing that made me smile on December 25, courtesy of Dr. Vamsi Aribindi:

Happy New Year, everyone!

13 Responses to “Reflections on Working in the Hospital During the Holidays”

  1. Rachel Shemtov says:

    Agree! Being a fellow Christmas day worker, a lot of this rings true. But don’t you think the volumes were insanely high this year? Don’t mind it at all, but it was overwhelming having less people working and volumes higher than ever. I do agree that volumes are usually low.

  2. Mimi Breed says:

    You’re the best, Paul. Happy New Year.

  3. Bernard McNamara says:

    Happy New Year, Paul. I’m ER and ID, and worked on Christmas day in the ER, and the camaraderie and sweets were great! I especially appreciated the reference to the “Quiet” paper from the Journal of Emergency Medicine. I’ll have to include it in our journal club. Thanks again.

  4. James Thompson-Crawford says:

    I too have been working a zillionth Christmas & Easters, I do it quietly (being a Christian Physician, yes there are many of us!) knowing these aren’t true dates of what I believe were historical events. I just get on with it however, I take umbrage with this dialogue as it’s just another attempt to divide and conquer. Interestingly absent is no comment about NYE? Oh, yes! not faith based. Also just for the record, many of us Christian doctors face ridicule, scorn and even aggression from colleagues and senior Physicians when this is found out. Now I’m a Consultant ID Specialist I no longer put up with these behaviours. So, please use discretion and sympathy before speaking, knowing all to well that these are traits that most of us lack.

  5. Gordon Huth, MD says:

    I worked every Christmas as well. I also felt good about myself for doing it (a little self-pat on the back). Nice to spend the day at what was in many ways my second home.

    Love the pic!

  6. MK says:

    Wait, but in the article, it’s the researcher who used the quiet word, and he only asked “is it quiet?” I think the study would be more convincing if the ED providers said themselves that it was quiet (when it was) and then waited for Murphy’s Law to set in.

  7. Barbara A Body, PhD, D(ABMM) Emeritus says:

    As Director of Microbiology, I set a precedent in 1991 at what became labcorp by working Christmas Day. It was important to me to have coverage for blood cultures & sterile body fluids. So, I worked the bench. One of the blood cultures from a community hospital was positive (from my training & experience) for Group B strep. I could report it to the ordering physician and subsequently the physician at the academic center where the patient was transferred. That episode demonstrated to the entire micro staff the importance of our work and holiday coverage became the norm. The staff could get the perk of getting holiday pay for working & another day off. Win-win

  8. Ana Lozano, MD Almeria, Spain says:

    “My mom used to tell me how every Dec 25th the hallways in American
    hospitals were filled with Hindu and Muslim doctors earnestly wishing
    Merry Christmas to bemused Jewish ones.”

    So nice words from Dr. Vamsi Aribindi’s mum. Made me smile and felt happy for such a peaceful mixed society. But the, quickly came to my mind, the war over Gaza, just the other side of human condition, the awfully opposite situation.

    Let’s all work for the peace, multicultural hospitals best examples these days.

  9. Joe Elia says:

    While in college I had a summer job as a lab tech, which enabled me to work some weekends during the school year. One of those weekends, inevitably, was over the holidays.
    Paul’s descriptions brought me back to those days in the pathology lab, roughly 60 years ago.
    Thanks, Paul, for the sweet evocation.

  10. Frank Friedman says:

    Working Christmas day in the ED has always meant, at least at my hospital, a few minutes of one-on-one time with the CEO (whoever that happens to be, have been through several), who invariably comes in him/herself to thank us for working. Usually it’s just an exchange of pleasantries, but if there’s something we really need, or is really bugging me, it’s that golden opportunity.

  11. andi says:

    I recall a Thanksgiving where both my parent and I were working at the same hospital, in different departments. We had Thanksgiving dinner in the cafeteria and then had bonus Thanksgiving at home on Friday.

    I was happy for the extra $1/hr holiday rate!

  12. Konrad E Hayashi, MD, MPH & TM says:

    Was an orderly before medical school. Was glad to take all the holiday shifts as there was the camaraderie of work colleagues, and could still get home in time for family dinners. As a GS Civil Servant there was a holiday pay premium, and that certainly helped for medical school applications and gift giving.

  13. Jaan Naktin says:

    I remember spending Christmas of 1998 rouding with Roger Pomerantz, who was our Chief at Jefferson at the time. I recall being in the neuroscience ICU seeing a case of severe cerebral toxoplasmosis in a newly diagnosed HIV patient. There were other compelling circumstances that I cannot share for confidentiality reasons, but I would add “Durability” to your list as I still remember details with amazing clarity even though it was 25 years ago!

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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