In December, the questions parents ask in the hospital are different. Instead of “Will my child be OK?”, we pediatric hospitalists hear:
“We have plane tickets to go skiing for Christmas. Will he be well by then?”
“She’ll be home for Christmas, right? We’ve never been away from home for Christmas.”
“It’s his first Christmas. He’ll be discharged by then, right?”
And every other variation you can think of. The hospital for Christmas is not what anyone wants, but it is what some children and their families get.
Over the years, I learned how to say,
“I hope he’ll be ready to go home by Christmas, but I can’t promise.”
“I don’t think skiing is in the cards for you this year. I can write a letter to send to the airlines to help you get a refund.”
“I’m sorry to tell you, she will definitely be here for Christmas. And we will take great care of her.”
“Yes, your baby is still going to be in the hospital, and by the time she’s a teenager, she’ll be sick of hearing you tell the story of how she spent her first Christmas here.”
Winter is always a busy time in a children’s hospital; there is more sickness, so there are more admissions. It’s a bustling place. We struggle when the “house is full”. We often have no available beds, so there’s a juggling act that goes on.
There are patients in the ER who need admission. There are ICU patients who have improved enough to leave the ICU and come to a regular room. There are surgical patients coming out of the OR who need a room. And of course, there are patients who are worsening, who need to go to the ICU. Add to this the patients in other hospitals who need to be transferred to us for specialized pediatric care. When we are operating at 100% capacity, (which is often in the winter), there is nowhere for any of these patients to go.
So, the first order of business every winter morning is to decide who has improved enough to be discharged. It takes a while for doctors to review lab work, learn how patients did overnight, decide who can go home and meet with them. Then there are IVs to remove, bandages to change, medications to review, and equipment to go over. More time passes while families arrange transportation, pack up, get all their discharge instructions, and actually leave the room. Then, the busy and meticulous housekeeping team must clean the rooms. The precise room cleaning protocol, designed to keep the next patient from catching anything the last patient had, and to keep the housekeepers safe, takes over an hour. (Among the many unsung heroes in children’s hospitals, housekeepers rank pretty high on my list.) Then, once there are available rooms, the dominoes can begin. Of course, the surgical patients need a room on the surgical floor, the pneumonia and asthma and RSV patients need to go to the respiratory floor, etc. etc. Thankfully, the House Supervisor (a nurse wizard) is adept at making sure everyone ends up where they should be.
But all of this is behind the scenes. If you are a patient or a parent, you don’t see this. For you, what is most evident is that the nurses are chatting about Christmas decorations (Shall this year’s theme be Santa, reindeer, elves, or snowflakes?). Small tabletop Christmas trees sprout in most patients’ hospital rooms. Every day, kind-hearted volunteer groups visit the hospital to sing carols, distribute gifts, donate toys, and add to the excitement the children already feel. Football teams come to sign autographs, basketball teams bring swag, racecar drivers park a cool car outside for kids to sit in. A huge Christmas tree brushes the ceiling of the two-story hospital lobby. There’s a calendar of events for the kids who are well enough to leave their rooms: face painting, construction paper Santa hats, popsicle stick North Pole houses, cookie decorating. Some nurses dress as elves. Even doctors can be seen wearing festive Santa hats or Christmas tree earrings. One year, a snow machine was put on the roof, and magically, snow fell for several hours, drifting down past patients’ windows on Christmas Eve afternoon.
About December 23, the hospital starts to empty out, sort of. Cancer patients have had their chemotherapy schedule carefully arranged months earlier so that Christmas can be spent at home, if at all possible. All elective surgeries have already been done, and children are recovering at home. On December 24, any child who can possibly be discharged goes home, with grateful parents. The census is as low as it ever gets in the winter. What a blessing.
And what about the children who spend Christmas in the hospital? The hospital makes sure that, late at night on Christmas Eve, Santa comes to each and every child in the hospital, leaving a sack of presents hanging on their door. Even the premies in the NICU get a gift from Santa. As much as possible, good memories are made when children spend Christmas in the hospital.
The sad reality is that the patients who are still in the hospital are really sick. And any child who gets admitted on Christmas Day really HAS to be in the hospital. So, although the numbers may be lower, the intensity is higher. The doctors, nurses, respiratory therapists, and other staff who work on Christmas must be at the top of their game. They work HARD.
Lunch on Christmas day is a potluck affair, held in the nurses’ break room, with casseroles, brownies, sandwiches, pies brought from home and shared. People eat in shifts, darting in and out between taking care of patients. There’s not much complaining. Everyone knows that’s just how it is. They will have Christmas with their family tomorrow, or tonight.
For many years, on Christmas Day, a Jewish civic group volunteered in our hospital, doing any job that could be done by non-medical personnel (working at the information desk in the lobby, stocking supplies, rocking babies) so that Christians who celebrate Christmas could have the day off.
We all know a young man who saves his allowance and lawn cutting money all year so he can stand at the cash register in the cafeteria, wish each parent a Merry Christmas, and pay for their lunch on Christmas Day. He’s done it for years. He remembers being in the hospital on Christmas and wants to give back.
Working in a children’s hospital has opened my eyes. I now know that people are at their best during Christmas, especially in the hospital.
(Originally published 12/25/2024 https://kevinmd.com/2024/12/christmas-in-a-childrens-hospital.html)
From a reader:
Ann, that’s a timely, informative, and personal reflection of one of those things that people rarely (if ever) think about…the duty and sacrifice of others at times of celebration and family gatherings. Out of sight, out of mind. For those who give at Christmas in such a sacrificial way, and those whose lives are deeply impacted, even saved, the experiences are not soon forgotten.
You took me back to my first year of residency when I drew the short stick (the other guy had a handful of short sticks!) for in hospital call on Christmas Day. I was at the hospital before 8 a.m. that day, and worked nonstop till 10 a.m. the day after Christmas. Lucy spent Christmas with a friend in Siler City. That was tough on both of us.
I was surprised at the rush and urgency of radiological patient care during that 24 plus hours. I suppose I thought things would slow down and maybe even be festive if not quiet. Fat chance for a major tertiary care teaching hospital. I was the only radiologist (and a completely ignorant, greener than green one at that) in the hospital. The ED never slowed. The house was almost full. The CT, ultrasound, nuclear medicine, radiographic, and fluoro units hummed. My only friends were disgruntled techs who felt put upon for having to be on call. It felt like I spent a week there in one day. I guess I went home after read out with an attending, and went right to bed. Opening presents, eating Christmas ham, and drinking egg nog would have to wait.
I’ve forgotten most Christmases of my life, but not that one, December 25-26, 1978.
Thank you for the commentary and the remembrance. And honors to you for those same and more sacrificial services that you rendered on more than one Christmas.
Tommy
From a reader:
Being Jewish, I volunteered to work every Christmas day for 40 years (other than my two years at CDC). As you point out, the children in the hospital on Christmas needed to be there, and my favorite story is as follows: When I was still in Baltimore and the Baltimore Orioles were World Series caliber, some of the biggest Orioles stars came to visit our inpatient service to bring some cheer to the kids bummed out by having to be in the hospital. The problem was that, on that particular Christmas day, none of our inpatients were “with it” enough to know that they were being visited by sports royalty: Some were too young, some were too neurologically incapacitated, and some were simply too sick. The Orioles players were clearly taken aback, having come to the inpatient service full of energy, enthusiasm, and excitement; they seemed particularly disappointed– until the staff came to their rescue. The children may not have recognized the Orioles but the staff sure did, so the Orioles wound up signing autographs, receiving all sorts of adoration and smiles. So it all kind of worked out to reflect Christmas cheer after all.
What a great story, Ann. Having just spent Thanksgiving with my sister in the hospital, my eyes were opened to how wonderful the staff handled her. I hadn’t even thought about kids being in that situation for Thanksgiving, much less for Christmas. And how bout when parents are the ones admitted? Thanks for opening our eyes to the reality of so many families not getting the Christmas they had hoped for.