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Another Christmas

Another Christmas, another day at work. Nothing new or heroic about that, of course: someone has to work the Christmas shifts, right?

Wildly differing estimates exist about how many people work on Christmas Day; the ONS’s Labour Force Survey1 suggests around 800,000 or so people in 2012, so we’ll look at their broad-brush figures. Nearly half of the workers in this survey were working for the caring and emergency services (carers, NHS, fire, police, coastguard, etc.). However, there were also 33,000 chefs, 6,000 farmers, and even supposedly “up to 1,000” Architectural and Town Planning Technicians at work on 25 December that year. More than zero but less than a thousand – that’s quite a broad range for possible numbers of people sitting at emergency architectural and town planning response desks up and down the country over the festive period. I think we should be told…

Of the NHS workers, 15,000 were “medical practitioners” – just 6% of all doctors work on Christmas Day, apparently. Don’t you feel special now?

This year will be my first on-call as a consultant, so that’ll be a nice change. I’ve worked the last twelve Christmases – every one since I graduated. This has almost always been my own choice, although sometimes the choice has been made for me by the rota design. Somehow then it feels like a gross imposition, even though it was what I was going to offer to do anyway – funny how the mind works. But at least it means I always get New Year off. Because I’m such a party animal. Yeah.

I don’t celebrate Christmas any more than absolutely necessary for propriety’s sake, so I don’t really care what day it is. It would be better if I hadn’t ended up several hundred quid out of pocket for un-reimbursed taxis taken over the years due to there being no public transport, but of course it all works out since I’m paid so much extra for working on Christmas Day – oh, wait…

The worst Christmas shift so far has to be the first one, when I was a medical house officer. It was going fairly well, busy but manageable, until mid-morning when the cardiac arrest bleep called us to A&E. A woman in her fifties had been brought in from home in cardiac arrest, and resuscitation was in progress. It was my job to get a blood gas sample from a femoral vessel, and thus I received a needlestick injury. Moments later someone found some notes and announced that the patient appeared to have end-stage hepatocellular carcinoma… because of her Hepatitis C infection. Being irremediably English as I am, I think my response to this was “Ah, tremendous,” as I squeezed blood from my finger under the tap.

Resuscitation was unsuccessful, unfortunately; about twenty minutes later, I was started on PEP (anti-HIV medication), as the virologist on call advised that HIV was not infrequently found in the same patients as the HepC virus.

From what I remember, 12 years later, I basically spent the rest of the afternoon sitting at a desk in Majors trying to summon the energy to write. I think I probably managed to clerk just one more patient that day; I don't know if you’ve ever tried PEP but it’s not a fun experience. “Enervating” is one way to describe it; “as if you’ve been awake for 48 hours” springs to mind too. Fortunately I was spared the gastrointestinal side-effects.

I gather these days the PEP drugs are a bit nicer, and it’s easier (or more common) to be allowed sick leave due to the side effects of taking PEP after a needlestick. I don’t remember being asked that day if I’d like to go home, but I’m not sure my contribution to the team effort was that great for the rest of the shift. Everyone was very nice to me, especially the medical registrar, but I just sat at the desk, unable to muster the strength to move my hand to write.

The all-clear from Occy Health a few weeks later, and the passage of twelve years, have made this seem like a reasonably great medical-life anecdote to shock non-medical friends with. It’s also a fairly good hand to play against colleagues in any game of “I Bet I’ve Had The Worst Christmas Ever At Work” (though my story doesn’t always win…). But at the time, I probably would have been terrified about the HIV/HCV, had I not been too zombified to think.

In the early evening I somehow dragged myself back to my base ward, and found that the nurses there had saved me a Christmas dinner from lunchtime. I cried a bit at that kindness, and managed about three mouthfuls before lying down in the break room with my eyes closed, in a vacant state until handover. Meanwhile my poor PRHO2 colleague dealt with all the bleeps; this was not my most productive day ever. 

Subsequent Christmases have been better. The night shifts have tended to be better than the Long Days, and they’ve all started to blend into one blur of inconvenience, forced cheerfulness and chocolate3. The one constant that stands out is the sheer difficulty of actually getting to work without public transport.

And there’s no fairness to it; it’s just “suck it up: it’s your turn this year” for most people. I’ve known plenty of colleagues who have worked many Christmas Days in a row quite involuntarily because no hospital seems to care whether you have worked last Christmas in your previous hospital, and the one before.  

There’s no moral to be drawn from this. No great lesson. No final declaiming that we do it for the love of medicine, or because it’s a privilege. It’s just your turn this year. Luck of the draw. Have a mince pie and go see the next patient please. Thank you.

1 http://bit.ly/1P58rCW - I have such an exciting life

2 Yes, I’m aware that having been a PRHO shows my age somewhat. Still, I’ve never used halothane to anaesthetise someone, so…

3 Oh god, so much chocolate. Make it stop. Please.