Home for the Holidays (Not Really): Part III

EDITOR’S NOTE: Not everyone will be home for the holidays this season. Healthcare doesn’t ever take a holiday. Emergency departments across the country will be prepared to admit patients on Christmas Eve right on through the New Year. Holiday work schedules have been in place for some time now, and caregivers will also be checking in, ready for the long nights ahead. For those who tend to the terminally ill on Christmas Eve, they’ll be prepared as well to provide comfort and support. For this new series, RACmonitor Publisher Chuck Buck interviewed those who will not be home for Christmas – but who most likely will find a sense of personal satisfaction when they’ll be on the front lines for the holidays.

Jessica and Jon, the proverbial All-American middle-aged couple (married, two children), won’t be home for Christmas.

They won’t be skiing at Whitecap Mountains. Nor will they be sunning in Aruba this holiday season. But that’s by design for this unassuming Midwest couple that you’re unlikely to spot sampling at Costco or shopping in the Van Aken District. Still, don’t count them out for Seder when it comes around April 8, in a mere four months from now during Passover.

Jessica and Jon are both emergency department (ED) physicians. And for Christmas, as in years past, this husband-and-wife team volunteers to assume their ED duties at their respective hospitals – she, Jessica Goldstein at University Hospitals of Cleveland Ahuja Medical Center, and he, Jonathan Klein, MD, at Cleveland Clinic South Pointe Hospital.

“We absolutely volunteer to work Christmas Eve. We are both Jewish, so it’s a pleasure for us to work this shift and allow our colleagues to spend time with their families,” Jessica said. “In turn, our non-Jewish colleagues will make sure we are off for Jewish holidays, so we can spend time with our family during an important time for us. It definitely helps to have a diverse group of caring providers spanning various religious affiliations (in our work family we have providers who identify as Jewish, Christian, Muslim, Buddhist, Catholic, and nonreligious) and age groups – from those in their 30s with no kids to their 60s with grandkids).”

Strictly speaking, Jessica and Jon are not a team – they have different employers – but they share the same mission as all emergency physicians: a passion to care for the highest-risk patient populations regardless of their ability to pay. 

“Our hospitals are 2.5 miles from one another, so we do in fact share patients, sometimes,” Jessica explained. “Our colleagues know they can always call the other ED to collaborate on a complex or challenging patient and provide streamlined, value-based care, despite being in different hospital systems. So we like to think we act as a team both at home as well as across our hospital systems.”

So on Christmas Eve, just a few days from now – when their Shaker Heights neighbors, in homes festooned with blinking lights and Santa Claus sleighs, settle in for the evening – Jessica and Jon will take separate cars and head to their respective hospitals in preparation for the long evening of medical emergencies that await them. Jessica will pull out of their driveway at 4. Jon will have left an hour earlier. His shift will end at the storied hour of midnight. Jessica will remove her scrubs and climb into her car at 3 a.m. on the morning of Christmas Day.

What can both of these ED physicians expect, when patients begin the process of being admitted on Christmas Eve?

“We’ll be heading into widespread flu season, so we will see lots of respiratory illness spanning all age groups, from infants to the elderly,” Jessica explained. “Holidays are also challenging, psychologically, for people, so we will see increases in patients who are depressed, suicidal, and have substance abuse disorders.” 

Jessica said that with holiday gatherings, she and her team will see the typical food prep lacerations and the unfortunate fall from a height, with the last-minute hanging of decorations. With the cold weather, they may also see hypothermia, unintentional carbon monoxide poisoning if people are using gas stoves or ovens to heat their homes, and heart attacks, when people start shoveling snow. 

“Of course, we are always prepared for the most common acute conditions patients experience, including patients with chest pain, shortness of breath, abdominal pain, weakness, dehydration, changes in mental status, and pediatric patients with fever,” Jessica said. “We must make sure that these patients do not have life-threatening conditions, and stabilize and treat those who do. When a loved one dies unexpectedly on Christmas, it can be especially upsetting for family members – because every holiday, they think about losing their loved ones. So we try to be especially sensitive when a patient is critically ill, and support a family through this stressful time.”

Although the peak volume of patients at most facilities (not just Jessica’s) is from 11 in the morning to 11 at night, she is expecting a lull in the middle of the shift, around dinner.

“We are most likely to see patients in the later evening hours, as the family get-togethers are winding down and people or loved ones decide someone is too sick to wait until the morning,” Jessica explained, adding that the ED is the only option for healthcare emergencies on Christmas Day, with medical offices and urgent care facilities usually closed.

During the lull, Jessica is likely to think about the inflow of patients yet to arrive. And when they do arrive, devoid of any adrenaline rush, she is prepared by her experience and discipline to render aid and comfort by determining, through a logical process of elimination, how best to proceed.

Jessica’s approach to evaluating a patient who presents to the emergency department goes like this: “what is the life-threatening condition I need to rule out after an appropriate history and physical? How can I provide care in a compassionate and unbiased manner? What is the one thing that is worrisome to this patient or family that I can try to treat or answer?” said Jessica, an ED physician for 15 years.

So on Christmas Eve, Jessica and Jon, working separately but also with a shared passion, will be doing the work – their calling – while keeping in mind that medicine has brought them together, and given them their sense of value.

“The most satisfying part of the job is being a part of an effective compassionate team, and knowing you would trust your family to be cared for by this team,” Jessica said. “Being part of the frontline healthcare delivery team on the holidays is a privilege for us. The majority of our patients will return home for Christmas Day. For those we need to hospitalize, rest assured, they will have a hospital full of caring staff committed to an excellent outcome. Being part of the A team is the best holiday gift.”