Joel Diamond 11/26/09

Thanksgiving Edition

"When it comes to life the critical thing is whether you take things for granted or take them with gratitude.”-G.K. Chesterton

Back in the day, I used to moonlight in my local Emergency Department on Thanksgiving and Christmas. It was nice to hear both patients and staff compliment me on my dedication. Some would be a bit more realistic but equally sympathetic for my willingness to “give your Christian friends a break on the holiday”.

For me, it allowed me to — I need to be careful as my in-laws sometimes read this blog — extricate myself guilt-free from an otherwise wonderful family experience, “Isn’t it nice how he gives his Christian friends a break on the holidays”. The real truth is that the emergency department was relatively quiet and I got paid time and a half.

Ahh… the holidays. The memories linger in one’s mind as if they were yesterday. While most of you think about overeating followed by loosened belts in a tryptophan-induced stupor, I think of arriving to my ER shift having three patients waiting with a turkey bolus stuck in their esophagus. Sometimes administration of IV glucagon worked, but oftentimes I would have to rouse one of the gastroenterologists away from their own family gatherings to relieve the gluttonous patient endoscopically.

Who amongst up doesn’t invoke emotional images of Native Americans sharing their bounties with Pilgrims when they think of beer and the deep-fried turkey? I think of 2nd and 3rd degree burns. And I wipe the tears from my face recalling the Norman Rockwellish scene of an entire family during the holidays, all hooked up to IV fluids and festively filling emesis basins as a result of and undercooked meal and resultant food poisoning.

My shift almost always concluded with some alcohol-induced injury. Drunk and alone on the holidays. This is when you begin to re-examine your own sense of Thanksgiving. All joking aside, working in healthcare during the holidays is a privilege, as it is easy to take for granted all that we are blessed with — food, shelter, family, friends, and health.

Want to really be depressed? Walk through a hospital cafeteria this season. The juxtaposition of holiday decorations and music with the sad and lonely faces of the sick or their visitors is heart-wrenching. Even worse is seeing the half-eaten trays of dying patients. The hospital dietary service’s best attempt to render turkey, mashed potatoes, and canned peas as festive somehow compounds the tragedy in horrific irony.

Today I delivered some bad news to a longstanding patient. After many years of surviving a battle with a second cancer, she had to hear from me that she had yet another malignancy. This is another year that I had to deliver bad news before the holidays. Ethics aside, I sometimes wonder if it would just make more sense to hold off and let them peacefully enjoy Thanksgiving with their families before throwing their lives into turmoil.

I know that this is not a “funny” blog today, but since we are all in the business of healthcare, let us — during this tumultuous year of recession, debate on healthcare reform , global warming, war, and swine flu — take pause and reflect that we are really in the industry of healing.

"Thanksgiving, after all, is a word of action."-W.J. Cameron

 

Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh, and a practicing physician at UPMC and of the Handelsman Family Practice in Pittsburgh, PA. He also blogs on interoperability.