By Dr. Jim Dahle, WCI FounderI work with a wonderful group of doctors. We have a really cool system where evening and night shifts pay more than day shifts, so all of our later shifts are covered voluntarily by people who either want to make more money (often younger docs with student loans and mortgages) or want to work fewer shifts and make the same amount. We also allow docs to choose how many shifts a month they want to work, so long as that number is between six and 18.
However, everyone still has to work their share of weekends and holidays. For a full-time doc, that typically means two shifts on the “high holies” (Thanksgiving Day, Christmas Eve, Christmas Day, and New Year’s Day). For me, working a little less than half time, my share is one shift on the high holies.
So there I was, walking into an evening shift on Christmas Eve 2024. I’ll be honest. As much as I missed practicing medicine while I was disabled after falling off a mountain and as much as I like the people I work with, I didn’t really want to be there. Holiday shifts can be rough. The patients are either very sick or have an . . . interesting social situation. This shift would prove to be no different. Hospital support is often less than ideal, as well. Consultants don’t want to pick up the phone, much less come in. And every other department is operating on a skeleton staff.
But the real reason I didn’t want to be there is that there was a big family event at my house while I was at the ED. Two of my sisters and their families came over to eat dinner, play games, do our traditional Nativity pageant, and just enjoy each other’s company. And I was missing that to continue practicing medicine with this great group, despite not needing the money.
Everyone Has a Price
I got to see three of my partners at some point during this shift. I asked each of them the same question. If they had been the day doc and I was coming in to relieve them, how much would I have had to pay them in order to stay another eight hours and work my shift, too? They all quickly acknowledged that if I needed them to do it, they would do it for nothing. You know, if I were sick or had to go see my mom in the hospital or something. Like I said, they’re a great group of docs.
But I pointed out that this hypothetical situation would not be a need. I would just rather be at home celebrating Christmas Eve with my family. After a few moments of thought, they all came back with a price. In addition to getting paid for the shift (a typical eight-hour EM shift pays something like $2,000), one of them wanted an extra $1,000, and two of them wanted an extra $2,000. They would cancel whatever plans they had that night and call their spouse and stay. One admitted he might not be completely truthful with his spouse about the reason why he was staying, but he would do it. Another said, “$2,000 would pay for all of the Christmas gifts we bought.”
Everyone has a price, and I was actually surprised by how low it was for these partners. My price would have been several times higher. Had I been given the option the day before, I probably would have taken every one of them up on their offer. Sometimes you can buy time with money.
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Holiday Deaths
My least favorite day in the year to work is not actually a holiday. It’s December 26, with the day after Thanksgiving being a close second. Many of the clinics and urgent cares are still closed, and while you can prop up Grandma on Christmas or Thanksgiving, she just has to go in to the hospital by the next morning. But when you work Christmas, you mostly just hope that nobody dies. It isn’t because it’s a huge deal to the ED staff. It’s a downer for sure, but we usually didn’t know the patient before they “arrived dead and stayed dead,” and it’s not like we’ve never run an unsuccessful code before. We just feel terrible for the family.
A death on Christmas Eve doesn’t just ruin this Christmas. It ruins every Christmas. Unfortunately, midway through my shift, the EMS call came in. “Full arrest, we’ll be there in six minutes, gotta go,” and they hung up. Ten family members huddled around room 1. The code was run for twice as long as it probably would have been on any other day of the year, but the outcome was the same. Sad stuff.
Other Sad Stuff
Another patient living in a memory care center took a minor fall and had some lacerations that needed to be repaired. Trying to reach family revealed that there was no family. A guardian had been appointed by the court. Merry Christmas.
A patient my age had been fighting cancer for a couple of years but was dealing with a new complication—ascites. After two ED visits in two days in another state where no one was willing to do a therapeutic paracentesis, they spent Christmas Eve driving home to our facility associated with the oncologist. They felt a lot better after I removed the equivalent of a jug of milk from the abdomen, but I still had to be the bearer of the news. Not only would this need to be done again in a couple of weeks, but it would likely need to be done every couple of weeks for the rest of life. Merry Christmas.
Another patient came in at 5pm on Christmas Eve with hip pain.
“How long has this been going on?”
“A couple of years, but it’s worse over the last two weeks.”
“It’s Christmas Eve at 5pm. What are you hoping I’m going to do for you this evening in the Emergency Department?”
“I was hoping for a cortisone shot.”
“Here’s what we’re actually going to do and why.”
Resetting expectations. And so the evening went on. The hospital CEO and the ED director both came in with treats. I think we have the best administrative team we’ve had in the 15 years since I’ve been at this hospital. But it’s still Christmas Eve. By the time I got home at 10:30pm, having had only a banana for dinner, the extended family was long gone and the festivities were mostly over for the night. Everyone stayed up waiting for me so we could open our “Secret Santa” gifts, and then I pointed out to the 20-, 18-, and 15-year-old how rude it was that they were still up at midnight keeping the 9-year-old believer up while their parents were falling asleep on their feet. Besides, NORAD said Santa had just left Denver.
A substantial minority of WCI readers are not physicians, and that’s perfectly fine. We’re glad you’re here and deliberately try to create personalized content for you, too. But this post is mostly a thank you to those of you who have been doing this for years, often well past financial independence. If nobody has told you “Thank you” today, let this post be the first. Your work matters, and it is often challenging for reasons that few others understand. At a minimum, we could at least make sure you get a fair shake on Wall Street.
What do you think? What holidays did you work last year? How much would you be willing to pay to get out of a holiday shift? Why do you appreciate essential workers?
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