Merry medical memories of the holiday season

This is probably not what you thought I’d be writing about. As much as Chanukah for me has been genetically programmed and traditionally perpetuated, there exists a special place for Christmas in my life experience. The year, 1966, found me in first year medical school at the University of Ottawa. My initial foray into the world, outside of Toronto was daunting and disorienting at times. Routines, my forte, were a precipitously established survival tactic. I was open to accepting novel practices and established observances. Congregating in the medical school library to study qhs was a mandatory right of passage. This was invariably followed by a congregate exit and organized convoy to the Standish Hotel’s subterranean “Rendezvous” bar across the border in Hull, Quebec. It was there that I learned that beer came in quarts and pickled eggs came in jars. Talk about epiphanies. But when it came to Christmas, there was no tradition more deeply ingrained than Christmas carolling at med school faculty members’ homes. In fact, the professors and clinicians participated in the highly competitive exercise of lobbying or jockeying for the sacred opportunity of hosting the travelling carolling event for each of the four class years. Schedules were set along with strategies, based on past performances, specifically, the extremes of food and drinks provisions and the overall social performance of the individual hosts. They knew that ratings ruled if they were to be considered a prospective candidate for the following year. The chief of surgery, Dr. J. Burke Ewing, greeted the crew in a silk smoking jacket, clutching an enormous goblet of cognac, a classic gout caricature. He regaled us of his generous hospitality in the opulence of his Rockcliff estate. One of my classmates had parked his car on the steep sloping driveway on this icy December eve. As we were saying our goodbyes to Dr. Ewing, said vehicle was no longer in its original parking place. It had slid down the lengthy ice-covered asphalt, repositioning itself on the front lawn of Dr. Ewing’s across-the-street neighbour, proximal to the front porch. Apologies were profusely proffered, none sufficient enough to assuage our embarrassed and somewhat distressed professor. I recall some of our other benefactors. Dr. Alexander Heggtveit, pathology professor, whose ground-breaking work in cobalt cardiomyopathy was regularly referenced in his lectures. He also had a more well-known sister, Anne, of Olympic skiing renown. Dr. Westwood, whose stunning daughter made more of an impression on me than the beer nuts, appetizers and Molson Exports that were offered that evening. Dr. Margaret Beznak, aka Mamma, neurophysiology professor by title but also a kind and caring human being with a special place in the hearts of anyone fortunate enough to have been part of her academic world. Dr. Leonard Belanger, “the father of micro-radiography” who reminded us repeatedly of his singular place in history. There were many other gracious participants but after the evening’s third session of carolling, they all became part of the same cocktail. As a post-script, given the tendency for medical students to over-consume alcohol, especially when provided free of charge, the class decided (evidence of our maturity and insight) to hire a bus for all subsequent Christmas carolling/carousing in future years. This unfortunately didn’t mitigate circumstances, as an overly enthusiastic imbibing classmate threw up on a host professor’s family room carpet. *** Christmas Eve, 1978, found me at Nathan Phillips Square with our children, ages five and three, for a special evening of skating under the stars. It was a long journey from Thornhill, requiring much preparation, supplies and patience. My wife, our children’s resident RN and mother, had accepted the evening shift in the Emergency department at York Finch Hospital, allowing her work colleagues to spend Christmas Eve with their respective families. After lacing up skates which were either “too tight,” then “too loose” and definitely never “just right,” we stepped carefully onto the ice. The festive music and momentum of the crowd carried us across the slippery surface. There was exuberance and a carefree freedom this night in downtown Toronto. The kids loved every moment of it, that is until “my feet are cold” and “I’m tired daddy”interrupted the splendour of the night. The antidote was hot chocolate, a universal panacea when adversity insinuates itself into winter’s good times. Once satiated with the vendor's chocolaty treat, we once again hit the ice. I did so literally, much to the pleasure of my cackling kids. I didn’t want to push my luck and overstay what had been a singularly wonderful evening’s activity. Children have a saturation point beyond which salvage potential rapidly goes south. When I suggested we unlace, there was no argument. Just as we were about to step off the ice surface, a CityTV reporter approached us with her microphone outstretched, accompanied by her videographer. After verbally consenting to her interviewing the kids, the reporter asked my daughter if she had any Christmas wishes for a special person in her life. She boldly stepped forward to the mic and looking directly into the camera lens said: “I want to wish Merry Christmas to my mummy who’s working in the emergency department tonight.” Not bad for a three-year-old who'd just celebrated Chanukah. *** Internship in 1971 rotated me to the Hospital for Sick Children in downtown Toronto for two months, the last of which was December. The overtly festive facies is, however, a facade given the preponderance of crises at every turn of the corridors within. Each month at SickKids took a year off my life. I also learned a lifetime of pediatrics, but institutional, not practical. It's a place of miracles for many and a final destination for some. Children are the precious commodities here, their parents and families, the secondary priorities and beneficiaries of the care received by their children. Fifty years has not changed the mission of hope so many rely on at this epicentre of excellence. I have many stories of my days, and nights at SickKids. Most had positive outcomes, were redeeming and relevant to my ultimate goals. Some were fraught with fear and loneliness with the realization that you alone were charged with the responsibility and decision-making that could or would be life-changing. This was a tough assignment in my rookie year. On-call at SickKids was a perpetual loop, 36/12, 18/6, arbitrary numbers that have blurred with the passing of time. All I know is that exhaustion was served for breakfast every morning at 6:00 and excuses were forbidden. The house staff was the safety net but remember, safety nets are porous and house staff surprisingly can only be in one place at one time, unlike the intern who needed to be omnipresent and effervescent. In addition to the trees, and garlands and holiday decorations at Christmas and, the giant Santa sleigh with reindeer attachments on the front lawn on University Ave, SickKids is a joyous institution within its walls. Red-nosed doctors, antlered nurses and a variety of elf-eared staff attempt to bring smiles to children, some of whom have little to smile about. Television commercials today emphasize the “brave list.” A self-evident truth. There was a process in place at Christmas to discharge as many children as possible, even if it was only for the eve of and the following morning—an attempt to restore a feeling of normalcy to the children whose lives had been anything but for so long. Planning began well in advance and with critical exceptions, this was the gift that would never be forgotten. I was requisitioned for on-call Christmas Eve through Boxing Day, inclusive. I was unaware the emergency department took on a war-zone persona during these 48 hours. No one cared or dared reveal the truth in advance. If we’re talking numbers, more children were seen in this time period than any other two-day stretch during any given year. The onslaught would begin with a trickle on Christmas Eve, postprandially. It would gain momentum, reaching surge-like proportions early Christmas Day, once gifts had been unwrapped, revealing fevers and rashes, vomiting and diarrhea, the culmination of 12 treacherous days of preparation for the “comfort and joy.” By noon on the Day, hundreds of children and their parents lined up beyond the entrance to emerg onto University Ave. This would be a long day for all and looking back, the words “wait time” had not yet been introduced into our lexicon. Social media and selfies would eventually disseminate life’s harsh realities. I have never looked in so many throats, palpated more abdomen, performed auscultation on more chests or negotiated with more hysterical children than I did in those two days of infamy. Sleep? No one slept. Eat? Always time for a quick nosh. We worked on adrenalin and the realization that we were now some of the vital part that was medical practice. We had arrived at a point in time that was defining, one that would inform our future, no matter the direction ahead. This was the first of many “flashbulb memories” for me, one that was imprinted 51 years ago and one that will never be forgotten. Today we hear of a crisis of care in children’s hospitals, the confluence of COVID, RSV and influenza responsible for overcrowding, protracted wait times, cancelled surgeries, chopper transfers to parts unknown and communities unfamiliar, “redeployment” of medical and nursing staff, having to run twice as fast to stay in the same place. In this most vulnerable patient cohort, there is urgency to adapt to the realities of the times. Achieving this goal will take a miracle, but then, ‘tis the season.

Piece of Mind

Merry medical memories of the holiday season

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Blog Author

HOWARD GOLDSTEIN