American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Humans of RAS—Holidays in the Hospital

Something to Be Thankful For

Laura Bloom

I sit in the middle of the fishbowl. Twelve rooms encircle me, monitors from each projected on a screen to my right. The ventilator alarms; airway pressure high in Bed 3. The telemonitor chimes: Bed 8 is tachy to the 140s. The ICP monitor was recently removed from Bed 10, finally silent. The voices of the nurses, nursing aids, and respiratory therapists hum in the background.

It is 34 degrees outside on the streets of Newark, NJ, a chill that can at times penetrate the walls of this hospital fortress and sew social discord. But there is a cheerfulness, a softness, a sincere kindness in the interactions tonight.

In many ways, this night in the Surgical Intensive Care Unit is like any other. The a-lines need to be placed, the chest tubes inserted, the bronchi scoped. But tonight is Thanksgiving.

Rutgers staff celebrating Thanksgiving

The staff lounge table runneth over with cranberry jellyroll, pancit, pumpkin mac and cheese, and lechon, a multicultural amalgamation of fragrant aromas and well wishes. It's even more delicious than the potluck on Thanksgiving last year. I FaceTime my folks back in California in moments when my 12 patients' levels of stability are in synchrony.

I'll have my day of rest tomorrow. For tonight, I will fulfill my childhood dream of doing something to make the world more beautiful, one critical care decision at a time. And that is something to be thankful for.

Laura Bloom, MD, MS, MBA, is a PGY-2 general surgery resident at Rutgers New Jersey Medical School in Newark, NJ. She plans to pursue critical care surgery with a global surgery focus.

Illumination through Microwaved Turkey and a Missed Meal

Jonathan Vacek

Waking up at 4:00 am to come to work and have my first missed Thanksgiving took an incredible amount of effort. As an intern I hit the jackpot and had both Thanksgiving and Christmas off, but now I would miss out on my favorite holiday and all the turkey drowned in cranberry sauce and gravy. However, the real tragedy as I made the trek to the hospital, was not being able to enjoy the traditions with my family. My amazing wife was away with our two young kids to be with family celebrating and, in part, to have help as she continued to function as a single parent.

I made it to the ICU to take care of some of the sickest patients in the hospital and was going to be there until rounds were over the following morning. While adjusting ventilators and trying not to be frustrated with minimal sedation weaning, I was fighting bitterness about breaking long-established customs. Some satiation came in the form of an unexpected lunch invitation to a nursing potluck in the unit. Sharing in well-wishing, sarcasm, microwaved holiday poultry, and pumpkin-shaped sugar cookies brought about a semblance of family. However, only later in the day did my pity party end and a new life outlook surface.

The morning was mostly quiet, but the remainder of the shift forgot it was supposed to be a time for merry making. Patients were trying to prove they were the sickest as they demanded my attention, while the rest of the team was in the OR keeping unfortunate travelers from having their last holiday. My job of not messing up their success was proving difficult. I was looking for my chief in the work room after one case to ask for some advice when I saw a full feast laid out for us by (I found out later) our department chair. The meal went untouched until our work was over in the morning because of clinical needs, but the care it displayed had an unanticipated effect.

I would have paid to be with family that day, but I never would have learned surgeons aren't without family during holidays in the hospital. The difficulties that come with providing care during festivities elevate us to a better appreciation for our colleagues. Although the feeling of loneliness is tangible, it can quickly be dissolved with the kindness of sharing a meal or showing an effort to make one feel like they're as important as a sibling. I felt taken in by the nursing team and our chair that day. Their recognition that the warmth of the holidays should fill the hospital just as it fills our homes was a realization I needed.

When I was reunited with my wife and kids that weekend, instead of moping because of missing out, I was primed to share the joy I had experienced. I know future holidays in the hospital await, but no longer will they be met with dread, rather they will be faced with an eagerness to build community and promote cheer.

Jonathan Vacek, MD, is a pediatric surgery research fellow, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, and a general surgery resident, University of Louisville School of Medicine, KY.

The Most Wonderful Time of the Year

Rebecca Williams-Karnesky

Rebecca Williams-KarneskyFor the first three years of residency, I had the good fortune to be on night float during the winter holiday season. As an intern looking at my assigned schedule, I didn't realize how lucky I was.

As a child I always had mixed feelings about the holidays. I think many children from divorced families do. Being assigned to night float during the holiday season my intern year I felt a sense of relief in not having to decide who I would spend the holidays with, a sense of comfort in not have to choose what I wanted to do. I was going to spend the holidays with my co-workers and my patients. And I embraced it.

New Mexico has wonderful culinary traditions, many of which make special appearances during the holiday season. This includes the bizcochito—the state cookie—which falls somewhere between shortbread and a sugar cookie and is traditionally made with lard, anise, cinnamon and brandy. Other New Mexican holiday foods include green chile stew, tamales, and posole, a hearty soup made with hominy, red chiles, and pork. During my first holiday season in the hospital I happily floated from floor to floor, socializing with my favorite nurses, enjoying homemade sweets and savory potluck dishes.

Some of my favorite memories of holidays in the hospital include Christmas lights in the resident work room, a gift exchange around a miniature Christmas tree, taking a spontaneous walk outside with co-residents to catch snowflakes on our tongues, a trip to the helicopter landing pad on the roof of the hospital to welcome in the New Year, and shared meals with nurses and staff. I especially loved the bike ride home in the morning after work and the cold, crisp, refreshing air and the smell of piñon smoke from the neighbors' wood stoves.

If it seems idyllic it was, and it wasn't. Night float at every stage of training is fraught with peril. As an intern even ordering a seemingly benign medication can result in critique from the day team. As a second year, night float means seeing all the emergency surgery consults. As a third year, it's your job to manage the surgical ICU and all the incoming traumas. It is always hard to tell a patient they need an emergent surgery or to tell a family that their loved-one has died, but it can feel especially emotional during this festive time of year.

The poignancy of these experiences made them more memorable, the sharp contrast between the suffering and the joy, and the interconnectedness of it all. My intern year, I started a new life as a surgery resident in a new city. Spending the holidays in the hospital I was embraced by a new community with new foods, new friends, and new traditions. Holidays in the hospital taught me to look forward to the holiday season. I even started my own holiday tradition: biking home with a warm tortilla sandwich from the hospital cafeteria to my husband on Christmas morning.

Rebecca L. Williams-Karnesky, MD, PhD, is a surgical education research fellow, department of general surgery, University of New Mexico Hospital.

Kevin Kemp, MD, University of Nebraska Medical Center shares a photo of Holidays in the Hospital