A Memorable Christmas Day

An intimate doctoring experience from very early in my career

Climbing nightshade (Solanum dulcamara). ‎⁨⁨Saint-Joachim, ⁩St. Lawrence River, Quebec⁩, ⁨Canada⁩; photo by the author 25 September 2025

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Working on Christmas Day is part of being a doctor. It just goes with the job. We often share this responsibility, but in the rotation my name came up often enough. In 40 years of practice, I’m guessing I worked Christmas Day at least 15 times. I found that most of us approach working on Christmas Day with an upbeat attitude and a smile. And it usually seemed less busy. Hospital census was lower and there were fewer phone calls. My colleagues and I often commented that patients we saw on Christmas Day were really sick.

I worked the first Christmas Day after graduating from medical school. I was an intern assigned to the Emergency Room and worked a 24-hour shift every-other-day. My every-other-day was December 25. There were only two doctors in the Emergency Room that day, just me and the surgical intern. I admitted a young man with alcohol withdrawal and evaluated an older man with chest pain that turned out to be a heart attack. An elderly woman had fallen on ice. The surgical intern casted her wrist fracture and later sutured a teen’s scalp laceration resulting from a vigorous game with a new football. Overall it was fairly quiet. That afternoon our spouses brought dinner, which we shared in the small call room. It wasn’t the usual jovial Christmas dinner, but we were with family for a few minutes. I spent the rest of that day (and night) treating patients, finally going home the next morning to open gifts the day after Christmas.

After residency I joined a private practice group of four internists. By tradition, the newest member of the group took call on their first Christmas Day after joining. That was me. I finished hospital rounds and admitted a patient with pneumonia, then headed home shortly before noon to join my family for Christmas dinner. Soon thereafter, the answering service notified me that my group’s founding partner was very sick at home. Famous for his diagnostic acumen and acerbic comments, many felt him to be the best physician in town. He had retired a few years earlier after suffering a stroke that left him hemiplegic but cognitively intact. “That damn stroke ruined my taste for Scotch,” was his infamous quip.

If I received this call today, I would likely advise his wife to dial 911 and have paramedics transport her husband to the hospital. But this was an earlier time and place, before thrombolytics and the widespread availability of advanced brain imaging, where our hospital emergency room was literally just a room staffed by a nurse, and when doctors regularly made house calls even for serious medical conditions. Furthermore, it was less than a 10-minute drive, I could be at his house before our local emergency medical response team.

I drove there right away. His wife, whom I had met just once before, anxiously greeted me at the door. Earlier she had found him unmoving and unarousable. She led me to his bedroom where my exam revealed obtundation, irregular respirations, and a fixed and dilated pupil. My assessment was that he’d suffered another stroke with brain swelling that would likely be rapidly fatal. I explained to his wife that a craniotomy might relieve the intercranial pressure and prolong his life, but that in my judgement, his overall prognosis was poor; even if he survived he would likely have additional neurologic deficits. She felt certain that he would not want to go to the hospital but would prefer to die at home. She asked that I call and discuss this with their son, an academic neurologist in another state. Oh my gosh, here I was, just out of residency, attending my group’s beloved founding partner who was facing a fatal neurologic disease, and I am about to call his son, a renowned neurologist? Talk about a stressful Christmas call day!

In the end it went well. I explained my exam findings and my diagnosis to the neurologist son, who had been expecting my call. He thanked me for my thoroughness and diagnostic reasoning. He had spoken with his mother earlier and agreed that his father would not want to be hospitalized, but should be allowed to die peacefully at home. “He wouldn’t want to spend his last Christmas in a hospital.” So my group’s founding partner would die at home that Christmas Day, on my watch.

I returned to his bedside and sat unspeaking with his wife, neither of us wishing to dispel the intimacy that filled the room. As a resident, most of my death encounters were associated with resuscitation efforts for a hospitalized patient who had died just moments before. This was the first time I was present with someone who died at home, without chest compressions and urgent ministrations of a Code Blue team. This was a much gentler death, characterized by peaceful unconsciousness, gradual slowing of breathing and then a sudden departure which was distinctly palpable. During my subsequent years of medical practice, this strange perception at the moment of death would become increasingly familiar.

I gently placed my hand on his forehead, silently thanking him for his lifetime of service as a doctor. And I thanked God that on this Christmas Day, when we celebrate the sacredness of a birth, I had the privilege of experiencing the sacredness of a death.

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Author’s note. The American Journal of Medicine graciously published this greatly revised and more intimate version of my previous post. I thank the patient’s children for allowing me to share this story.