Christmas on Call

This month I made a recording of “Away in a Manger” with my wife and kids. This is one of my favorite Christmas carols because the lyrics contain such a heartfelt prayer for the Lord’s love and presence to be felt in our lives.

I have lately been remembering my first Christmas as a resident physician, when I had the assignment to do an overnight call on Christmas Day. This was in the middle of my medicine internship, and I was working in the cancer hospital that month. The other residents on my team felt bad for me because I had to be on call, and let me come in a bit later in the morning so that I could open presents with my family before coming to the hospital. This was a Christmas like no other one I had ever experienced.

Earlier that month I had heard a story about Dr. Michael DeBakey, one of the pioneers of heart surgery. He was rounding on Christmas Day with one of his residents, and complained that none of the medical students were there rounding with them. “Don’t they want to learn from the great Dr. DeBakey?” he asked. His resident replied, “Well, Dr. DeBakey, they are all at home celebrating the birth of another Great Man.”

You would imagine that most hospitalized patients would rather be home on Christmas Day than in the hospital. We actually had discharged a lot of people home on Christmas Eve that normally would be considered too sick to go home. Those left in the hospital were some of the sickest people in the city, and these were the ones that I took care of that night.

The day actually passed quietly, but when the evening came things got pretty busy. I had three admissions come in within about 90 minutes of each other, and at the same time I had to put a central line in another patient we had lost IV access on. There were also two other patients on the hematology service who were unstable, and required a lot of my time and attention.

One of the patients I admitted to the hospital that night was a man that I will call Mr. Joyner (but that was not his real name). I was a bit distracted and in a hurry when I went to do his admission history and physical exam, and right as I entered his room I realized that I knew him. He had a history of chronic myelogenous leukemia, and I took care of him on the hematology service about 4 weeks earlier when he was hospitalized with a spleen about the size of his head. I was on call the night we learned that his spleen had ruptured and was bleeding into his abdomen.

I walked into his room and said hello. He and his wife were happy to see me, and I was glad to see them again too. Back in November I had helped him make it through the night, and he went to the operating room to have a splenectomy in the morning. The pathology report from his spleen had revealed that his leukemia was transforming into a more aggressive type of malignancy. Over the past month since his splenectomy he had noticed enlarging lymph nodes all over his body. He was in the hospital now because some blood cultures that were drawn the day before were starting to grow bacteria, and he was called and told to come in. After finishing up with my interview and examination, I rushed off to do something else.

Later on when I was typing up his admission note I spent some time looking over his recent lab reports and imaging studies. I noticed that he had had an MRI of his brain the day before, so I pulled up the images. “Oh, no,” I thought as I scrolled through them. The images showed that his mantle cell lymphoma had invaded the cranium and was settling on the linings that surround the brain, called the meninges. This type of cancer metastasis is referred to as “meningeal carcinomatosis.”

By this time it was very late at night, probably 2:00 or 3:00 in the morning. I thought about going in to Mr. Joyner’s room to tell him what I had learned: that this would probably be his last Christmas. After some deliberation I decided to let him sleep through the night. At least one of us should be able to.

I don’t know where this story ended for Mr. Joyner. Many Christmases have passed since that day, but none of them have torn at my heart like this one did. It felt like a burden for me to be away from my family on that Christmas Day, but my burden was nothing compared to Mr. Joyner’s.

On this special day we celebrate the birth of Jesus Christ, who said, “Come unto me, all ye that labour and are heavy laden, and I will give you rest. Take my yoke upon you, and learn of me; for I am meek and lowly in heart: and ye shall find rest unto your souls. For my yoke is easy, and my burden is light” (Matthew 11:28-30). As many times as I have followed his invitation to come unto him, to learn of him, and to yoke myself to his work, I have found his promise to be true; my burdens are made light and I feel peace in my life. Whether you are at home surrounded by loving family members, or lying in a hospital bed wondering if you will live to see another Christmas, I promise that you can find hope in Jesus.

“I love thee, Lord Jesus; look down from the sky
And stay by my cradle till morning is nigh.

“Be near me, Lord Jesus; I ask thee to stay
Close by me forever, and love me, I pray.
Bless all the dear children in thy tender care,
And fit us for heaven to live with thee there.”

Alan B. Sanderson, MD is a member of The Church of Jesus Christ of Latter-day Saints and is a practicing neurologist.