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Working in the hospital on December 25th has become an annual tradition. During residency, this took the form of grueling call-every-other-day sprints of four or five days. This allowed half of my colleagues to have the holiday off and the rest of us to have days off around New Year’s. This scheme did not do much to set me up for a big New Year’s Eve out. Two years in a row, I was laid out with nasty gastro as I limped past the Christmas coverage finish line. New Year’s was more about recovery than revelry. Children’s Hospital Boston does have one Dec. 25 tradition that I very much missed this year: bagels and lox brunch in the house staff lounge, fully catered with all of the trimmings. The queue for bagels could easily pass for a Saturday afternoon Bar Mitzvah receiving line in Brookline.

With my promotion from resident to fellow, covering our service over the holidays has become much more civilized. I brandish the pager. Yes, amazingly, even after drug dealers and pimps have moved on to more sophisticated devices, doctors still are made to wear pagers. I answer questions from nurses, residents, ER doctors and parents. We round on our admitted patients in the hospital, see a new consult if need be, be helpful without being too available and try to be home by luncheon.

As in every public sphere, the Christmas season comes early to hospitals, particularly children’s hospitals. Once the night nurses have cleaned up the midnight turkey feasts from Thanksgiving and started working down the leftovers, the hospital is fully adorned with yuletide decorations. December was a busy month at our hospital with a fundraising radio telethon, constant performances from musical acts ranging from tweener garage bands to 75 piece semi-pro orchestras, a rain-soaked downtown parade with celebrity marshal Jordin Sparks, holiday visits from the Cowboys, Mavericks and Stars (“Hey, who were those big guys with the mullets?”) and, in the form of a toy drive, the much anticipated launch of the Khloe Kardashian Dallas franchise. The focus is on ensuring that kids who need to be in the hospital around the holidays and kids from the socioeconomically challenged communities we serve get to experience American Christmas as fully as circumstances allow. Even when coupled with publicity seeking and brand development, the outpouring of support is genuine and generous. The kids benefit.

After the frenzied weeks-long lead-in, where one got used to dodging through lobbies full of well-dressed visitors and red-vested volunteers, the hospital was quiet on this Dec. 25th morning. As I made my way past the security desk, I saw a knot of Santa-hatted high school kids receiving instruction from holiday cocktail party attired hospital staff. Industrial-grade, wheeled canvas laundry carts, filled past the brim with wrapped presents, were at the ready. Although Santa Claus was nowhere to be found, his elves were ready to round.

True to form, the holiday weekend was eventful from a children with inflammatory conditions perspective. An 18 year old bull rider and his dad pulled up to the security entrance of Scottish Rite hospital late on Friday night. They produced a hand written note from their adult rheumatologist in a West Texas town which referred them to the Scottish Rite emergency room (Scottish Rite has no emergency room and frowns on emergencies), said that he needed urgently to see our boss and mentioned that the young man has dermatomyositis. The charge nurse went down to help the security guard direct the young man and his father to the Children’s emergency room. He paged me to give me a heads-up and wanted me to know that he was required to complete an incident report form. We also met an adorable toddler admitted on her eleventh day of daily fever who had swelling of her knees, hands and feet. Her story and findings easily fit the pattern for systemic-onset juvenile idiopathic arthritis. One day, two new patients with rare inflammatory conditions.

My attending and I were finishing an extensive conversation with the bull rider and his family about his condition, what we understand about its causes, what we don’t understand about its causes, our proposed treatments and what they could expect for the months ahead. Although he had difficulty swallowing without having food or liquid pass into his nasal cavity due to the extent of his pharyngeal muscle weakness, the young man answered our questions in a steady voice, with near-military politeness. When our attention turned to his assembled family members, he looked down to text on an iPhone with his calloused fingers. A relative, maybe an uncle, wore boots, cowboy hat, wranglers, and a Marlboro man mustache. At one point he removed his hat, smoothed his jet black hair while bowing his head, paused, looked up and said, “We sure do appreciate what you are doing. We did not know what to do and we were scared to death.”

The young man’s father followed us as we finished our goodbyes and turned towards the door. His sheepish posture and anxious expression made it clear that he had a few more questions for us that he wanted to ask out of earshot of his son. Stepping through the doorway, I saw that the hallway was full of people, the kids in red hats, the elves. The canvas laundry baskets were there, the mountains of presents were now foothills. To my left I saw Santa Claus, himself and no ministering elf, processing down the hallway. A handler with clipboard, headset and mouth piece hussled alongside, trying to keep up with the big man’s strides, relaying the essentials, “OK, this is an 18 year old. No brothers or sisters.”

The Santa came up behind the patient’s father and as I looked up, he must have been about 6’ 3’’, I got a good look at his face. Deeply creased eyes under the white polyester of the hat brim. Sallow, wrinkled cheeks that appeared almost gaunt compared to the mental image of Santa’s sanguine chubbiness. Just as the dad was explaining to me how his son’s illness forced him to drop out of college, Santa nearly pushed him aside with a sweep of a red forearm. “I need to get behind you,” he barked at me. I looked at my feet and found a neat stack of presents sitting outside the patient room’s door. He charged forward as the father and I cleared out of the way. Gesturing with exaggerated servility, I said, “Ah yes, right this way Dr. Klaus! Your patient is awaiting you!” The father was so worriedly intent on our conversation, I don’t think that he even noticed the exchange.

This wasn’t my first near-altercation with a Santa making the Dec. 25th hospital rounds. I was told off by a crotchety Boston Santa when I suggested that he might pause his rounds for a moment so that my All-Star Jewish Pediatrician ward team could pose for a picture with him. Although I’m learning that medical care takes a distant back seat to Santa on Christmas, I’m afraid that one of these years, one of us will snap, me or Santa, and that it might come to blows. If need be, I think I could take Santa. My main concern is the elves.

Happy New Year from Left on Longwood! 2011 has been a great inaugural year. Thanks for your readership and curiosity, we’ll look forward to more interesting discussions in the year ahead. Also, a special thanks to friend of Left on Longwood, Ari Bernstein, for the updated fall-early winter Longwood Avenue picture.

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