Best Christmas Gift I Ever Gave

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I pounded Tyrones outstretched fist: Id rather be anywhere else. Youre off tomorrow?

Aw yeah! Christmas is my jam, man. We got a real tree and everything this year.

Drink something fun for me tonightmaybe eggnog?

Tyrone looked revolted. I walked on.

It was my last 24-hour call in the ICU. December had been a rough month. The flu had wreaked havoc among the elderly and weak. And then there was the steady stream of patient from the Oncology floors. An orchestra of alarms constantly reminded me that these patients were teetering on the precipice of mortality. Some got better. Many didnt.

After rounds, the admitting resident told me I was needed in the ED. He smiled wryly: They say shes dead to the world.

Find her a graveyard, I muttered, as I slunk down to the ED.

I immediately felt guilty. The last 26 days in the MICU had eroded my compassion and curiosity. I found no joy in the cool physiology others had raved about. I just felt irritation and despair. I wasnt bad at critical care, but neither was I great at it. The patients seemed to get better or worse regardless of what I did. The attending physicians called most of the shots anyway. Id probably be more consequential if I tried to convince Tyrone about the merits of eggnog.

I found her lying alone in the resuscitation bay. The tube in her mouth urged her to go on breathing. The debris on the floor around her bed testified to the frantic efforts of the ED team.

CAROL, I yelled in her ear over the din of the ventilator, my name is Dr. Sinha. Dont panic! Well get you feeling better. No response. I went through a standard list of barbaric actions that we euphemistically call noxious stimuli. I pinched her, rubbed her sternum, and pushed hard on her fingernails with my pen. Any one of these stimuli can have a Lazarus effect on most lightly sedated people, but she didnt turn a hair. Her neurological exam was otherwise normal. On her left hand, I saw an antique gold ring. In the ICU, fingers often swell up with IV fluids. The ring needed to come off to safeguard the blood supply of her finger.

The ED resident moseyed over as I was easing the ring off her finger. He sported a leather holster on the waist of his scrubs that held a stethoscope. I wondered if he called himself Dr. Quick Draw.

Big stroke, he surmised, tapping his index finger on his right temple. Shame, he hastily added in case he seemed flippant.

Hmm certainly possible. Lets keep a broad differential for now. Is the family around?

Following the cowboy's directions, I found Carols wife, Ann, and mother, Claire, in a small windowless waiting room. Ann told me the story as Claire nodded. Carol and Ann had spent the previous evening cooking up a storm for their upcoming Christmas party. Their tiny kitchen felt even cozier as it filled with laughter and the competing aromas of chocolate and apple pie. They ended their night by swapping childhood memories by their fireplace, clinking whiskey glasses, and laughing some more.

Next morning, Ann woke to find Carol still sleeping next to her. A self-confessed type A person, Carol had always awoken, dressed, and cleaned up her email inbox before Ann awoke. Today was different. Ann spent the first minute teasing her, but became worried when there was no retort. She started shaking and pinching Carol first tentatively then frantically. Hearing Anns screams, Claire called 911.

In the ED, she was not breathing well and was intubated. Ann kept asking the physicians about what was going on. One of the early possibilities that had been suggested was a massive stroke with a poor prognosis. Ann felt her stomach lurch. Carol had been laughing next to the fireplace not twelve hours ago. How could this be? She needed to sit down. There is no new drug, no new test, and no new gadget that can give a physician the words to comfort a grieving spouse or a bereaved mother. I pressed the ring into Anns hand and hugged her.

Carols head CT did not show a stroke. We were in the dark about her sudden unconsciousness. But Ann remembered that in addition to her regular medicines, Carol kept a bunch of expired drugs in her bathroom cabinet. She drove home to get them while we ordered a tox screen. By the time she returned, the sky had darkened. Carols urine tested positive for benzodiazepines and the mostly-empty bottles Ann brought back confirmed that Carol had been using old prescriptions for Valium. The story now seemed clearer: the whiskey and valium had combined to knock Carol unconscious. Maybe they had also depressed her breathing to a dangerous degree.

Do you have an antidote?

I nodded: Yes, but its better to let the drug wear off.

How long will it take?

Difficult to say. Why dont you go home and get some rest? Ill call you if things change.

Reluctantly, Ann got up and stretched. She gazed out at the inky New Haven sky as if scanning for Santas reindeer. Then she kissed Carols forehead, picked up her coat, and began walking out. She stopped abruptly and turned to me: Do you have someone you love?

I am careful about sharing my personal life with patients, but I could see no harm here.

Yes, I have a girlfriend. Shes pretty special.

Make sure you kiss her every night. You never know what tomorrow will bring.

During a rushed dinner of Graham crackers and peanut butter, I texted my girlfriend: FYII love you.

Youre a weirdo, she responded.

I didnt have another spare moment after that. The MICUs pace that night was unusually frenetic. I ran from room to room managing ventilator settings, titrating norepinephrine drips, and adjusting sedatives. Around 5am, I was summoned to Carols room. She was flailing her restrained arms wildly to rip out her breathing tubes. Her face was literally beet red and she was drenched in sweat.

The nurse prompted me: Should we push some propofol to sedate her?

I agreed reflexively. It wouldnt be long before she pulled the tube out. But a quick glance at the monitors showed that she was breathing quite well on her own. She didnt need the tube: Wait, just pull the tube.

The respiratory therapist was uncertain: Shouldnt we check with the attending?

No time! Lets do it.

Within minutes, the tube was out and Carol had a violent coughing fit. She frowned at me accusingly: WHAT are you doing to me?

By now everyone in the room knew she was going to be fine.

I smiled: Welcome back, Carol!

She didnt remember what happened after the Valium, but admitted that she sometimes dug into her old prescriptions when she had difficulty sleeping.

Two hours later, Ann ran past me and engulfed a bewildered Carol into a bearhug. Carols blonde hair glinted in the sunrays streaming in through the large window. Snowclad hills in the distance made for a dazzling backdrop. I ignored the ill-tempered pager buzzing in my pocket for a minute to savor the moment.

Rounding took longer than usual that day. I did have to explain my unilateral decision to extubate Carol and got a mild slap-on-the-wrist for breaking the code about asking attendings first. I didnt mind. It was worth it. Before leaving for the day, I stopped by Carols room. Discharges from the MICU are rare, but Carol was far too well to be in a hospital now. They were getting ready to leave. I bid them good luck with their Christmas party which was now back on. Ann walked me out of the room.

Hey, she said, I never got to thank you.

Oh, its nothing, I protested with half-baked humility, just doing my job.

The truth was that I was feeling pretty good about myself. Something I had done had directly made a difference in another human beings life. In residency, it was easy to forget that this work mattered. That I mattered! Christmas-themed or not, every doctor has a similar story to tell.

This was the best Christmas gift ever, she said as she gave me one last hug. It had been a hard four weeks, but in that moment, I knew that I had the best job in the world.

Merry Christmas, Andy! I hollered at one of the nurses as I left the ICU.

Merry Christmas! Still here?

I grinned: No place Id rather be.