Doctor-turned-comic on working Christmas Day in an NHS emergency department

Doctor-turned-comic Adam Kay was on duty across six Christmases in his years with his beloved National Health Service.

His festive experiences ranged from the painfully tragic to the downright bizarre.

Now the best-selling author of Diaries of a Junior Doctor has written a new book capturing the highs and lows of having to work while many of us are celebrating.

In his first book Adam told how punishing long hours on the ward forced him to quit the vocation he cherished.

These extracts from Twas The Nightshift Before Christmas, again based on his diaries, are equally funny, thoughtful and searingly honest.

Here are some of his best bits;

The NHS front line sadly doesn’t get invited to Christ’s all-you-can-eat birthday shindig. For medical personnel the world over, Christmas is just another day.

Employees divvy up the shifts and put in absurdly unsociable hours to ensure the rest of us make it through to the New Year in one piece. Of the seven Christmas Days I was a practising doctor, I ended up on the wards for six of them – removing babies and baubles from the various places they found themselves stuck.

Dec 22, 2004 Sharing what I think is a top-level anecdote in the doctors’ mess. I’m delighted with my story of the 20-year-old whose half-a***d attempt at a costume for his Christmas party landed him in A&E.

He had wrapped himself in layer upon layer of tinfoil, made a couple of holes for his eyes and one for his mouth, then dispatched himself to the party as a turkey.

Hours later he collapsed, having desiccated himself to the human equivalent of a Ryvita and needed intravenous rehydration.

Xmas Day 2004 Santa might be putting his feet up but his pal the Grim Reaper never gets the day off. And so I find myself in a side room with a distressed family having The Chat about mum/gran.

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Granny is outnumbered by E.coli bacteria in her bloodstream to the tune of several billion to one and there’s now only one way this can end.

Hoping to show empathy through my body language, I lean in to say all we can do now is keep her comfortable and concentrate on her dignity. As I do so, I inadvertently lean on my tie.

It’s a seasonal tie – a night-sky blue with old Santa on his sleigh perched right up near the knot. Moving down the tie we come to Prancer and Dancer and the rest of the reindeer massive with Rudolph proudly front and centre.

Crucially, and disastrously, underneath Rudolph’s red nose – and now the pressure of my elbow – is a button that activates a tinny speaker to blast out a frantic rendition of Jingle Bells.

I turn ketchup red, apologise and jab at my abdomen. But all I succeed in doing is restarting the f***ing tune.

Thinking of superlatives to add to my apologies, I notice one daughter laughing uncontrollably. Maybe there is an easier way to deliver bad news, after all.

New Year’s Eve, 2005 I meet Patient AW who prepared for the new year with a bang. Followed by a whimper. Finding herself in a suitor’s bedroom, in need of lubrication, she went to the kitchen and re­­­turned with a tub of peanut butter.

It wasn’t the most terrible choice – it’s oil-based, plus it offers the option of smooth or crunchy for added “pleasure”.

Downsides include the fact that oil-based lubricants are kryptonite to condoms. Also, some people have peanut allergies. Patient AW, for example.

But whyyyy?’ I asked, stret­ching the word longer than Annie Lennox ever managed.“I assumed it was only a problem, you know, up the other end,” she explained. Luckily, she escaped the worst-case scenario of breathing difficulties and ultimately not breathing at all.

Xmas Day 2006 Despite my best efforts it’s a hat-trick: three Christmases on the trot opening up patients instead of presents. I’m bleeped away to see Patient NW who has come to labour ward with reduced fetal movements at 38 weeks. And the baby’s breech – so caesarean section it is. “Oh, for f***’s sake,” she says.

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I reassure her everything’s going to be absolutely fine. “Oh, it’s not that,” she groans. “My other one was born on Christ­­mas Day too. Everyone’s going to think I do this deliberately to save on presents.”

Dec 28 2006 And then there’s Patient KM, a lady in her 60s, about to kill herself with sharon fruits.

A decade or so ago KM had a gastrectomy for stomach cancer and now has to keep to a strict diet, avoiding certain food types she can’t digest.

Top of the list is the persimmon or sharon fruit – not exactly a Granny Smith so an easy fruit to avoid. You might think. Grow­ing up in Malta, KM’s family Christmas always involved eating sharon fruits and this isn’t a tradition she is prepared to let slide, despite her surgeon’s threats.

She knew it wasn’t an idle threat either; these little f***ers have caused five episodes of intestinal obstruction, ruining five Christmases. “It just wouldn’t be Christmas without it,” she tells me. I’m not sure whether she’s talking about the fruit or her hospital admission for intestinal obstruction.

Dec 29 2006 Medical emergencies don’t get any less frequent just because Slade is belting out of every shop’s PA system.

Prof Devereux’s termination of pregnancy list is too time-sensitive for a week off. I’m rota’d into theatre with Prof today and first on the list is Patient SH whose unbelievably sad story is the stuff of ethics textbooks.

She’s 21 and has a cardiac condition that means she’s unlikely to live if she continues with her pregnancy.

At 15 weeks her heart function has already significantly deteriorated and she’s had to make the heartbreaking decision to end the pregnancy to save her own life.

Prof Devereux, chatting to the anaesthetist about who got treated the worst by the Christmas Rota Fairy, turns to me and asks: “Do you want to do it?”

I really, really don’t. The procedure is going to be grim beyond words – one more trauma for me to push down into a box that’s already full to bursting.

But if SH is brave enough to go through this then I should at least have the balls to step up for her. I wish I could say I was overreacting but the truth is that every single step of it was absolutely horrible.

I’m jolted back into the here and now by Prof Dev­ereux. “Right, we’re done!” he bouncily announces. “Who’s the next customer?” I say: “I need to head back to the ward.” But I don’t. I need fresh air or a quiet room. Even a noisy room – any room that isn’t this one.

Jan 5, 2006 “I don’t want to die,” Patient JM said, plaintively. None of us wants to die, of course – it’s human nature – but I was surprised to hear it from a 91-year-old.

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We’re conditioned to describe this as a good innings. I decided the best thing was pretend I hadn’t heard and continued to insert the drip. She touched my hand.

“Is this it?” she asked, her eyes searching mine. “Am I dying?”

She knew. And she was dying – it wouldn’t be more than a day.

I’d never been asked this before and I had no idea how to deal with it. I copped out and lied: “No, don’t be silly!” Not just “No” but “No, don’t be silly!” – negating her, throwing her off the scent, in reply to the bravest question of all. She pretended to accept my answer with a faint smile. I realise I never actually talk about death with patients.

For the rest of the night shift I obsess over what I should have said. At the end of the shift I trudge back to her ward. I tell myself I’m going to speak to her again, giving myself a motivational pep talk as I go. You’ve got this, I say, you owe it to her. There’s an empty bed in bay three. I don’t have to.

Xmas Eve 2007 Patient HL presents with post-coital bleeding. Inside, everything looks a bit… grazed. There’s clearly a piece of her story missing.

The actual answer is that, with no condoms available, she and her fella dipped into a selection box and improvised with a Mars bar wrapper – really embracing the “play” aspect of “work, rest and play”.

I advise less abrasive methods of contraception and, until it has totally healed, to take a break. By which I don’t mean she should move on to KitKats.

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Dec 30 2009 “What’s your name?” I ask the 10-year-old at the antenatal clinic with his mum. “Coyle,” he says. “That’s a nice name,” I reply. “It’s be­­­­cause I got pregnant with him when I had a coil in,” his mum informs the room, loud enough to induce labour in a Serengeti elephant.

New Year’s Eve 2009 Patient CW is booked for a caesarean next week but it seems her babies are anxious to put in an appearance. She’s huffing and puffing away but only a couple of centimetres dilated so I explain there’s no great hurry.

The husband looks at me furtively and asks if the babies might be delivered at midnight. I tell him it’s not unfeasible. He gets that conspiratorial look about him again – is he planning to eat these children?

“So technically,” he says “you could deliver one just before midnight and the other just after, so they’d be born in different years?”

He looks at his wife for her take and she agrees it’s the best idea ever. How can I not be in on it?

I’d forgotten, however, that nothing ever goes to plan on labour ward.

Maybe next year.

• Twas The Nightshift Before Christmas (Picador, £9.99) is out now.

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