Completions and Connections

I'll always have a warm spot in my heart reserved for the Waitresses' Christmas Wrapping, the enduring tune that makes me smile every December (though it was inevitable that, this year, the Pogues' Fairytale of New York eclipsed Christmas Wrapping as my favorite holiday song.)

But I'm still impressed with what the Waitresses accomplished in their yuletide epic: they weave a complex tale of isolation and self-pity as a woman prepares her Christmas meal for one, interspersed with flashbacks to a yearlong, frustrated courtship. Yet the song is insanely upbeat, catchy, and singable -- remarkable qualities for any song, but more impressive when you consider it was one of the first mainstream proto-raps, written in 1981 (which makes the title a pun, always a plus in my book).

Christmas Wrapping also has the best sax part in any holiday song (except possibly Morphine's Sexy Christmas Baby Mine).

The finale involves a chance encounter that ties together multiple threads and leaves you optimistic for 1982 and beyond. The song takes on additional heft when you realize the singer, Patty Donahue, died of lung cancer just fifteen years later.

Perhaps because it's only played after Thanksgiving, the song never seems to get old. Or maybe it's beloved because it speaks to universal themes -- who among us hasn't endured a prolonged, punctuated courtship, only to have Christmas magic (or benevolent vacation scheduling) intervene?

Regardless, the lasting message of Christmas Wrapping is: this is no time to be alone. Here's hoping we can all be with friends and loved ones this season.

Escape from Manhattan

Last year I learned that, during the holidays, leaving New York's never easy. This year, it's downright difficult.

The significance of the strike was made clear to me today, while I, the intern, was griping about waiting in the cold for a hopsital shuttle that was running late.

A cardiology fellow was standing with me. He'd begun his commute well before me, and had budgeted the entire afternoon to get to the hospital.

"Why so much time? I think they'll understand if you're running late," I offered.

"If anyone has an ST-elevation MI tonight, and I'm not there..." His words trailed off.

We both stared down the avenue, searching for a sign of the approaching shuttle bus.


It looked like it was going to be a bad call on pediatrics. Signout was full of new, borderline admissions -- asthma exacerbations that were already improved, a rule-out sepsis or two with the mildest of fevers. Plus, we got word that two more RSV's were heading up to the floor.

On rounds we learned that the patients slated for discharge didn't want to leave -- or at least, the parents didn't want them to. I caught a mom feeding her (supposedly NPO) baby, then complain of his vomiting, five minutes later.

I was quickly becoming as cranky as some of the infants.

As the day wore on, though, the work got done. The new admissions were straightforward, the language barriers were easily surmounted. I still felt like a cog in a vast, inefficient machine, but at least we were moving forward.

When an opportunity for sleep presented itself in the evening, I took it. As I drifted off, I recalled an episode from morning conference, earlier in the week:

One of the residents has presented a potentially interesting case of progressive lower extremity weakness in a twelve year old girl -- the differential included Guillian-Barre syndrome and cord compression. Workup had been negative, and when it came time to do electromyography, the kid fought off the needles -- vigorously. She had been faking it, for days.

We then discussed conversion disorder vs. factitious disorder, a psychiatry consult was decided upon, and it was my turn to present a case. I had a two month old with cough that just wouldn't quit. At the top of my differential, I jokingly put "malingering." Everyone laughed, but I remembered thinking that such a remark a few wouldn't have occurred to me, a few months ago. Floor medicine was jading me, far more than any experiences in the emergency room.

Sleep that night was fair enough -- just one call to the floor (the NPO baby had somehow managed to spit up milk again). At around midnight, my resident woke me.

"A new admission?" I asked.

"Actually," she replied, "kind of the opposite." The pediatric emergency department was swamped, and the attending was requesting another set of hands. My resident, like any good resident, was protective of her call intern, but knew I was in EM and might agree to it.

"Sure," I said.

And so I went down to the peds ED, which was indeed busy. I only saw a few patients; just enough for the attending to get a handle on the situation. But in that short time, I got away from those perfunctory floor exams and took real histories, real physicals, and made real decisions on the info I'd collected. I reassured some nervous parents, made a few kids smile, and generally felt like I was making a difference.

It's been months since I've been assigned to the emergency department, and it will be months until I'm formally back. But this little midnight ED stint was more refreshing to me than any sleep -- making my last call for 2005 my best.