Twas The Nightshift Before Christmas

Adam Kay | 5 mins


Christmas is this pine-scented, tinsel-strewn timeout where, like it or not, everything just . . . stops. It’s a temporary apocalypse where everyday norms are replaced with a fever dream of cheer and goodwill, and for an interminably long week, your daily grind goes out the window, replaced by weird, compulsory rituals.

You’re forced into playing board games with your family, those blood-strangers you spend the rest of the year wilfully avoiding. You eat food like it’s a competitive sport in which every kilo of meat or cheese gets you to the next level. And in order to cope with the steadily increasing strain of facetime with first-degree relatives, you don’t so much flirt with alcoholism as fall into an S&M-heavy relationship with it.

It’s a bizarro version of real life, an alternative reality where jollity is mandatory and apparently achieved only through a combination of charades, acid reflux, anger management and couch-sores. And all this is made possible because – thanks to the little baby Jesus – you no longer have to go to work. Well, most of you don’t.

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.

Coming but once a year – and thank fuck for that – the Yuletide brings more than its rightful share of hospital drama. Festive flus and pneumonia keep the respiratory teams busy, while norovirus and food poisoning are the season’s special guest stars for the gastro doctors. Endocrinologists drag patients out of their mince-pie-induced diabetic comas, and the orthopaedic wards heave with elderly patients who’ve gone full Jenga on the ice, shattering their hips like bags of biscuits.

A&E departments are busier than turkey farms, thanks to black eyes from carelessly popped champagne corks, fleshy forearms seared by roasting tins, and children concussing themselves by hurtling down the stairs in the box their Scalextric came in. Not to mention the fairy-light electrocutions, turkey bones trapped in tracheas, and finger amputations from careless parsnip-chopping. Incidences of drunk driving go through the roof, often literally.

And then of course there’s the carnage when families reach breaking point – usually some time between the Queen’s speech and the late-night list shows. Under the influence of Christmas spirits and mistletoe, crimes passionnels erupt like violent genies in living rooms across the country, and still-sticky carving knives find their way into the nearest racist uncle.

I spent most of my medical career in obstetrics and gynaecology. Labouring mothers don’t really have the option of staying home for a couple of days to ‘see if it’ll settle down’ and, over in gynaecology, egged on by eggnog, there’s a definite uptick in objects that have found themselves in orifices and are struggling with the return journey.

And then there’s the heart-wrenching stuff. The middle-class pastime of Christmas Eve granny-dumping – bringing one’s elderly or infirm relatives into hospital with some vague, fabricated medical complaint, so the dumpers can dedicate the next few days to solid partying, unfettered by caring for their parents.

Pushed to extremes by John Lewis adverts, Instagram exaggerators, and that terrible Paul McCartney song insisting that everyone else is simply having a wonderful Christmas time, many patients find this time of year too much to bear, and need to make use of our cruelly underfunded mental health services. And while of course there is never a good time to lose a loved one, there is something all the more harrowing about grief during the festive period, oppressively surrounded by global joy.

The annual winter health crisis rightly makes headlines every year, but over the festive period, the media – not wanting to piss in your Baileys – turns a blind eye, instead feeding us feel-good stories about a polar bear who’s done a forward roll or some royal toddler trotting off to church in fur-trimmed couture. But, just as putting your hands over your eyes won’t make you invisible, the patients don’t go anywhere and the ambulances are still lined up outside A&E like lorries at Calais. And the staff are still there too, putting vocation over vacation. There’s no reserve service, no fleet of Green Goddesses to give the healthcare professions a bit of time off. Instead, 1.4 million NHS 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. There were a few reasons for this, amounting to a perfect snowstorm. First of all, everyone thought I was Jewish, so assumed I wouldn’t mind working on the least Jewish day of the year. In fairness to those people who thought I was Jewish, I was Jewish – and indeed still am – but with the emphasis very much on the ‘ish’. I’m the kind of Jew who has a Christmas tree, doesn’t go to synagogue, and in fact had to google the correct spelling of ‘synagogue’ when writing this sentence. Oh, and I don’t believe in god, which I understand the more scrupulous practitioners generally do. Still, as far as my colleagues were concerned, I was certainly Jewish enough that I would happily sacrifice the annual twenty-four-hour TV-and-food-athon for the greater good.

Added to this, I didn’t – and indeed still don’t – have any children. Christmas being a time for kids and all, the medics with young families would rise to the top of the Norway spruce and get the day off. I didn’t begrudge them this, though for a while I did consider inventing some convenient yet imaginary offspring. The thankless toil of actual parenthood would probably have been an extremely expensive, stressful and inefficient way to get a free pass to eat sprouts on the same day as everyone else.

Due to the peripatetic nature of junior doctor training, I worked every Christmas in a different hospital, so I couldn’t really call foul and complain I’d worked the previous year. That would be like refusing to buy the first round of drinks because you’d bought the last round the week earlier, for a completely different set of friends. In a pub 85 miles away.

Of course, I might have had more luck if I’d arranged the rota myself – the rota-organizers would always get a suspiciously easy set of shifts. But colour-coded spreadsheets were never my forte and the price the organizers paid for this privilege didn’t seem worth the bother. I preferred to spend my already scant free time with my partner, not fielding angry calls from hard-done-by colleagues and wrestling with #VALUE! errors on Excel. Besides, even if you do end up avoiding Christmas Day, you’ll almost certainly be stuck with the nightshift, or Boxing Day, or New Year’s Eve. Hospitals attempt to slim down Christmas staffing to the bare minimum of doctors to provide safe care, but with ‘bare minimum’ generally representing the best-case scenario on a normal day, it’s rather hard to tell the difference.

Ultimately, the shitty shifts still have to be filled and no one ever gets to avoid them all. There’s about as much chance of a junior doctor getting the whole week off at Christmas as having enough cash to spend the time in Mustique, sipping vodka stingers across the pool from Bernie Ecclestone. Or Jeremy Hunt.

So here follow my diaries from those Christmases spent on the wards, removing babies and baubles from the various places they found themselves stuck. But it wasn’t all bad. At least I had an excuse not to spend time with my family.


Somehow my Jewish credentials didn’t quite stretch to being able to skip work every Saturday. Talk about persecution.

In my first book, This is Going to Hurt, the most common reasons for entries being omitted included ‘too disgusting’ or ‘too Christmassy’. Here I make amends for both.