This being the last issue before Christmas, I shall postpone until the New Year writing of the many problems confronting those who work in the NHS and social care, and of those waiting for their services. Instead, I have consulted the ghost of Christmases past.
In those days, for the first year of our careers we newly qualified doctors lived in the hospital, in the residents' mess. The 10 or so of us ate together in the doctors' dining room when we could and had occasional parties to which we invited other staff of the opposite sex. In our sitting room we had a bar, which I controlled during my year, for which I bought wholesale drinks from the local brewery and which we used sparingly when not on immediate call. But most of the time we worked in the wards and operating theatres with our patients, of whom each of us was responsible for about 50 at any one time.
At nights we also worked solo in the accident and emergency department either up to midnight or from then to 8am, stitching cuts, setting fractures, admitting emergencies, and attending to numerous incidents including attempted suicides and aggressive drunks. We rarely went outside the hospital doors save on our annual leave, even having clinics on Saturdays and occasional ward rounds on Sundays. We worked hard and certainly earned the £300 that was left from our annual salary after paying for our compulsory accommodation in the hospital.
As Christmas approached, something happened. 'Let's have a pantomime!' said some enthusiast, and we were roped into writing and performing sketches to be performed in the out-patient department later. The nurses had a choir and practised their carols. On the wards, every patient who could possibly be sent home, either permanently or temporarily, was allowed out with appropriate medication and we were able to admit for a night or two of relief some of our past patients whom we knew to be lonely or facing death at home.
The ward sisters, who were absolute rulers of their territory and generally feared even by the consultants, relaxed a little and started baking cakes for Christmas day and, in my role as honorary mess barman, I took orders from every ward in the hospital for sherry and wine, making a small profit to cover the losses from colleagues who had forgotten to sign for their drinks. On Christmas eve, the pantomime was performed, the jokes and satire being mostly at the expense of the consultants and later, as night fell, the nurses, in their capes and frilly caps, processed round the wards in candlelight, singing carols for the patients.
Of course, illness and accidents do not stop on holidays although generally people would try to avoid coming to hospital if they had people at home, so Christmas eve always produced work for the doctors and nurses – indeed nights of celebrations would always produce plenty of injuries and drunkenness in casualty. Then in the morning a quick check on the ward patients was followed by the arrival of the consultants, often bringing their wives (they were almost all men in those days) and children who would be spoiled by the sisters. All then went round the patients who were offered drinks and given small gifts before returning to the sisters' offices for drinks themselves.
The final ceremony was the carving of the turkey – every ward received a hot bird and it was carved by the senior consultant, the generous servings being carried round to each patient on the ward. Later that day, we doctors had our own Christmas dinner in the mess, unless interrupted by an emergency.
I witnessed this event from 1947, just after the NHS was founded when I attended my father's ward with him and my brothers and sister, and then as a house physician and registrar, in various hospitals in England and USA (no drinks there – it was a dry state). As a consultant in Wales from the early 1970s, I successfully carved a few turkeys – in one case being interrupted by an emergency admission requiring a tracheostomy on the ward – and family accompanied me, but from the 1980s in Edinburgh ready-carved portions were delivered to the wards and the ceremony faded away.
At least since 1980, the convivial nature of the doctors' mess has been lost. The 24-hour pattern of illness is now managed by doctors working shifts, as nurses always did. This is humane and better for the patients, as time off is allowed for nights spent working. However, the increasing age and frailty of the population and thus burden of admissions to hospital at all hours means that the intensity of work during a shift is much greater than it was. The camaraderie of the mess which in many cases, including my own, led to the altar has gone. By the end of the year, I had saved £80, just enough for an engagement ring.
None of us would wish to spend Christmas in hospital but, if you or I have to, we can be sure we shall be looked after by dedicated young doctors and nurses whose own celebration is being postponed on our behalf. As we share our Christmas with our families and friends, let us give a thought to those in hospitals, ambulances and social care for whom it is necessarily another working day, and to those who are their patients, and hope that they will nevertheless have as happy a Christmas as is possible in the circumstances. To my readers, my best wishes and thanks for putting up with my articles through the past year.
Anthony Seaton is Emeritus Professor of Environmental and Occupational Medicine at Aberdeen University and Senior Consultant to the Edinburgh Institute of Occupational Medicine. The views expressed are his own
