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Second Opinion

The ER as Christmas Parade

Leap, Edwin MD

doi: 10.1097/01.EEM.0000365496.64794.0b

    I remember one year that my family went to our local Christmas parade. Boy Scouts and Cub Scouts on floats drifted by, chucking candy at the crowd, as church groups marched, waving and handing out tracts, and cloggers (for the uninitiated, that's a kind of Southern tap dance) jingled and scooted on the pavement. They all eased down the street to Christmas music, along with lovely, wide-eyed Southern beauty queens of assorted ages, gowns too thin for the weather, too proud not to show off their smooth shoulders, smiles barely containing chattering teeth as they longed for the hot days of summer.

    This being South Carolina, there was that delightful mixture of Jesus and the apostles, followed by Jesus crucified, then Jesus triumphant, not to be outdone by fat old St. Nick bringing up the main, highly anticipated position at the end of the parade.


    Like an army on the march, the parade was flanked by strange, frightening little people (children, but not unlike elves) riding motorbikes and four-wheelers dangerously close to the crowd, mixing combustion engine noise with “Jingle Bells,” “O Holy Night,” and “Frosty the Snowman.” Various auto dealers cruised by with their best bargains, signs posted on the side, also launching candy out the window at sometimes eye-threatening speeds.

    It was the best, and worst, Christmas parade I have ever seen. I vowed not to go back. But I probably will, just out of curiosity. The same way one of our nurses used to love going to county fairs. “Dr. Leap, we went to the fair this weekend! Put down my five dollars, and saw me some fair trash!” she would say. She would wander the aisles and displays, fascinated by the people she saw, not a few of whom had been her patients in the emergency room. She would laugh and tell stories about it. But she always, always did the right thing when they were her patients again. Sometimes, people are crazy and needful; sometimes life is horrible and wonderful; almost always, both are true. But it is never boring.

    It's a lot like life in emergency medicine. Some days, we swear we won't go back to the ER. These past few months, I've come home many days, and wished I could never darken that door again. But I do. And every day, you do. Sometimes, we swear those nuts we call patients don't deserve a second of our time or a dollar's worth of our efforts. Most times, we give it whether they deserve it or not. We do it, not because of federal law but because we can't help ourselves.

    It's like that Christmas parade. Humanity glides through our hospitals, flinging requests at us, telling us surreal stories, dancing, laughing, lying, and trying to convince us of some thing or another. Some of them are the lovely beauty queens, and we would stand in any bit of cold or misery just to help them. Some of them are crazy elves on dirt bikes, and we would do anything to stay out of their way. Pain pills fly like wrapped candy. Lies float as thick as exhaust from floats pulled by green tractors. Along the way we see proud children and worried parents, we feel like Santa, asked to give ourselves away all day and all night. Often, we think even Jesus would be irritated.

    But we do it because, as with the parade, to watch it is to be part of it. The glorious drama of life and death, crazy and demanding, and all the rest is a drama in which we are as much actors as our patients. And so, we find ourselves swept up in the moment. We find ourselves oddly addicted to their stories and their plights. We immerse ourselves in finding ways to save humans from their own ridiculous behaviors, habits, and misfortunes.

    We realize that individual lives, too, are like that parade. They are a mixture of beautiful and broken. Even the oddest, felonious freak show was, at one time, an innocent child. Even the most dangerous, profanity-spewing drunk will, out of the blue, open the door for you, thank you, push you out of the way of oncoming traffic. Doctors, we can be whiny and gifted, too. We can go out of our way to save lives, even as we spend hours to avoid 10 minutes of work.

    Ultimately, that was the perfect Christmas parade with which to understand Christmas. Christmas is not about perfect music, towering trees, shopping, parties, or even about church services. Christmas is about brokenness, deliverance, redemption; it is about the worth of every blessed idiot and every single man or woman that drains the life out of us in our work.

    Christmas is no pie-in-the-sky assessment of humanity. Humanity is loud and difficult, scary and darkly intriguing. Humanity is a parade I would avoid if I could. Christmas is the reminder that the parade is worth watching. And that the ER would have been as likely a location as Bethlehem, filled as it is with need, suffering, loss, and the faint but powerful hope of healing and redemption.

    I hope that you always enjoy the parade. Merry Christmas, dear friends.

    Dr. Leapis a member of Blue Ridge Emergency Physicians, an emergency physician at Oconee Memorial Hospital in Seneca, SC, and an op-ed columnist for the Greenville News. He welcomes comments about his observations, and readers may write to him [email protected] visit his web site and blog
    © 2009 Lippincott Williams & Wilkins, Inc.