One Emergency Doctor’s Christmas Day Journey
Third in a three-part series about Christmas in the Emergency Department.
Dr. Anne Klimke is consulting with three medical residents she’s supervising on this Christmas Day in the Emergency Department at Einstein Medical Center Philadelphia. She asks rapid-fire questions in a Socratic exercise, probing their decisions about the patients in their care. Did they think of this? Did they test for that? Her manner is kind, low-key and collegial.
The four of them are wearing Christmas hats.
Dr. Klimke’s journey to this moment started many years ago when her family was devastated by a tragedy. “I was always interested in science and thought I wanted to do research,” she said. “When I was 19, my younger brother died in a car accident. So that steered me towards something more clinical and took me to emergency medicine.”
Today, she’s the doc in charge of C pod—one of four sections of the Emergency Department—which handles everything but trauma cases. At the moment, she’s focused on a patient with severe side and back pain. She enters his cubicle and, after examining him, invites Dr. Jennifer Hwang, a first year resident trained as a doctor of osteopathy, to do the muscular manipulation that’s part of osteopathic training.
The beds here are half empty today, which is typical for Christmas. “The patients who come in are genuinely sick,” she said. “It’s not so much a cough or cold or I-need-a-note-for-work kind of stuff.” Holiday patients often suffer from what she calls “positive dietary indiscretion”—overeating or overdrinking and violating diet taboos. Often, she said, the culprit is the holiday ham that gives heart failure patients more salt in a day than they should have in a year.
And then there are the folks who are outsiders on a day of family, friendship and festivity who seek refuge from loneliness. “We see a lot of mental illness around the holidays,” Dr. Klimke said. “Depression, substance abuse—so we refer a lot of people to the Crisis Response Center this time of year.” With these patients, Dr. Klimke uses a different kind of medical intervention: tenderness. “You have to be as compassionate as you can,” she said. “You have to meet people where they are.”
Working Christmas and other holidays when families and friends are home celebrating is “just part of this career,” Dr. Klimke said, and she’s worked quite a few since finishing her residency in 2009. “Our families come to accept that’s just the way things are going to be and accommodate that.” She echoes others’ remarks that the camaraderie in the ED makes such days enjoyable, as does the special holiday meal they share with food brought from home. (Her donation is her husband’s chocolate chip cookies.) “Everyone is making the best of it,” she said.
This year, though, for the second Christmas in a row, the Kentucky-born Klimke left a little girl at home to celebrate without her. She was hoping her husband would bring their 15-month-old daughter for a brief visit to the ED just so she could see her. But the baby got sick, and she has to settle for the photos on her smart phone. “I’m grateful for technology,” she says, scrolling through to photos of the baby. “I’ll show them to whoever’s willing to look.”
Today is not a busy day, but neither is it an easy one. There’s a critically ill patient who came to the ED in pain. The patient has a terminal illness and has been counting down the months docs said were left. Is this month of December the last? Is this pain the final notice? Dr. Klimke gathers herself and goes to the patient’s side for “the end of life conversation.” She doesn’t make predictions about when time will run out: “I don’t have a crystal ball, I never do that,” she says. She’s as reassuring as possible, under the circumstances. She makes sure the patient is comfortable and stable and can go home “to spend what could be their last Christmas with the family.”
This work—fixing a broken body, soothing a broken mind—is as fulfilling as she’d hoped.
“I can finally do what I set out to do all those many years ago in my applications to medical school,” she said. “I can help people, as trite as that sounds. Sometimes it’s not even a medical thing. It’s just being able to make a difference in people’s lives. Nobody comes to the ER because they’re having a good day.”
At 7 PM, after a 12-hour shift, Dr. Klimke goes home to share the rest of Christmas with her husband and her beloved baby.