That’s Dr. Santa Claus to you again this year

It’s a good thing I am a doctor, because I get to shop for what my patients need in the moments that I care for them, instead of giving them all wooden bird feeders for Christmas. Then I am Dr. Santa Claus, handing out gifts to make the bad better or the worst the best it can be. Sometimes the choice of a gift is obvious; pain relief for the broken wrist or rest for the racing mind. Sometimes I have to look hard for something to give, but that something is always there, amidst the chaos, beneath the pain, past the frailty, a tiny diamond in a stocking full of life’s coal.

I often get to give the gift of spared humility, because many of life’s dumber moments end up with an explanation to a doctor. I hear about how the car went off the road, the foreskin got zipped up in the fly, the necessary pills did not get taken, or the hand ended up in the table saw. I get many chances to chew patients out for doing something dumb, but I work very hard on such occasions to educate instead of castigate. Doing so spares their feelings and makes me like my patients, my work, and myself more than I would if I practiced medicine as though my name was Dr. Ebeneezer Scrooge.

To my patients who are flushing themselves down life’s toilet, I try to give understanding that I think that’s a waste of a good life. Alcoholics are a case in point; their drinking often washes them into the emergency department (ED), depressed and suicidal, lacerated or contused, sometimes belligerent but never proud. The misery they bring to EDs and others makes it hard not to suffer them poorly, and at times I struggle to keep my frustrations from flushing my compassion down the Hippocratic toilet.

Sometimes I just give them sedatives and antipsychotics, but when I am at my best I also give them compassion and respect, and my sadness at the gradual loss of their lives to the misery of addiction.

To the family of a patient who has just died the best I can give is often just a better memory of a terrible time. I can remind the patient’s family that they took good care of him while he lived, and say that he did not suffer at the end. I can help the nurses clean him up and take out the tubes and IVs, and arrange the blankets carefully, so when the family comes to see him he appears to be at peace. I can help make the last image a better image, and perhaps make the pain a little less painful.

Often what a patient needs from me is just a bit of my time and the sense that I do not think they have wasted it. A case in point; an elderly woman came into the ED at 3 a.m. to have a “spot” checked on her foot because she was convinced it was cancer. “I saw it just before I went to bed and I can’t sleep for worrying about it because I just know it’s cancer,” she explained.

After careful inspection of the “cancer,” I put years of medical training to use and “cured” the “cancer” by washing off what turned out to be a patch of tenacious grunge with an alcohol swab. Then I told her we in the ED that night were glad we could help her, because we understood why an elderly woman with poor vision who lived alone would want reassurance at 3 a.m. Many of our mothers are such women, including mine.

Insight is a gift I occasionally help patients gain for themselves. Young women having sex without birth control need insight into why the reason they think they will not get pregnant is probably not going to work as a barrier to pregnancy, and that such women usually end up being called “Mom.” Families need insight into mental illness, parents need insight into the link between their smoking and their child’s asthma, an adult child may need insight into a parent’s dementia, and most patients need insight into their disease. In return, I get insight into why teaching patients about their disease works more effectively than telling them what to do.

Once in a while I get to give the gift of life, though infrequently enough to keep it something extraordinary and special. Several years ago I saved the life of an elderly man who came into the ED nearly on his last breath. That gift to him has kept on giving, because each of the years since then his wife has given it back by thanking me when she sees me at the Fourth of July parade in which he marches. Eat your heart out, Santa.

But I am not some Super Santa, and there are days when a sleigh-load of coal is my due. On better days I simply do what any of us can do – look for chances every day to give those we meet small gifts, because every act of unnecessary kindness is a light against the darkness. I give in part because I can, because I get back the warmth of giving, and because millions of people doing so can warm a world. And on Christmas morning I can look at my reflection in a Christmas ornament and know that I have been a pretty good boy most of the time, one who deserves almost every woodworking tool that awaits him under our tree.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.