Christmas Eve on call

For many people, the Christmas season is a time of celebration—families gather, travel plans culminate, and long-standing traditions take centre stage. However, Christmas has always carried a particular weight for me as a doctor, as during my professional career to date, I have worked more Christmas Days than I have had free.

Outside the hospital, on Christmas Eve, it is a night of anticipation—with presents being wrapped, meals being prepared, and children counting down the hours. Yet inside a hospital, Christmas Eve is simply another shift, albeit one with its own familiar patterns and pressures.

After all, illness does not pause for celebration, and neither do we.

Over the years, I have learned that Christmas Eve brings predictable trends in hospital admissions. Emergency departments often become busier as the night goes on. Increased travel and alcohol consumption lead to more road traffic accidents, falls, and injuries. As a doctor in training, I have seen fractured bones from falling off ladders while painting, head injuries after late-night celebrations, and other trauma cases that arrive just as families elsewhere are sitting down to dinner.

Cardiovascular emergencies are another stark reality of the holiday period. Christmas Eve is commonly a night when patients present late with chest pain or stroke symptoms. Many admit they delayed coming in because they “didn’t want to spoil Christmas” or hoped the symptoms would pass. Unfortunately, those delays can mean more severe illness, more complex treatment, and sometimes worse outcomes.

As doctors, we see this pattern every year, and it is one of the quiet tragedies of the season. Numerous studies have demonstrated an increase in heart attacks, strokes, and sudden cardiac events during the Christmas period, including Christmas Eve. Emotional stress, disrupted routines, heavy meals, and alcohol all contribute. Patients may dismiss symptoms or postpone calling for help because of ongoing Christmas celebrations, arriving later and often sicker than they might have been on an ordinary day.

Respiratory and infectious illnesses are another consistent feature. Flu and other viral infections peak in December, and Christmas gatherings bring multiple generations together in close, indoor settings.

Older adults and those with chronic conditions are particularly vulnerable, leading to hospital admissions for pneumonia and other lung diseases. These cases often present overnight, adding pressure to already stretched on-call teams.

What is less visible, but no less important, is the rise in mental health crises. Christmas can intensify loneliness, grief, financial strain, and unresolved family tensions. Many healthcare workers would have their own stories of caring for those with severe anxiety, depression, or suicidal thoughts, and these encounters remind us all that not everyone experiences the holidays as a time of joy.

Working on Christmas Eve or Christmas Day, though, has never felt unusual to me, because from the very start of medical training, we are taught that this is part of the profession. Long before we qualify, we learn to work nights, weekends, and public holidays.

Being on call over Christmas is almost a rite of passage. It reinforces a fundamental truth: patients do not choose when to become unwell, and our responsibility and duty to care for them does not stop for a calendar date.

This has always been true worldwide. Medicine has a long history of doctors and nurses giving up holidays to care for others. Records from 19th-century hospitals describe Christmas Eve ward rounds, emergency surgeries, and bedside care delivered by candlelight.

During wartime and epidemics, doctors and nurses worked through Christmas under extreme and unimaginable conditions. The continuity of care during holidays became a defining feature of medical professionalism. The idea that medicine “does not pause” is not modern—it is woven into the profession’s identity.

Of course, there is a personal cost. Like many colleagues, I have missed family dinners, early mornings of opening presents, and other cherished traditions—all moments that cannot be replayed. Celebrations are shifted, shortened, or postponed. Many a time, my husband, also a doctor, has had to leave in the middle of festivities to deliver a baby, as they are well known to make an appearance at any time!

Yet most of us accept this, not because it is easy, but because we understand the privilege and responsibility of being present when people are at their most vulnerable.

On Christmas Eve, the hospital feels different. There may be tinsel and garlands on the nurses’ station, a shared box of biscuits, or a quiet exchange of holiday wishes between cases. But the work continues—admissions are assessed, decisions are made, lives are stabilised.

While much of the world celebrates, the lights in hospitals always remain on. Christmas reminds me, every year, why healthcare is not just a job, but a commitment—to show up, to stay present, and to care, even when everyone else is celebrating.

And as we mark Christmas tomorrow, it is worth remembering all of those healthcare workers for whom the holiday is spent not at the table, but at the bedside—ensuring that medicine, quite simply, does not pause.