'Tis the Season...

Eric Lis

The two weeks of Christmas and New Year's are an odd time for people who work in hospitals, at least in the Western world. At the holiday period, most people take it as a given that they're going to get some time off work, and many businesses close entirely, at least on the holidays themselves. A large hospital generally isn't able to close for an entire day, however, because even at a jolly time of year, plenty of people still get sick, injured, or depressed, and at the very least, emergency services have to be maintained. Anybody who works on weekends at a hospital can tell you how challenging it can be to run a health care centre short-staffed for two days out of every week, but around the December holidays, many centers find themselves running with a reduced staff for one to two weeks straight. I don't celebrate Christmas and don't tend to take any special time off work around it, so I much more frequently find myself covering the emergency department on Christmas Eve or Christmas Day than do many of my Christian colleagues. As a result, I've had the dubious pleasure of getting to see in what ways the emergency department's clients differ on those days. It turns out that my observations are far from unique; a small but rich body of literature exists which is specifically interested in how people find themselves coming to hospital (which isn't necessarily the same as getting sick) on major holidays, and at least in North America, where I practice, Christmas is about as big a day as they come, but a lot of the same data undoubtedly holds true for characters celebrating Swallowtail Festival, Agelong, or Saint Melmac's Day. In the spirit of the season, here's some of what we know about it.

We know a lot about the times that people are most likely to decide that they have a medical emergency. Very recently, for example, McHale and colleagues demonstrated that useless emergency visits are highest on Mondays, during regular business hours. As far as the holidays go, in 2008, a study was published which showed that emergency visits for heart failure peaked in the four days after Christmas. There are a few possible explanations for this phenomenon. The most boring explanation is that people at risk for heart failure eat too much salt over the holidays and then experience heart failure, but the funniest explanation is that people experiencing potentially life-threatening symptoms of illness on December 25th may delay seeking help because they don't want to miss out on the holidays (or, more cynically, because no relatives will bring them). Similar findings have been shown in other research: that visits to the emergency department for most common complaints drop off sharply just before Christmas but rise just as sharply afterwards, with an attendant rise in mortality. Mental health may follow some of the same trends. Popular wisdom among mental health workers is that rates of depression rise around Christmas, because society unceasingly tells people that they ought to be happy and have money to spend, and this can be a pretty depressing message to hear when you're sad, alone, and poor. At least in terms of emergency visits, the numbers show that visits for depression fall off shockingly prior to Christmas and rise again steeply afterwards, which may suggest that 1) nobody wants to admit that they're depressed at the holidays and 2) a lot of people are probably made depressed by their families. Suicide rates seem to drop too, although many individuals report that their mood is worse than ever at Christmastime.

This is pretty consistent with my own observations about the emergency department, except for one thing: in my experience, although general emergency visits drop off, involuntary visits related to alcohol use skyrocket. Unsurprisingly, this, too, has been demonstrated. Earlier this year, an Australian team published data showing that alcohol intoxication cases brought to the emergency department by ambulance peaks just before pretty much all major public holidays, or on the day of, in the case of News Year's. Christmas wasn't noted to be any worse in this sense than any other holiday, but the authors make the interesting observation that Christmas was the only holiday where alcohol intoxication cases peaked on the last working day prior to the holiday.

The question, as always, is how can this inform our stories. We can pick out a few bottom lines. First, right around a major holiday, nobody wants to admit that they're sick, and this means that there's a fair chance that they'll put off seeking help until they become VERY sick. That's one thing if the illness in question is a pneumonia, but it's something else entirely if the illness is lycanthropy. Second, it's reasonable to assume that despite a holiday season ostensibly being jolly, many people will be at their most depressed and most irritable, precisely because they aren't as happy as society tells them they're obligated to be, and a person who's down to their last nerve can be counted on to make all sorts of interesting, plot-advancing decisions that they might not otherwise make. Third and lastly, it's plain old human nature to take your celebrations a little bit too far, and intoxicated NPCs are a storyteller's friend.

With all of that in mind, whether you celebrate anything in the next two weeks or not, may they be pleasant days occupied by gaming and friends. If you celebrate Hanukkah, of course, then I'm already weeks late and have no excuse for that, so enjoy the next few days instead.

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on December 22, 2013. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system