Last Sunday morning, Santa Claus was whisked into the emergency room at Massachusetts General Hospital. He arrived with a racing heart, fever, and jaundice, and over the next few days, he went downhill faster than the Grinch’s sleigh plunges into Whoville.
In Room 1280 of the hospital’s surgical intensive care unit, St. Nick was evaluated by some of the country’s most esteemed oncologists, cardiologists, neurologists, and psychiatrists. Nurses tracked his blood pressure and pulse every hour, radiologists scanned him, and surgeons booked an operating room.
“He’ll get his best shot here,’’ said hospital president Dr. Peter Slavin.
But don’t worry, kids. Harvard’s top doctors healed Santa in the nick of time - again.
First-year surgery residents, called interns - in notoriously the toughest year of training in the toughest specialty - have “admitted’’ Santa Claus every December since the early 1950s, dreaming up dire medical problems, conducting exams and tests on a costumed actor or life-size doll, and filling out medical forms. What began as an attempt at comic relief late on a slow night in the emergency room has blossomed into a 60-year tradition.
It is part medical humor - this year, Santa was admitted with “coalidocholithiasis,’’ or coal in the gallbladder, and tachycardia (rapid heat rate) “with reindeer gallops and jingle bells’’ - and part a window into a hospital culture where exceptionally driven doctors-in-training strive to be the best even at having fun. There is a serious purpose too - to build camaraderie across hospital departments.
This month, Dr. Andrew Warshaw - who led “Santa Rounds’’ as an intern in 1963 and later became chief of surgery - and Dr. Gregory Ruhnke of the University of Chicago published a paper detailing the history of Santa’s admissions in the Annals of Surgery. The paper, written in recognition of Mass. General’s 200th anniversary this year, breathed new life into the tradition.
Santa’s medical records from the past six decades, collected in a 4-foot high stack of folders in Warshaw’s office, will be donated to a new Mass. General museum on Cambridge Street.
Warshaw, who retired as chief in April, e-mailed surgery department leaders and residents on Dec. 9 and asked what they “knew about this year’s planning for Santa.’’ The expectations high, interns arranged one of the most elaborate hospital stays ever for the bearded guy.
Mass. General has a strict hierarchy - interns call more experienced residents with questions and the residents call senior doctors or “attendings’’ - but that structure crumbled when it came to Santa.
Dr. Jordan Bloom, a Jewish intern from Colorado who organized the group, said he and Warshaw talked by phone several times over the past two weeks. Warshaw advised that the most important step was to get Santa an actual bed in the hospital several days before Christmas Eve - a tough assignment since 900-bed Mass. General is full almost daily. Fortunately, the hospital’s surgical intensive care unit is so new that it had empty rooms, and Bloom persuaded the head of the unit to give him a room for the week.
Dr. Geoffrey Anderson, one of the interns, donned a Santa suit on Sunday and made his way to Boston Common, where “Boston emergency medical technicians discovered him unresponsive in a puddle of eggnog,’’ according to his chart. He got a full workup in the emergency room - with one hitch.
A young girl visiting the ER spotted Santa on his gurney and cried.
Bloom and the other interns began paging doctors in dozens of specialties, asking them to evaluate Mr. Claus. Physical therapists exercised his limbs, lab techs sent up test results, and nurses wrote progress notes in his medical record, using red and green pens. (“Consult everyone. Do everything,’’ the ER plan directed - though Santa was uninsured.)
‘Consult everyone. Do everything,’ the ER plan directed - though Santa was uninsured.
“It’s astonishing to me how into this people get,’’ Bloom said. “We have had surgeons come up at 7 or 8 p.m., after a long day, to do the consult. It cracks me up every time I look at the chart.’’
Anderson was needed back in the operating room for a real procedure, so in the surgical intensive care unit, Santa was an inflatable doll. Psychiatrist Dr. Charles Welch, evaluating Santa for electroshock therapy, wrote: “Acutely despondent about lack of snow in the Northern Hemisphere this year, and new 80-hour week for reindeer and elves.’’ That last remark was a reference to the maximum number of hours residents are allowed to work. The hospital’s surgery training program was put on probation from 2009 until this fall for allowing junior surgeons to exceed the weekly hour limit.
Over the years, Santa has been hung with psychiatric diagnoses like they were ornaments, and he once landed in group therapy for obsessive-compulsive disorder for “making a list and checking it twice.’’
There were a few Scrooges this year.
One specialty refused to return the interns’ pages, while another doctor said “we’re too busy treating real patients.’’ A tube of eggnog Bloom sent to the hospital laboratory for a cholesterol analysis prompted a concerned call from a technician, who said it could ruin the equipment.
And when interns tried to book a liver transplant for Santa, the computerized scheduling system - not in on the joke - fired back an e-mail saying the requested surgeon was not credentialed to perform this type of operation.
In the end, though, Santa did not need a liver transplant. With irreversible jaundice creating a “Grinch-like appearance,’’ doctors settled on a face transplant instead. “They’ve done it across town, and it’s time we get in the game,’’ Bloom said, referring to Brigham and Women’s Hospital.
On Thursday morning, physicians and nurses crammed into an auditorium to hear the group of eight interns give “Grand Rounds’’ - a ritual at teaching hospitals in which doctors present a patient’s case. The trainees had stayed up preparing a Powerpoint presentation on Santa until nearly 2 a.m., fueled by coffee and Thai food.
During the presentation, the bandages were unwrapped from Santa’s face to reveal Warshaw. “I can now go off on my annual holiday spree,’’ he said, drawing enthusiastic applause.
Santa was discharged, the interns basked in congratulations from senior doctors, and then they left for a long day of evaluating real patients.Liz Kowalczyk can be reached at firstname.lastname@example.org.
Correction: Because of a reporting error, the original version of this article gave an incorrect name of the medical journal that published a paper detailing fictitious admissions to Massachusetts General Hospital for Santa Claus. The article appeared in the Annals of Surgery.