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For many who are working today, Thanksgiving Day is just another holiday in which they finds themselves on duty.

EDITOR’S NOTE: Dr. Hall is the chief medical officer at rural Midwest hospital. Dr. Hall is a prominent panelist on Monitor Monday, and he shares his observations about the observance of Thanksgiving at his facility.

Today, Thanksgiving Day at the hospital will be predictable. It will be like most Thanksgiving Days, indeed most holidays, before. The parking lot will be mostly empty except for the staff parking lot and around the emergency department.

No one wants to be a patient on a holiday. The docs have discharged as many patients as possible. Most of the remaining patients are too sick to go home. Some need post-acute care that’s not available- the nursing shortage hasn’t ended yet. A few don’t have family who can, or will, take them. Almost all of the patients would rather be anywhere but here.

The staff mostly fall into three indistinct groups with some overlap. For one group today, Thanksgiving, is just another day. They have come in to take care of patients and go home. They won’t think about the holiday until all the work is done and their patients are safely transitioned to someone else. They’ll quash the occasional thought about festivities they might miss. Then, they’ll go home, usually exhausted, and revel in the remainder of the holiday. Many families will delay the celebrations until after work. Their families understand and often embrace the commitment that goes with being on a healthcare “team.”

Another group will be here, begrudgingly. They’ll resent being away from their families. They’ll be annoyed they’re caring for someone they don’t even know. But they’ll deliver the best care possible. Then, they’ll finish the day and head home to family and friends.

Finally, there’s a small group who are glad to be at the hospital today. The patients invigorate them. They know they’ll work hard. They’ll be short-staffed. But they’ll find the work gratifying- fulfilling even. Some in this group are relieved they don’t have to sit around a table pretending to enjoy quais-political arguments disguised as conversation. Some will be glad they don’t have to listen to the “odd” uncle who asks all the kids to “pull my finger.”

Small rural hospitals build more intimate kinships within the staff. These are more than co-workers caring for generic patients. These are friends working together to help friends heal. Each day I marvel at their tenacity, integrity, and resilience. Like big-city hospitals, food services will serve up something resembling a traditional Thanksgiving dinner. The skeleton kitchen crew won’t be able to open the cafeteria. But patients will eat well. In some cases they’ll eat better than if they were home.

I’ll wander through the units stopping to talk for a bit. Every unit is trying to be festive. There’s usually lots of food. Everyone is nice. Most are happy. This will be the third “COVID Thanksgiving” and the wear on the team is obvious. They’re worn down, frazzled, but coping. Thanksgiving Day marks the traditional start of the holiday season. This has lifted spirits even amongst those who would rather be home.

After I make rounds, I’ll return to the mostly empty parking lot and head home. “Black Friday,” will be slightly busier. A sense of normal won’t return for three days. Few people at work will recognize “Cyber Monday” as anything but another Monday. The holiday season will be an added stress for everyone at the hospital until the first week of January. COVID, flu, and myriad other maladies are going to make the holiday season more stressful than usual.

I’m fortunate to serve here.

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John K. Hall, MD, JD, MBA, FCLM, FRCPC

John K. Hall, MD, JD, MBA, FCLM, FRCPC is a licensed physician in several jurisdictions and is admitted to the California bar. He is also the founder of The Aegis Firm, a healthcare consulting firm providing consultative and litigation support on a wide variety of criminal and civil matters related to healthcare. He lectures frequently on black-letter health law, mediation, medical staff relations, and medical ethics, as well as patient and physician rights. Dr. Hall hopes to help explain complex problems at the intersection of medicine and law and prepare providers to manage those problems.

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