'Amongst the tinsel and the baubles, we cried.' The reality of Christmas Day in the ICU.

Working over Christmas in the Intensive Care Unit [ICU] is hard to explain to those who aren’t health care professionals.

We all bring in food to share, and lay a big spread out on the balcony and we transform the department into a brightly coloured happy place with decorations everywhere. We wear our Christmas scrubs, Santa hats and reindeer ears and everyone is happy with a festive mood in the air.

However, the day is often marked by sadness and regret too.

You see, most of us cross our fingers and hope that we will be the lucky ones who have the day at home with our own families. When the roster is finalised and we see our names blazoned across that little square, the time of negotiations begins: “Can we move present opening until I get home at 4pm?” I asked my mother one year, before ultimately conceding that isn’t fair to anyone else.

“Should we skip seeing your parents this year and stay local, it’s just too exhausting travelling between night shifts…” I hear a colleague saying to her husband. Yes, working Christmas requires sacrifice and concessions from the health care and admin staff. But honestly, we love caring for you and your families and it is a pleasure to share Christmas with you.

Watch: Things nurses never say. Post continues below.

Some of my favourite Christmas Day memories at work involve assisting patients to celebrate the day with their families and help them feel just a little more ‘normal’ in this sterile and regimented environment. One year I was able to facilitate the extubating (removal of the breathing tube that attaches to the ventilator and controls a patient’s breathing) of a patient who had been with us for several weeks.

He was awake and had been writing on a communication board. As Christmas approached, he expressed how important it was that he be able to speak to his family on video chat on Christmas Day. He told me that he was a first-time grandfather and had not met his grandson yet as he had been with us in ICU when the baby was born.

After much discussion with the treating doctors, the decision was made that we could trial him without the breathing tube, with the understanding that if there was any deterioration at all he may need to be re-intubated. At 8am on Christmas morning, another registered nurse and I prepared him for the procedure and removed the tube.

Seeing him take his first breath and then speak to us brought tears to all our eyes. He was able to talk to his daughter via video chat and had many other family members visit and stay with him. Communicating with those we love is something we all take for granted – I know I do – and that day will stay with me forever as watching him talk and laugh and interact with family was such a pleasure.

There are some Christmas shifts that are not so happy, though.

People are in the ICU because they are very, very sick. Just because it is Christmas doesn’t mean that trauma cases stop coming in, or people don’t become more unwell.

Some patients even die on Christmas day.

Comforting a family on a day that has traditionally been one of joy, to one that’s now marked in sorrow, weighs heavily.

One of the five stages of grief is bargaining and many people use Christmas as a bargaining chip either for themselves or their loved ones. They say, “if I can just make it to Christmas it will all be okay,” and if they don’t or if they pass away on Christmas Day, the family can feel as though they failed.

The best we can do as a nurse is support them with information if they want it, give time to grieve and be with their loved one and each other, and provide the space to accept what has happened.

I will never forget a young mother who passed in the early hours of Christmas morning. Her husband was present while her little ones slept at home with their grandparents.

My patient’s beautiful husband squeezed himself in to the small bed with her and held her in such a tender embrace as her breathing gradually slowed. As the sky began to lighten, just before sunrise, she passed away.

Life isn’t fair, and it was a sad day for her family and for the staff who cared for her. Many of us cried together that Christmas morning, amongst the tinsel and the baubles.

I am proud to be a nurse and proud to be part of a team that can help the community, and maybe bring some extra cheer to them on Christmas Day, when they would rather be at home.

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