Every year in December, the hospital mood changes. Everyone seems to be making that extra little effort to bring the festive spirit into our everyday activities. Decorations go up, sweets overpopulate the nurses’ station and Christmas cards start pouring in. With the usual excitement, I roll my sleeves up and look at the patient list. I start considering which patients will be the winners of the “lucky draw” this year; in whose notes will my juniors write the ever-anticipated ‘MFFD’ (Medically Fit for Discharge). To my non-medic managers’ delight, the ward round starts taking the form of a quest to discharge as many people as possible. Everyone is working harder to send patients back to their friends and family. After all, all patients ought to be home for Christmas. Plans are drawn, phone calls are made, family meetings take place and occasionally bureaucratic barriers are broken.

As the ward round goes on however, a different reality begins to emerge. Every year, I try to forget and alas, during those last ward rounds of the year, I am always reminded. For what I consider home and family bliss, will not be available for Mr JC, who is 83 and lives alone. Nor will it be there for Mrs DC, whose only daughter believes that her mother is responsible for all her medical problems and her metastatic breast cancer, and for this reason they have been estranged for more than five years. Mr TR will not be able to enjoy a warm turkey meal over Christmas as the friendly neighbour who cooked on Christmas day for the last 30 years passed away two months ago. Mrs OR is the sole carer of her demented husband, who has been taken to a care home since she was admitted into the hospital with pneumonia.

My job description is never straightforward but part of what I do is try to understand people’s wishes and manage their expectations. Often, their comfort does not lie within the treatments I have to offer but in the ears I have to lend. And this is why the final ward rounds of the year take slightly longer. Most people assume that Christmas is a time of togetherness, a time to be spent with the ones we love and cherish the most. But for some, there is no warm home to be sent to, there is no family bliss, nor a turkey dinner to be shared with a loved one. And until you ask, you can never imagine the complex family backstory, or the prospect of profound loneliness a hospital discharge over Christmas might mean to a certain patient.

This is a post dedicated to those patients who were disappointed when I smiled and said, “You are going home”. This is a post to consider those people who desperately wished to stay in hospital because they did not have a better place to be over the holidays. And this is a reminder post to myself for next year; not to get carried away by the festive atmosphere around me, and to rather anticipate that some people will choose hospital food over cold turkey from Meals on Wheels. To expect that some will take the helpful hand of the nurses over the chairlift in their empty homes, while some others will opt to stay in a ward full of strangers, yet so much more familiar than being alone with a demented partner, who has long-forgotten their 40-year-old marriage. Next year, I will hopefully remember that the colourful Christmas cards at some bedsides do not translate into abundance of friends and family for everybody, and that saying “I do not want to go home” is another form of bravery all together.

My job is never straightforward. In the rush to discharge patients and empty hospital beds, it can sometimes go unnoticed that certain beds needn’t be emptied. Amid the anticipation for an upcoming family holiday that fills the hospital wards, it can often be overlooked that for some patients, holidays are not an exciting prospect at all. And while striving to offer hope and comfort with a discharge note home for Christmas to my patients, it can occasionally transpire that comfort and hope are located in altogether different places and faces for different people. And unless you ask, you can never imagine.

Happy New Year to everyone, a little kinder to one another, a little more open-minded, a little more willing to listen hard and really understand.