It was a dreary cold, December day and I was on call. It had been slow, but that was about to change. An 82-year-old man was admitted to my service with diarrhea, vomiting, fever, and abdominal cramps. He had never had any gastrointestinal problems and was on no medications. The only pertinent history was that his grandson was sick with a similar illness, and his daughter had been sick three days earlier.
Moments later, I received a second call for a preop clearance on a man who had been electrocuted while decorating his house for the holidays. He had fallen and broken his hip. Before I put the phone down the pager went off again—a patient admitted with a glucose level of 820. The light bulb over my head went off: We had entered the Dangerous Season.
What is this season that bodes well for no one? This poorly understood clinical risk factor begins during Halloween and lasts through Christmas, New Year’s, Valentine’s Day, and—in some areas of the country—until Mardi Gras. And now they’re upon us again: the holidays. Our bodies shudder, increasingly deprived of sunlight and oversupplied with calories, as we begin our festive mode.
All Hallow’s Eve: The Dangerous Season starts with Halloween, a pagan ritual. What child would not want to stay up after dark, run around in a mask scaring people, and eat too much candy to commemorate the leprous dead?
Halloween is the most medical of holidays. Many costumes and traditions are related to medicine: Frankenstein’s monster was assembled from body parts obtained by anatomic grave robbers. Mummies are well-preserved corpses, and mummy powder was a traditional remedy for skin ailments for centuries. Vampires may have nutritional deficiencies, and werewolves porphyria. Spider web is a traditional therapy used cutaneously as a styptic and internally for asthma.
For diabetics—especially diabetic children—Halloween is a painful time. In addition, there’s no shortage of pumpkin seed-induced diverticulitis, not to mention the unfortunate periodic occurrence of poisoned candy. According to the American College of Emergency Physicians there’s also a serious increase in risk of injury from collisions with motor vehicles, eye injuries from sharp objects, and burns from flammable costumes.
Other Halloween problems include minor inconveniences such as lost fillings secondary to nougat, falls from trees while removing toilet paper, and the occasional rotten egg to the posterior occiput. In our household there appears to be a higher than usual incidence of emesis and general abdominal pain.
Turkey Day: Next comes Thanksgiving, a seemingly benign day of turkey consumption and family cheer. The greatest danger of this holiday remains Salmonella, though Campylobacter jejuni lurks somewhere nearby. Undercooked turkey is a potent source of this infection, as are uncooked eggs in cookie dough.
The amount of time to properly thaw and cook a whole turkey, for example, is much longer than the standard-size poultry pieces and cuts of meat served year-round. When thawed correctly in the refrigerator or at a temperature of no more than 40 degrees F, a 20-pound turkey requires two to three days to thaw completely. Thawing the turkey completely before cooking is important. Otherwise, the outside of the turkey will be done before the inside.
To check a turkey for doneness, insert a food thermometer into the inner thigh area near the breast of the turkey (but not touching bone). The turkey is done when the temperature reaches 180 degrees F. If the turkey is stuffed, the temperature of the stuffing should be 165 degrees F. It is not unusual for whole families to fall ill after eating the Thanksgiving feast. Salmonella may be found in turkey, gravy, stuffing, pies, and other foods served at the Thanksgiving dinner.
Another danger of turkey consumption is its high L-tryptophan concentration. Excessive turkey consumption may lead to significant sleepiness, which when combined with substantial alcohol intake may lead to traffic accidents or, at minimum, falling asleep in front of the television. Of course Thanksgiving is not a healthy day for turkeys.
Perhaps the safest thing about Thanksgiving day is the cranberry sauce. If you can get real sauce and not canned, jellied sugar, you might prevent a urinary tract infection caused by E. coli by inhibiting the bacterial podocytes’ adherence to your bladder wall.
Christmas: Christmas can be a time of great stress, especially for the non-Christian members of our society, who are deluged with holiday images. There is an increased incident of suicide over the peri-Christmas timeframe, perhaps worsened by seasonal affective disorder, though there is no study showing higher suicide rates in this time period in the north.
For some unclear reason there’s a higher rate of deadly train collisions and other disasters over Christmas. The year 1910 was an especially bad year, with eight accidents in the United States, England, and France on Christmas Eve and Day with a total mortality of 56 lives.
As per Thanksgiving, the same dietary risks exist at Christmas, along with the addition of deadly bacterially infested homemade eggnog (best to drink the pasteurized variety). Fruitcake, a mysterious substance not currently listed on the periodic table, is used most frequently as a doorstop. In a limited survey of holiday revelers none of the subjects had actually ever eaten any. In all fairness to fruitcakes, Dec. 27 is National Fruitcake Day.
The most dangerous part of Christmas, besides paper cuts from wrapping presents and frustration from assembling bicycles, is the venerable Christmas tree. A tradition that likely started in 16th century Germany, Christmas trees only became accepted in the United States in the mid-1840s. Trees are a fire hazard and can fall, injuring children. The biggest problem, though, is electrocution from holiday lights placed on the tree and home.
In 1999 the New Zealand Ministry of Consumer Affairs’ Energy Safety Service warned consumers to cease using certain types of lights because of a danger of electrocution. Metal objects—especially tinsel—from a Christmas tree could come in contact with the adapter and act as a conductor. Perhaps Charlie Brown’s tree was best after all.
Both Hanukkah and Kwanzaa have candle-lighting ceremonies—the menorah and kinara, respectively—and carry an increased risk of burns and fires.
New Year’s and Valentine’s: New Year’s Eve (aka amateur night) is a chance for those who never stay up late drinking to do so. Other than vehicular manslaughter, a major risk of this evening is stray gunfire. The Los Angeles Police Department has launched a Citywide Gunfire Reduction Campaign for New Year’s because this has become a time to shoot guns. The best-known treatment for over-libation is the ever-popular menudo (a Mexican soup made with hominy and tripe—not the boy band).
Saint Valentine’s Day is another Hallmark bonanza, as well as an amateur day for lovers. There are many myths involving this saint. One legend contends that Valentine was a priest who served during the third century in Rome. When Emperor Claudius II decided that single men made better soldiers than those with wives and families, he outlawed marriage for young men—his crop of potential soldiers. Valentine, realizing the injustice of the decree, defied Claudius and continued to perform marriages for young lovers in secret. When Valentine’s actions were discovered, Claudius ordered that he be put to death.
A less likely version is that while in prison Valentine fell in love with a young girl—his jailer’s daughter—who visited him during his confinement. Before his death he allegedly wrote her a letter, which he signed “From your Valentine,” an expression still in use today.
The dangers of Valentine’s Day are so pervasive and hideous it is difficult to write about them all, so I won’t. Let it be said, though, that from herpes to HIV, lipstick on the collar to lymphogranuloma venereum, lust can kill.
In the South, Mardi Gras ends the dangerous season. Eye trauma from flying beads and sightings of flying monkeys are a constant threat. I have been to Mardi Gras, but this is all I can remember of it.
So ’tis the season to be jolly, to spend time with our loved ones, and to bask in the familial hearth. Bah, hum and bug. TH
Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, senior associate consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine at the Mayo Clinic College of Medicine, Rochester, Minn.