It's not a myth: death rate spikes during the holidays


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Bill DeSano had been in and out of hospitals for years because of his diabetes.

But this year, there was no way the 59-year-old Shaler man was going to spend Christmas in the hospital, despite a stomach ailment that left him listless on Christmas Eve.

"Oh, no, he wanted no part of the hospital," said his mother, Marie.

On Christmas morning, Mrs. DeSano, who lived with her son, found him unconscious in his bed. She called 911 and paramedics worked on him for 15 minutes.

"But then the officer comes out and tells me, 'I'm sorry. He's gone,' " she said.

It was hard enough losing her only child, but Mrs. DeSano said it seemed doubly cruel to lose him on Christmas.

"I mean, then to have to call people that day and tell them of his passing," she said, choking up. "I just can't believe he's gone."

Unfortunately, Mr. DeSano's death is an all-too-common occurrence around the Christmas and New Year's holidays.

Although sometimes dismissed as anecdotal myth, the spike in holiday deaths has long been a stark reality to those who deal with it as their jobs, from funeral home directors to priests and emergency room staffers.

The Rev. Don Breier, pastor at St. Paul Cathedral in Oakland, has seen it this season.

"I just had my second funeral this week and I'm doing my third tomorrow," Father Breier, a priest for 41 years, said Tuesday. "I've noticed over the years that it is true" that deaths increase over the holidays.

As for why it happens, Father Breier said: "I'm a firm believer that the Lord gives us our day and there's not a thing we can do to change it."

Matt Schellhaas grew up in the funeral business and noticed the jump in funerals over the holidays in college, when he'd come home for winter break and work nearly nonstop. "But it was never like that during summer vacation," he said.

"For some reason, we do find ourselves busier around the holidays," said Mr. Schellhaas, now supervisor of his family's Bakerstown funeral home, which as of Tuesday had already scheduled eight funerals for the week, about double the normal volume. "There doesn't seem to be any rhyme or reason ... though people in the industry tend to say it's because of the cold."

A national study published in October in the journal Social Science & Medicine tried to point to possible reasons after concluding that an increase in holiday deaths indeed occurs every year, in all regions of the country, during the two weeks around Christmas and New Year's.

The study, led by University of California at San Diego sociology professor David Phillips, looked at 57.5 million death certificates from 1979 to 2004.

It found 42,325 more people died of natural causes -- which make up about 93 percent of all deaths -- during the two-week Christmas/New Year holiday period than would normally be expected, given the typical winter increase in deaths.

There also were increases in every major disease group of 1 percent to 10 percent and in every demographic group of 3 percent to 9 percent.

In particular, the study looked at deaths from natural causes in which the patient either was dead on arrival at a hospital or died receiving emergency care, and it found significant spikes throughout the holiday period. In fact, the three days when the most people die of natural causes in either a DOA situation or in an emergency setting are Dec. 25, Dec. 26 and Jan. 1.

"This is not insignificant," Dr. Phillips said. "There is an unusually large number of deaths on Christmas and New Year's. So we can be confident that there is a spike on or around those days. But the explanation of those findings is much less clear and it is probably a bunch of different things."

One emotional explanation Dr. Phillips looked at was whether people fight to stay alive either to die on the day that Jesus Christ's birth is celebrated or because they know family will be around and they can say goodbye.

Dr. Phillips said his data does not contain the kind of information that would describe what people deal with as they approach death, but, "if people were holding on for Christmas, you would expect a significant decrease in deaths before and after Christmas, and we don't see that" and deaths continue to run high throughout the holiday period.

As for Mr. Schellhaas' guess that it's simply colder in the winter, Dr. Phillips said if that were the case, "You would expect fewer deaths in the warmer, southern United States compared to the North, and we don't see that."

In all, Dr. Phillips looked at nine possible explanations -- including that people travel more during the holidays, that there is overcrowding at emergency rooms, and that terminally ill patients try to be home during the holidays -- but could find no data to support any of the explanations.

But considering the data -- and the fact that Dr. Phillips in a prior study found there was an increase in in-hospital accidental deaths related to the traditional changeover in residential staffs in July every year -- he has his own idea about what is going on over the holidays.

"If I had to guess, I'd say it's probably a degradation of medical care and a 'juniorization' of the medical care," he said.

By that he means that a lot of senior medical staffers take vacations over the Christmas and New Year's holidays in such numbers that it contributes to the increase in deaths.

He doesn't expect that would be well-received information.

"If someone says to the medical staff, 'It's because you're taking vacations that people are dying,' it's not easy to hear," he said.

The administrators overseeing the two busiest hospital emergency operations in Western Pennsylvania -- West Penn Allegheny Health System and UPMC -- both said staffing could be a factor in increased deaths, but not a major factor.

"We certainly do see more serious cases and certainly a larger number of DOAs in the emergency departments this time of year," said Tom Campbell, WPAHS chairman of emergency medicine for 17 years. "But I really haven't seen the staffing piece of it to be a problem, at least in the emergency medical world."

Everyone in WPAHS shares holiday duties. But, he pointed out, patients don't have regular access to their family doctors over the holidays, either, "so you have someone not as used to dealing with a patient trying to help them." In addition, patients tend to put off care over the holidays, said Donald Yealy, chairman of emergency medicine at UPMC and an emergency doctor for 22 years.

Of course that's not the case with everyone who dies over the holidays. Dorothy Tame of McMurray was a month from her 92nd birthday when she died on Christmas Day.

Mrs. Tame, who ice-skated into her 80s, had Alzheimer's for several years and "her death really occurred over a three-week period," said her son, Charles Jr.

"I don't see it necessarily as providential; she'd been sick a long time," said Mr. Tame, whose late father, Charles Sr., was a well-known pastor in the region because of his Happiness Hour Radio Ministry, which his mother produced.

"She just happened to pass away on Christmas," he said. "But we're a family of faith, and we kind of take delight in the fact that the birth of our lord and savior that we celebrate on Dec. 25 happened to be the day he called her home."


Sean D. Hamill: shamill@post-gazette.com or 412-263-2579. First Published December 31, 2010 5:00 AM


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