Spooky Nights on Call: Halloween Tales & Tricks for Resident Physicians

Sign Up for Free Qbank Access

Halloween, for many, is a time of spooky fun, wild costumes, and candy overload. But for resident physicians on call, the night is far from a playful scare. Instead, it’s a dizzying gauntlet of bizarre injuries, illnesses, and the occasional patient still dressed as a spaghetti monster with bloody marinara sauce dripping off a fork accessory. Meanwhile, you scramble to figure out whether it’s the costume or an actual medical emergency. Not exactly the kind of Halloween trick you were looking for!

Tales From the Shift: Three Halloween Stories

When the clock strikes midnight, the hospital transforms into somewhat of a haunted house. Patients dressed as witches, werewolves, and zombies stagger into the ED. It’s hard to tell where the costumes end and the real injuries begin.

Here are a few stories I’ve seen/heard from witching hour on Halloween night!

Case 1: Zombie Panic Attack

Ah yes, the time a teenager strolled into the ED wearing a full zombie costume, complete with rotting skin, a foul stench, fake blood, and a dead stare that made even the seasoned ED nurse do a double take. But this wasn’t just your average post-apocalyptic zombie roleplay—this patient was in the middle of a full-blown panic attack. It turns out he’d been working at a haunted house, giving patrons the fright of their lives, when suddenly he was the one who needed resuscitation after collapsing during a scare.

Rumor has it he got punched in the chest by a terrified customer, which left him gasping for air and in a state of cardiac arrest. Could it have been a case of commotio cordis? Possibly. A direct blow to the chest is no joke, as it can lead to dangerous heart rhythms, even in a seemingly healthy teenager without prior cardiac history. Luckily for our zombified patient, a quick defibrillation brought him back to the land of the living.

Lesson learned: if you’re working at a haunted house, remind your audience that laying hands on the actors is NOT part of the show. And to my fellow residents, be prepared for anything in the ED, especially around Halloween. If someone in full costume comes in gasping for breath, take it seriously and rule out the dangerous causes first. An EKG is often easily obtainable!

The main ED seems quiet for now, let’s check out how things are in the trauma bay.

Case 2: Pumpkin Carving Gone Wrong

We all love a good jack-o’-lantern, right? Well, this patient’s pumpkin carving took a sinister turn. A young woman, two weeks shy of her wedding, tried to impress her groom-to-be with some decorative pumpkins in the front yard. As she was channeling her inner Picasso with a table saw, instead of crafting a masterpiece, she ended up carving off a couple of fingers, including the one with her engagement ring.

Cue the Halloween safety reminder: pumpkin carving might seem safe, but it can land you in the OR faster than you can say “trick or treat.”

As we prepared the woman for surgery, we couldn’t help but think about all the other festive hazards lurking around. Knives, saws, sharp props—Halloween is a goldmine for hand injuries. If you happen to get called to the ED for one of these, remember the first aid basics: wrap those severed digits in saline-soaked gauze, bag them up, and keep them chilled. Just don’t put them directly on ice, unless you want frostbite to be the final nail in the coffin. Then, a quick call to the plastic or orthopedic hand specialists is in order.

Pro tip: if you’re on call this weekend, prepare for a flood of lacerations, burns, and—yes—severed fingers. And remind your friends to carve pumpkins with caution.

Case 3: Bee Sting Surprise

A middle-aged man had been enjoying a fun afternoon at a pumpkin patch with his kids. His stomach grumbles as he chomps down on a delicious apple cider donut. He’s living the autumn dream—until a rogue bee, drawn to the sugary glaze, decides to hitch a ride into his mouth.

The man, allergic to bee stings, experienced an immediate reaction: tongue swelling, hives, and the works. Thankfully, he had an EpiPen on hand, and he was only 10 minutes from the hospital. He presented to the ED as a precaution, and we treated him with the usual cocktail of epinephrine, antihistamines, and steroids. His allergic reaction? Defeated.

Halloween tip: for patients with allergies, the treats may contain some hidden tricks. Make sure they’re carrying their EpiPen, and remind them to read candy labels carefully. You never know when a well-meaning neighbor will hand out peanut-laden chocolate bars disguised as a fun-size treat.

Want to test your knowledge with more practice cases? Sign up for Question of the Week to get Rosh Review practice questions sent straight to your inbox—for free!

I hope you enjoyed the spooky stories! Now, here are some tips to surviving Halloween night if you’re on call.

10 Tricks to Help Residents on Halloween

1. Prepare for the unexpected.

Halloween is prime time for unusual injuries. Be ready for patients showing up with costume-related mishaps, from accidentally gluing themselves into outfits to burns from DIY makeup experiments. Your job is to expect the unexpected and handle whatever comes through the door with calm competence.

2. Pace yourself.

Halloween night on call is a marathon, not a sprint. With the emergency department bustling and the wards full of activity, it’s essential to pace yourself. You’ll likely need a boost to keep going, but try not to overdo it with caffeine.

Instead, make sure to stay hydrated, have snacks on hand, and take breaks when possible, even if they’re just a few minutes to catch your breath. Prioritize your tasks and know when to delegate or ask for help.

3. Dig deep and lean into your history-taking skills.

There will be some strange cases and it’s up to you to identify and separate relevant symptoms from mystical stories. In other words, be thorough, ask the right questions, and don’t let any cryptic details slip through the cracks!

4. Watch out for candy.

While candy is everywhere during Halloween, it can bring its own set of challenges. Be prepared for cases involving allergic reactions, particularly to nuts, and for kids showing up with candy-induced stomach aches or sugar highs.

You might also need to manage concerns about choking hazards, especially for younger children. Keeping an eye on these potential issues can help you anticipate and act quickly.

5. Stay safe yourself.

Amidst the chaos, don’t forget to look after yourself. It’s easy to get caught up in the flurry of activity, but maintaining your own well-being is essential. Take short naps if you can, drink water throughout the night, and make sure to eat. Maintaining your focus and energy will help you provide the best care for your patients, no matter how wild the night gets.

6. Stay vigilant for intoxicated patients.

Halloween is a prime night for parties, which means you’re likely to see a spike in cases involving alcohol and substance use. Be prepared for everything from minor intoxication to severe cases like alcohol poisoning or drug overdoses. Remember to check for hidden injuries or illnesses that might be masked by intoxication, and always monitor for signs of aggressive behavior in overly intoxicated patients.

7. Be mindful of psychiatric concerns.

Halloween’s themes of horror and fear can exacerbate anxiety, PTSD, and other mental health conditions. Some patients may experience heightened stress, flashbacks, or panic attacks. Approach these situations with extra sensitivity and patience, and be prepared for a potential increase in mental health admissions.

Costumes can bring unique challenges. Watch out for patients with issues related to tight or restrictive outfits, skin reactions from face paint or latex, and even injuries from props (like swords or wings). Costume accessories can also pose hazards, so be mindful when assessing injuries and don’t overlook the possibility of foreign objects or compression injuries.

9. Have a plan for triage and crowd control.

The hospital may see an influx of patients, especially in the ED. This can lead to bottlenecks and overcrowding, which can increase stress for both staff and patients. Have a plan to manage patient flow, triage effectively, and ensure everyone gets the care they need. Communicate with your team to stay organized and coordinated throughout the night.

10. Keep some emergency supplies handy.

If things get busy, it helps to have a stash of essentials like extra gloves, masks, snacks, and water. You never know when you’ll get a chance to refuel, so having quick access to necessities can make a big difference in getting through the night. Plus, a quick snack break can boost your energy and morale.

Final Thoughts

Halloween may be spooky, but the real horror stories unfold in the hospital. Between panic attacks from haunted house actors, pumpkin carving injuries, and bizarre cases like a mouthful of bees, the nights on call during this holiday are anything but dull. You’ll encounter everything from candy-induced sugar crashes to costume mishaps, and maybe even a few patients who believe they’ve been hexed.

So, as you don your white coat and step into the night, keep your guard up, your sense of humor intact, and a stash of gauze ready for the unexpected. Use the tricks above to help make a hectic Halloween shift a bit more manageable. Happy Halloween, and may your on-call night be more treats than tricks!

By Mike Ren, MD

Mike is a driven tutor and supportive advisor. He received his MD from Baylor College of Medicine and then stayed for residency. He has recently taken a faculty position at Baylor because of his love for teaching. Mike’s philosophy is to elevate his students to their full potential with excellent exam scores and successful interviews at top-tier programs. He holds the belief that you learn best from those close to you in training. Dr. Ren is passionate about his role as a mentor and has taught for much of his life–as an SAT tutor in high school, then as an MCAT instructor for the Princeton Review. At Baylor, he has held review courses for the FM shelf and board exams as Chief Resident. For years, Dr. Ren has worked closely with the Office of Student Affairs and has experience as an admissions advisor. He has mentored numerous students entering medical and residency and keeps in touch with many of them today as they embark on their road to aspiring physicians. His supportiveness and approachability put his students at ease and provide a safe learning environment where questions and conversation flow. For exam prep, Mike will help you develop critical reasoning skills, and as an advisor, he will hone your interview skills with insider knowledge to commonly asked admissions questions.