Every December, I return to Charles Dickens’ A Christmas Carol. It has become a ritual—my small act of seasonal medicine. For some people, this time of the year calls them to parang; for me, it calls me back to Ebenezer Scrooge, staring into the shadows of his own life, waiting for the ghosts who will remake him.
Dickens published the novella in 1843, in a Britain that was staggering under poverty, malnutrition, child labour and preventable disease. It was a time before penicillin, before public sanitation, before humane labour laws. He wrote not from comfort, but from the memory of his own childhood suffering—his father imprisoned for debt, his family shattered and young Charles sent to work in a rat-infested blacking factory to survive. Dickens wrote the classic tale as a protest, a plea, and ultimately, a prescription for a sick society.
The ghosts examine Scrooge the way we examine our patients—through history, through context, through prognosis. They take a man hardened by wealth and isolation and force him to look directly at the consequences of neglect. In Scrooge’s transformation lies the heart of Dickens’ message: no society can be healthy if compassion is absent from its bloodstream.
Nearly two centuries later, Dickens feels eerily contemporary with wounded spirits. The crowded clinic waiting rooms. The ambulance sirens that pierce our nights. The elderly man who comes to the hospital not for medication but for conversation. The children who struggle through school while living with disabilities that no one diagnosed early enough. The diabetic who rationed insulin because the pharmacy shelves were bare. The exhausted family overwhelmed by caregiving duties.
If Dickens were alive today, he would not need ghosts; a simple tour through any regional hospital would give him material for another masterpiece.
When the Ghost of Christmas Past lifts Scrooge back into the memories he tried so hard to bury, we witness the soft wounds that hardened him. Dickens understood what modern medicine now confirms: early trauma shapes lifelong health.
Children who grow up in unstable homes, exposed to violence, poverty, or abandonment, face higher risks of diabetes, hypertension, heart disease and depression. Their bodies remember stress long after their minds force themselves to forget.
We see these “silent scars” in our clinics every day. The adult with uncontrolled hypertension who grew up skipping meals. The woman with chronic pain whose childhood was marked by trauma.
The man battling alcoholism because he learned early that the world was not a safe place. Dickens’ own childhood incarceration in poverty rippled through his writing like a prolonged ECG tracing. He knew that society often blames the individual without acknowledging the environment that shaped him.
So does medicine. I am reminded that many of our patients carry similar ghosts. They do not need judgement; they need understanding. They need the kind of compassion Dickens begged the world to show.
When the Ghost of Christmas Present leads Scrooge through London, we see hunger, overcrowding, illness, and the quiet heroism of everyday families—conditions that mirror our own Caribbean challenges.
Look at Tiny Tim. A child with a disability who—like so many here—relied on the strength of his family because the system around him failed. Dickens never named Tim’s illness, but modern scholars suggest renal disease, tuberculosis of the spine, rickets or muscular dystrophy. Whatever the diagnosis, Dickens used Tim not for sentimentality but as a spotlight on public neglect.
T&T’s own Tiny Tims exist in plain sight:
Children needing speech therapy but waiting years for an appointment. Teenagers with autism whose parents fight daily battles for school placement. Young adults with sickle cell disease navigating pain crises without adequate support.
Children with disabilities who are refused entry into schools because “we don’t have resources.”
And we dare call ourselves a modern society?
Dickens wrote Tiny Tim not to trigger pity, but to galvanise action. If the Ghost of Christmas Present landed in a hospital at 6 am on a Monday morning, he would see Dickens’ world alive again—different century, same wounds.
The final spirit—silent, hooded, relentless—shows Scrooge the stark truth: if nothing changes, nothing improves. The future, uncorrected, becomes tragedy.
As physicians, we know this ghost well. It appears in the predictable arc of uncontrolled diabetes leading to neuropathy and amputation.
In untreated hypertension culminating in stroke. In missed screening leading to a late cancer diagnosis. In the young man with untreated depression who finally stops calling for help. In the dialysis unit overflowing with patients who should have received preventative care long before.
Dickens was warning his readers: ignore suffering now, and you guarantee suffering later.
Our health system today rests on the same precipice. If we do not invest in prevention, education, nutrition, mental health, and disability support, we will spend decades paying for the consequences.
We already are. If Dickens walked through T&T in 2025, he would not be shocked by our health disparities—he had seen them before. But he would ask: How can a nation with so many resources still allow children with disabilities to be excluded from education?
How can we celebrate Christmas while families beg for food or lifesaving medication?
How can we claim to value public health but ignore the tsunami of chronic disease?
How can we profess goodwill while our most vulnerable citizens fight silent battles?
And most painfully:
Why do we only talk about compassion in December?
By the end of the novella, Scrooge awakens transformed—not just joyful, but responsible. He pays fair wages. He supports care. He shows up. He becomes, in Dickens’ words, “as good a friend, as good a master, and as good a man as the good old city knew.” This Christmas, may we—like Scrooge—wake up transformed.
I cannot read A Christmas Carol without hearing modern echoes. Every ward round, every clinic, every emergency department becomes a stage where compassion either thrives or fails.
Dickens’ ghosts are reminders:
• Look back—understand the roots of suffering.
• Look around—see the need before you.
• Look ahead—change the future before it becomes irreversible.
The health of a nation is not measured by statistics. It is measured by how we treat the most fragile among us.
And perhaps that is Dickens’ true brilliance: he knew that in healing others, we sometimes heal ourselves.
