Abstract
Every Christmas season children’s hospitals in the United States are flooded with gift donations. Businesses, service organizations, and the public deliver carloads of new toys, puzzles, games, books, electronics, sports equipment, art supplies, cosmetics, blankets, and clothing for sick children. The practice is so common and widespread that donors rarely ask whether they may donate, what types of donations are welcome, and when and where they should deliver their donations. Based on ethnographic observations of holiday gifting at University Children’s Hospital, a nationally ranked pediatric hospital on the West Coast, the purpose of this paper is to investigate the implicit cultural beliefs that guide holiday gifting practices. Eschewing the popular rhetoric of American hyper-consumption and hedonism, I use a Durkheimian framework to argue that holiday gifting in children’s hospital is a sacred ritual. The data presented describe the wide-ranging variety of donors—from Boy Scouts to nightclub strippers—who journey to the hospital bearing gifts. Drawing on sacred conceptualizations of childhood and gifting in American culture, I argue that children’s hospitals are more than medico-scientific institutions. They represent sacred unifying spaces and the heart of their local communities where individuals and organizations come to privately and publicly reaffirm their moral commitments to society through holiday gifting.
University Children’s Hospital is a 150-bed public teaching hospital in a midsize city on the West Coast of the United States. With a Level I pediatric trauma center and nationally ranked programs in pediatric cancer, cardiac surgery, and neurosurgery, the life-saving hospital treats patients from four different states, logging more than two hundred thousand discharges, surgeries, transports, and outpatient visits annually. At the front entrance of the hospital, in the center of a large elevated metal disc burns an eternal flame, memorializing past patients and symbolizing hope for the future. Just inside the hospital’s first set of automatic sliding doors, the vestibule houses a fleet of shiny red Radio Flyer wagons, available to help families transport their wee ones and belongings up the elevators and down the corridors of the hospital. The second set of sliding doors opens to the lobby where brightly colored papier-mâché birds hang from the ceiling and framed nautical-themed watercolor paintings, created by children, adorn the walls. There is an information desk, restrooms, an elevator bank, two sitting areas, a grand piano, and an eternally long line to the coffee shop counter. 1
At the end of each year, a local company erects an eight-foot festooned Christmas tree in the vestibule. Local service organizations deck the halls of the hospital wards and clinics with tinsel garland and Christmas décor. Nurses and medical assistants don their candy cane and snowmen-patterned scrubs. Parents sport ugly Christmas sweaters and holiday print leggings, toting children bundled inside puffy coats and warm hats to keep off the winter chill. Holiday cheer floats above the dramas that play out daily inside the hospital. Babies fuss. Children chatter. Parents shed silent tears. All the while, talented hospital volunteers strike up familiar Christmas carols on the grand piano.
Throughout the month of December, service organizations, local businesses, and private individuals pull up to the front doors of pediatric hospitals across America to deliver carloads of Barbies, Transformers, Legos, and My Little Ponies, sparkling new in glossy packaging. The consumption frenzy that characterizes the marketplace and defines intimate social relations at Christmastime in America permeates all aspects of American life, including children’s hospitals, which are buried annually under a veritable avalanche of toy donations. The tradition (Duncan 1993; Fuller and White 1923; Oxtoby 2003; Wahlstrom et al. 1912) 2 is so widespread and taken for granted that most donors do not ask hospitals whether they are permitted to bring gifts, which types of donations would be most suitable for patients, or when and where to deliver donations. Based on ethnographic observations at University Children’s Hospital (UCH), this paper unpacks the yearend holiday gifting tradition in children’s hospitals to better understand the sacred nature of this practice and how integral public pediatric hospitals are to the moral fabric of the communities they serve.
Presently, the United States is characterized by declining religiosity, persisting segregation, and unprecedented political polarization (Charles 2003; Chaves 2017; Hochschild 2016; Massey and Denton 1993). In an age of secularization and deep division, holiday gifting practices demonstrate that many disparate sectors of American society still find common ground based on shared values. This paper presents accounts of the individuals and organizations that deluge a children’s hospital with holiday gifts to demonstrate the diversity of these social groups, raising the question, what are the shared cultural values that inspire collective behavior? Drawing on Emile Durkheim’s (2001) concept of the sacred and bringing together scholarship on gifting, the sacralization of childhood, and Christmas commerce, I argue that holiday gifting in pediatric hospitals is a sacred ritual in the United States, which reflects deep-seated cultural beliefs about modern childhood, the pricelessness of children, and Americans’ spiritual relationship to shopping.
This paper contributes to current conceptualizations of medical institutions by reframing pediatric hospitals as sacred spaces. Social scientists have long identified medicine as an institution of social control, exploring the biomedical model of disease and theorizing the processes of medicalization and biomedicalization (Clarke et al. 2003; Conrad 1992b, 2005; Zola 1972). The medical sphere has proven to be a useful field site for examining social constructions of race, class, gender, sexuality, disability, and disease, and for exposing social inequality (Barnes 2014; Bridges 2011; Brown 1995; Conrad 1992a; Dull and West 1991; Farmer 2001; Martin 1987 among many others). Rather than examine the internal workings of medical institutions, this analysis of holiday gifting zooms out to an aerial view, metaphorically, allowing us to see how communities relate to their hometown pediatric hospitals, demonstrating that pediatric hospitals are situated at the center of a web of organizations and individuals.
Pediatric hospitals serve basic practical and social functions. In practical terms, hospital staff administer medications, manage equipment, and perform procedures that help make sick children well and help families manage chronic pediatric illnesses and disabilities. The obvious social functions of children’s hospitals are to educate families, provide social support, and connect patients with community resources. Holiday gifting practices, however, demonstrate that pediatric hospitals serve a broader social function that extends beyond the immediate patient population to the surrounding community. In Durkheimian terms, the ritual of holiday gifting to a children’s hospital provides social cohesion for large networks of disparate individuals and organizations—from philanthropic groups to casinos, the Boy Scouts of America to strip clubs—and reaffirms society’s moral commitments.
In the following section, I introduce Durkheim’s concept of the sacred and review scholarship on some of the sacred elements associated with holiday gifting in a children’s hospital. Next, I describe the ethnographic research methods used for this study. From there, I present my data: a sampling of the businesses, private individuals, and service organizations that donated to the hospital in 2017. This section includes fieldnotes, thick descriptions, and some analysis of my observations. The penultimate section of the paper draws on data and literature to consider the sacredness of sick children, their role in society, and how sick children shape Americans’ affinity for pediatric hospitals. Finally, the concluding section recommends a model for understanding the social and sacred functions of children’s hospitals, describing how and where they fit in their communities.
Conceptualizing the Sacred: Childhood, Gifts, and Christmas Commerce
In his seminal work, The Elementary Forms of Religious Life, Emile Durkheim (2001, originally published in French in 1912) defined religion as more than a set of rote answers to imponderable questions and a list of rules for moral behavior. Rather, “religion is a unified system of beliefs and practices relative to sacred things” (46), which binds people to their god and each other (171). According to religious scholar Mark Cladis (2001), nineteenth-century Western philosophers predicted that the downtrend in religious participation would inevitably lead to the concurrent disintegration of religious life and community life. But Durkheim believed new moral communities could be forged in secular spaces—in “political, economic, and even scientific realms” (vii-viii)—with the same energies, passions, and sensations as religion (Durkheim 2001, 317). When others augured the unraveling of society, Durkheim “saw the possibility of the birth of new gods, that is, innovative, sacred avenues of human flourishing not yet realized” (Cladis 2001, xxxv).
Over the past century, Durkheim’s work has been criticized as methodologically weak, theoretically overreaching, analytically racist and sexist, and functionalist to a fault (Allen, Pickering, and Miller 1998; Cladis 2001; Gane 1992; Santiago 2012). The most common critique, perhaps, regards Durkheim’s theory that the world can be neatly divided into two domains: the sacred and the profane (2001, 36). According to Durkheim, sacred things are “superior in dignity and power to profane things” (37) and are the unifying symbols of religion (46), whereas the profane refers to the banal, the mundane, the everyday. Critics persuasively argue that many objects, ideas, practices, and spaces cannot be neatly classified as sacred or profane; rather, things can have sacred and profane qualities and move fluidly between the two domains (Evans 2003; Mckechnie and Tynan 2006). A century of scholarly debate has demonstrated that Durkheim’s notions of the sacred and profane have staying power. In short, Durkheim aptly identified the tangible qualities of intangible phenomena and created a language for discussing “the religious aspects of the social and the social aspects of the religious” (Cladis 2001, xxxv). The notion of the sacred remains foundational to social theory and analysis and is recognized as a cultural universal. Durkheim’s work is useful to this analysis because it has framed and influenced so much of the scholarship on gifting, childhood, and commerce, which this analysis builds upon.
According to Durkheim (2001), “anything at all” has the potential to be sacred (36). In recent decades, social scientists have identified dozens of seemingly profane or secular things that are imbued with sacred meaning, from tangible objects and spaces, like money and tourist sites, to abstract concepts, like memory, politics, and violence (Misztal 2004; Belk and Wallendorf 1990; D’Agostino 1988; Jacobsen 1997; Joas 2008; Mathias 2013; Meuschel and Konczol 2006; Ryan 2015). According to this wide-ranging literature, “the sacred” inspires joy, peace, strength, and collective veneration and reaffirms shared beliefs and social identities. The sacred maintains transcendent power and incalculable value; requires or symbolizes sacrifice; and represents political, religious, or moral ideologies. Many examples of the sacred, including childhood, Christmas, shopping, market goods, charity, and gift-giving (Bartunek and Do 2011; Beckert 2010; Belk 1987; Mauss 2000; Zelizer 1985), relate directly to this analysis of Christmas gifting at a children’s hospital, representing overlapping and compounding notions of sacredness.
While Durkheim envisaged “the birth of new gods” in Europe, childhood was undergoing a process of sacralization in the United States. In her historical analysis of wrongful death lawsuits of children, Viviana Zelizer (1985) describes the sacralization of childhood, how children’s lives, redefined by child labor laws and compulsory education laws, became imbued with religious meaning and sentimentality at the turn of the twentieth century (11). Children’s labor production was historically essential to most American families’ economic survival, so the worth of any given child could be calculated in fixed dollar terms. In the era of industrialization, urbanization, and immigration, new protections emerged to ensure children’s health and safety: labor laws forbid child labor, and children’s rights to public education were expanded. As children’s economic roles changed, as they were phased out of the labor market, and as their earning potential diminished and they became economically “useless,” children became increasingly valuable, even “priceless” (3, 70–72).
Many objects undergo the sacralization process. Belk and Wallendorf (1990) posit that when otherwise banal objects are gifted, collected, or inherited, they become sacred. Gifts, collections, and heirlooms “involve the self-transcendence, myth, mystery, and power of the sacred” (40). More broadly, Beckert (2010) frames all marketplace goods as objects with symbolic meaning and, drawing on Durkheim, “totemistic qualities” (10), because they offer status, personal transformation, and meaning to people’s lives, promises that transcend calculable economic value (8-9). Contrary to popular belief, Beckert argues that consumption is not the expression of hedonistic individualism, but “is in many ways connected to the social and moral order of society” (6). Similarly, in her analysis of American consumerism, Zukin (1991) maintains that shopping “defines the spiritual territory of our lives” (2) and represents “a virtuous ideal of value that we no longer get from religion, work, or politics” (8). Perhaps, no form of shopping is more virtuous than shopping for others (Miller 1998). Giving to others is a sacred act (Belk 1987; Caplow 1982; Linn 2004; Mauss 2000), particularly when people give “pure gifts”—those that meet the desires of the receiver with no expectation of something in return (Malinowski 1922), and especially when giving is part of a larger holiday, or holy day, tradition (McKechnie and Tynan 2006). Three decades ago, Belk (1987) argued that Santa is the god of materialism, the Deity of modern America, and consumption is the new religion (93–94). More recently, Bartunek and Do (2011) have argued that the sacralization of Christmas commerce is nothing new, but a cultural phenomenon three centuries in the making. From Calvinist theology to modern Christianity, predominant American religions have long avowed the virtues of financial prosperity, charity, and social order, all of which are celebrated and sacralized through Christmas commerce and gift exchange.
Much of the pageantry and lore of Christmas focus on children as the beneficiaries of the elusive chimney-hopping Santa Claus, his hardworking elves on the production lines at the North Pole, and the flying reindeer that transport goods. According to holiday tradition, children deserve presents for Christmas (Barnett 1954; Levi-Strauss 1993; Miller 1993; Restad 1995). While families lavish their own children with gifts, there is ample evidence that Americans also give generously to children they do not know. Numerous toy drives, giving trees, and adopt-a-family programs lead by schools, churches, service organizations, and private foundations collect gifts for needy families, foster children, and sick children. The stated mission of the popular US Marine Corps Reserve Toys for Tots Program is to “collect new, unwrapped toys. . . and distribute those toys as Christmas gifts to less fortunate children in the community in which the campaign is conducted” (Marines Toys for Tots Foundation 2017). Likewise, the San Francisco Firefighters Toy Program “believes that no child should be without a toy during the holiday season” (San Francisco Firefighters 2018). In 2016, this single program alone collected more than two hundred thousand toys, which were distributed to individual families in need, family shelters, inner-city schools, and pediatric cancer and AIDS patients. By any rough estimate, Christmas toy drives in cities across America pull in and distribute millions of donations for children each year.
With so many programs designed to provide Christmas gifts for children, what is unique about holiday gifting at a children’s hospital? First, children’s hospitals do not usually hold their own toy drives. While most hospitals provide online information about the types of donations they accept year-round, they do not explicitly solicit Christmas gifts. In other words, donors’ behavior is based on shared cultural beliefs about what sick children need and deserve during the holidays. In the case of University Children’s Hospital described here, many donors, from private individuals to large organizations, host their own private toy drives for the hospital. These campaigns are often unsolicited by UCH and may even use the name of the hospital in advertising without permission. This leads to my second point: because holiday gifting in a children’s hospital is unsolicited, spontaneous, and instinctual for the American public, this vast collective effort demonstrates shared beliefs, common values, and tacit knowledge across a wide population. As the data presented here demonstrate, children’s hospitals serve as their communities’ nerve centers, a common space where businesses, churches, schools, social clubs, and individuals make appearances to exercise and reaffirm their moral commitments to their community, a practice analogous to the millennia-old custom of lighting votive candles in cathedrals. Local institutions become linked to each other through their shared ideology and visits to a shared space.
Methods
In 2015, in preparation for research, I spent one hundred hours volunteering in a playroom at UCH, where I led art projects, played Legos, and pieced together puzzles with UCH patients. From February 2016 to December 2017, I returned to UCH as a “Visiting Sociologist,” and conducted an ethnography of University Children’s Hospital. With the IRB approval of my home institution, UCH issued me a standard photo identification badge, which all hospital staff and trained volunteers are required to wear, and which provided me with swipe access to all hospital units. Though my IRB application listed several hypotheses and a dozen research questions, my ethnographic research was inspired and guided by one simple question: Why do children’s hospitals look and feel different than adult hospitals? In the field, as I shadowed hospital staff in their daily routines, I quickly discovered how essential holiday donations were to the material culture of the hospital. Toy, game, and book donations were carefully hidden in the cupboards and tucked above the cabinets of nearly every office and staff lounge throughout the hospital. The gifts, which were distributed year-round—long after the holiday season had passed—were used as social lubricant to aid staff in building trust with their patients, to provide entertainment and distraction for patients, and as therapeutic tools to help patients develop physical and cognitive skills. While UCH receives massive donations each Christmas, the adjacent general (adult) hospital receives only paltry handouts: a few bags of socks, crocheted afghans, and books. In 2015, as a hospital volunteer, I helped with donation intake in the days leading up to Christmas. To better understand the flow of holiday donations through the hospital and the cultural meanings of gifting practices, I offered to help with donation intake again in 2016 and 2017. 3
This analysis of holiday gifting represents a slice of a larger research project on the culture of pediatric medicine. In 2016 and 2017, I logged seven hundred hours shadowing UCH staff on their daily activities and conducting semi-structured interviews with UCH staff and patient families. 4 In December 2016 and December 2017, I conducted participant observation, working alongside staff and volunteers to receive, sort, and store the holiday donations that inundate the hospital at the end of each year. 5 Participant observation has a longstanding tradition in the social sciences as an ethically responsible method for understanding human behavior, because firsthand participation disrupts researcher subjectivity and promotes physical, cognitive, and emotional empathy (Evans-Pritchard 1940; Malinowski 1922; Mead 2001). 6 As a participant observer, I witnessed and handled the delivery, volume, and types of holiday donations brought into the hospital. I held informal interviews as I personally interacted with representatives from local businesses and organizations as well as the private individuals and families who delivered donations to the hospital. I observed the incoming stream of donations from countless groups. I recorded my interactions and observations in fieldnotes and elaborated them in journal entries. Finally, I coded my data thematically and sorted it for presentation here.
General observations are drawn from my experiences in 2016 and 2017, in which I logged roughly twenty-four hours each year from mid-December until Christmas receiving and sorting donations. 7 The stories highlighted here are from 2017, specifically, but they represent the types of donors and donations that characterize holiday gifting at the hospital in any given year. In 2017, I worked six four-hour volunteer shifts in the ten days leading up to Christmas. I spent the first two shifts manning the donation intake station in the lobby. For the remaining four shifts, my duties entailed transporting donations from the lobby to the sorting room upstairs and sorting donations. (I address the elaborate processes of sorting, storing, and distributing donations in a separate paper.) Some data presented are drawn from news stories and social media, in which donors describe their holiday gifting experience at UCH. As per HIPAA regulations and the IRB protocol, the names of the hospital and individuals have been pseudonymized.
Because I could not confirm the racial or ethnic identities of the donors, I do not include racial or ethnic descriptions in these accounts. In the stories that follow, I describe the donors I observed as men or women based on apparent gender identities and I suspect that the donors represent people of white, Hispanic, Native American, and Asian backgrounds. UCH serves a diverse, though predominantly white, population and is publicly committed to serving children regardless of their race, ethnicity, legal status, religion, or gender. While I do not know the religious backgrounds of the people I observed, it is worth noting that UCH is in a state bottom-ranked in religiosity. And though Christmas is a historically Christian holiday, in the United States people of all religious and nonreligious backgrounds may participate in the holiday tradition. The hospital patients who are the beneficiaries of holiday donations represent various racial, ethnic, and religious backgrounds.
Pediatric hospital patients in the United States generally range in age from newborn to late adolescence. Admissions also include some adults, as pediatric age cut-offs vary by medical specialization and disease. UCH patients include infants, children, teenagers, and young adults with birth defects, genetic disorders, injuries, disabilities, infectious diseases, and noncommunicable diseases. Children’s hospitals may be private for-profit organizations, private nonprofit organizations, or public organizations that receive government funding. Many of the top-ranked pediatric hospitals in the United States, including UCH, are academic teaching hospitals, which receive public funds. UCH charges patients’ insurers for services rendered and bills patients for remaining balances. Because UCH receives public funds, they are required by law to provide quality medical care to anyone who seeks care there regardless of their ability to pay. Children from low-income families often qualify for federal- and state-funded insurance programs that provide comprehensive coverage. Because of the astronomical costs of medical care in the United States, and inequitable health insurance programs, families at any income level can incur large medical bills.
I am a medical sociologist and ethnographer. I am also a white heterosexual woman, a US citizen, and a resident of the geographic community UCH serves. Though no member of my family has received care at UCH, I personally know people who work at UCH or have been treated there. As a parent and adult cancer survivor, I champion accessible quality healthcare for children and adults. I recognize that my own identity, experiences, biases, assumptions, and political leanings shape the lens through which I view my field site. I strive to acknowledge my biases by providing raw data and introspective analysis. 8
Gift Donations: Businesses, Individuals, Service Organizations
At nine o’clock in the morning on December 14—just eleven days before Christmas—I met Jennifer in the lobby to receive instructions for my first holiday volunteer shift. Jennifer is the administrative assistant to the UCH Child Life Program. Certified Child Life professionals are included on staff at many, though not all, children’s hospitals. The job of Child Life staff is to help children cope with their medical experiences inside the hospital through play, education, and expressive activities (AAP 1985; Burns-Nader and Hernandez-Reif 2016). The UCH Foundation, the fundraising arm of the hospital, manages all monetary contributions to the hospital, but the Child Life staff is responsible for processing and managing all in-kind donations in the form of toys, games, books, arts and craft supplies, clothing, and blankets. During Christmastime, peak donation season, the hospital recruits volunteers to assist Child Life staff with donation intake. My job, as Jennifer explained it to me, was simple: sit at the donation intake station in the lobby (a folding table with a handmade sign taped to the front, which read, “Drop Off Donations Here”) and graciously accept donations as they arrive; load donations into the large rolling bins on hand; ask donors to fill out a donor receipt form in triplicate; give the donor the white copy, keep the carbon copies; use the donor address on the receipt copies to address thank-you notes; write thank-you notes to donors; and page Jennifer to let her know when the rolling bins were full. 9
The ritual of holiday gifting attracts an eclectic array of participants. Here I describe a sampling of the many donors who bring gifts to the hospital, including private businesses, private individuals and families, and service organizations.
Businesses
The day before my first volunteer assignment, the nationwide retail chain Happy Pet, had donated dozens—possibly hundreds, but no one counted—of plush stuffed animals: furry dogs, cats, and bunnies, each with a red scarf tied around its neck, embroidered with a white snowflake and the year “2017.” The reason for the donation was unclear. A few staff and volunteers mentioned that the stuffed animals with squeakers inside their bellies were sold at Happy Pet stores as gifts for pets. Perhaps, Happy Pet donated their excess stock to UCH, presumably because the cuddly sixteen-inch stuffies would be difficult to sell in 2018 and the company would receive tax benefits by donating the merchandise to charity. Child Life staff decided to distribute the donations before the end of 2017 rather than store the items for future distribution. They delivered one stuffed animal to every child admitted inpatient at UCH and their siblings and still had dozens leftover. Poorly hidden behind the donation intake station were huge white plastic bags filled with stuffed animals.
“Give every kid one—heck, give ’em a whole bag! I’ve got twenty more bags of these upstairs I have to get rid of,” Jennifer instructed me with some exasperation.
Jennifer was responsible for managing the organization, distribution, and storage of holiday donations. Twenty-odd bags of stuffies portended the inevitable holiday onslaught.
Two women from a local loan agency, overdressed in black pencil skirts and pumps, were the first donors to arrive on my shift. They handed me five large bags full of toys, crayons, and coloring books, which they told me were collected at their office’s Christmas party the night before. Many local companies invite their employees to bring a gift for a UCH patient to put under the decorative Christmas tree at their yearend company holiday parties. In most cases, company donation drives are not coordinated with the hospital beforehand. Both years I volunteered, I observed a steady stream of realtors, paralegals, salespeople, and administrative assistants from various local businesses arrive in the UCH lobby unannounced, arrayed in red Santa hats and dragging wagons and rolling bins brimming with Polly Pockets, Enchantimals, Strawberry Shortcake dolls, Roblox, Teenage Mutant Ninja Turtles, Power Rangers, True Heroes, and Playmobile playsets. The donations from company holiday parties represent hundreds, if not thousands, of American workers who mark another bygone year by exchanging their wages for toys for sick children.
The following afternoon I watched as a large delivery truck pulled up to the loading dock of the hospital and unloaded more than a dozen pallets of large boxes filled with toys, games, puzzles, and arts and craft kits for patients. The delivery came from Blue Skies Casino, located sixty miles from the hospital, which holds an annual toy drive for UCH. According to their online advertisements, casino club members receive $10 of free slot play when they bring a toy gift donation into the casino. The casino supplements the donations collected from their members with more toys and a check for several thousands of dollars. The casino employee who leads the annual campaign arrived at UCH dressed as Santa’s elf in 2016 and as Mrs. Claus in 2017, surrounded by an entourage of Blue Skies employees. Both years, Blue Skies distributed press releases beforehand and, upon arrival, held interviews with local television news crews inside the hospital. In front of the cameras, Mrs. Claus detailed the volume of their toy donations, presented a large check to hospital staff, expressed her gratitude for the services UCH provides for sick children in the community, and reiterated Blue Skies’s commitment to support the community by “bringing smiles” to the children at UCH.
In contrast to Blue Skies Casino, which carefully coordinates their three-week toy drive in cooperation with the hospital, Marco’s Nightclub hosts “Tatas for Toys: A Benefit for University Children’s Hospital” independently. The annual “Tatas for Toys” evening event, which is covered by local media outlets each year and has been replicated in cities around the country, entails two and a half hours of pole and lap dancing performed by strippers. The cover charge for the event is five dollars or one new unwrapped toy for a UCH patient. Funds are raised through admissions, strippers’ tips, and a gift basket auction. After the event, strippers pool their earnings with the event profits, and take the money they have raised (an impressive $5,000 in 2017) to Big Box Discount Store for a toy shopping spree. Then, they fill their cars with stuffed animals, sports equipment, Barbie dream vans, and Matchbox race tracks, and deliver their large haul of goods to UCH. For several years, Marco’s has created YouTube videos documenting the strippers’ late-night shopping sprees and deliveries of hundreds of toys to the hospital.
Holiday gifting practices differed across companies. While Happy Pet used the hospital as a tax-deductible avenue for unloading its surplus merchandise, local businesses led toy drives that encouraged people to peruse, select, and purchase new merchandise in the marketplace. Most local businesses called on their employees to make donations in the spirit of holiday giving, while Blue Skies Casino rallied their customers to bring in donations and Marco’s Nightclub solicited monetary donations, which employees used to purchase toys. Blue Skies supplemented the customer collection with additional items and a monetary donation, whereas most companies did not. From company parties to slot play, the acquisition methods varied across toy drives, but they all culminated in company representatives loading caravans with loot and personally delivering them to the hospital.
Individuals
During my first volunteer shift, an attractive woman with red hair, looking sharp in a gray boiled wool jacket, long skirt, and heels, arrived in the lobby. She dropped several bags of toys next to my table and asked if she could take a rolling bin out to her car to transport more bags. When she returned with a mountain of toys, I thanked her and asked her to fill out a donor receipt. I recorded our interaction in my fieldnotes:
“What company do you represent?” I asked.
“I’m not from a company,” she replied sheepishly.
“Are all these toys from you?” I shot back with wide-eyed surprise.
In a soft voice, she shared her story. Several years ago, she gave birth to a baby girl born with a heart defect. Her daughter underwent multiple surgeries at the children’s hospital in the state where they were living at the time. For months they lived in and out of the hospital until, eventually, her daughter succumbed to the genetic disease. At Christmastime, when she has felt up for it, the grieving mother holds a “social media toy drive,” created as a Facebook event, in memory of her daughter. Over the past month friends dropped gifts off at her home in honor of her daughter to be delivered to UCH.
I listened to her story intently, sorry that I had been so intrusive, grateful for her candor, and heartbroken for her loss. She asked what the hospital would do with the donations. I explained that the children admitted inpatient at the hospital, along with their family members, would receive large bundles of gifts on Christmas morning. The hospital receives more donations than it can use for Christmas, so most items are sorted into boxes and stored for distribution throughout the year. The rims of her eyes reddened, then, smiling, she recalled the many gifts her daughter received during her hospital stays.
“They would tell me my daughter won Bingo.” [No-cost Bingo games are a weekly event in many children’s hospitals, including UCH, where every participant wins a prize.] She laughed, “She was one month old, couldn’t talk—didn’t even have a Bingo card—and they would tell me she won!”
The social media toy drive, she explained, did more than honor her daughter’s memory. It was a way to “give back” to the medical community that had served her family and help other families dealing with medical crises.
The next day I returned to my station in the lobby. Maggie, an eighty-three-year-old retired nurse and hospital volunteer, was assigned to be my partner. Amid the waves of donations, a couple in their late fifties approached our table.
The man wore a conductor’s cap, glasses, wool jacket, faded camouflage army pants, boots, and a long gray ponytail down his back. With a full white beard and lugging four massive white plastic bags over his shoulders, he looked like the inspiration for the kitschy motorcycle-riding Santa Claus figurines. As he dropped the bags into a bin, they fell open to reveal dozens of beautiful quilts—over two-hundred, I later learned. During my fieldwork, I’ve seen bundles of handmade blankets pass through the hospital made by well-meaning amateurs, local church youth groups and Girl Scout troops. However, this trove was different. The quilts were especially well stitched, professional in quality and design.
As if on cue, Maggie and I turned to the woman and asked in unison, “Did you make all of these?”
“No, he did,” she replied, motioning to her husband. “He needed something to keep him busy after he retired.”
Biker Santa, a man of few words, grunted, “She pieces. I quilt.”
The woman, with a plaid shirt and long gray-streaked hair, explained that they have a long arm quilting machine at home. Her job is to collect the fabrics, cut the pieces, and sew them together. Then he loads the quilt layers—quilt top, batting, and backing—into the machine for stitching.
“He’s good with machines,” she said with a mock-manly voice, “So that’s his thing.”
The woman confessed that although many people donate fabric to their quilting efforts, she loves shopping for fabrics and is always buying new prints to complement her existing stock. Then she handed me a bag filled with new children’s clothing and explained that she collects department store coupons and shops the sales events throughout the year. At this, Biker Santa chuckled, poking fun at his wife’s excessive shopping habits. We thanked them again as they said good-bye. Deflecting our gratitude, Biker Santa said that he just wanted to do something for the children at UCH, because—his voice caught in his throat as he choked up and shook his head—
“This is such a special place.”
The following week I received a new assignment: sorting donations with a team of volunteers in a designated room on an upper floor of the hospital. When especially large donations arrived, our team was called downstairs to help transport toys from the lobby to the sorting room. Midweek, we received word that Bailey would be arriving soon, and everyone was to report to the lobby. Bailey is a former UCH patient. Since her life-saving treatment three years ago, she has led toy drives every Christmas season for UCH children. I captured her arrival in fieldnotes as it played out:
All the [Child Life staff] gather downstairs for a special delivery. Bailey, an eleven-year-old brain tumor survivor, has led her own toy drive—a way for her to “give back” and say thanks to the hospital that saved her life. Bailey arrives with a large entourage of adults and a few other kids—friends and family—in matching red shirts, which read, “Bailey’s Toy Drive.” Bailey is easily identifiable as the person with the biggest smile. Bailey’s team brings in a parade of toys in bags and open boxes; returning to the parking lot multiple times to haul in more loads. Soon the entire front half of the hospital lobby is a sea of toys. The Executive Director of the UCH Foundation arrives at the hospital with his own entourage of Foundation staff. Before a crowd of onlookers, the director shakes Bailey’s hand and thanks her for the incredible donation. “The children at University Children’s will be so happy to receive these toys,” he says as the two pose together for pictures in front of the mounds of toys. Bailey is beaming.
Bailey has become a hometown hero. She has appeared on local television news programs every December since her surgery, heralded for her “courage” as a cancer survivor and her “compassion” for other children. Bailey—presumably, with the help of her parents—recruits local businesses to serve as drop-off sites for her toy drive. From construction companies to orthodontist offices, local businesses encourage their employees, customers, and the public to purchase new toys and drop them off for delivery to UCH.
Both the grieving mother and Bailey expressed their desire and intention to “give back” to the hospital. However, in neither case was reciprocity a direct exchange. The grieving mother’s baby was treated at a hospital in another state, but she offered her donation to UCH. Bailey told a local news station that her toy drive was a way to “give back” to the UCH doctors that saved her life, when in fact UCH patients were the beneficiaries of Bailey’s toy drive. Toy drives provide a circuitous route to “give back.” Presumably, pediatric medical professionals find their work with children rewarding. So, if toys bring joy to patients, that will bring joy to the hospital staff, and the circle of reciprocity is complete.
Medical treatments are exchanged for money, so, in theory, when medical bills are paid, there are no outstanding debts to repay. And yet, many patient families feel indebted to the hospital and staff that serve them. Many objects at UCH, including park benches, artwork, toy chests, a costume closet, and art supplies, are donated by families to honor their children who were treated there. Many holiday donations come from families seeking to repay the hospital for the services they received. Repaying medical services with plastic toys for children may not be the most logical exchange. But as several scholars have shown, that which is sacred has no clearly calculable dollar value (Beckert 2010; Belk and Wallendorf 1990; Belk, Wallendorf, and Sherry 1989; Zelizer 1985). In the sacred ritual of holiday gifting, toys for sick children take on transcendent meaning. Because Bailey’s life is priceless, no amount of money can repay the hospital for saving her life. Likewise, a grieving mother’s love for her lost child is infinite, so no calculable figure can honor the child’s memory or the medical professionals who tried to save her life. Holiday gifting is a symbolic gesture, a ritual that taps into Americans’ spiritual connection to shopping (Zukin 2004) and sacred respect for childhood (Zelizer 1985).
I do not know whether Biker Santa and his wife have personal connections to past or present UCH patients. Nonetheless, their story highlights some of the meaning people find in holiday gifting at the hospital. The consumption practices of Biker Santa’s wife, who shops year-round for quilting fabrics and clothes to donate to the hospital at Christmastime, are justified because her purchases are for UCH. In a culture where shopping is a form of entertainment, Americans’ hyperconsumer appetites are often characterized as selfish and hedonistic. These popular beliefs about shopping are what allow Biker Santa to teasingly nudge his wife about her excessive shopping habits. Yet, scholars have argued that greed is a weak explanation for consumption. Market goods are not desired simply for their presumed pleasure, but because purchase and ownership confirm belonging in a moral community and affirm shared values (Beckert 2010; Pugh 2009; Zukin 1991). As Beckert asserts, goods have “symbolic value,” based on the meanings we ascribe to them, the potential we see in them, and how we imagine they will make us feel. The act of shopping for sick children demonstrates belonging in and adherence to a moral community that prizes childhood and strives to protect and preserve the most vulnerable members of society.
Upon retirement, after decades of paid work, Biker Santa had free time to fill. Learning to operate a quilting long arm made him industrious again. Working year-round to produce more than two hundred quilts for UCH patients gave special purpose and sacred meaning to his newfound hobby. Despite his masculine and taciturn persona, the quaver in Biker Santa’s voice revealed a deeply emotional affinity for UCH and the children there. Biker Santa, his wife, the grieving mother, and Bailey are just a few of many examples of people who journey to UCH to deliver holiday gifts.
Service Organizations
UCH receives donations from local service clubs 10 year-round and especially at Christmas. During my volunteer shifts, I observed knitting clubs drop off hand-knit toques, the arrival of one-hundred-plus pairs of colorful socks from the local chapter of the Philanthropic Educational Organization (P.E.O.), and watched as a team of high school students unloaded a van full of toys as part of their senior year service project. Amid the many deliveries to UCH, one especially large load came from a young man’s Eagle Scout Service Project for the national nonprofit organization Boy Scouts of America (BSA). I did not see the delivery as it came into the hospital but watched as intake volunteers shuttled rolling bins filled with donations, a seemingly endless parade of toys, down the corridors from the elevators to my assigned station in the sorting room. Donations clogged the sorting room, logjammed our sorting system, and spilled over into the hallway, blocking traffic and violating the fire code. The toys arrived in large open top donation boxes that had been covered in shiny giftwrap paper with an advertising flyer stapled to the outside of each box. “Christmas Presents for University Children’s Hospital,” announced the flyers. The second line read, “Eagle Scout Project for Jason Stearns,” followed by a bullet point list of preferred donation items. The boxes had been placed in several businesses around town, including a beauty salon and an auto detailing center, where employees and customers were encouraged to donate.
Staff were aware of at least three Eagle Scout Service Project toy drives for UCH that holiday season and said they could expect more throughout the year. According to the BSA, the purpose of the Eagle Scout Service Project is to give young men an opportunity to demonstrate leadership of others by planning and executing a service project aimed at benefiting the community. According to BSA guidelines (Boy Scouts of America 2018), service projects cannot benefit businesses or be commercial in nature, casting high-capital/low-labor projects like toy drives in an ironic light. Unlike, for example, park beautification projects, which recruit volunteers to labor under the direction of a Boy Scout toward a common goal, toy drives encourage people to shop for new merchandise on their own time and dime and drop off their goods for subsequent collection. Arguably, toy drives do not provide an opportunity for Boy Scouts to demonstrate leadership, because there is no direct interaction between the Boy Scouts and the participants, or donors, they are supposedly leading. The solicitation for new items is indeed beneficial to large retail chains and very commercial in nature. Nonetheless, toy drives are approved by the organization and are wildly successful precisely because they tap into widespread moral beliefs about the sacred nature of childhood and Americans’ desire to shop for toys as a way of helping sick children at Christmas.
Discussion: Making Sense of Gifting
In his book The Gift, originally published in 1925, Marcel Mauss (2000) documented the excess of some cultural gifting practices. Drawing on the anthropological record of Native American tribes and Pacific Islanders, Mauss cited several examples of people giving away their wealth, such as food, precious objects, and money, and, in some cases, publicly destroying their wealth. Though these practices appear as “lavish expenditure and childish prodigality,” Mauss surmised that seemingly excessive consumption and giving serve to reinforce social ties and hierarchies (74). Though there are real differences between the gifting practices identified by Mauss and those analyzed here, Mauss’s work helps us to understand that excess does not always mean waste. Excessive giving can have meaning that transcends economic logic.
One could make the case that the practice of holiday gifting to children’s hospitals is wasteful. Flashy new toys do not meet the immediate needs of sick little ones or their families. By contrast, monetary donations, which the hospital also receives, can be used to cover medical bills, prescriptions, and equipment for patients; provide accommodations, transportation, and food for families traveling to the hospital; and are invested in medical research, staff training, community education, and outreach programs. According to hospital staff, the most valuable gifts for patient families are gift cards for gas, groceries, and restaurants, because so many families in the hospital are on unpaid leave from work and are far from home. And yet, most donors choose to donate toys and material things. While there is ample evidence in the field of play therapy that some toys have therapeutic value, the types of toys donated to the hospital are not selected based on research data but on donors’ preferences.
Child life specialists who had previously worked in other pediatric hospitals in other states reported that holiday gifting is ubiquitous: large pediatric hospitals across America are buried under an avalanche of toys each year. One volunteer I worked with in the sorting room told me that she had just moved from another state where she had helped with holiday donation sorting at the children’s hospital there in previous years. She claimed that the other children’s hospital received more holiday donations than UCH, which was beyond my imagination. As I watched the deluge of new toys flood the hospital, I thought about children around the world, many of whom live in poverty in the very countries that produced these toys, for whom this level of consumption would be unimaginable. I thought about the inevitable futures of these plastic toys, making graves in landfills and oceans, polluting the environment. On many levels—socially, economically, medically, environmentally—holiday gifting practices appear wasteful, hyperconsumptive, hedonistic, unnecessary, inefficient, and damaging. I struggled to make sense of the practice until I reframed holiday gifting as a sacred ritual. Sacred rituals do not subscribe to the rules of logic, efficiency, rationality, and pragmatism, but are characterized by traditionalism, symbolism, performance, devotion, and commitment to shared moral beliefs (Bell 2009). Importantly, sacred rituals have redemptive potential and value.
At the end of Charles Dickens’s (1843) beloved classic, A Christmas Carol, the parsimonious Ebenezer Scrooge finds redemption on Christmas morning by providing the Cratchit family with the means to afford medical care for their ailing son, Tiny Tim. Dickens’s novella, which has sold millions of copies and inspired numerous stage and screen adaptations, tapped into the zeitgeist of his day and continues to capture contemporary mores and the collective imagination related to Christmas and the sick child (Gold 1972; Lucas 1970; Tilley 2007). To understand holiday gifting as a sacred ritual and the affinity people have for children’s hospitals, it is important to understand the sacred role of sick children in society. As James and Curtis (2012) note, for contemporary English-speaking societies, the “sick child” presents an oxymoron, a philosophical paradox. They write: “the very idea of ‘the sick child’—one whose future is in danger and whose body is at risk . . . contradicts a set of fundamental cultural values about what children are and should be” (755). Holiday gifting practices demonstrate that sick children are not shunned or shamed in American culture. Rather, sick children hold a special place in the collective conscious, elevated to sacred status.
The morning that Jennifer oriented me to my assignment at the intake station, we had the following exchange, recorded in my fieldnotes:
“You know the rule about not letting people in, right?” Jennifer asked.
I hesitated, confused.
“They can’t,” said Jennifer bluntly. “Don’t let anyone upstairs.”
I recalled the rule, realizing that the “people” Jennifer was referring to were the holiday gift donors. Visitors are welcome in the hospital, namely, family and friends of patients, but strangers are not permitted to visit patients at random. I had been warned the previous year that, on occasion, spirited do-gooders showed up unannounced with plans to sing carols and pass out candy canes and gifts to children in their hospital beds. Such merriment would jeopardize patient privacy and health and unsafely crowd the corridors. It was strictly forbidden.
While Zelizer (1985) emphasized the sacred qualities of childhood and children’s lives, the anonymity and invisibility of the patients inside the children’s hospital underscore the sacredness of the children themselves. Sacred things are “set apart and forbidden” (Durkheim 1995, 35, Fields translation) or “set apart and surrounded by prohibitions” (Durkheim 2001, 37, Cosman translation). Durkheim reasons that the sacred–profane dichotomy should not be confused with other dichotomies, such as good and evil or pure and impure. What is sacred can be good or evil, pure or impure. He writes: “The impure are no less forbidden than the pure, and they, too, are taken out of circulation, meaning that they are also sacred” (305). In some instances, impure sacred objects must be avoided, because they elicit horror and fear; in other circumstances, impure sacred things are holy objects of veneration (305).
Scholars of new childhood studies posit that popular characterizations of children as innocent, vulnerable, and worthy of protection are particularly salient for sick children (Christensen 2000; Mayall 2002; Tisdall and Punch 2012). The characterization of children as cherubic is especially befitting sick children, but the sick child is notably both pure and impure. She is pure because at her age and in her vulnerable condition, she is innocent. She is impure because her youthful body has been contaminated or broken by disease, injury, or disability. Both her pure and impure characteristics highlight her sacred nature. As sacred beings, sick children stir the horror and fear Durkheim warned of, but also inspire public sympathy, veneration, and collective action.
As one example, during my fieldwork I spent time shadowing staff inside the UCH pediatric intensive care unit (PICU). Generous benefactors to UCH receive personal tours of the hospital to observe how UCH operates and how donation money is spent. I witnessed a few occasions, and heard about many more, in which benefactors touring the hospital refused to visit the PICU, because they were afraid to see the children there, or entered the PICU and had visceral reactions, such as crying, shock, and nausea. In interviews, hospital staff and families frequently commented on the surprising fact that many UCH patients are cheerful and playful. The noted exception was the PICU, where children were connected to lifesaving equipment around the clock. PICU patients included children who had sustained life-threatening injuries in accidents, victims of child abuse, and children with cancer, kidney failure, or heart disease clinging to life. Durkheim (2001) used the example of a dead corpse to demonstrate that some sacred things inspire “terror and distance,” but may be “treated later as a venerated relic” (305). Likewise, PICU patients strike fear, shock, and terror in benefactors, but that does not inhibit benefactors from continuing philanthropic support. On the contrary, PICU patients inspire benefactors to give generously to the hospital.
Holiday gifting is the collective practice of honoring and venerating sick children, invisible, anonymous, sacred beings. In a culture where childhood is characterized as a time of innocence and vulnerability (Christensen 2000; Corsaro 2005), where affection is demonstrated through consumption and gifting (Caplow 1982), and where human worth is demonstrated through property ownership (Christman 1994), the act of giving material goods to sick children is a way to dignify the lives of the innocent, to right a perceived injustice, and to celebrate and bolster the innocence and purity of childhood.
Conclusion: The Sacred Role of Pediatric Hospitals in Society
Previous scholars have argued that childhood is sacred, shopping is a spiritual and sacred experience, marketplace goods have transcendent meaning and sacred qualities, and Christmas shopping for others is a sacred ritual (Bartunek and Do 2011; Beckert 2010; Belk and Wallendorf 1990; Mckechnie and Tynan 2006; Zelizer 1985; Zukin 1991). Building on these notions of the sacred, I have argued here that the process of donating toys to children’s hospitals at Christmastime is a sacred ritual in America, grounded in fundamental moral beliefs about the value and quality of children’s lives, particularly sick children, and the meaning of shopping, market goods, and gift-giving. Importantly, this sacred practice illustrates the sacred function of children’s hospitals, how they are situated within and integrated into the moral fabric of their communities. Though the loan agency, casino, strip club, grieving mother, Biker Santa, and Boy Scout are literally and figuratively miles apart in the local community, their links to UCH bring them within two short degrees of separation of each other and every other individual or entity that donates to the hospital. Local businesses that serve as toy drive drop-off sites, such as the orthodontist office, beauty salon, and auto detailing center mentioned in the accounts above, as well as the countless people who donate gifts at these drop-off sites are linked to the hospital by just two or three additional degrees of separation. In other words, UCH is the hub of an expansive network of social institutions and private individuals who are connected through a shared moral code. The annual tradition of gift-giving allows institutions and individuals to demonstrate their moral commitment to alleviating the suffering of sick children. Because so many people, businesses, and service organizations participate in this same practice, subscribing to the same moral code, the ritual serves as a communal pact whereby every participant commits to a common goal. Arguably, it does not matter what the shared moral code is. What matters is that there is a universally shared moral code and that a host of seemingly disparate members of a community are bound together by their pledge to that code.
As I observed in my fieldwork, the relationships between donors and the hospital can be deeply emotional for people. From verklempt Biker Santa to beaming Bailey, holiday gifting elicits feelings of profound gratitude and joy. Not surprisingly, donors openly expressed how good they felt about their gifting experiences and many return year after year with more donations. Cultural beliefs about the infinite value of children’s lives and the joy of Christmas presents amplify the “warm glow” for givers—the positive feeling identified by Andreoni (1990) that rewards charitable giving (see also Mayo and Tinsley 2009; Crumpler and Grossman 2008). Granted, it is impossible to know the individual motivations of everyone who donates to children’s hospitals at Christmas and, doubtless, there are many different reasons why people participate in gifting rituals. Some people, like the grieving mother and young Bailey, feel indebted to the medical community and strive to repay that debt. Blue Skies Casino and Marco’s Nightclub, two businesses that represent industries historically stigmatized as deviant (Alemzadeh 2013; Jeffreys 2008; Narayanan and Manchanda 2012; Riconda 1995), give generously to UCH, then advertise their generosity in media interviews and on social media, perhaps as a symbolic way of seeking absolution in the public eye. Meanwhile, Boy Scouts lead toy drives to demonstrate sterling citizenship and leadership in their communities and earn the crowning rank of Eagle Scout. Finally, the copious donations from company holiday parties represent hundreds of American workers who may delight in buying gifts for sick children or may feel socially pressured to participate in the holiday tradition. For Durkheim, individuals’ motivations for participating in sacred rituals are less important than what happens when they do. As the various examples illustrate, playing Santa to sick children can be redemptive, elevating, morally validating, and community building.
A century ago, Durkheim (2001) theorized that religion “is above all a system of notions by which individuals imagine the society to which they belong and their obscure yet intimate relations with that society” (170–71). Based on the data presented here, it may be overreaching to argue that pediatric hospitals constitute a secular religion. However, holiday gifting provides evidence that at the intersection of medicine and childhood, something special is giving added meaning to shopping and pulling disparate individuals and social groups together. Children’s hospitals are catalysts for social cohesion and represent sacred spaces within their communities. They are temples to childhood and the final culminating destination in a holy pilgrimage that involves shopping for, collecting, and transporting gifts to sick children. Children’s hospitals and the pint-sized patients they serve hold a special place in society’s collective imagination (James and Curtis 2012). Holiday gifting to children’s hospitals is a way for people to imagine themselves intimately connected to the moral heart of their communities.
Footnotes
Acknowledgements
I wish to thank C.J. Pascoe, Arthur L. Greil, David Lancy, and Scott Sanders for providing invaluable comments on earlier drafts of the manuscript. Many thanks to editor Charles Edgley and the anonymous reviewers at JCE for their constructive feedback, which improved the depth of my ideas and strength of my argument. I thank the program directors and general advisory panel of the Science, Technology & Society program of the National Science Foundation for their support of this research study. I express my deepest gratitude to Christena Turner whose wisdom and encouragement have inspired so much of my research and thinking. Finally, I am indebted to UCH staff and patient families for so graciously welcoming me into their community.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research study was funded by the Science, Technology & Society program in the Division of Social and Economic Sciences of the National Science Foundation (Funding Opportunity Number NSF 15-506).