It’s 7 a.m. The hospital is just starting to wake up from its slumber, stretching arms and blinking eyes. I’m 54 minutes away from the end of another night shift.
Night shifts are curious creatures. They are a part of the fabric of emergency medicine life — one of the often hated aspects of our jobs. They steal us away from our families, cutting short bedtime snuggles and picture books so we may await other families and other needs.
Night shifts throw off the easy rhythm of days, forcing us to hide in dark rooms as we chase sleep and miss the sunlight. There are many ways to try to fit nights into life, and none of them work well. No matter how you toss and turn it, you trade missed days for bleary-eyed short tempers and a vague feeling of nausea.
The hospital is weirdly bright and quiet at night. There is activity, but it’s hidden behind doors and shushed for the neighbors. You wander the halls in search of a source of caffeine to prop up drooping eyelids, slinking down halls filled with people you plucked from their lives and installed into your healthcare assembly line.
Monitors beep. And about once a night, the alarm for the medical gas line goes off. It’s loud, like a siren, and lasts about five seconds. It scatters that tiny bit of sleep you’d started to catch in your chair. Muffled clicks of nurse computers and quiet conversations tease your ears, coworker confessions brought out by the intimacy of a night shift.
Through it all, patients come. As each one checks in, I feel a small flare of anger. Why aren’t you asleep? Get back to bed! I feel like I’m scolding one of my children. Then I realize that is a wasted emotion, so I tag myself in on the computer and head for the room. Emergency medicine is always an adventure, but on the night shift, there are common visitors. Babies who won’t stop crying. Adults who won’t stop drinking. There is often a helpless victim of two dudes, the people responsible for all of the assaults in the U.S. Just like your mom said, nothing good happens after midnight.
Patients expect you to be as fresh as the noonday sun, even at 3 a.m. I think there is a misunderstanding that doctors are human too — with lives and pillows like everyone else. They are often disgruntled when they are told that every service is not available and that their testing will take longer to wake up others to come in. Sometimes, it might even be put off until the morning. Our eight-hour hospital fits awkwardly into our 24-hour society, via the adapter of the emergency room.
I doggedly explain to patients that I’m happy to call their doctor in the morning, but that I will not be calling to wake them up in the middle of the night just to tell them one of their patients was in my ER. I try to protect my colleagues, so they will answer when I really need them. No one likes me well enough to want a phone call at 3:21 just to say “hi.”
As the night wears on, my brain starts to slow. Numbers are harder to multiply to make doses look right. I find myself drifting, easily distracted by the quiet hum of this space. It entices me to just close my eyes for a moment.
Danger lurks in the early dawn light. This is when heart attacks like to happen when the belly pain you’ve been ignoring all night finally motivates you to hit the road. This is when the work note becomes an imperative. This is when I’m at my worst, when the only fantasy in my mind is the sweet smoothness of my sheets. I have to hang on for one more hour.
The ambulance calls in, the pressured speech of a full nights’ sleep, a cup of coffee and a crashing patient blaring through the speaker. I prod my tired brain and ask my team to watch me because I know my reserves are almost gone. I place tubes with hands that tremble gently from the caffeine and sugar that fuels my last hour. The hour of my sweet release comes and goes, as I guide my new companion to a different sort of bed, a resting place no one ever wants to be in.
Finally, it is over. I stumble to my pickup through the early morning light. I slump over my steering wheel as I realize I forgot my lunch bag in the communal fridge. I contemplate a moment going back, then decide it’s too far to a trek. I hit the road, windows down, mentally cataloging the friends I can call at this hour to try to keep me awake.
My front door is but an obstacle between my pillow and my cheek, as is my husband. A hurried good morning is traded, and then I pass into oblivion, time and again choosing sleep over food. I need to get some rest; I do it all again tonight.
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