Your first 24-hour shift

How can you work for 24 hours in a row? My friends outside of medicine ask me that often. What is it like? I wondered the same thing the night before my first 24-hour shift or “24.” I lay awake worrying, ironically, that I should have gone to bed earlier to rest up for the ordeal.

When I get to work, full of nervous energy, I am relieved to find out the shift starts like any other, pre-rounds, rounds, patient care. I finish notes, update families, follow up tests and repeat.

In the afternoon the attending stops by the resident room to develop a contingency plan for the results of a lab test that should come back overnight. “I will let the night team know to look out for that,” I tell her. She pauses. “I thought you were the night team?” she says. “Oh yeah,” I chuckle and affirm that I will personally follow up the lab. “See you tomorrow morning,” she kids on her way out.

The next 14 hours are a blur. The hospital does not seem to know that I am on a 24-hour shift. Calls and pages come thru at the usual frantic pace. Strangely it all feels easier than usual. I know what to do with every test result because I was there when the team decided to order them. Families with questions seem to trust me because they know me from the daytime. A number of people comment, “Wow. You’re still here? They work you hard.”

I take a break to use the restroom and come across one of the senior residents, also on a “24” washing his face and brushing his teeth. He catches the confused look on my face. “You wouldn’t go the whole day at home without brushing your teeth would you?” he asks. “I guess not,” I answer. After he leaves I quickly scrub my face with the foamy hospital brand hand soap.

Around 3 a.m. I start to drag. My eyelids droop, my feet hurt, and my mind wanders easily. The beeper goes off. A little girl with asthma on the 8th floor is getting worse. I feel a burst of adrenaline and run upstairs. Her lungs are tight. We try magnesium, then epinephrine. She is still struggling to breathe. I call the ICU to start BiPAP. The ICU fellow comes to examine her and agrees. She is rolled away to the elevators on her way to intensive care. It is 5:15 a.m. Only 45 minutes to go. I dig into my last energy reserves to quickly update my notes and sign-outs for the next team.

As the sun rises, the new daytime resident shows up — fresh and energetic — her hair still wet from the shower. I run my hand through my own hair. It somehow feels simultaneously dry and oily. She gives me a sympathetic look. I guess the night has left me looking a little ragged. She worked the “24” last weekend so she understands. We sign out the patients, and I head home.

My bed has never felt this good, sleep comes easily. I wake up mid-afternoon to street noise and sunlight squeezing around the corners of my blackout shades. A fresh cup of coffee gives me the energy to leave the house and determined to enjoy my post-call day. This is my reward for spending a full turn of the earth inside the hospital.

At a nearby coffee shop I meet some friends and tell them about my night. They are incredulous. “You worked from Saturday morning until just a few hours ago? That seems impossible.” Their disbelief stirs a surprising emotion, pride. “It was tough,” I say, “but it’s something you have to do to become a doctor.”

Joseph Shapiro is a pediatric resident.

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