Working the Night Shift

May 26, 2010

There is a different vibe in the hospital at night. In the wee hours of the morning, things are less rushed, and conversations seem to have an intimacy that they don’t have when the sun is shining.

I love working the night shift. There is a different vibe in the hospital at night. In the wee hours of the morning, things are less rushed, and conversations seem to have an intimacy that they don’t have when the sun is shining.

I feel like I can spend a little more time with each patient, getting to know them and developing an understanding as to why they chose to come to the ER in the middle of the night. I’m astounded at how many people seem to have their circadian clocks reversed and spend almost all day asleep and all night awake - fat, illiterate, fast-food eating urban vampires.

Doctors, nurses and techs are less guarded at night. We trust and rely on each other moreso than in the daytime - I think this is a survival mechanism from when we lived in caves and there were things that came out at night that wanted to eat us. I have developed long-lasting friendships with residents and nurses just by having spent night after night working and talking with them. I have covered for pregnant colleagues that desperately needed to catch 40 minutes of sleep in the middle of the night, and they in turn have covered for me so I can hunt around the hospital for milk and sugar for coffee.

The paramedics arrive throughout the night and deliver reports about what kind of action is going down on the streets of the city. There seems to be a temperature of maximal violence when it’s warm enough to be outdoors but not so stifling that physical movement is uncomfortable - late spring, early summer and autumn. On those nights we huddle around the police scanner and listen to this great city dying.

There is a soft pretzel factory near the hospital that begins churning out pretzels at 4:30 a.m. One of my fondest memories of residency was chipping in for pretzels (we could get 300 pretzels for $8 by sending a medical student to buy the pretzels directly from the factory - hot and steaming, fresh out of the oven) and eating them with coffee on the helipad while watching the sun rise over the city.

Working nights frees me up to get to recitals and ball games and birthday parties. I haven’t missed a parent-teacher conference in eight years, although I have fallen asleep during a few of them. Sleeping during the day has never been a challenge for me but it is for some. An old-time ER doctor once told me his secret - during the day he sleeps on the floor of a walk-in closet. It’s pitch-dark, and the clothing serves as noise insulation so he can’t hear his teenage kids. I remember thinking “Is this what I have to look forward to when my kids are teenagers? Sleeping on the floor of a walk-in closet?”

Staying awake all night can sometimes be a challenge. On slow nights, the minutes and hours drag by and sleep sneaks up on you - walking briskly around the ambulance bay helps. Some of my colleagues use modafinil. I use an old trick from medical school: I drink really old coffee (the thicker and chunkier, the better) and the pain from the gastroesophageal acid reflex helps keep me awake.

My lifestyle is healthier working nights. I usually sleep during the day, then get up in the afternoon, exercise, eat a sensible meal, avoiding alcohol, and go to work. Then I get up the next day and do it again. The worst part is the daytime of the first night. I don’t drink any caffeine all day which usually gives me a rip-roaring withdrawal headache by 2:00 in the afternoon. I lie down in the evening and try to take a nap but I often lie awake in bed making mental calculations about how much sleep I can get if I fall asleep right……now.

That was the plan today. I had contractors in the house to install a new air conditioning unit and they finished up around 6:00 p.m. I ate dinner with the family, helped the kids with some homework and then lay down around 7:30 p.m. thinking, “I can sleep for two hours if I fall asleep right…now.”

That’s when every smoke alarm in the house began screaming. The new air conditioner is leaking and water is pouring through the ceiling, shorting out all the electrical appliances and creating a nice puddle in the bedroom.

It’s going to be a long night’s journey into day.