I worked seven years of full-time nights in the emergency department. And before I knew it, I was beaten; I just didn’t know it. Night shift was good for me for a while. It gave me more time-off, because my group pays a proper night shift pay-differential. Therefore, while I could endure, I worked less for the same money. But eventually, as I closed in on 40 years, I slept badly during the day, waking and watching the clock every couple of hours. I had the awful feeling of sleeping hard and fast, waking, thinking it was evening only to discover it was 10 am, and I had been asleep barely one hour. And I had the awful knowledge that the more I craved sleep, the less it would come. I went to work, night after night, aching from head to toe. And inside, I was anxious, full of negative thoughts, full of doubts and fears, leaning against cabinets for a few seconds of rest.
My wife Jan eventually pointed out that I was irritable. A doting father, I even snapped at the children when I was tired. She was worried and began to encourage me to stop. ‘No way honey! I’m not weak!’ The thing is, my identity had become ‘night doctor’, that special breed of medical professional spliced with werewolf genes, able to smell a drunk at 100 yards, able to jump transfer hurdles on a single bound, able to stabilize or admit anyone before 7 AM. I worked in league with amazing night nurses, who (along with me) had a special bond with police officers, drunks, strippers, drug abusers, long haul truck drivers and disabled, television addicted patients with back pain. We joked ‘they’re our people!’ We called ourselves names; ‘king of the night,’ ‘princess of darkness,’ ‘empress of the evening.’ It was fun for a while.
We knew the how it felt, at 3 AM, to have another cardiac arrest, two ambulances out on traumas, five vomiting, febrile children and a suicidal patient needing psychiatric commitment after his 12 inch laceration was stapled. We also knew how it felt, after sorting it all out, to face the sunny, dayshift folks with their clear-minded criticism of everything. ‘This place is a mess! Why didn’t you finish the admission paperwork? I never left it looking like this when I worked nights!’
And for me, the comments of other doctors, sometimes from my hospital, often from receiving facilities where I had transferred our severely ill or injured; ‘You didn’t call me about that admission? How could you forget about that?’ ‘Did you know that you missed a fracture in that trauma?’ The lilting sounds of dayshift, telling us how badly we did everything from the perspective of eight hours of proper unconsciousness. Who were we to argue with their insights, anyway?
The other professionals, the ones solidly entrenched in well-deserved dayshifts, the administrators and educators, managers and consultants, responded to the complaints of our night workers with ‘well, I did it and I survived,’ or ‘after you’ve been here a while, you’ll earn a day job!’ ‘It won’t kill you, you know!’
In a larger sense, nationally, the same people ask (from comfortable offices in the light of day) ‘Sure you feel badly, but what does the science say? Is it really worse to work tired? We need to look at this prospectively. Let’s apply evidenced-based medicine to the idea that nights feel worse; maybe they don’t after all! Do you really make more mistakes, do you really get sicker, or does it just seem that way because you’re sleepy? I never wrecked my car going home, so we don’t need to change anything!’ And my favorite: ‘Naps? I’m not paying you to sleep!’
I noticed eventually that my royal court was slipping away. Slowly, surely, they migrated to day and evening jobs. They knew the answers to those questions, but without requiring the confirmation of studies. They were, themselves, sample populations in the science of weariness. They were fed up with exhaustion, and with not seeing their kids in the morning or evening. They were tired of living on caffeine and junk food. Sick of feeling the miserable ache of chronic sleeplessness. They ‘paid their dues’ and left. They were tired of worrying about mistakes. No surprise. A seasoned emergency physician, I worried about making mistakes, too.
I finally listened to my wife and migrated with my nurses. Now I work two nights each month. Now I sleep again, and dream. I love to dream! I seldom snap or grump. I go to work smiling, knowing that however bad it gets, I’ll get to sleep when the sun goes down and my old friend Orion crosses the sky. My daughter used to say that I was like a Whippoorwill; I slept all day and worked all night. Now, I listen to the Whippoorwill outside my window in the dark blue of the lovely South Carolina night, my wife beside me, my children resting nearby.
I know the score now. I walked through it and back to something like sanity. But not everyone appreciates the problem of nights. The reality is, if you’re reading this, and you’re in a position of authority as a physician or nurse, or if you’re an administrator over physicians and nurses, then you’re probably reading it in the daytime. And if so, why aren’t you reading it at 2 AM, or 5 AM? And why don’t you work at night? Why not do your administrative paperwork at 3 AM? Why not teach at Midnight? Why not be in the office for night-shift, instead of for dayshift, to polish up those delinquent e-mails and policies, answer some complaint letters, and chip in to the complexity of late-night patient care? The reason is obvious. You know it feels terrible, you know you aren’t as efficient, and you’re afraid you’ll make mistakes or become unhealthy or depressed. You think your migraines might come back. You’ll miss your husband or wife.
So why not try to find ways to make everyone else feel better, too? Why not use the power of your pen, and chair, and rested mind to help the ones doing the hardest things at the hardest time of the day?
It’s time for night-workers to be treated, not as second-class citizens, but as the first class professionals they are, taking one for the team night after night so that everyone else can rest. It’s time for night shift, already perilous enough, to stop being the entry level job for he inexperienced until they earn ‘something better.’ It’s time for us to recognize that medicine doesn’t stop at 11 PM and resume at 7 AM. People are sick and wounded and dying and broken at every hour of the day and night. And the nurses and doctors and all the rest who care for them are struggling to do their best with less rest, less help and more criticism than anyone else.
We need to make the night safer; for staff and for patients alike. Administrators and educators and researchers…step up to the plate! Give them some help, some money, some creative shifts, some naps. Show them your interest by seeing, first hand, just how much harder it is now than it was back when you did it. Give the vampires the support they need to work and live well. They have earned at least that much in the bloody, soul-sucking watches of the night.