I woke up today after last night’s 11P-7A shift.  It was a busy shift, but not terrible.  The same litany as always, a drunk, some weird complaints that defied physiology, a few febrile children, every other person with chest pain, some numbness here and there, a positive drug test for cocaine that mysteriously appeared in someone who had never, ever, used it and ‘I swear I’d tell you if I had!’  It was old and weak, it was falling down, it was high blood pressures and low heart-rates and migraines that were never really diagnosed officially but needed narcotics.  It was chronic pain on oral morphine who was just ‘in…tho…musccch…paiiin, zzzz.’

I saw somewhere between 21 and 23 patients for my eight hours.  Not a lot compared to big centers, I suppose.  But then, I’m not doing nights as well as before.  I just can’t cope with the fatigue the way I did.  I used to do full-time nights, and I think something broke inside my pineal gland, or somewhere in my reticular activating system.  I don’t sleep before, and I don’t sleep well after, and it’s a tremendous stress.

During nights my mind wanders to every imaginable worry, not just about patients but about my own family. I worry about mistakes, and my past, and our future and just about anything.  I can control these during the day.  But at night, when I’m tired, all bets are off.  Furthermore, to make matters worse, my dear wife Jan doesn’t sleep well when I work nights.  We both miss the immense comfort of having one another nearby.
Sitting today, writing this, I had plans to play in the woods with the kids.  But I’m just too tired.  It’s a cool, lovely South Carolina evening.  All is well in my world.  And yet, my head is vaguely throbbing, my neck is stiff, my thoughts still addled, my eyes burning and my knees sore from walking.

It’s the great conundrum of emergency care.  24/7.  Someone will always have to be there, and no amount of years in the job, no amount of seniority can really excuse us if we’re being fair.  I have lavish amounts of time off; but the one thing that gets me is this physical, emotional drain of night shift.

I used to be a creature of the night; I loved it.  I still like the patients for all their weirdness, but I find that my 43-year-old body can bear the disruption of sleep less and less with every passing year.

I hope, if you’re working a night now, or worked one recently, that you feel well, and sleep, and that your dreams are pleasant.  I hope your shift is slow, and populated by simple complaints with simple solutions.  I hope your headache goes away, and the hallucinations stop.  (They might not be from fatigue, so be careful about that one!)  And I hope God makes you wise and smart as you make decisions about other people’s well-being in the middle of the darkness of night.  May he guide you home safely in dawn’s blessed light.

Blessings on you all, weary, pale bat-people of medicine!

Yours truly,

Edwin Leap, formerly King of the Night, now abdicated

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