I have been a physician for 31 years.  Mind you, that includes my three year residency in emergency medicine.  But that’s a long time anyway you slice it.  And over those years I have learned to love and hate night shift. Because to do emergency medicine is to be consigned to the reality of nights.  Some love them and do full-time nights. I did that for a while when my children were young and my wife and I were young and it didn’t matter as much how tired I was.  I recovered quickly.

These days, at a spry 57 years of age, I still do nights. In fact, last week I did five nights in a row, twelve hours in duration each. Oddly, I feel as if I function on nights better than ever. This is probably the result of neurologic pathways and memories etched into my brain so deeply that I can access them readily.  I know the questions to ask, the things to order, the actions to take, the tiny parts of every procedure that I learned all those years ago as a resident at Methodist Hospital of Indiana.

I do not sleep as well before my shifts. That’s a hard one.  I never ‘anchor sleep’ before the first night. I just plow forward.  And it works.  But the subsequent nights and days find me all too often working on four hours of sleep per day.  That’s hard.  Fortunately, I work in a place where I can sometimes put my feet up in a dark room and sleep a bit between patients.  A precious gift that is.  Other physicians have said that they ‘just can’t sleep.’ But I have been blessed with the ability to drift off between patients, while waiting on labs or xrays or CT scans.  It makes it tolerable.

I have also discovered that I am very, very cold at night. Presumably my cortisol drops and I just feel chilled.  I now wear long-sleeve t-shirts at night. And in the winter I carry pocket hand warmers. Oddly, it helps. It’s probably psychological, but it gets me through.  Furthermore, I drink hot drinks like coffee (decaf after midnight), hot tea and lately, hot water with lemon.  A hot water dispenser in the break-room is a God-send.

I also eat.  I used to try and eat less at night but I have realized that I walk and work and burn calories in the wee hours and I have to ‘keep the engine stoked’ as it were.

There are, however, lessons more ethereal, gleaned in the night.

I pray before I work.  I try to do it every time. I pray for my family and for my patients and for my staff.  That anchors me.  (If you want my exact pattern of prayer I’m happy to share it, just let me know.)

And I laugh with the staff, whom I love like family. And many nights, I listen to music.  It does indeed have ‘charms to soothe the savage breast.’  I turn on the speaker and listen with my work family.  Some nights metal, some nights country (Tyler Childress, Alison Kraus or the Pistol Annies these days), lately Christmas.  It makes the time pass. It makes us laugh together and smile at songs we all love, or hate.

Finally, I reflect and take notes.  I carry a pen and note-pad.  For a writer, few things eclipse an ER night for topics worth recording and using later.  Nights are a fearful time you see, and souls are often laid bare; tales of woe shared openly.  Patients come to the ER because they are sick or hurt or frightened, alone or intoxicated or stoned or paranoid.  Sometimes for ridiculous reasons, many times for reasons I cannot comprehend but try to understand with compassion.  Particularly in the winter, when it is cold and dark, the bright lights of the ER may be the only warm, welcome place around when the demons of remorse, addiction, abuse or other painful memories come stalking.  Or perhaps, the real demons that afflict mankind.

I learn things, I get stories from patients.  I see insights into the beauty and brokenness of my fellow travelers.  These are present all the time, everywhere. But they are distilled and so evident when the sun goes down.

Nights can be hard. I don’t know how many years my body will bear them.  But I will keep it up.  Because for all that I am cold, tired and hungry, so are my patients. And I can get by with a few simple coping mechanisms.  And the knowledge that at the end, I can once more lie down in my own warm bed beside my own warm wife, and sleep well again, uninterrupted by sickness, sorrow, death or the madness of modern life come calling.




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