Getting through the shift

Here’s my column in this month’s EM News…

What gets you through the shift, friends? I’m not being elevated and philosophical. I’m simply asking, in the press of life and death, rules and regulations, fatigue and soul-weariness, what makes you feel better when you go off to your emergency department for eight or 12 or 24 hours?

Let me illustrate. I have a ritual. I don’t believe it has any supernatural powers, and I sure don’t believe it makes for a good shift if I do it or a bad shift if I don’t. It only makes me happy. My ritual is this: I stop by Jack-in-the-Box for what is arguably one of the largest styrofoam drink cups in the fast-food world. (Although not as big as the Route 44 cup from Sonic, which is 44 ounces of sheer soft-drink delight. And in which a small, careless primate could likely drown.)

When I go in, I obtain one large Diet Coke with ice, and fill it almost to the top, at which point I add an ounce or so of regular Coke for flavor. (I mean, for sugar.) Then I take a second cup, and fill it with sweetened tea sans ice. The first half of the eight hours, I drink the Diet Coke. Then, I fill the cup with ice a second time, and transfer the tea over. I know; it sounds ridiculous. But it gives me something to look forward to, and serves as a kind of mile-marker for my work. I could say, quite accurately, that my “tea time” is the halfway marker to home.

Of late, however, I have found simple saltines to be a lovely addition to my work rituals. A fairly low-calorie sleeve of off-brand saltine crackers will bring me back to the desk to dictate more consistently than my desire not to get behind in charting! The amount of sodium chloride on each one does make me feel a little like a buck deer coming to a salt-lick.

Sure seems like I’m motivated by food, doesn’t it? I guess you could say that our entire department is motivated by food. On Sunday the nurses have chips-and-dip day. They bring pita chips, tortilla chips, crackers, and other crunchies, which are then complemented by chicken salad, hummus, salsa, bean dip, cheese dip, and whatever else they can throw together the night before or on the way to, work. Chips and dip day is awesome.

Of course, we are Southerners. My friend Frank once brought a funnel cake maker and cotton candy machine to work. It was carnival night, after all. And of course, as Southerners, casseroles, beans and cornbread, cobbler, mac and cheese, and all other sorts of goodies are apt to appear in our kitchen.

But that’s not the point. Food is always great, but food isn’t what gets everyone through the shift. It just happens to be one of the things that works for me. For others of my acquaintance, it’s the intense workout before coming on shift; for some, the workout after. For one partner, it’s the knowledge that she can soon return to her beloved New York City to see a show and enjoy a fine restaurant.

There are those physicians who can endure anything because they have done the math, and they know exactly how many shifts they need to buy a new car, go on a fishing trip, or retire. My math is not so advanced. Four sleeves of saltines per box plus 40 ounces of a soft drink in a large sytrofoam cup equals sanity.

Perhaps the thing that helps me most of all is that before I go to work, my little (well, not so little) clan of homeschooled kids always runs to my side, and each places a hand on my person. (The beard apparently has special powers, and is a favorite connection point.) I kiss each one on the head, and we count 1, 2, 3, and all let go at the same time. That’s a send-off! Last, I kiss my dear wife, Jan, who, often as not, has made me (you guessed it) food to take to work.

My daughter Elysa frequently has already handed me a sucker for a snack and a toy to remember her by. And my youngest boy Elijah has perused the pocket knives, and has asked me to carry one that he gave me for Christmas or my birthday.

Off I go, my energy stoked by the love of the ones I love best; knowing I am missed and valued. My mind assured that I have ample goodies to consume. My heart consoled with the knowledge that when I return, usually in the late evening or early morning, I’ll have the kiss of my sleepy wife to welcome me as I lie down in the warm covers.

Over the years, many things have comforted me. YouTube videos (before they were blocked by the IT ogres), cups of hot tea, a rare classic movie on a slow overnight shift. Years ago, our nurses had a tradition called running the schedule. Typically on a slow overnight, they’d pull down the schedule, look at every name, and lay forth the gossip. I won’t say whether I approved. But I did enjoy sitting nearby, pretending not to listen.

Another thing that helps me is that I always carry a notepad and pen to save ideas, and I always carry a book. I don’t usually have time to read it, but it anchors me. Whether it’s theology or poetry, historical fiction or my Bible, having a book is (as my Grandma Leap always said) like having a friend at all times.

I guess this behavior is typical of everyone whose work takes them to the dark places of human existence. Was there ever a major battle involving troops from the UK during which a pot of tea was absent? Was there ever a beach assaulted by Marines without cigarettes and coffee, before or after? Why do firefighters cook chili? Why do police officers eat junk food? Why do college students … well, let’s stear clear of that one.

Our work is difficult at best and monstrously hard at worst. It is a grand thing that we are motivated by professionalism, that we are driven and guided by excellence. It is noble that we care for the sick and wounded, and it is reasonable and natural that we work for financial gain.

But somewhere just below the higher motivations that maintain our work-a-day momentum, we simply have to have our feet on the ground, our hands on the patients, our bleary eyes open, and our fuzzy brains pressing onward. And that is the point where small comforts, whether caffeine or sugar, gallows humor or storytelling, really make the difference. It’s those things that get us through the shift. And that’s fine by me.