I haven’t worked a night shift in many months.  For a time, years ago, I worked full-time nights.  I did it for about seven years, at which time my wife told me I was acting depressed and should move to a daytime schedule.  Still, the vagaries of the ER require that we sometimes be here all night.  Blech. 

So, I thought I’d take this opportunity to chronicle my thoughts through the night.  Please be patient if my thought processes seem to ramble.

1)  I had, in my lunch container, a cheeseburger, two packs of Swiss Cake Rolls, and a turkey, pepper-jack and honey-wheat bread sandwich.  I arrived at 2250.  It is 2330.  I have consumed one turkey sandwich and one pack of Swiss Cake Rolls.  It may be a long night.

2)  I came to work without sleeping much.  I simply couldn’t.  But God provides.  When I arrived, there was one patient to be seen and zero in the waiting room.  My partners worked hard before I arrived.  Nothing worse than coming into the ER with 20 patients waiting. 

3)  Night shifts, or rather night work in general, is an essential part of medicine.  Recent attempts to continue reducing the number of hours residents can work are going to prove problematic if not catastrophic in the end.  I believe the most recent ruling is this:  No one can work more than 16 hours straight.  Very kind, very humane.  However, in terms of real medical practice, remarkably short-sighted.  Unless the government mandates work-hours for everyone, residents used to ample rest will enter real practice (after residency) and be shocked to find that nobody cares how tired they are when they’re on call; least of all sick and injured patients.  Or crazy people.  To mandate this would almost require that every physician be a federal employee or that all physicians be unionized.  What’s the likelhood of either?  Hopefully quite small.

4)  Texting my wife is a great comfort.  When I am at work, we can communicate without going through any secretaries or anything else.  I love her and she is my better half.  Especially in the ER, I love to see a message from her.  My darling.  I would much prefer to be lying beside her in the night, rather than bathed in flourescent lights, surrounded by the feigned-sterility of a noisy ER.

5)  The wind was fierce tonight, with ran, thunder and lightning.  My wife, who was out driving, thinks a microburst may have hit near our home.  Nobody hurt, but the weather seems to have slowed down the ER traffic. 

6)  Eyeing my hamburger at 0023.  How much longer can I wait?  I mean, what if some disaster happens and my burger has to sit alone, unloved and untouched?  Be strong…be strong.

7)  I have the greatest ideas for books and columns when I work nights.  Fatigue seems to lower my inhibitions…for ideas, that is.  Of course, unless i write them down as I go, they’ll be gone by 8 am. 

8)  For instance, why is it that if anyone complains about life in medicine, they’re accused of being burnt out?  But if someone complains about economics, politics or culture, they’re called innovators?  ‘That Jesus, he was just burnt out on sinners, that’s all.  Needed a new job for a while…’

9)  Psychiatric commitment papers are among the most inefficient, useless forms in all of South Carolina, and must have been originally generated 30 years ago. Ironic that they are seldom filled out by psychiatrists…

10) 0159 am.   Pity the poor wandering teens who are overcome with anxiety and dysfunction, but who cannot even contact their parents in the night.  Worried about social drama, or pregnancy, or any  number of things, they are free-range, all but feral humans who have never been taught anything about life, or coping or propriety.  They are alone far too often, and when they are with some parents, they might as well be.

11)  Cheesburger…I love you!  Where have you been all my shift?  MMM.  Thank you, dear, for making me a wonderful dinner!

12)  To add to the bizarre nature of night in the ER, the floor cleaning team is here, with a waxing machine, a large fan to dry, and lots of loud conversation at all times. 

13)  In the middle of the night, simple dispositions are unlikely.  Dizziness resolve becomes chest pain.  Chest pain resolved becomes headache.  Headache cured becomes fever.  It is the nature of the night.

14) 0428 Fatigue, as the saying goes, makes cowards of us all.  At night, my anxieties multiply, and these days so does my irritability. 

15)  Drama is so often the rule in the wee hours:  teenage fight, teenage pregnancy, demanding intoxicated patient, he said, she said, etc.  Drama is very hard to sort through when working in a thick cloud of weariness.

16)  Turns out floor cleaning machine is excellent white noise.  Nap from 0430 to 0600, (Praise the Lord!) whench comes ‘tingling and burning all over,’ with not a whif of actual fire nor a focal neurological finding.

17)  Fine, fine!  The burning is a red rash in a patient taking Lamictal, which can cause dangerous skin reactions.  Yes, it was legitimate.

18)  The sound of medicine today is the endless sound of fingers typing across keys and the constant click of mouse on screen.  We have sold our soul for computerization and now we are as surely data entry clerks as physicians.  Perhaps, in some ways, more.  Tragic, that.

19)   Thank you for hanging out with me!  My partner is here early.  I’m finishing up and going to bed.  Have a great day!

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