Recovering from, and reflecting on, the night-shift

I was once a creature of the night.  That sounds like an opening line from a vampire novel.  But it’s actually by way of biography.  I was once a full-time night-shift physician in our emergency department.  The nurses called me ‘King of the Night.’  On our computerized patient tracking, they picked purple for my color.  Purple for royalty!  I had nurses I referred to as Princess of the Dark and Empress of the Night.  We had a way of handling things; we laughed and joked and endured.  and I was, of course, younger.

That was a time in my life when my children were very small, and I was in my mid thirties.  The kids didn’t care if I worked at night; I would play with them when I was awake, and I would lie down to nap with them after we had bed-time books and prayers.  And I would rise at 10, like a phantom, and leave them in their warm blankets to head off into the night.  By breakfast, I was back.  Once, my daughter said sweetly, ‘Papa, you’re like a Whippoorwill, you work all night and sleep all day!’

Eventually, I had to stop.  As I approached my 4th decade, I became more fatigued.  I slept less, and my sleep was of less quality.  I was irritable and I was growing depressed.  My wife recognized it and I changed my schedule.  Now, I work every shift we have, and only about one night per month at the most.  Although, even now, years later, other medical staff members  see me in the day and say, ‘are they letting you out in the light!’  ‘Yep, for about five years now!’

I worked my night on Saturday.  It was a perfect arrangement, really. I spent the day at a black-smithing class with my boys.  I hammered and bent and gripped for hours.  I came home and went to bed for three hours while Jan and all the children were at a church youth meeting.  The house was quiet.  I rested.

And when I went to work, I ran smack into a brick wall of exhaustion.  The problem is, I wasn’t just tired.  I was deeply tired.  Maybe it had to do with my pneumonia this week.  (Feeling much better already). But whatever the cause, I was bone-tired.

Worse, my fatigue made me cynical and frustrated.  I always tried to carry grace and love to work with me.  To show it to even the most maddening patient, as I believe God shows it to me.  But this time, tired as I was, it was hard.  I say this by way of confession and education.  I did not like people.  I did not like the fact that we were wrestling a drunk, suicidal woman who was trying to bite us, and that due to lack of support, we wouldn’t even be able to consult a psychiatrist except by video ‘tele-psych.’  I did not like the fact that I was dealing with several complicated wounds, and knew that even if I called a consultant, they would decline to come in and help.  I was annoyed at the woman who complained, at 3 am, of chest pain and headache, and ‘oh, while I’m here, can you look at my plantar’s wart?’

And I was annoyed that I was annoyed.  I hate being like that.  I hate being unable to reign in my frustration.  Mind you, I don’t think I yelled at anyone.  And I’m pretty sure I did my job well, even if without joy.  But if just felt bad; or rather, I felt badly.

Fatigue is miserable.  Physicians who don’t address it are setting themselves up for personal and professional catastrophe.  Hospitals and practicesthat ignore the variations in individual tolerance of fatigue (‘everyone has to tough it out ‘) are making a terrible mistake in wellness and longevity.  And hospitals and groups that don’t pay lavish night differentials aren’t really in touch with the problem.  Enough money can motivate some to dedicate themselves to the ‘way of the night.’  That helps everyone.

But in my press of night frustration, another problem came to mind.  That is, the general belief that coming to the hospital at night is the same as the day.  As if the emergency department were like a 24-hour Wal-Mart.  ‘Well, you know I’ve had this back-ache for 6 months, and it was just bugging me, so I came to get it checked.’  The same as the patient with the wart on her foot.  It happens all the time.  ‘My child has a cold, we saw the doctor today and he said it was a cold.  He still has a fever, but I didn’t give him anything, I just brought him here.  And we’re going to the doctor again in the morning.’

I understand anxiety, and I’m happy we can alleviate it. And I want 24 hour access for the sick and injured.  But when the barely sick and the non-injured use the ER as if it were a day-light clinic, they do some very bad things:  they make the care slower for everyone; they add to the fatigue of the staff; they add to the many bits of hay we have to sift through to find the needle; they add to the cost of keeping the place open; and they expose themselves to the inherent risks of the night, like violence and car-crashes.

The night is hard, and potentially dangerous.  Physicians and patients must always bear this in mind as deliverers and recipients of care.

Even the King of the Night finds it scary.  And I don’t scare easily.

Edwin

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