A few nights ago I worked one of my many night shifts.  As a mom with two young kids, I find it is a lot easier on family life and on the kids, if I work while they are asleep.  This means I do my regular day, take a nap at some point if possible and then again once the kids are asleep.  I head out to work for 11 pm as one of two docs responsible for our giant ED until 8 am.  It used to be one doc on at night, but seeing 30 new patients while reassessing at times up to 60 others, was clearly unsafe for all involved.  After we filled our roster with a few new MDs, this allowed us to put a second doc on at night.

Working the night shift, there is a motto that many of us learn in medical school: “keep them alive until 8:05”.  This phrase always rang true for everything from the pediatrics ward, to the internal medicine ward, the ICU, and the Emergency Department.  Having less people to take care of patients in the wee hours can often feel scary, but now that I work so many nights I am very comfortable with all of it.

In fact, I rather enjoy it.  I love the peace and quiet of the place.  Walking the halls of a hospital at night has brought me solace since my clerkship years in medical school; there is something about the silence, the emptiness, that soothes a doctor’s soul.

In the ED itself, there are way less bodies, because the consulting services round during the daytime hours with gaggles of students and residents.  These groups are like ducklings, following their leader around the hospital, bringing chaos and noise wherever they roam.

So at night, when they are not present, neither is the chaos.

The last night shift I worked, was quite calm.  I don’t use the word “quiet” in the ED, because this inevitably jinxes everything and suddenly the resus room is full and everyone is trying to die.  (Given that I am writing this while sitting on a chair in the mall watching my kids play, rather than in the ED, means that I can actually use that word for once).  There was a steady influx of new patients most of the night, but the cases were straightforward and no one was really sick.  The patients that were handed over to me from the evening were relatively stable, so I didn’t have to worry too much about them either.  I actually found myself bored!  A big change from the week before, when my resus room was full and I intubated three patients, did CPR on two, and saved two of the three.

While a quiet shift may seem like a blessing to some of you, others will recognize my need to constantly be busy on shift.  When I go to work, I like to work hard.  Otherwise why be there at all?  I could stay home and watch TV if I wanted to relax.  If I’m at work, give me a full rack of charts, a packed waiting room, lots of sick people to help, and then I’ll be happy.  It’s not that I crave illness in others – it’s that if they are going to be sick, I’d rather they be sick during my shift and not during the next.

As an ED physician, I have also realized something I never knew about myself:  I likely have some form of attention deficit hyperactivity syndrome (ADHD).  I think perhaps all ED MDs must have a component of this, to be able to handle the constant interruptions, diversity of patient presentations, responsibility for dozens of patients all at once.  My brain is constantly going, on fire, all shift long,  Multitasking more than you might think possible, is the way to get through the day/evening/night.  Pay too much attention on one thing, focus too hard on it, and you develop tunnel vision.  The rest of the ED risks being blocked out.  This can happen, especially in a long resuscitation – and it’s vital that I keep reminding myself to shift back and forth in my thoughts between the resus going on in front of me and the rest of my patients in the department who may also need me at the same time.

Speaking of needing me – when the shift was over, the patients all still alive and some of them better off than they had been previously, as I was getting changed in the locker room, I got a call from my son’s daycare.  Turns out, my sickest patient of the day wasn’t in the ED – he was in my car.  After I picked up my febrile 2 year old and was driving him to the pediatrician’s office, he proceeded to vomit silently in the back seat.  I looked back at one point and his face was purple; he was choking on vomit and could not breathe.  His eyes were huge and he had his hands in the air.  I pulled over hastily, jumped out, ran to his side of the car and stuck my fingers in his mouth to pull out the chunks.  Thankfully his airway cleared and though he continued to vomit, he could breathe again.  I wrapped him in a blanket and got him to the doctor, having had the only adrenaline rush of the night.

My shift was over, but the next shift, that of motherhood, had begun.

Only bedtime would finally let me rest.

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