Wednesday, October 30, 2013

One Night Back on Nights

Time has been just flying by, as always. Suddenly, its the end of October and I'm nearing the start of another rotation. Sadly, I am finishing my time on oncology. It has been an interesting month, and I've seen some very interesting cases and, being the only resident on a busy service, I have been busting my butt trying to do well and shine this month (since it is what I want to do with my life, after all). It's been really great, I'll share more in a later post, but I've had such a great month!!

Tonight I have one pick-up shift as night float. Since I had to find a colleague to cover me while I was away for a wedding, I'm paying him back by working for him tonight. It's not all bad; because of the duty hour restrictions (thank you once again ACGME), I can't work both days AND nights, so I had this morning off from work. And it has been truly unbelievable. The weather was uncharacteristically warm and sunny, with a nice little breeze. I got to spend some time with my husband (that doesn't happen often, let me telll you), and we even went on a *very tiny* 3 mile run together this morning. I needed a half day off, I really did. I'm feeling so much better about being a doctor - I was starting to burn out after only having 3 days off this month (all of which were spent busy at a wedding, which was great but I need one day to just catch up on life you know!). The downside for tonight - the other intern scheduled to work asked me to cover for him as well. So it's just me, watching over the entire hospital. Please, I know that most of my shift will be during Halloween, please please no one crash on me. A nice quiet night is all I am asking for! ;)

Now that I've officially jinxed myself, I best be on my way! Caffeine is a necessity tonight for this 18 hour shift!

Wednesday, October 9, 2013

Night Float: Recap

After 30 days of living the night life, it feels better than I can say to be among the living again. I feel like September was all just a big dark hole in my life, where I spent it working and getting behind on everything else. For example, just yesterday I was beyond thrilled to have done my first load of laundry in over a month. Of course that means I actually did about 5 loads of laundry in one evening, but it felt amazing to finally have matching clean socks again! And I spent the remainder of the day (after only working 8 hours) on Sunday tidying the house - it hadn't been swept or the floors cleaned since the middle of August. I can't even tell you how good that makes me feel to have a clean house to come home to. I also (please share in my joy with this one) washed my bedsheets last night and slept in a clean room with clean sheets with a clean puppy. Someone might as well have told me I won the lottery, I was so happy! The only downside of all of this is that I do have another night shift this weekend - but it's only one night (and dang it I will sleep part of that night! -please patients don't crash on me).

Just a few generalizations about my experiences on night shift - when you work nights, you never, ever feel good.  You always feel tired, like you need to go to bed, or like you just got up from an ill-timed nap, or like you desperately need a nap regardless of the timing.  You also feel so disconnected from society – just as people are going to work, you are headed to bed, and just as the kids are getting home from school, you’re trying to wake up again and get ready for another workday. You almost lose touch with reality, because all you know is hospital work and answering urgent patient problems quickly for the entire month (and praying that no one crashes while they're in your care).

Six nights in a row every week for a month can be difficult. On the one day off, all you do is sleep all day (and try to sleep all night). By the second week, I started to lose perspective.  I left home with my husband no where to be seen (he works afternoon/evenings), unhappy about never seeing any one, ever. I started to get teary-eyed when I saw other people enjoying life, when I saw other people happy doing things they love, then I started to get mad about it - why should they be out enjoying life? what are they doing that's so important that they deserve to be happy while I'm stuck working every night and dealing with sick people all the time? I started to get annoyed with everything - residents leaving bits of work behind for me to finish every night, patients not receiving adequate pain control all day leaving me to deal with it all night, colleagues that don't communicate well enough with patients throughout the day and leave me to explain their diagnosis and treamtent plans to the patient and their families at night, annoyed at families for visiting after hours and demanding to speak with a physician, patients for having chest pain, patients for dropping blood pressure or spiking a fever (causing me more work), etc etc etc. I know that those things are clear signs of burnout (and are harmful to patient care), so I did my best to acknowledge these frustrations and shortcomings and to overcome them. But as the nights dragged on, it became more difficult to do So by the time you get a day off, you don't want to do anything because youve been forcing yourself to do things you really don't want to do all week long (and will have to do it all week long all over again). It is just so draining. And the responsibilities are huge - if you stop and think about it, I'm the one watching over half of the hospital. Sure, I have backup and seniors I can call, but if things get busy I'll be the one running the show if things start to go downhill. Its a stressful thing hanging over your head all night, which is why I could never sleep at night even when I had time to. I was terrified I would wake up to a code and be so foggy in sleep mode that I wouldn't run it well. So I'd sit at my desk all night, waiting for any important calls. There are some long nights at the edge of your seat.

All in all, it was a fantastic experience. I worked with a phenomenal team, and I got to do so many procedures and I've learned an incredible amount, as well as pumped up my confidence to a totally different level. This is just one way to show that medicine isn't merely about knowledge and compassion, it's about how you can handle the insurmountable pressures and stresses that physicians are faced with everyday without losing your mind.