Dr. Decipher: Reflections on Night Shift in the E.R.

June 28th, 2010 by Kim Lenz

I am in the middle of working a string of 12-hour night shifts in a local hospital Emergency Department. I have previously written a blog on night shift and circadian rhythms, but to summarize it is rough on the body and mind, and one can only partially compensate.

The hospital changes at night. There are no administrators roaming the halls, and only a skeleton staff is present. Scrubs are worn. The cafeteria is closed, only machine food is available supplemented by staff food runs (with the urgency and planning of a military mission), and pizza or Chinese delivery.

The only other physician around is the OB, and only at the time of a delivery. It is an ominous feeling to know that I am the lone physician; in partnership with the nurses and ER staff I am responsible for fixing whatever problem is present in all patients coming through the door, with little warning or historical information, liable for any mistakes (real or perceived) or bad outcomes.

The patients at night generally fall into 2 categories: those who are genuinely ill, and those who have some other reason to be there in the middle of the night. There is a high incidence of patients under the influence of alcohol or drugs, as well as those looking to get  prescription drugs. Many mentally ill patients come in, and trying to find a place for them to go is always a challenge.

Quiet times are intermixed with hectic emergencies. One minute it is relatively calm, then suddenly a patient presents in respiratory distress, or having a heart attack. I experience and participate in the whole gamut of human emotions and experiences, from birth to death.

When a specialist is needed  for consultation I am usually waking them up at home, and at each hospital I quickly discover who the “nice” physicians are, as well as those who are “unpleasant”. Think about several docs you have met, then imagine calling them at 3 a.m. and trying to convince them to either come in to the hospital or to admit a patient that they do not know.

There are gaps in the call lists of every hospital except huge medical centers, and it can be tough to find an accepting physician at a different hospital, then arrange fast transport there while continuing to treat  the patient to prevent deterioration until transfer. I recall treating a young woman in the Outer Banks who was found on the beach unconscious from a ruptured brain aneurysm. I called four different hospitals to find a neurosurgeon to accept the patient for transfer before I was successful, as precious minutes ticked by.

The good part about nights is that you have the run of the hospital. I can go into the lab and look at slides of blood smears. I can enter orthopedics to find appropriate splints for my patients, and escape to an empty ward or step outside for 5 minutes of quiet.

There is a sort of “night shift brotherhood” among the ER staff, the local EMS and firefighters, the mental health counselors, and the police. We shoot the breeze at the nurse’s station and share war stories as we all share much of the same “clientele” at night. We all suffer from sleep deprivation, and have  symptoms of post traumatic stress disorder (although this is rarely addressed outside of military service).

Then, just as exhaustion really sets in around 5:30 am, the sun comes up, with rays shining through the one glass door to the outside.

Gradually, nicely dressed day shift workers begin to arrive, in contrast to the disheveled and tired night shift workers. Administrators in suits breeze through the ER, collecting the summary of night shift admissions, transfers, complaints, and deaths for their morning report meeting.

I think about the sick folks I sent home – did I do the right thing? What made me choose this as a career? I then recall all the patients who were helped, all the saves, and the 8-year-old Little Leaguer from earlier in the evening who gave me five after I glued his forehead laceration.

Finally at home, I go to sleep with shades drawn, ear plugs, and white noise from an air cleaner. Tomorrow it will be time to do it all again.

2 Responses to Dr. Decipher: Reflections on Night Shift in the E.R.

  1. Anonymous

    June 28, 2010 at 1:04 pm

    You are definitely a hero!

  2. Anonymous

    June 28, 2010 at 6:57 pm

    I have worked the night shift on a medical/surgical unit for 15 years. Patients frequently say to me “at least it’s quiet at night”. I smile. The unit area is quieter because there are no family members visiting, no administration people, no discharge planners and no physical therapists but patients still require care and medications throughout the night. Even though it’s night there can still be a crisis or two that requires immediate attention or a call to the patients physician. We also receive admissions at night and patients who have had emergency surgery. So, it might be “quieter” but night nurses are awake and alert for whatever might happen from 7pm to 7am.
    I have read the studies about how working nights can cause health problems and/or lessen ones life expectancy but I can “do nights” so I will continue to do so. Thankfully there are other nurses who can also “do nights” and are right there with me when I have a question or need help. We are a team and we are there for our patients during the night.

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