On Becoming Temporarily Nocturnal

Good morning!

Ever ask yourself: How do doctors ever manage to sleep? (Of course you do. What else could you possibly have to think about?)

Uhhh, Japan? The Middle East? Getting a job so I can pay my bills? Whether or not a country can stay great without investing in its critical infrastructure (education, transportation, innovation, etc?)

………..I’ll just pretend you said “nothing”. (I ain’t touching those topics. I’d rather see what wiser people have to say about them.)

I mean, it’s not doctors aren’t needed 24/7. After all, people don’t just magically stop being sick at night, on weekends, or on holidays. Although, come to think of it, that would totally rock. But, alas. Sometimes people get even sicker during the WHEN hours (Weekends, Holidays, Evenings, Nights), for a variety of contributing reasons.

::Sigh:: I’ll play your silly game. So how can doctors ever manage to leave the hospital?

Well, the glib answer is, “They don’t.” (Well, at least, they didn’t. That’s why new doctors were initially called “resident physicians”. And often it’s still true, despite the fact that it’s now technically illegal due to work hours regulations.)

But the real answer is: Either people take turns working overnight (the shifts are about 30 hours long), or everyone takes turns doing a couple of weeks of a shift called “night float”. Basically, a couple of people take responsibility for taking care of all of the patients in the hospitals so the doctors working during the day can go home and get some rest and something to eat.

My program does night float, and tomorrow, I start doing my time. I’m lucky that it’ll only be for two weeks; some of my friends got rather screwed over by the schedule and had to do up to six weeks!

There will be two night float teams when I’m on, each covering half of the Medicine patients in the hospital. Night float teams in my program consist of an intern and a resident. The resident takes care of most of the overnight admissions, and the intern handles at least one admission and all of the calls from the floors. (Doctor, this patient’s IV infiltrated and I tried three times to put another one in and now I need you to come do it…….Doctor, this patient wants to talk to a doctor……..Doctor, this patient’s blood pressure is too high……….Doctor, this patient’s blood pressure is too low………….Doctor, do you still want me to give this medication?…………..Doctor, this patient’s family member wants to talk to you RIGHT NOW………..Doctor, this medication is ordered for a push and I’m not allowed to push medications………Doctor, this patient has a fever and you have come immediately to do the fever workup because we don’t draw blood except for three specific times during the day………..Doctor, that patient that wanted to talk to you earlier is really upset ’cause you didn’t come talk to him immediately, and now he’s signing out against medical advice and you have to come talk to him RIGHT NOW……… Doctor………. Doctor……….. Doctor………. All………. Night……….. Long……….)

If there’s a code, everyone drops everything and runs to that patient’s room. If a patient decompensates, the night float team responsible for that patient tries to keep them alive until the morning when their regular team (who actually knows them) can take over. In the morning, the night float teams pass over the patients that were admitted overnight to the accepting team.

Gah, I’m getting an ulcer just thinking about it. (It’s probably going to be the most stressful two weeks of the entire year.)

Anyway, since I’m on vacation at the moment, I figured I’d take advantage of the luxury of schedule flexibility and flip my sleep schedule a few days early in preparation for having to make rational medical decisions at four in the morning.

So now I’m nocturnal.

It’s like self-imposed jet-lag, except for the sun doesn’t help you cue to what time it’s supposed to be.

As a matter of fact, that’s the hardest thing about this whole nocturnal thing. I’m surprised at how difficult it is to orient myself to what time it is without the sun.

Having been a regular quasi-insomniac, though, I conveniently know a lot of sleep-hygiene tricks that help me make the switch. (Although I’ve been kind of testing myself by lying in my hammock reading during the most difficult stretch of the “day”, practicing staying awake. It’ll be much easier when I’m running around all night like a crazy person.)

Anyway. I figured I’d talk about some of the benefits and detractors of being nocturnal (at least, while not working).

-Benefit: Long, quiet hours with no expectations. Potential to get a LOT of work done.

-Detractor: It’s a LOT harder to actually be productive through the night, at least for me. It’s a lot easier to watch movies than study or write my book.

-Benefit: I get to watch lots of movies, without feeling guilty about not using the time to go out and spend it with cool people doing cool things. (Not to say that I don’t like doing cool things with cool people. But if you’re an introvert like me, you know what I’m talking about. Sometimes it’s just nice to sit and watch a movie without anyone else around.) Same thing goes for reading books.

-Detractor: If there’s really nice weather, you miss it.

-Benefit: If there’s really crummy weather, you miss it.

-Detractor: No one is awake to go out to dinner with. Or lunch.

-Detractor: If you want to go out to dinner, you’re SOL because the only restaurants open at “dinnertime” (7-8 am) are breakfast places.

-Benefit: You get to go out with your brother and his friends and watch a ‘cuse game in a bar that has more peanuts than any normal person would ever think about eating, without worrying about what time you get home, because it’s actually the beginning of your day.

-Detractor: BoingBoing doesn’t really update much overnight. Neither does Whatever. Neither do your friends on Facebook. Or (insert your favorite website). You don’t get new emails, either.

-Detractor: It can get a little lonely. I remember that when I did nights in the ICU, it got a little frustrating that the only people I had a chance to talk to at any length were my patients and co-workers. I mean, they’re great people for the most part….but there’s definitely a difference between them and my friends/family.

-Benefit: It’s easier to catch up with your buddies on the west coast. Or on the other side of the world.

-Detractor: You kinda feel like a zombie. Unless you’re asleep. But you don’t really sleep brilliantly either, even if you have blackout curtains.

-Detractor: The vast majority of light that hits your eyes is artificial.

-Benefit: You can go out and look at the supermoon or any other astronomical events without worrying about how it will affect your sleep schedule.

-Detractor: If you live in an apartment, you feel guilty about doing housework or laundry or anything else that makes noise. Playing instruments is right out. Movies and music are borderline, as long as you keep the volume low.

-Benefit: You get to hear the first birds in the morning. And watch the sunrise, if that’s your thing.

-Benefit/detractor: You end up spending a lot of time surfing.

-Detractor: You end up muddled enough to think that something like this would be a good entry for your blog.

So, there you go.

I’m for bed; you guys have a great day!

Or night?

Or whatever. So long as it’s great.

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Published in: on March 20, 2011 at 6:16 am  Comments (3)  

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3 CommentsLeave a comment

  1. Ah, yes, the night/day swap.

    I’ve had to do this several times in my career and I think the single most awesome thing is the illusion of having more freedom with your time.

    The reality is that I would just sleep more because I wasnt relying on the natural progression of the day to regulate my waking hours, but still. I love working nights.

  2. Another benefit: there’s that whole separate reality of people who are nocturnal that you get to see for a while. Kind of surreal and fun!

  3. I guess maybe I was lucky. Whenever I’d have to go out to the mountain to do research, I found if I could just NOT SLEEP the first day I’d be perfectly adjusted for the rest of the trip. Sometimes that was a tall order. And once it didn’t work that well because I got fairly sick (like debated driving me down to Tucson to visit an ER sick, though not enough to actually do it, though in hindsight it maybe would have been the better call. Being sick without a pharmacy sucks. Also? The zinc-laced hippy cough drops your prof is packing do not work, no matter what anyone says.)


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