The Thirty

The thirty hour shift. The reason I didn't pick medicine other than, as stated before, endless metabolic work-ups, intact PTH draws, and anemia work-ups that make me want to stick a pen run dry from hand-written six page H&Ps in my eye. The reason we're losing so many primary care folks to specialization. The reason your primary won't come and see you in the hospital. Also, to listen to some of the old hands, one of the best learning experiences ever. What-everr, old dudes.

Hour 10. The normal work day is over. The rest of the team leaves. Have a good night, they say. See you tomorrow morning. They leave. The sunlight from the window kisses them hello as they escape into the world. The shadows in the hallway for the call taker lengthen, distort. The sounds of the hospital are eerily calm.

Hour 16.One or two admissions have occured by this time, perhaps accompanied by a hurried supper. It's past the kids' bedtime but still when a normal person might be awake. A bit of fatigue starts at this point but not too much. You can still assess a patient somewhat well. Skills are maintained at probably about 85% of normal. Cross-cover gets worse as the night nurses come on and re-evaluate sloppy day orders--this isn't a slam, just a point. Each nurse has their own style just as each doc does. We get better at writing PRN tylenol on peds, or 'beer at bedside' on trauma.

Hour 20. This was about when I got my favorite page of all time, from a senior I actually like. "Your night is about to blow up. Call me about the first of the admits." I'm now up way past my bedtime--I'm old, after all--and any hope of sleep is squashed, although it's best to assume it won't happen anyway. Total coffee--approaching 32 ounces for the day. Taking a history, now at about 2 or 3 am, I find myself pausing between questions, getting glassy-eyed. How many histories? I don't know. Three asthmatics. Two adrenal insufficiencies, one from CAH on cross-cover, one no one knows why. I close my eyes to listen to the heart sounds better and sway. One night, getting a kid at this time that was really sick with what we thought was Stevens-Johnson Syndrome, I was shocked awake by a six-month old pussing from his eyes and crying through secretions. The sick ones wake you up. Still, probably about 70% capacity.

Hour 24.One falls asleep finishing notes. The sun rises again. Somehow, that makes it better. I usually have time to spread out my admissions and finish up details around this time, as the morning team comes in. It takes me a minute to write a tylenol order without dropping a decimal point. Maybe 30% capacity. Differentials down to dead or not. What's wrong with them? I dunno. Can we figure it out tomorrow? Or at least later, when I'm gone?

Hour...um...the best is trying to be coherent on rounds. Usually I save a cup of coffee for this time, first to walk to the stall as a some sort of break, and second to be able to form sentences. It's just survival for the last hours.

Home, for recovery. This is the cruel part. It's the middle of the day. My kids are cute, my wife is gorgeous, the crock pot is aromatic, the sun is out and beaming across the kitchen. Despite that, despite all the reasons to stay up, all I can think of is bed. I sleep for 2 to 3 hours so hard that, per report, I'm sideways on the bed and I don't even notice getting moved.

The evening brings some post-nap attempt to stay awake in order to reset the clock. So I can go to bed, and get up early, and do it all again. The rounding. The anemai work-ups. And the pen in the eye. Suh-weeeet.

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medicine girl said...

One of the best posts ever. You've captured the essence of the 30-hour shift. Or at least I think you have, since as a student I have to stay the course for 30 hours but at least have no real responsibility. Interns often stay longer than 30.

The 5-7 am window hits me the hardest. Somewhere in there I begin to frantically consider ways I might avoid internship & its q3-5 call altogether. By 8 am morning report my eyes wander separately in directions I can't control.

I have pretty good stamina, but sometimes a body has to sleep. There's gotta be a better way.

tyro said...

Ah, students know what it's like on one level. You often have less responsibility but then you also have the double-edged sword of not being in the loop. I think there is a better way; it's called night float. The surg program at my med school was going to that for trauma. There was a day team and a night team, and they worked 12 hour shifts. It's hard to be on nights for a month but at least you can sleep.

medicine girl said...

You're right on the mark. I love night float! My week of NF is yet another reason (needle stick aside) that I've so enjoyed my surgical rotation. I rode the NF for a week and spent my days sleeping soundly.

Transition to NF requires a single 24 hour shift, but it makes the medicine 30 look like a medieval torture device.