Adventure on Night Shift

I distinctly remember working night shifts at Children's Medical Center in Dayton as a nurse's aid overnight in the Pediatric Intensive Care Unit thinking to myself that I never wanted to work a nine-to-five, show up and sit-in-a-cubicle job where'd I type expense reports and give talks involving pie charts and bar grafts. Something about working nights in the hospital was glamorous in a twisted way, as if practicing medicine while everyone sleeps somehow qualified you as plucky or maybe good-crazy, not I-talk-to-my-hamster crazy. Even then, something about night shift attracted me.

As advertised in my own imagination, night shift always proves to be an adventure of some sorts. From folks with sciatic back pain to the sore throat that couldn't wait for daylight, people bring a myriad of expectations and concerns to the emergency department in the wee hours of the night. It's a challenge to weigh their concern and your own clinical suspicion when your resources are more limited than those available to you in the day. When a call to a primary care doc during office hours to arrange close follow-up or inquire as to the status of some chronic complaint may be welcome, the 3:21 AM, "Hey, do you know Mrs. So-and-so who says she can't remember if her blood pressure pill is metoprolol or tenormin?" is a somewhat less welcome interruption to a primary care physician's evening. Also, as much as you see numbers of intoxicated, out-of-luck, repeat customers during the evening hours in the emergency department, a lot of folks end up in the department at ungodly times because their gravely ill. Heart attacks and congestive heart failure, pneumonia and kidney stones don't know how to tell time. On night shift, the scaled down volume allows you time to process and thoughtfully consider treatment options and differential diagnosis. Day shifts are often so hectic, that time for reflection and consideration is often cut short by the demand of moving patients and beds in order to see the next sick patient.

As a second-year at my program at Akron General Medical Center, night shifts are a second-year emergency medicine resident's time to shine. As the senior resident from 2:00 AM on, with an intern, you're looked to carry the load and manage critically ill patients. It's an audition for the acuity and fervor of a day shift as a third-year. It's your first shift of managing the ED and being the go-to guy to see and admit or discharge patients. So, I've been reveling in the past week straight of nights I've just finished. From trauma teams for car crashes to little-old-ladies in nursing homes that need central intravenous access, my attendings expect me to do and teach the interns critical management of ill patients. In just this past week, I walked a medical student through our case when a short-of-breath gentleman reported to the ED with new left bundle branch block, a conduction abnormality of the heart. He was breathing so poorly we used a mask that actively blows air into your lungs called Bi-pap to help him breathe. Low and behold, we popped him back into a narrow-complex heart rhythm that revealed the heart attacks that had caused both the shortness of breath and conduction anomaly of the heart. Minutes later, his 100% lesion of his coronary arteries was stented open by one of our interventional radiologist. Not every night time tale ends so well. The next morning a very similar patient, this time an elderly African-American with a history of heart and lung trouble presented similarly. Despite our efforts, evening intubating the patient and connecting her to a breathing machine with drugs dripping to drive her heart could keep her from passing that night.

Night shift has its ups and downs, its nights full of toothaches and intoxicated patients with lacerations. Medicine has its ups and downs, it triumphs and sacrifices - like a good night's sleep. Still, not many people get to go to work and get to restart hearts, plunge tubes down throats, or sew together lips and foreheads, and splint shattered bones. I need to remember that I'm lucky, even and 4:21 AM with the fourteenth EMS squad call for chest pain or fall from a nursing home. I need to remind myself that this is all the adventure, all part of my dream that I'm living.

--Andrew Jacques ('05)