Watching in the Night
2002; Lippincott Williams & Wilkins; Volume: 24; Issue: 9 Linguagem: Inglês
10.1097/01.eem.0000334449.31393.cb
ISSN1552-3624
Autores ResumoThere are things I love about the night. I love the stillness and the way it feels on clear Southern nights when I have the sensation I am driving among the moon and stars on the way to work. I love the cooler air, the silence, the mystery. People who work only in the daytime miss a lot. Night can be magnificent. I don't like leaving my family, when sleep has enveloped the children. I hate the way it feels to cover them with a blanket, close the door, and go out into the world, knowing that I will not be there if they are sick or in danger. I hate kissing my wife goodbye when she is curled up in her robe, reading a book in our dimly lit living room. It seems hateful and blasphemous to leave such holy things behind. But that's what I do; I work at night. One of the problems with emergency medicine, and with medicine in general, is that it never stops. Medicine is a ship, and there's always an officer of the watch. About 12 nights every month, I'm that officer. I accept that duty because it is a necessity. But also because there are things about practicing at night that I find pleasant. Once, when I couldn't sleep, I thought back on my medical education and practice and calculated how much of my life had been spent working at night. I've been in practice almost nine years. I spent three years in residency, two clinical years in medical school and two academic. But I'll discount those academic years. In spite of late-night study sessions, they don't compare with making life-altering decisions in the middle of the night. So the tally comes to some 14 years in which I have been attempting to live, function, and treat patients after the sun has gone below the horizon. Sometimes I feel a deep ache as my body tries to convince me to sleep those nights when I'm awake. Someday I may have to. But for now I'll stay the course. I have four small children. When I work nights, I can put them to bed before work, see them and send them to school in the morning after work, sleep a bit, then have all evening with them again when they return home. And because I'm willing to work so many nights, I work less each month than most of my partners. My free time with my wife and children is luxurious. I can't throw that away just to work when the sun is warm. Dangerous conditions sneak up at night; the third shift requires insight into the human condition But there's more. I enjoy the night because medicine at night is an adventure. I know that ideally it should be the same as in the day. But I'm not nocturnal by nature. I wasn't meant to be up all night. I do it, but somehow it's wrong. My mind and body aren't at peak performance. That means that nights require special vigilance. Dangerous conditions more easily sneak up on me. And the third shift requires a certain insight into the human condition. People act differently between sunset and sunrise. I've learned through the years that people come to emergency departments for many reasons at night, but one of the most important ones is fear, pure and simple. As children we learn to fear the night. It's a time of uncertainty. Our ancestors embodied their fears in imaginary monsters, like vampires, witches, werewolves. Something within them was afraid of what they could not see or express. I've worked enough nights to know another reason for that basic human fear. There are, in fact, things out at night that aren't there in the day. Predators, two legged and four, stalk the darkness. Or maybe we learned to fear the night because we weren't always confident that morning would come. Maybe we still wonder the same thing. Regardless of the source of the fear, patients present with difficult complaints like vague chest pain, numbness, swollen body parts that aren't swollen, and many others. Often these bizarre complaints are just the anxiety or loneliness of night. I'm at a point in my practice where I don't attempt to solve all of these puzzles. Instead I often do a minimal work-up to rule out dangerous problems. Then I reassure. Reassurance is a skill vital to the night doctor. “You aren't having a heart attack;” “Your baby has a fever, but is just fine;” “It's OK that your child ate a piece of deodorant.” Of course, sometimes bad things happen at night. I take pride in being available for those times too. Patients have horrible car wrecks. Angry drunks shoot and stab one another. Beloved infants die of SIDS. During those times, it is the job of the night doctor to be the one “on the wall,” there to intervene and try to save a life which, not so many years ago, would have been lost because there wasn't much health care available after hours. I've found that this is a lonely job. When I was a resident in a teaching hospital, there was always another doctor to bail me out of tough spots. Always someone to ask a question. Always someone else to go along when I had to say, “I'm so sorry, but your wife died.” In my community hospital, in my medium-sized emergency department, I'm the lone ranger at night. Like so many things in my life, the night shift has become a part of who I am. The night doctor, the vampire. I don't always like the fatigue or the uncertainty. But I love the unique character of the night and its citizens. The night holds secret pleasures for everyone, especially for doctors. We get to see all of its terror and beauty, and can participate in making it less terrible for everyone else. No matter how tired I get, that fact keeps me coming back each night.
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