Eighteen Years as a Nocturnist
2023; Lippincott Williams & Wilkins; Volume: 45; Issue: 11B Linguagem: Inglês
10.1097/01.eem.0000996972.45625.38
ISSN1552-3624
Autores Tópico(s)Advanced Thermodynamics and Statistical Mechanics
ResumoFigureFigureI started working full-time night shifts right after my second son was born. This spring he turns 18, which means I've now spent almost 18 years as a nocturnist. Why? That answer's easy: I wanted the rewards of a set schedule that worked with my sons' lives. As any EP parent understands, it's no easy feat to make it to every ball game, dance recital, spelling bee, or whatever other activity your child likes. Being there for every touchdown, basket, and goal was worth the constant jet lag. How? That answer's not as easy, so when people have said, “I don't know how you do it,” I've never quite known how to respond. I certainly don't have unique physiology that makes me less affected by circadian rhythm. I feel every bit as bad after working 7 p.m. to 7 a.m. as all the folks who say, “I can't do night shift.” I've just pressed on because I felt I had to for my kids. When I ask myself how exactly I've gotten through all these years of night shifts, I think about all the moments I've managed to function among day-walkers while sleep-deprived after working all night. Short of a button that says, “I worked all night in an ER while you were snug in your bed. Please bear with me,” there's no free pass for being grumpy, forgetful, or only half awake with store clerks, school personnel, or even friends and family. I've spent a good portion of my life trying to act as if I've slept when I haven't. No Priority for Sleep I remember dragging myself to basketball games at 3 p.m. (my equivalent of 3 a.m.) with an energy drink in hand. I was typically the only one sporting sweats and a baseball cap (or on a particularly rough day, no bra) in bleachers full of coiffed and perky moms. I was also frequently the only mom nodding off in her folding chair on the football practice sidelines. I sat silently while other moms talked about how tired they were (because, let's face it, all moms are tired). There is no socially appropriate way of saying, “Come to a game or practice at 3 a.m. and then talk to me about tired.” I remember showing up in scrubs to many a social event after well-meaning people encouraged me to “just come before work.” They might not have been so encouraging if they stopped to ponder how they might feel waking up at 4:30 a.m. to arrive by 5:30 a.m. to a meal or party where everyone else could enjoy a cocktail and had no place else to be so they could watch the clock during a rushed hour of socializing before their 7 a.m. shift. My kids, God bless them, dealt very well with my untraditional schedule. I think I did a decent job raising them considering the circadian mess I was handling, but I always wonder how much more I could have done if I weren't chronically jet lagged. Sometimes my unique schedule has been an asset, like at sleepovers during their teen years when I cooked for them at midnight and enjoyed cheering with them at the 1 a.m. finish of a college football game on TV. More often, my schedule was a great hindrance to being as attentive as I should have been. I recall one night during their elementary years when I made the mistake of sitting down on the couch during our evening routine. Next thing I knew I was hearing two little voices whisper, “She's sleeping,” as I drifted into oblivion. They scurried off together to do something (I'll never know what) that was most definitely not getting ready for bed. My kids didn't know the 24/7/365 nature of emergency medicine; they just knew I worked at night and needed to sleep during the day, so they tried their hardest to let me sleep. In comparison, hospitals and staffing groups—who know the demands of the job and should fully grasp that daytime sleep is imperative for those of us working all night—have not seemed to prioritize letting us sleep. Administrators who have never worked a night shift caring for patients have zero firsthand knowledge of what nocturnists endure and sometimes don't think to make accommodations for us. In Spite of Admin I remember one year on Doctors' Day my hospital had bottles of champagne for physicians. By the time I got to work at 7 p.m., none was left, which is curious because the small hospital had a small number of physicians in the building on any given day. I expressed dismay, so the PA working second shift insisted I take hers. For the record, my dismay was not about the champagne. (I tried to refuse, but she left it on my desk when she left.) It was the too common lack of consideration for night-shifters that bothered me. Anyone who has ever worked night shift has at one point grumbled, “Day-walkers who expect night-shifters to be at 10 a.m. or 2 p.m. meetings should try going to a 10 p.m. or 2 a.m. meeting.” When I look back on all the training sessions and mandatory meetings that occurred mid-morning or late afternoons, I know that I did nights all these years in spite of, not with the help of, hospital administration. Despite all my years of working nights, I never got good at it and never reached a point where it felt normal. I just got smarter about overcoming the circadian insult. I figured out exactly how much coffee I needed and when during my shift to drink it, and I perfected my timing and dosing of Benadryl to sleep during the day. I ended up on high-dose Wellbutrin to counteract the grueling effect of nights on my mental health. It's a challenging life for all night-shifters. The strategies each of us employ may vary, but after 18 years I think I've finally come up with a perfect response we can all give to the comment, “I don't know how you do it.” “WITH GREAT DIFFICULTY.” That being said, I would do it again. We do what we have to do as parents to give our kids the best life we can. If you knew the amazing sons I raised, you would know it was worth it. DR. SIMONS is a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on X @ERGoddessMD, and read her past columns at http://bit.ly/EMN-ERGoddess. Share this article on X and Facebook. Access the links in EMN by reading this on our website: www.EM-News.com. Comments? Write to us at [email protected].
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