The Graveyard Shift
This is really a precursor to a larger discussion on sleep deprivation and medicine that hopefully I someday finish.
As I sit and write this, it’s Tuesday night. I worked overnight shifts this previous Friday, Saturday, and Sunday in our pediatric emergency department. My shift was from roughly 11pm-8am each night. I saw over 30 patients during each shift (with help from our residents of course). There was the usual variety of patients, ranging from not-so-sick to septic-and-need-the-ICU.
All in all, the shifts were busy, but nothing extraordinary happened during any shift. While I was physically tired at the end of each shift, I did not encounter any situations that were emotionally draining (for me that is; many ER visits are both physically and emotionally draining for the patient and/or family, regardless of circumstance).
Between shifts and after the third shift I got about 5-6 hours of sleep. When between multiple night shifts, I will also try to catch a short nap (even it’s only 15 minutes, though sometimes up to an hour) right before I walk out the door. Many times those 5-6 hours aren’t enough and the extra nap just before the shift makes all the difference.
Yesterday (Monday), after finishing up the last of the three night shifts, I got some sleep during the day, and was up with the family afterwards. I then went to bed at my “regular” bed time; this morning I headed into the office to work on projects and attending some meetings/conferences.
I was standing in the corner of a jam-packed conference room listening to a lecture, when I briefly looked down at my feet and saw this:
No Two Are Alike
I noticed this nearly three hours after arriving to work. Not a single person had said anything to me. No one said anything the remaining few hours I was there. I’m not sure if people didn’t notice (someone must have noticed), if they thought I was just making an odd fashion statement, or if they were just not sure how to broach the subject.
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I don’t usually have my own “wacky-clothes day” at the office. I often dress casually, but my shoes generally match each other.
There is a point to sharing this story: when discussing whether residents (or doctors in general) should be doing 24-30 hour call shifts, I think most people are asking the wrong question.
Without entirely giving away the take-home point of my future blog post, the “anything other than call” mentality is missing large parts of the discussion, particularly ignoring the “other” things that happen.
What things have you inadvertently done when tired? Share your stories below!
I’ve never understood why doctors have such crazy hours. If there is any profession I want to be well rested and at their best, it’s my doctor. I think pilots have similarly bizarre schedules, and again, I’ll take my pilots very well rested thank you very much. Great post, looking forward to the follow up.
Well, I think it’s largely a practical issue. Hospitals are 24/7 operations — someone has to be there all the time. However other countries do things a bit differently than us.
LOVE that picture – bizarre that you were too numb to realize you were tying only one shoe. Inquiring minds want to know – did you keep them that way or go home and change?
I leave them tied usually 🙂
Joanna, I realized I didn’t actually answer your question. I went and hid in my office as soon as I could, then I scampered home to finish working from there once I finished up some tasks that had to be completed immediately.
It takes a walk across some highly trafficked areas to get to my car, with plenty of people walking behind me, towards me, and around me. I was watching people’s faces and eyes — I did not see any reactions, but I was sure that every person behind me was silently chortling.
Thanks for following up. I can only imagine how you felt!
I don’t remember if I already shared this or not. Dealing with my own level of sleep deprivation. :O)
I feel asleep while driving in my early years, while delivering newspapers. I hit and totaled a parked car. No injuries, thankfully. What gets a small laugh now is I had to knock very load and the person obviously exited their shower early. I couldn’t just leave that mess for them to just walk out to.
I also once thought my car had been stolen when I arrived home. Guess what – it was the car I was driving.
Again, it gets chuckles now, but sleep deprivation is real and dangerous and now they believe long periods of it may increase the chances of dementia and Alzheimer’s. My mom has the latter. She never complained about lack of sleep, but my dad was a really bad snorer, so I wonder.
Just a wrong shoe, funny. Amputating the wrong leg, not so funny.
cd :O)
I think you shared some but not all of this earlier — thanks for sharing more. Yes, sleep deprivation is a big issue. My wife acts as mother hen to me sometimes to make sure I don’t stay up too late too often…
I’m surprised that not one person noticed or said anything about your shoes, especially considering that most of us who work in the hospital always seem to notice everything! I agree that while the hospital is open 24/7 there obviously needs to be coverage, but the hours that some specialities have to put in is quite unreal… And then they wonder why mistakes happen. As a nurse, I do 12 hour shifts and I’m a night shift person. There hasn’t been anything crazy that I recall doing as a result of sleep deprivation, but it definitely causes a change in my mood and patience when I don’t have enough rest. The thing that I struggled with when I first started was people saying, “You only work 3 days per week! You can’t possibly still be tired! You’re young! You can handle it!” Needless to say that after I educated them that 12 hour shifts ended up being more than that and then trying to catch up on sleep… They would change their tune. Haha. I’m looking forward to your extended article on this topic.
Someone must’ve noticed but it’s possible it was only people in the hallway that noticed and the people I know well didn’t notice.
Yes, the 3 day a week as full time is hard for some people to fathom. That’s what my wife did for 5 years when she started. Initially on nights then on days, then later as an NP rotating nights/days. It’s exhausting.