[Ann Emerg Med. 2009;54:754-755.]
I start my night by saying good morning to the charge nurse. He tells me, “It's night.” I say, “Close enough.” This is our ritual, and we adhere to it like a secret handshake. No night shift can go well without the right beginning. This is true for everything, so I'm always careful when I start something.
I dig through the people who have been waiting since late afternoon, apologizing for wait times and distributing the humble offerings of Percocet and saltines. I wonder if the 35-year-old man who took an ambulance to the emergency department for his dental pain would ever take the time to return a Press-Ganey, and then dismiss this thought as being counter to the cause. Besides, I'm fairly certain his mother will write a complaint regarding his care no matter what I do. She's probably drafting it as I examine him. I turn my name tag around when I hand him his ibuprofen script, banking on the fact that there's no way either of them could remember or spell my name. I don't remember theirs.
It's 3 am when I start hitting that wall. You know the one: you're a little cold or too warm, a little hungry, a little nauseated, kind of punchy, dull around the edges. My eyes feel dry and watery at the same time. I'm hearing patients answer my questions, but I'm not remembering what they say a minute later. The caffeine is prodding me to talk too quickly and shake too much.
I look over the tray of leftover breakfast foods from this morning's conference. Yesterday morning's conference? I don't know what day it is. Someone has actually eaten the center out of a Danish and left behind the rim. Among the crumbs, there is half of a muffin top and a ragged quarter of a jelly doughnut. I don't even know how you quarter a jelly doughnut. What is wrong with people? What kind of animals would do this? I reject these as unworthy of my time.
There are 9 croupy children between the ages of 1 and 2. Nine. I know, because they are louder and achieve better surround sound than my entertainment system does in my warm and cozy living room. In my mind, they merge into one giant barking seal baby, and I have true empathy for their sleepless mothers. I briefly wonder if seals get croup, then even more briefly toy with the idea of studying the sound frequencies of children barking and seals barking. I decide maybe it's already been done. It sounds like something I might have read somewhere, so I tell a resident I think it's been done, and almost believe myself. The resident doesn't believe me, but doesn't say so. I feel self-satisfied for having taught her something tonight.
I give my well-rehearsed “this is a virus and doesn't respond to antibiotics” speech for the 18th time since today started. Yesterday started? I'm not sure and check the clock. How can it only be 3:45? The mom doesn't believe me, either. I pull out the “I'm a mom, too” card. I find that parents are more impressed with the 4 children I have than with any number of years of training and practice I've achieved. I decide I'm more impressed with the kids most days, too. I try to really win her confidence by making up a long-winded story about the time my son had an otitis and I chose not to give him antibiotics. She buys it and goes home happy.
A woman who crashed her car comes in. She is drunk and was not a conscientious steward of her vehicle. She has a head injury, and as part of her exam, I ask her what the date is. She tells me, and I reflexively ask the nurse if she's right. She's wrong, but she's close enough. The patient isn't so drunk that she doesn't notice me asking about the date. She asks me if I'm drunk. I can see her point and don't give her a hard time, but I'm glad when the cops arrest her.
It's almost morning, or maybe it's already technically morning but it's almost sunup. The stale Danish rim looks delicious, and I've eaten about a third of it. I follow the unspoken rule of always leaving something on the plate, and throughout the night the crumbs have gotten smaller and smaller, but they are still there. I have a stroke of genius about doing a study correlating shift time of day with willingness to eat old food, but I know I don't have the statistical expertise to control for all the variables. I feel the excitement of this short-lived epiphany fade away and decide I must be tired. I'm disgusted about the Danish and lie to myself that I will go for a run later.
I discharge my last patient of the morning. He tells me he already has an appointment for tomorrow. Tomorrow? Or does he mean today? I ask him, and he tells me that it's not tomorrow until he's slept. He will go to his doctor's office after he has had a nap. That means his appointment is tomorrow in his mind, although it is today on the calendar. This makes more sense to me than anything I've heard tonight, and maybe ever. I thank him for his wisdom while I try to work out if my nap before work means it's been tomorrow all along, or if I need to nap when I get home for today to come. I ponder the possibility that if I don't nap, it will never be today, and I will somehow skip a day. This seems crazy.
My replacement is just late enough that I worry he isn't coming at all, but then he's there, cup of coffee in hand, ready to take sign-out. I feel grateful that he's decided to come to work and forgive the tardy 10 minutes without him acknowledging it happened.
I go home jittery, not sure if I should eat breakfast or dinner. I decide on dinner and have curry. I wonder if anyone else in my time zone is eating curry right now. I drink a beer. I work in a college town, so I know I'm not unique in having a beer at 8 am, and I don't feel guilty about it.
I go to bed and have my favorite dream. I dream about sleeping. I know when I wake up, it will be today, or close enough.
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