Requiem for the Night Shift: In Memory Of….

I’m awake. Had my anchor sleep, but I’m still groggy and trying to be civil to the people around me, the ones that really care about me, my family. It’s the first morning after my last night shift as a full-time emergency physician. I’m not retiring, just done with nights and slowing down. “No nights after age (blank)” is not a group policy where I work... it’s my own choice, and thankfully supported by my current group. But doesn’t it seem reasonable? What is the toll of a shift-work career and the night shift? I was finding the night shift more difficult to adjust to and requiring a longer pre-shift sleep. I could handle fewer distractions beforehand and was very aware of a longer post-night-shift recovery period. The next day was not as much of a readjustment, but there seemed to be more of an effect two days after the night shift. I was more taciturn, more withdrawn, and isolated myself more from life events. I didn’t really like myself postnights for a day or two, nor did the people around me from time to time. The youthful days of working all night and playing all day were so far gone as to be mythical. The adrenaline rush of the night shift wasn’t happening any more, and there wasn’t a good enough tradeoff to continue to work those midnight shifts. Night shifts in the ED do have an upside. The night shift seems to feed the “raison d’être” of most emergency physicians. Over the years, I have come to regard emergency physicians collectively as individuals who think we can make order out of chaos, while at the same time being dependent on the personal and private adrenalin rush that comes with a fast-paced, highly unpredictable work environment and the demands of complicated cases. For most ED docs, the night shift finds you alone, in charge, and making complex decisions that really matter. Administration is tucked away in their warm beds and not looking over your shoulder. The consulting services are happy to have you “hold the fort” until dawn, then more willing to move in and deal with the accrued “problems.” The successes of the night shift can build you up; however, the mistakes and problems can drag you down. The cases vary, from mundane to rare and exciting. Last night in the last hour of my last night shift, I had a partial upper airway obstruction and an ST-elevation MI arrive back-to-back. The 0500 hour nadir of my alertness and responsiveness shattered by the demands of these sick patients–my adrenalin rush. Of course, there is always what I call “the breakfast club,” the early arrivers who have minor or long-term problems and present at 0600 hours to get a “jump” on the day. These patients have no idea what type of staff they are facing at the end of the night–cognitive capabilities and caffeine levels are zero and are commensurate with compassion levels, lab and x-ray are busy elsewhere, staff are all at their mental and physical low points. I’ve been known to refer to the last hour of the shift as the “CPR hour”– if you don’t need CPR, you can wait, and if you do need CPR, we’ll see you, but since CPR doesn't work, the visit will be short. Do you really want to deal with this type of department? The night shift ends with patient transfers and morning communications to admitting services. This is the moment in the shift when you feel the