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Diary of an FY2 – Nights

October 23, 2015

One aspect of working in medicine that I was spared in my first year doctorin’ was the night shift. St Elsewhere’s felt the service provision of a terrified baby-doctor was not balanced by the supervision and teaching necessary for a doctor at that stage of training. Given how hard some of the daytime on-call shifts tried to break me, I am grateful for that.

But a panic deferred cannot be denied forever. In my current rota, the majority of my night shift on-calls fall in this month. As my first ever night shift approached (at the end of a regular week in work), I was bricking it big time. I was acutely anxious that I would have to look after all the sick patients all by myself. AT NIGHT!

screams-internally

But I quickly learned that was not the case. At Worthwhile General, a motley crew is assembled:

  • The medical registrar.
  • A clerking SHO
  • An SHO who covers the medical wards, geriatric wards and more clerking if the need arises.
  • The geriatric SHO, responsible for admitting the delightfully elderly.
  • The FY1, largely at the beck and call of the wards.
  • Two nurse practitioners, who sort out beds, bloods and cannulae and field the bleeps from the wards, parsing who needs a doctor – and what kind of doctor they need.
  • There’s also a surgical SHO but I never saw them much.
Artist's rendition of our Hospital at Night team.

Artist’s rendition of our Hospital at Night team.

It’s not a foolproof system but, damn does it work! The nurse practitioners keep most of the flak away from the FY1, who in turn only calls on the SHO (i.e. me) when they’re really stuck. The SHOs crack on with seeing new admissions and ward reviews (doing medicine, kicking ass) and the Med Reg gets down to sorting shit out (Oh captain, my captain!)

In short, I was not alone. I couldn’t have been further from it. With so few of us to cover so many patients, we struck together and got busy – there’s real fellowship in that. I feel blessed that I had such good people to work with. I hope the feeling is reciprocated.

And y’know what? The patients don’t all suddenly get sick at 8:55pm – most are too busy sleeping. And that’s fine with me. One of the delights of working in a district general hospital is the lack of available investigations at 1 in the morning. Bloods, blood gas and XRay – pretty bootstraps medicine.  It actually becomes quite empowering – what can I do with the tools and knowledge I have tonight?

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Step 1: Remember who I am and what I’m about.

I don’t mean to boast but my ABG game has been on form. Because I’m all about that gas, bout that gas, bout that gas…

Time is a weird thing on nights. I don’t think it really exists. It’s just one thing happening after another and then the AMU consultant is doing the ward round and there’s light coming through the windows again and the sun is up?!

It’s not fair on the patients either. How can anyone be orientated to time and place when I’ve just woken them up at 3am? When asked the time during an AMTS, one patient replied “Since you’re here, doctor, I’d say it’s around 7am.” Ha ha. I wish.

Another patient asked how I could look so neat and trim after being up and on my feet all night. Of course, I sent off a confusion screen and arranged an urgent ophthalmology review.

I owe my survival on nights to my team, maybe actually being competent at what I do (?!) but most of all, I owe it to Eve. Light of my life, I was fortuitous to have a little bit of time with her before/after most night shifts. Even being with her for just a few minutes made my evaporate and lifted my soul. How lucky am I to have her in my life? And just what would I do without her?

Pop songs suddenly start making sense when she's around

Pop songs suddenly start making sense when she’s around

I’m sorry if I’m getting too mawkish but I’m writing this after my last night shift for a while, I have been awake for 30 straight hours and have seriously over-caffeinated myself. Before I descend into a full-blown delirium, I must lay myself down in sleep’s sweet embrace.

But now I know that night shifts are not an ogre to be feared. They’re long, sometimes excruciatingly busy, and my circadian rhythm has been shot to pieces, but I can survive them. I remain the med reg of my soul.

Good night.


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