Life as a night owl

14 11 2011

Which is a ridiculous expression, as a night owl is just a regular owl.

Anyhoo, I just finished working two weeks of night shift, which I found out is very different from just pulling an all-nighter.  This is completely flipping your schedule upside down, and when it comes to doing things like getting errands run or making phone calls to friends, everything is made more difficult.  I was also told that I slept through two weeks of gorgeous weather that we likely won’t see again until Spring.  Even though I was getting a decent amount of sleep, I still felt relatively listless and drowsy.  Fun fact, I was told that people who work 3rd shift live significantly shorter lifespans because of the stress that sleeping odd hours puts on the body.  One of the residents told me that, and I’ll have to look up that study for you all.

As 3rd year students, we are required to work on night shift for a bit during internal medicine.  Aside from that, the only night experience most students got was elective if that student chose to do an elective in trauma surgery or working in the emergency department.  The rationale for including a month of nights was twofold: one, to help distribute the students more evenly among the hospital’s residents; and two, because as one of my superiors put it, “we don’t want you starting residency without working nights at an institution.”  Very well.  Thus the night shift commenced.

I was pumped to be working nights because my father, an ICU physician, had told me at the beginning of 3rd year to take any opportunity I could to work nights because “You learn the most working on nights.”  In my mind, things are slower at night and there would be more time to really sit down with some of the patients, follow their care for a couple of weeks, and really be able to read about and learn from their cases.  But as I learned in family medicine, how much I learn is highly correlated with how much the residents are willing to teach.

Working night float at this particular hospital primarily consists of three responsibilities for the residents:

  1. Admitting patients from the ER
  2. Responding to codes
  3. Consulting on patients who are unstable for whatever reason

For the most part, every single resident with whom we (me and the other medical student on the team with me) worked with seemed surprised that the med school wanted students to do night float.  Why?  “We don’t do much (and there’s really no place for students in what we do).”  That last part in the parentheses weren’t actually spoken in words, but the tone and facial expressions definitely said that.  And that was true the vast majority of the time.  Here’s why.

Things I did not do on night float:

  1. Interview, examine, or present patients on my own
  2. See or learn any new procedures
  3. Help with a code
  4. Write a single note
  5. Interact with any attending physicians

Things I did on night float:

  1. Rectal exams.  The nurses won’t touch that, and the residents choose to pass that responsibility on to the med students. Yippee.
  2. Read textbooks (but retained very little)
  3. Improved my billiards and ping-pong games
  4. Watched television (and I don’t have TV, so that was a big deal)
  5. Got pimped out the wazoo by the senior resident for the last 4 nights (for you non-med students, and I’m sure I’ve mentioned this,  but it’s basically asking intense quiz questions that are ridiculously difficult and continue to do so until you feel incredibly stupid.  There will be a subsequent post about this later).

We did admit patients from the ER.  It was my only real patient contact during the entire 2 weeks, and I only went alone to see and examine a patient one time (and even then, I was joined halfway through the interview by the rest of the team).  The vast majority of consults about unstable patients were fielded by the intern, but one time we got to see the residents place a central line  (a big IV in the internal jugular vein) during which I neither really saw what was going on nor did I assist, but I did meet the world’s most power-hungry, ticked-off nurse practitioner.  That, however, is a story for another day.

As far as the codes go, I went to four codes (two for the same patient).  Let me just stop a moment and say that I went to four codes, I did not see any codes.  Let me explain: it’s the night shift.  Nobody else has better things to do than to run toward the action whether they are necessary or not.  So when a code blue happened (for you non-med folks, someone who isn’t breathing or heart isn’t beating), we would sprint across the hospital to the room and then the other med student and I hung out in the hallway while the resident and intern squeezed their way into the room past 15 nurses and their students, 4 respiratory therapists and their students, 2 pharmacists, at least 2 paramedics and/or care flight nurses responding (usually unnecessarily) to the code, at least 2 other residents, sometimes an attending, and usually at least 1 of the patient’s family members.  So the other med student and I were stuck outside the room, unable to learn anything about how a code is run, with another 10 or so nurses, plus the techs wheeling in things like EKG machines and portable X-ray machines.  This was bad, because EKG and X-rays are important.  Even when the doctors asked for unnecessary people to clear out, nobody moved, because a lot of those people felt that they were necessary, even if they were only watching.  I have many opinions about this, but this is also a post for another day.

For the most part, nights with the first and second teams I worked with were usually composed of 4 hours of seeing patients, 8 hours of sitting around.  Sometimes they let us nap in the med student on-call room.  On night team number 3, it was 3 hours of admitting patients, 4 hours of getting pimped like no other, and maybe an hour and a half of the residents sitting down and teaching something.  Even this left a solid 3 or 4 hours of sitting around.

On the upside, the resident’s lounge contains a ping-pong table and a pool table, as well as a TV.  So at 3am when the cafeteria opened for night staff lunch, we’d get food and hang out with the TV on, playing pool.  Let’s be honest, the only thing missing was beer  😉

The pimping was not fun while it was happening, to say the least, but I learned a lot during those 4 nights with team #3.  Those nights were really worthwhile.  The other night shift experiences?  I’d rather stick to traditional daytime education.

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