Night Shift

Here’s this week’s reflection. I hope it resonates with you and ask that, if you enjoyed, please comment and share on your social media. Heartfelt thanks for all your support!

Keeping the light on for you,

Carol

“Tomato and cheese omelet and large coffee to go, please,” I tell the cashier in the coffee shop. I sidestep other patrons and take my place in the wait queue. It’s 2AM and the hospital’s only food station for us night owls is soon to close. Bleary eyed, I head back upstairs to sit at a nurse’s station and hurriedly ingest this breakfast gut bomb and rocket fuel needed to get me — a rookie RN navigating critical care — through the rest of the shift.

Dawn peeks through the clouds as I skirt around a bedside for one last set of vitals. Though my stomach, where the omelet has stalled thanks to a recently flipped circadian rhythm, aches from grease and worry, the caffeine jitters have helped make the last four hours more productive. Another nocturne of stress and information overwhelm is ending as a new shift, with the scent of fresh coffee, arrives. 

Day shift is full of well-seasoned caregivers. I pray my developing vigilance has met the expectations of my patients, and of the Day Shift Divas as well.

After my twelve-hour stint, the caffeine decrescendos on my drive home. Most trips are uneventful, but one will include a rear-end collision due to a combination of outdoor murk and mental fog. Some colleagues recommend to chew ice en route home to stay awake. They too have experienced this lurking facet of the job:  motor vehicle accidents from fatigue. Once home, I utter another prayer of thanks as I climb into bed with the shades drawn to rest up for the next cycle around the moon.

The graveyard shift garners an interesting cast of humorous and exasperating characters. It is often a mix of terrified newbies, socially awkward souls, and crusty aggressive types now able to run the show on their own terms. Night dwellers enjoy the quiet and not having to deal with family members or gluts of rounding physicians. And unlike day shift, patients are conveniently right under our nose, not ricocheting in and out of a variety of departments. Even the lights are dimmed to promote rest for the infirmed. 

My initial foray into this underworld came right after nursing school. We had a rotating schedule of staffing coronary care, medical intensive care, and progressive care units. Several of us new grads routinely tested the patience of our preceptors as we developed our abilities to organize and prioritize. I tried to disguise my deer-in-the-headlights reality with an earnest face. “You look too serious!” a coworker frequently chided. Better serious than scrambled.

My next venue was a coronary care unit (CCU) in a large metropolitan hospital where we were privy to—at the time—the cutting-edge cardiac therapies. We were also tasked with treating the consequences. So many heart attacks occur in the wee hours and, despite the challenging roller coaster rides, our track record was thankfully positive.

One member of our swing shift posse was an older nurse with a prim, proper southern belle exterior complete with a slow drawl and mischief in her eyes. Her favorite activity was giving bed baths to male patients and grading their endowment on a one-to-ten scale. On occasion, she would emerge from the rooms with a smug grin and the satisfied proclamation: “He’s a te-en!” Long before modern reporting practices, and as she was nearing retirement, her behavior only made the management chuckle. I wonder to this day why we did not have more cardiac arrests in our unit than we did. In the event of a resuscitation effort, Southern Belle would help, not by rendering CPR or fetching needed items but, by picking up trash. Codes provide an avalanche of product wrappers, paperwork, and other detritus. Our Chief Tidiness Officer scurried about during any crisis to help maintain order in the (controlled) chaos. 

Our charge nurse chose the dogwatch to be available for her kids during the day. Years in the overnight trenches dealing with tough situations and difficult doctors rendered her relaxed, knowledgeable and delightfully sarcastic. She had little tolerance for wasted effort and reminded me regularly how to be more efficient and organized. Her constructive criticism was uncomfortable at the time, and I attributed her sometimes sour demeanor to a chronically reversed internal clock. Now a parent myself, I not only understand the depth of her exhaustion at that time, but also how limited a mother’s tolerance can indeed be. 

Back then, I was a shy voice among the Lions of Darkness and would have preferred to donate a kidney rather than rouse a doctor from sleep. This was still the era of well-professed dominance and expected subservience. So, before any call was placed, we would pool our questions for a particular provider in an effort to at least lessen the verbal abuse that we nurses would undoubtedly hear on our end of the phone. The twisted irony of being chastised by someone when following their orders to be notified, regardless of clock position, grew the tough hides and sharp tongues of my nursing mentors.

Once I secured a post in Anesthesia, overnight on-call time was either blissfully quiet or unabashedly crazy. The serendipitous procurement of a position without call (a rarity in this vocation) brought me back into the light of day. 

Not having to herd as many cats at night is a great place to cement vital skillsets – especially for critical care. It is also a setting ripe with surprise since the sick do not always follow Greenwich Mean Time. Emergencies can be plentiful and are tended to by the tight web of those savvy to multitasking as a skeleton crew. Many staff have chosen to work third shift their entire career and have bonded as “family.” And contrary to popular belief, intensive care never sleeps. With round the clock assessments, medications, treatments and the white noise of continuous monitoring and alarms, there is no time for napping.

Rotating through all three shifts during my nursing career has offered me the opportunity to understand the specific duties and priorities throughout a 24-hour period, not to mention developing compassion toward colleagues on other shifts. It has also helped me appreciate that my knowledge base, self-sufficiency, and perspectives have flourished the most once the external world has been tucked into bed and is fast asleep.