We are trained to do this in our sleep. 

More than ten years out from my residency graduation, I look back at my training and reflect on why exactly it was so grueling and arduous. I remember the innumerable ICU and Trauma rotations, overnight calls and night shifts, and I think part of the training on those nights was so that this knowledge and practice of medicine would be so engrained in our heads that we could quite literally do it in our sleep. 

Unfortunately, medical emergencies don’t always happen during bankers hours. In fact, they tend to happen at the most inopportune times. Kids start to have croupy coughs in the middle of the night, kidney stones decide to lodge themselves in ureters sometime around midnight, and coronary artieries clot off as corstisol levels rise causing heart attacks right around 3 or 4 AM. 

Working the night shift (I do a few each month) in the Emergency Department has become part of my life now for the past 15 years. And when the patients with heart attacks, renal colic and croup inevitably roll in, I call the appropriate consultant as needed. I wake up the cardiologist, urologist, and pediatric hospitalist if I must and when they answer the phone I feel bad to have awoken them in the middle of the night. I always apologize for having woken them up. It takes away some of the sting and shock of so abruptly jerking them from a peaceful reverie. I thank them too for returning the page. (As an emergency physician, you have to learn how to warm people up with kindness so that they are willing to help you with the patient.)  Those two things usually smooth out the conversation. 

I present the case briefly and succinctly and let them know the plan. I usually get a groggy reply. I try not to ask them too many questions as I know they likely didn’t even truly hear much of what I presented to them. But sometimes I need to ask for guidance and a recommendation. They wake up enough to give me a solid recommendation. We hang up the phone and I hope they remember the case in the morning. They may not, but there are mechanisms like the electronic medical record in place to remind them. 

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They fall back asleep and I hope not to bother them again that night. But you never know what else will come in through the ambulance bay or the front doors of the emergency department.  Mostly my colleagues are gracious about the interrupted sleep. They too have come to expect this. This is part of the duty of many physicians — doing this work even in your sleep. 

But the thing about working night shift in the ER, is that you plan on getting no sleep. You walk into the ER for a night shift and it’s like a casino. It may be 2 AM but the whole ER is awake — the nurses, the techs, the secretary, registration, most of the patients — so it may as well be 2 PM. Also most of the ER’s I have worked in did not have windows to the outside world (casinos also intentionally don’t) so you can trick your mind into believing that it is day time and I often do just that as a technique to keep myself awake. 

While I don’t love working the night shift (mostly because of how long it takes me to recover), I do find that I do get more true emergencies  — more of what I went into emergency medicine for. (You see, most people won’t come to the ER in the middle of the night for things that aren’t true emergencies.) So, I do get the middle-aged man having a widow maker heart attack whose life I get to help save. I do get to truly help the elderly lady with CHF who suddenly can’t breath in the middle of the night. I also do get to help the child with a bad ear infection who can’t sleep due to severe pain. In small ways and big, most night shifts when I leave, I feel like I truly made an impact. And the grueling residency training where I learned to practice emergency medicine in my sleep, it basically prepared me to be an everyday hero at all times of day and night.

Archana Shrestha, MD is a practicing emergency physician in Chicago. She is coauthor of “The Chronicles of Women in White Coats” and Cofounder of WomenInWhiteCoats.com. She is also an online health and fitness coach. Her healthy living lifestyle blog can be found at MightyMomMD.com and she can be followed on Instagram @MightyMomMD

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