I’ve spent so much time in the hospital lately that coming out into the sunlight feels like culture shock: there is light like this around commonly?

I’ve figured out (belatedly, perhaps) that the hard part of call is only between midnight and 5am. That’s when the circadian rhythm really demands to slow down and go to sleep. Before, and even after, is not that bad. In fact, looking at the sunlight now makes me feel fairly wide awake, although I know i’ve missed so much sleep lately that if I don’t catch up on at least a fraction of it today, the rest of the week will be ruined.

Part of it, too, is the discipline we started learning back in grade school math: I don’t want to finish these problems, to pay attention and work all the way through, but I will anyway. At a certain point in the night, I really do not want to be there at all. It would be so delightful to simply walk away; not even out of the hospital, just into the callroom, and decide to ignore pages for an hour or two, or even just to ignore the jobs that ought to be done even though no one will page about it (checking labs and imaging ordered earlier, walking around to check on the critical patients, filling out some of the mountains of paperwork that have to be done at night because if saved for daylight they’ll overwhelm the team’s resources). But I won’t; I’ll keep going regardless of what I’d like to be doing.

There’s a point in the middle of an endless stream of traumas, one or two every fifteen minutes, where every single person in the ER looks at the others and says, “Why am I here, and why am I doing this?” And no one has much of an answer, so someone says something flippant, and we keep going. Or a patient threatens to leave AMA, and we all shrug: Sure, do us a favor, the door is that way.

Then there was the time I decided to put my head down on the desk for five minutes, and when the nurse came to ask me about something, I jumped so hard she was more startled than I was. I think I have too much of a startle reflex. I’d been half-awake the whole time, knowing it was a matter of minutes before someone needed something from me, and I still leaped to my feet. I’m usually a very solid sleeper, but I’ve trained myself to never really sleep in the hospital. I’m too worried about the consequences (to a patient, or to my career) if I sleep through a page. So I’m always half listening, and waking up every now and then to check the pager and make sure I didn’t miss anything. Which makes me rather unsympathetic to the new medical students and interns who do occasionally sleep through their pagers. I can have slept 4 hours in the last 48, and still jump up the second my pager goes off.

Those are bad numbers. Maybe I’d better go to sleep now. . .

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