Blinded by the Light

Christopher L. Burnsides, DO, FACEP

This past Monday, my 2022 Honda Pilot pulled into the hospital garage at the ungodly hour of 2:45 pm. For the past 4 years I have been a nocturnist and, given the alternative, I generally love it. And yet here I was searching for a parking spot in the typically barren garage. Disoriented, I parked my car and loped across the medic bay under the watchful eye of the oppressive summer sun.

I grabbed a seat and was relieved to ne working with a good crew that day. There were only a handful of apparently straightforward patients assigned to me that had already been picked up by APPs. So far so good!  After I had settled in, and my colleagues had my sides splitting in laughter, I staffed the APP patients and went out to round on them.

The late shift typically only has a few hours of overlapping physician coverage remaining when I arrive and it is not uncommon to have 20 patients assigned to me within the first few hours of arriving on shift. With 2 docs and a single APP for most of the shift, many nights can feel like drowning during that initial onslaught. This level of manpower on shift was overwhelming. And I would be lying if I said it wasn’t nice.

Another surprise was how pleasant the consultants were that I had to speak with. I am typically interacting with different iterations of these same people when I call them at 3:00 AM. This afternoon I had the impression that they were actually happy to talk to me, or at the very least, were not quasi-homicidal during our discussion. The availability of social services and the expanded ability to coordinate outpatient care was a bit decadent to this simple creature of the night. It felt like one of those dreams wherein you perceive your surroundings as familiar and archetypal, and yet everything is superficially different.

Night shift has given a degree of freedom to my career that day shift cannot currently approximate. In our group we get preferential scheduling. We have financial incentives that help me to reach my current goals more easily. And in general, administrators are happy to leave us to our own devices so long as we keep the ship afloat while they are at home in their beds. The other side of the coin is that we are largely on our own. This unanticipated jaunt amongst day walkers has made this even more evident.

The shift proceeded in a wonderfully undramatic fashion. I was out on time with all of my notes signed and with good plans for my remaining active patients. I signed out to the folks that I typically work with. When I arrived home shortly after midnight it felt a bit strange. A big reason I switched to night shift is that I found second shift to be even more brutal on my circadian rhythm than the life of a vampire. Doing long stretches on and long stretches off has limited the amount of time that I spend flipping schedules. And for me, I fell like I get to spend more time with my family helping out with daily routines than I did when on a traditional variable work schedule.

To my day shift colleagues, thank you for a wonderful time. But I currently have no plans to abandon the night life after dipping my toes in the diurnal gutter. I sadly cannot allow myself to be dragged into your world of healthier sleep and comparatively infinite resources. I swear it’s not you. It’s me. But I will remember and cherish our time together in the sun.