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It is 1 a.m. on a Thursday night, and the only light in my apartment is coming from the laptop that sits in front of me in my bed. In four hours, I'll begin my third day of a monthlong rotation through the neonatal intensive care unit (the NICU). I normally do not have trouble with sleep, but every night since starting this rotation, I've laid in bed awake for hours, my thoughts coming fast and strange. Although I eventually sleep, I wake up in the middle of the night unable to rest for hours at a time. The only dreams I can remember are about being lonely and scared.

I'm not sure why this is happening.

I don't think I'm anxious about working in the NICU, although God knows I've got reasons to be. It's a a very different place from any other I've been-we work very long hours planning the care of very tiny patients who are so fragile that we are sometimes forbidden from examining them. The hours are certainly not easy-we work 27-hour shifts every fourth night, and the NICU is notorious for being a place where everyone goes over their work hour limit of 80 a week. But my colleagues are nice, and the backup in challenging situations is ample.

Although I guess the source of my insomnia certainly could be the NICU, it could also be the impending winter. It could be the distance between me and almost everyone I care about. It could be my usual insecurities, magnified by a major birthday and a longer stretch of singlehood than I'm entirely comfortable with. If it is these things, I can't understand why they would bother me now, and why they would bother me this much. I feel a little lost.

Sitting here in the dark in front of my laptop, it's not pushing it to say I feel a little like one of my tiny patients in an incubating isolette bed. The light shining on me only illuminates my confusion, without giving reasons or comfort. I'm reaching for things I am blind to, not sure why I'm here, not sure where I've come from. And even if I get sleep, I'm not getting much rest.