I don't mind working nights

Friday, Thursday, Sunday--when you're working the night shift, they're all just words. Days run into other days and their names become meaningless, signifiers only of times when the mail comes and when it doesn't.

I don't mind working nights for a couple of weeks at a time. There's a kind of camaraderie among the members of the night shift, a smirk we share when we catch each others' eyes in the elevator and the coffee line. We all know that what we are doing is not normal, and in some way prevents us from being completely normal. And, we say with that smirk, it's cool.

When I work nights, time flies in a way that it doesn't at other times. I leave the hospital in the morning, and when I come back in the evening, it is the same workday. When I leave again the morning after my shift, it is still the same workday, only an entire day has passed. Last week, Monday became Thursday so fast that I missed a hair appointment I'd made on Wednesday.

At first, I thought it was kind of funny to come in on the same day I'd left, but the hilarity has worn off. I don't mind working nights for a couple of weeks at a time, but a month of nights--especially nights in the emergency department--just makes me crazy.

Sleep scientists have studied the impact of night-shift work on residents' sleep, mood, and attention and have found that working nights makes us--gasp!--wonky . I am not sure why this is such a surprise, as the entity of shift work sleep disorder (SWSD) has been well-described, and treatment strategies studied in even legit journals.

Although it is not described as a feature of SWSD, one of my most notable symptoms is a meal dysphoria of sorts: I never know what to eat any more. When I wake up in the evenings, I want a bowl of cereal. When I come home at sunup, I want a bowl of cereal. The only time I want a hot meal is around 2 a.m., when the demands of work make anything requiring utensils a thoroughly impractical enterprise. Instead, I drink cereal from a cup.

Worse than my crazy diet is the difficulty I have enjoying time off. My internal clock is so thoroughly reversed that trying to manipulate it inevitably results in failure: I wake up early--at 1 in the afternoon--spend the afternoon trying to stay awake, then lie in bed at 10 p.m. and count the cracks in my ceiling. I wander into the grocery store at 2 a.m. because I've got to get out and there's nowhere else to go. I spend twenty, maybe thirty minutes deliberating over varieties of microwave popcorn. I stare at the other people in the store, wondering why the hell they're awake. I buy bulk chewing gum. I hope none of them recognize me as a member of the health care profession.

I try to read. I try to write. I want to see friends, but no one's awake, because it's Tuesday, or Sunday, or something like that. I lie under blankets and do deep yogic breathing and try not to think about things I need to do. When the sun comes up, I watch the previous night's Daily Show and, blessedly, yawn.

All of this might be vindicated somehow if the learning on the night shift were of high quality, but it's not. The patients that roll into the emergency room in the middle of the night are motivated by one of two things: extreme discomfort, or the anxiety that traditionally descends with darkness. As a result, they have either a whole lot or nothing at all going on. Most nights, it's just a whole lot of nothing--ear infections, colds, itchy genitals, and other things that could've waited until morning, and an appointment with a primary care doctor.

I don't think I have SWSD. But I do have the cranky pants, and I am wearing them thin.

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I remember when I had to do a sleep study for apnea, having a very surreal conversation with the polysomnographologist (or whatever his title is -- sleep technician, I guess) about the importance of sleep hygiene and avoiding shift work. "But you're up all night, as part of your job," I point out. "It's okay. I like it. I volunteered for this."

I get the same kind of feeling when my PCP stresses good nutrition, and I know that she's on her feet for 12 hours a day, grabbing whatever food she can, when she can.

Ironically, being a medical professional doesn't seem like a particularly healthy lifestyle.

Ahhhh, night shift. You bring back non-golden memories of the Clear Lake Bakery, and of that nursing home I worked in over winter break my senior year in college. Be careful! In both situations, I developed ill-advised crushes because I NEVER SAW ANYONE ELSE! I also ended up with a raging caffeine addiction... Anyway, if you want to talk about it, call me on, like, Sunday, or whatever. Just remember: it's earlier here. ;)

Oooh, Dr. Signout - the night shift/ICU-Q3 food-weirdness is definitely in full effect in CT. I've been on a steady diet of egg whites, cheddar cheese, and chocolate (of varying proportions...mmm...chocolate...) for nearly the past two months. [Surprised?] While the delirium has certainly been evident, the fact that I've worn scrubs for nearly 60 days straight makes it hard to tell what the net physical effect has been. But tomorrow, there will be nowhere to hide - it's time for an outpatient rotation and (gasp!) "real" pants...

HP: Ask me about my med school's student insurance plan sometime. HiLArious!

Heather: I'm not addicted. I can stop anytime I want to. And about the crushes: tell me about it. I've been calling a lot of consults to pediatric dentistry and neurology, due mostly to the hotness of the respective residents on call for each. "That kid doesn't have a broken tooth, Signout. He has appendicitis." How embarrassing.

TLR: I, too, have worn nothing but scrubs since early January, and that won't change until I see you in March. There will be lots of elastic waistbands in my suitcase.

um all i gotta say is that one of the more convincing reasons to go into emergency medicine is that you never ever ever have to wear anything but scrubs...you never notice the expanding wasteline for 3 whole years. mmmmm chocolate. mmmmmm

Signout reader named Benjamin Langer, who himself has a very nice critical piece on intelligent design in the current edition of SCQ.