In lieu of an abstract, here is a brief excerpt of the content:Night ShiftCalvin R. GrossI don't like working at night anymore. Too much goes wrong when you're alone.I'm sitting at my desk in the middle of the cardiac intensive care unit, and it's far later than I'd like to be awake—two or three in the morning. Things are calm, almost pleasant. I can hear the occasional alarm going off—an imperfectly positioned blood pressure cuff, a pulse oximeter with a poor (...) waveform, a ventilator with secretions in it. The night's initial frenzied work is done; my new admissions are tucked away, and my overnight to-dos are completed. Now it's just time to sit and wait. I could sleep, but despite the calm, I'm too afraid to leave the unit to rest. The fellow has gone to bed hours ago, and now it's just me. Sure, I'm surrounded by experienced nurses who know their work well, but somehow, I'm the one in charge. A brand-new second-year resident, the only doctor there. I'm no intern, that's for sure, but I've never led a code before, and I've only ever placed one central line without supervision. As second years go, I'm as fresh as they come.The daytime, you see, is far different than nights. There's a large (and even bloated) team of two attendings, two fellows, two pharmacists, and more importantly, multiple other residents. When you don't know what to do for a patient, there's always someone there to bounce ideas off of. When something difficult or surprising happens, there are peers and mentors to process with. At night, it's the opposite—no peers, no mentors, only a group of experienced nurses, whose circle is closed to me, the outsider. I long to be a part of that large and bloated daytime team."Can you come into 23? I think his pupils are a different size."I'm startled out of my thoughts. 23 … All I can remember from sign-out that evening is that he's young, close to my age, and supposedly stable. I look at my notes, a catalogue of tragedies: early onset heart failure, multiple prior suicide attempts, intubated because of pulmonary edema, and a left-ventricular assist device (LVAD) that's malfunctioning. Iwalk over to the room and look at the nurse at the other side of the bed. She's in the early phases of her career too—less than a year on the job—but she's still more experienced than me. I take a flashlight, open his eyelids, and look at the pupils. Sure enough, one of them is much larger than the other. When I shine the light into each eye, the large one doesn't change. When I turn his head from side to side, his eyes stay fixed. We look [End Page 83] at each other, she and I. We both know something terrible is happening."Should we maybe wake the fellow up?" she asks tentatively.I nod my head in agreement, glad to have been offered a suggestion. It's the right thing to do. Iwalk to the fellow's call room, knock on the door, and wake him up. He's set to work 24 hours and would like nothing more than to keep resting. He sleepily comes with me to the bedside, looks at the pupils as well, and says, "With the sedation on, your exam isn't going to be the most accurate. We should start by scanning his head, and then go from there. Wake me back up if you need me, but I know you've got this one."I don't think that I deserve the confidence he has in me. Iwalk back to my desk, open the patient's chart, and place the order for an urgent CT scan. The machinery of the hospital starts to rumble as the imaging schedulers find a spot in the queue for the scan, the patient's nurse and respiratory therapist disconnect and reconnect cables and tubes, the technicalities of the scan are ironed out, and he is... (shrink)
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