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Why do I choose the night shift?

After hours, it’s all medicine

November 2021

THIS IS A QUESTION I’m frequently asked by inquiring friends, family, fellow physicians and even patients. Some wonder if I drew the short straw or if I did something wrong to deserve this punishment—and if some day, if I am really lucky, I might get “promoted” to day shift.

On the contrary, I am a nocturnist because I love the work. I’m a night owl by nature. I hate getting up early in the morning but will happily be awake at midnight. Through 20 years and a number of different night-shift jobs, I’m used to being either the only internal medicine physician in the hospital or, at times, having only one other colleague with me.

Intensity and autonomy
Why do I like it? What fascinates me about the night shift? It’s pure medicine. I keep people alive, and I diagnose and treat patients, period. There’s an intensity and autonomy that I thrive on, and those are the very reasons I went into medicine in the first place.

I don’t have to jockey to get on a computer or wait for an elevator. All the social work consults, PT, OT and speech therapy sessions, family visitations, discharges and more are important—and will happen during the day.

Sometimes I feel that we nocturnists are not always understood.

But at night, I’m not distracted. I am focused, and I don’t have a host of colleagues around for a second opinion. I will probably have to wake up a specialist if I need a consult, so I have to think things through very carefully and practice at the top of my license. At night, we all know that the whole hospital is on a skeleton crew. That encourages collegiality as we band together.

We understand that a nurse may have to wait for a nonurgent order if I’m in a code blue. I love the quiet critical thinking I can do at night, without so much hustle and bustle around me.

Wish list
But sometimes I feel that we nocturnists are not always understood, acknowledged or appreciated.

I wish my colleagues knew that I’m doing my best as I jump in on unknown patients for whom I’m cross-covering. I wish bosses and administrators looped us in on issues and meetings that we often cannot attend because of our sleep schedule. I wish the night shift had its own call room, which isn’t a sign of laziness. Instead, it would be a gesture of respect and understanding that night work is different from day work. I wish patients knew and appreciated that we have great skills and that we want to be here and stay up with them at night.

I wish that colleagues who don’t usually work nights would come in with a better attitude when they do get assigned a night shift. Instead of throwing down their things and saying in a frustrated voice, “I don’t like nights, I don’t want to be here,” it would be nice if they asked, “What do you want me to do?” After all, I don’t come into day shift that way.

Lessons learned
Nights are hard on the body. I have to make additional efforts to maintain my physical and mental health by watching what I eat, managing my sleep patterns, controlling light exposure, taking a nap, using caffeine wisely, and planning time with family and friends. Each year, doing “the flip” from days to nights and back gets a little harder. And I’ll admit: Staying awake and alert between 3 a.m. and 5 a.m. is the toughest.

I’ve worked nights now for almost two decades, and I do not know how much longer I will keep going. However, whenever I age off the night shift, I will be eternally grateful for everything it has taught me: self-reliance, teamwork and collaboration. Until then, your patients can come on in after sunset. While the rest of the world sleeps, I will be happy to take care of them.

Marisa Echaniz, MD, is an academic hospitalist and co-director of the nocturnist service at Denver Health and Hospital Authority, with a dual appointment at the University of Colorado School of Medicine. For their help with this commentary, Dr. Echaniz would like to acknowledge Roselle Charlier and Allyn Echaniz.

 

Published in the November/December issue of Today’s Hospitalist

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