Nightland – a tribute

Had I the heavens’ embroided cloths,
Enwrought with golden and silver light,
The blue and the dim and the dark cloths,
Of night and light and the half-light

William Butler Yeats

I have reached a milestone. I am able to count upon the digits of a single hand the number of times remaining I will climb aboard the night train. For almost ten years I have napped prophylactically and taped tin foil to the windows of rental properties. I have drunk coffee and more coffee, and woken at 6pm and wonder what the hell I felt like eating (the default answer appears to be toast). I have eaten lovely treats baked by nursing colleagues at 2am and seldom returned the favour, as well as more patient sandwiches than I like to admit to.

I am in two minds about this development. While I have long made peace with the necessity of the alert presence of people like me in a hospital at a range of unsocial hours, when my then three-year old daughter sweetly asked, “Are you on f*%king nightshift tonight, mummy?” she spoke for many of us.

I won’t miss the fatigue, the all too frequent companion of the regular nightshift worker. I will not miss the post nights death blues- a spectrum of negative emotion ranging from irritable malaise to full-blown, “do I even exist?” existential crisis. I won’t miss the casual wrecking ball effect of nightshift on ongoing attempts to maintain a regular exercise regime and pattern of eating that could be truthfully described using the term “meals.” I won’t miss the continuous disruption to our family life. I will relish never again performing a 9am risk assessment as to whether I am safe to drive home, or need to take a $75 cab then work out the logistics of getting to work that night.

Yet I cannot deny a certain wistfulness at the closing of this chapter of my life. At times it feels like everything worthwhile I know about medicine I learnt between the hours of midnight and 6am. And no doubt in years to come the fatigue will fade and assume it’s rightful place, and I will fondly remember “the good times”.

The summer evening beach visit upon waking
I have always loved the corners of the day. The sun sets late in the Victorian summer, and will be high in the sky at 7pm. Holiday makers linger on the beach with fish and chips, families promenade with ice creams and surfers dance in the evening glass off. I blend with the revellers as I walk amongst them, but I am part of a different world now. Does anyone guess that it is my dawn? We are but ships passing in the night.

The nightshift revelation
Like a holiday or a new job, the inverting of circadian rhythms can provide a new prism to view an old dilemma, and occasionally lead to a satisfying clarity of path. Should I sit my primaries now? Should I get a puppy? Should I have a baby? (the answer was yes by the way)

A Good Day’s Sleep
Anyone can get a good night’s sleep. A good day’s sleep, on the other hand, takes careful planning, the right environment, a number of accessories and a good dose of luck. Waking in the early evening feeling alert and refreshed is an accomplishment one can truly be proud of.

Nightshift induced euphoric delirium
A condition which tends to strike around night three once jet lag is settling, and best enjoyed as a folie a deux. Characterised by semi-hysterical giggling, flight of ideas and silly “in” jokes, it frequently leads to…

Post-night shift eggs and beers with colleagues
The pleasure is clearly self-evident and requires no further justification.

The other
And then there are those moments which refuse categorisation, yet stubbornly imprint upon us. It is just gone midnight and the department is teeming. A pleasant lady comes in, not much older than myself. She has a headache, a strange feeling in her right arm, and a history of breast cancer. She is apologetic in her attendance and waits for hours, yet remains appreciative of our care.

Just before dawn, I bring her into a private room and attend to her comfort. Then I look into her eyes and tell her the worst news of her life. She looks into mine and I let her see beyond the mask, that I have sleeping children too. And amid the chaos, the noise, the hive of activity that is a busy emergency department overnight, we sit together, cloaked in the half-light. I give her my time and she gives me her trust and it feels a fair exchange. And as we leave that room, neither of us is the same person who entered.

And that’s what I’ll miss the most, the people. The community formed out of those who work while others sleep. The cheery residents, with their snacks and gossip and DVDs for increasingly less frequent quiet ward cover nights. The nurses, the true guardians of the patient, who keep them alive and safe and comfortable. They, along with paramedics, don’t share my option of moving on from nightshift if they wish to stay in clinical work. The “lifers”; the career night ward clerks, with their refreshingly sensible routines and iPhone photos of growing kids and grandkids. The frustrated police who rarely wish to come, but always seem quite happy to enter a place of warmth and bright light and banter. And of course, the patients. The weary and the feverish, the fearful and the nearly dead, the intoxicated and the traumatized. They are all my comrades.

Systems, patient flow, chest pain risk stratification, staff mix, disaster preparedness, airway management, early fluids and antis for sepsis, trauma teams, the septic screen of a febrile neonate, challenging vascular access, sutures and plasters; These are vital components of the service we provide, but it’s lifeblood and soul are the moments of human connection. They are why I love my job.

And I am grateful that while most only dip their toes in occasionally, I have lived and laughed and cried and played deep within the parallel universe of Nightland. I am a better doctor and a better person for it.