The night shift in the emergency room and trauma center is totally different from whatever has been shown in the TV shows. It is a very stressful and tactful job. I wish we could have all the fun shown in the TV shows, but the reality is totally different. I have tried many times to convince my former colleague, an emergency room physician and a famous filmmaker, to make a real emergency room show. Anyway, neither we were able to make a real show, nor we were able to get away from our stressful job. Of course, we don’t have time to eat on time, so how could we do the barbeque in the ED helipad area?
The night shift starts at the peak of chaos in the ED. Our night shift starts at 1900. The transition of patient care sometimes becomes impossible. We will try to clear the day shift issues. At this time of the day, most of the population is not very sick, but the volume of patients in the ED is pretty high. At the beginning of the shift, we perform a role of a primary care provider and handle real emergencies, including strokes, endocrine, neurological, cardio-respiratory, and GI. Real emergencies are only 20% of all visits.
The night shift starts at 1900, and the hospital cafeteria closes at 1900. Thank God Dunkin Donut (DD) is inside the hospital vicinity that closes around 8 pm, then reopens at 0400. The night shift staff cannot afford to go to the Starbucks run because it is outside the hospital boundary. The nearest SB closes at 10 pm. Does anybody have time to get coffee while everybody is busy? Neither DD nor SB have any idea how much money they are losing by not serving coffee to the night shift staff. Sometimes, one of us will look at the clock and remind us, “oh my god, it’s already midnight.” We all positively take this reminder, “DD will be open soon.” The aroma’s smell of coffee and donuts reminds us that we have sat in heaven and talked to God. However, nobody has time to get coffee when DD opens. Of course, this is prime time for ED staff handling “The Golden Hour” of trauma patients. All local clubs and pubs close at 0330 AM. so, we are ready to receive all GSW and MVA due to drunk drivers and overdosed patients. As soon as we are done working with the ‘Golden hour Rule’ patients. We get busy attending wake-up calls from nursing homes and homes, including stroke patients and broken limbs. Sometimes, we tell the paramedic,” Can you just stop somewhere to get coffee while the siren is still on?”
However, in reality, everybody gets busy. I have seen the staff members working hard on a “do and die mission.” It makes me happy to see the staff still has compassion and passion. They still have empathy and sympathy. The night shift staff treat each other as a family. Anything happens in your personal life, your co-workers will know first, then your family. During the day shift, our colleagues get hot and grilled food. Of course, the kitchen staff ensures that night docs will be taken care of. So, they don’t hesitate to fill the fridge with ham and turkey cold sub sandwiches. They never forget leaving us a tray full of fresh-baked cookies and chips. The fridge will be overloaded with coke and Pepsi bottles. However, I hardly notice if there is any cold milk or healthy drinks in the fridge.
Finally, our medical director convinced the hospital administration to buy an espresso coffee machine. Instead of keeping the coffee machine in the emergency room, the administration has decided to keep the machine in the main doc Longue which is at least 10 minutes away from the main ED. We are only two at night time and cannot leave the department. Unfortunately, only two of us have access to the lounge. Giving your badge away to get a cup of coffee is strictly restricted. How important are 10 minutes for one patient? Only ED staff could tell that? How often have primary care doctors come to make the rounds at night, and why have coffee machines been kept in the main lounge? Sometimes the Nescafe espresso machine breaks itself, and sometimes stressed, and impatient people break the machine. It means the next day, there will be no coffee at all. But we will get a nice household education memo. In the memo, all instructions would be written: “Nobody forgets to mention how expensive the machine is and how much it will cost to repair it, and how it would impact our annual budget.” However, nobody dares to instruct us on how we will manage the coffee during nighttime.
Of course, nobody has time to take a break. We share food with each other. Pizza is very friendly and is also delivered at any time. Fast food is not a problem anymore since Doordash and Uber start delivering the food at low delivery costs and at any time. Who cares about the nutritional value of the food when you are hungry? It often makes me sometimes laugh when after eating a pizza, you go to the patients telling them about the DASH diet. Most of the night staff are smokers. They need at least a 5-minute break which we allow them to take. Sometimes they don’t want to take a break from being busy. Of course, the nurse in charge makes them go. Or, I get out of my chair and yell at the charge nurse to send the staff for their health necessity break. The smoker needs to take a break for the safety of the rest of the staff. I tell everyone a specific person is busy getting their respiratory treatment if someone asks for a specific person. We don’t use the smoking word because our facility is a smoke-free facility.
We don’t get fussy and cranky patients all the time. We have patients who come high with an illicit drug overdose and are escorted by at least 15-20 people, including firefighters, paramedics, and cops. Do we need all additional people in addition to ED staff and our security staff? Definitely yes, we need them. Our ED looks more like a war zone than an emergency room at that time. After securing the patient, Cops also look for a cup of coffee. Sometimes, the local cops come to the ED to use the restroom. We have planned many times to make them pay for using our bathroom. We tried telling them many times, but they will never bring the coffee. Instead, they will look around if we have coffee.
The day shift staff are always jealous of us why they don’t get a fun time. By the time the day shift staff reaches, our funny patients are already sedated and sleeping soundly or in the withdrawal phase, which is not funny at all. So, this is the only time our job is stress-free. Most of our patients are well known to us. They know our names. Their demeanor becomes so nice that intoxication starts to wear off. Believe me, those people respect the ED staff a lot.
My boss starts to hate me exactly at the same time whenever the coffee machine breaks. I am not sure how he knows early in the morning that the coffee machine is broken. Of course, he doesn’t have any problem with the broken machine. The night shift crew suffers. My boss thinks I always end up breaking the coffee machine. I have failed to understand why I will break the coffee machine when I am a big-time coffee lover. He will announce to fix the machine as soon as possible before I say something. He knows well that coffee is life for night shift staff, and I will continue to remind him until the machine is fixed.
At the end of the long 12-hour shift, most staff become grumpy, which I have given the title of “homicidal and suicidal thoughts without the food and coffee.” Everybody asks me why I am not being frustrated and making a joke. I always have one response, “I am immune to the stress and frustration because I was born in the emergency room.” Of course, there was no mother at home who would eagerly wait for me with a hot breakfast. So, I end up eating the children’s junk food. Of course, I know their metabolism is totally different than mine. Everything goes down your throat when you are hungry. Who should we blame now? So, working night shifts is not a cup of tea for everybody. It asks a lot of sacrifices. It will be a challenge for me while I am on the day shift as of mid of July. I will miss all the fun. I have signed my new contract on one condition, if I cannot function on the day shift, I will be transferred back to the night shift.