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ER Goddess

ER Goddess

Why I Work Nights and Dress Like Rainbow Brite

Simons, Sandra Scott MD

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doi: 10.1097/01.EEM.0000482471.90214.a2
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    The long-winded elementary school principal droned on and on, and all I could think was, “I could have slept longer.” I had gotten up way too early before my third consecutive night shift to attend back-to-school night. As the PTA president took her turn at the microphone, I became more and more anxious that I wouldn't make it to my sons' classrooms before I had to leave for work. All I really wanted to do was leave sweet notes on their desks so they would know I was there.

    Being there that night, something other parents may take for granted, required foregoing sleep and making a frazzled dash from the school to the ED with barely time to eat. Just showing up for our loved ones is too often a luxury for EPs because we're busy caring for someone else's. Working our fair share of shifts means missing things no parent wants to — pediatrician appointments, games, musicals, back-to-school nights — unless, of course, we chose to become nocturnists and work the only shift when none of those events happen. That has been my solution.

    I started working nights to balance medicine and motherhood. I would rather lose sleep than miss a football game or a parent-teacher conference. With my divorce, staying on nights has been the only way to orchestrate a fixed schedule for shared custody. I don't know any EP who could get away with saying, “Now that I'm a single mom, I only want the Monday, Tuesday, and Wednesday 7 a.m. shifts.” When you work the shift that no one else wants, however, your colleagues are all too happy to let you keep a Sunday, Monday, and Tuesday night schedule. This schedule is written into our divorce agreement, so for better or for worse, I'm locked into a career as the night doc.

    On paper, my night shift schedule is the perfect solution for being able to be a full-time EP and to be available for my kids, but being able to be there consistently comes at a cost. Working against a person's natural sleep cycle disrupts the body's metabolic process and causes restlessness, sleepiness on the job, generalized fatigue, worsening mood and decreased attention, cognitive abilities, and reflexes.

    A&Ox1

    I have read articles about these hazards of nights, but I never fully appreciated them until I fell asleep getting a bikini wax. Saying the night shift causes fatigue is an understatement. The reality is that it causes my cleaning ladies to find me nearly unresponsive on the couch in the middle of the day, usually A&Ox1 on arousal. I'll respond in gibberish to people texting me during the day after a night shift or completely forget entire phone conversations with 2 p.m. callers because that's the equivalent of me calling them at 2 a.m. My marathon training is a frequent casualty of my night schedule because I'm often too exhausted to do my planned run. I'm often so surly when I do make it to the gym after a night shift that I keep to myself in the corner, avoiding all the chipper chatty moms who slept all night. My waistline is another casualty because I'll gorge on junk food overnight when exhaustion zaps my willpower. I'm also perpetually afraid of being that mom who ends up asleep and drooling where I'm not supposed to, like in my folding chair at football practice. The scariest hazard of night shift, though, is the many mornings I'm so tired I can hardly keep my eyes open to drive. Working nights to be there for my kids is all for naught if I kill myself in an MVC driving home from the ED.

    And days off aren't much better. Feeling bad once a week after finishing a stretch of nights is a brutal part of working night shifts. I have sarcastically dubbed Wednesdays “Peachy Wednesday” because of my crankiness and warped perspective after working the three previous nights. I pick more fights, get more irrationally upset, and make more bad choices on Wednesday. I'm useless Wednesday night for homework and anything else requiring Mom to be on her game. It is simply not that easy just to flip back over to a day schedule, and it gets harder the older I get. The daytime insomnia that keeps me lying in bed awake between night shifts becomes nighttime insomnia upon switching back to a day schedule. Just once I would like to be able to sleep through the night. No matter how hard I try to be mindful of my sleep hygiene, it seems nothing makes up for circadian misalignment.

    Choosing to constantly battle the exhaustion caused by that misalignment comes at the price of other responsibilities. One look at my disaster zone of a laundry room makes that painfully clear. Most mornings, I'm elated if I can find two pairs of matching Nike Elite socks for my sons. For myself, I forego matching for whatever is clean and frequently end up leaving the house dressed looking like Rainbow Brite on crack. A day doc with a stay-at-home wife looked at me one morning, and said, “You need to iron your scrubs.” Who has time for ironing? There is barely time for cleaning with my hectic life. I suspect my cleaning ladies judge me for the mess I'm able to accumulate in a week between their visits.

    My work-life balance also does not include much time for preening. Unlike the perfectly coiffed trophy-wife moms, I've been to the book fair rocking the makeupless-baseball-cap-sweats look; I've been to parent-teacher conferences in stinky, sweat-drenched running clothes, and I've been to a school musical in scrubs and soaking wet hair. No, maybe I don't always have a beautiful home and perfect outfits, but I do have a career as an EP and am still able to be there for my sons.

    My mother gave me good advice: “Always be able to take care of yourself so you never have to depend on a man.” She was prophetic actually. Decades later, I'm taking care of myself, my kids, and my patients. The night shift is not easy, but it's the only way I've found to achieve the balance I want and need.

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