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ER Goddess: Don't Judge a Night-Shift EP by a 9-5 Standard

Simons, Sandra Scott, MD

doi: 10.1097/01.EEM.0000546144.25287.b4
ER Goddess

Dr. Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter @ERGoddessMD, and read her past columns athttp://bit.ly/EMN-ERGoddess.

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Dear family, friends, neighbors, and the FedEx guy, Imagine you're sleeping when your doorbell rings. You grope for your phone: 2 a.m. You stumble downstairs in your pajamas, unbolt the door, and scowl at the offender. “I have to be at work at 7 a.m.,” you snarl. The culprit looks sheepish, knowing only the police or EMS should be knocking at this hour.

Now transpose a.m. for p.m., and imagine you're trying to nap before a night shift. Suddenly you are the culprit for sleeping. The stunned look on your neighbor's face when he sees you in your PJs in the afternoon makes you the sheepish one. Even though it's the middle of your night, you still feel you have to justify answering the door in your pajamas at 2 p.m. Such is the struggle of a shift worker in a 9-5 world.

If you're a 9-5er, you probably take for granted that no one is texting or ringing your doorbell when you're sleeping. The afternoon cacophony of mowing, hammering, and radio-blasting doesn't affect your slumber. Yes, 9-to-5ers may envy how we avoid rush-hour traffic and get days off during the week, but we pay dearly for these perks with many unenviable difficulties.

Christmas day off is a certainty for a 9-5er, but it's a privilege for shift workers. We try to tell ourselves “it's just a day,” but I always feel twinges of regret knowing that most people are with their families and I'm not. Weekends are similar. Being on a different schedule from everyone else can create social isolation. Does anyone get married when it's convenient for shift workers? Does anyone have his birthday party on a Thursday morning?

Most full-time EPs have to work at least one shift on the weekend, so that Saturday night event could be on a day we're working. Nine-5ers often fail to appreciate that we are giving up something else to get a weekend off to travel, attend the event you've planned, or even have our kids on particular weekends in the case of those of us with joint custody. Being available on the weekend you want means burning up our limited vacation requests, using up favors to switch shifts with colleagues, working other weekends, or working full-time nights to try to be off weekends.

Even when we're not at work, there's a chance we'll miss things because we're out of sync with normal people. Many parents work the night shift because they want to be available for their kids during the day. Sounds good in theory, but imagine going to a parent-teacher conference at midnight. That's what it's like for me to go to one on a Tuesday afternoon. Imagine family and friends feeling slighted because you didn't return their texts at 2 a.m. on a Sunday night. That's what it's like for me when I get texts on a Sunday afternoon. When we shift workers seem unavailable and delayed in responding, forgive us.

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Not on the Calendar

EPs must cope with never having a routine. If you've ever traversed time zones, you know how difficult it can be for your natural biological clock to adjust to the difference. We are constantly doing this to our bodies. We never have the same wake-up and bed times. Sleeping at night is a luxury. For those of us who work nights for half of the week and then try to get back to sleeping at night the other half of the week, our reality is like living in a constant state of jet lag. Readjusting back to our “work week” after a few days off requires resetting our internal clocks to a time zone on the other side of the world.

The health hazards of working while you 9-5ers are snug in your beds go far beyond caffeine addiction. Shift work sleep disorder causes excessive fatigue, difficulty sleeping, headaches, and trouble concentrating. The National Sleep Foundation reported that long-term overnight shift workers are at an increased risk of certain cancers, metabolic problems, heart disease, ulcers, gastrointestinal problems, and obesity. (http://bit.ly/2JDjtBD.) The World Health Organization classified night-shift work as a probable carcinogen due to circadian rhythm disruption. (Dtsch Arztebl Int 2010;107[38]:657; http://bit.ly/2JDK0hQ.) Night workers also face a 36 percent higher risk of breast cancer because prolonged exposure to round-the-clock light suppresses melatonin. (J Natl Cancer Inst 2001;93[20]:1563; http://bit.ly/2LxNlAY.)

Shift work also wreaks havoc on our emotions. There is a well-established link between night shifts and mood disorders like depression. When I finish a Sunday-Tuesday night stretch, I have no emotional reserve and can turn into a puddle of tears with little stimulus. Sometimes I wonder if my struggle with depression is more from working full-time nights than anything else.

Working three night shifts a week is utterly exhausting. Looking at a schedule on a calendar is a lot different from living it. What you don't see are the non-work days that are lost. The Sunday before a Sunday-Tuesday night stretch is lost trying to make myself sleep so I can successfully fight my natural circadian rhythm. The Wednesday after the stretch is lost to exhaustion. Thursday is spent in a state of jet lag playing catch-up. I've been told that three night shifts every week is part-time, but I challenge you to do three night shifts every week for six months and then tell me you're working part-time.

Don't judge a shift-worker by 9-5 standards. Forcing shift workers to accommodate to a 9-5 schedule does not end well for them. Yet, we'll still run ourselves ragged trying to adapt. We'll do things like rapid turnaround between shifts, leaving at 11 p.m. or midnight, just to be back at 7 a.m. We'll work a ridiculous number of shifts in a row, and some of us (like me) will just go full-time nights to try to have a set schedule. None of these is good for us, but those are the sacrifices we make to fit our schedule into a 9-5 world. It's hard. Please try to appreciate what it's like to be in our shoes. We promise we'll keep finding ways to be there when it counts.

Dr. Simons will be off next month. Look for her next column in the November issue.

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