Diary of an FY1 – Nightshift

[box] In the latest edition of his diary, Oscar laments the dark side and the loss of circadian rhythm   [/box]

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When I sent off my medical school application six years ago, I had never really understood what it meant to be a doctor. I had a faint clue of some generic dribble about life-long learning, working hard and a lot of other CV fodder, and most importantly I had my grades. To me, hard work had never meant anything more than putting a few hours of study in the weeks running up to the exam. What I had never realised was that hard work actually meant so much more than simple paperwork.

Everyone always hears of, ‘black Wednesday’ which unlike Friday is not about sales but of the handover between one set of doctors and the next in the first week of August. Nurses describe the newcomers as rabbits in headlights. This is hard work; the stress of learning for the first time in your life how to do the job you signed up to six years ago, whilst trying to ensure nothing catastrophic happens to those dear human lives under your wing. You do not have a clue. Your mind rakes away at everything wondering if it is a mistake or not and all of a sudden, the arrest page goes off. Every decision stresses you, as uncertainty seems to seep in from everywhere and all of a sudden there is another venflon to add to the list.

But this is a stress that one quickly gets used to. This hard work soon becomes the reason you come in, to ensure that the decisions made are the right ones to make sure people receive the care they not only deserve, but so desperately need.

But there is another kind of hard work that I had not considered. And that is the physical toil on your body as the long days of walking from room to room makes your legs ache and you wonder why every morning leaves you barely able to wake up apart from the blaring screech of your alarm. How those 13 hour days leave your kidneys in a state of acute injury as your urine output would probably need to be monitored with a catheter as all you’ve had to drink all day was your coffee at 7am.

But the fundamental fact of the matter is that patients have no choice about when they become ill and need treatment. And this leads itself to another piece of hard work: the night shift. Nights are a necessary evil for any doctor, as we are ripped out of the lives we normally lead and find ourselves transplanted in a timezone that accommodates the needs of the patients.

And it is here one begins to ask the question of how? Rotas that insist that it is possible, and nay, acceptable, to transition from day to night over the course of an evening. There are multiple schools of thought for how to achieve this, and as with many things, they are anecdotal and vary from person to person, though it will no doubt be presented as a dogmatic testament.

But the same challenges remain: in a world where the light marks the civilisation of man, how does one survive alone in the dark? And it is here that one realises that what they face is a protracted siege against a great frontier of the unknown as the darkness hides itself in wry corners and sullen sleepless eyes. Food becomes a stockpile accrued for days ahead as the fading of the light makes way. Woe behold the man that comes to the shift empty handed, for he will eat only as much as his own hands can carry.

And yet further there is the grasp of exhaustion itself in this strange world where the warmth of darkness, the temptation to close one’s eyes nips sweetly at you like the greatest joy is only moments away, if only you just… But the bleep hisses and the call beckons. You are here to serve, in a strange world of opposites, where a slumber can mean an eternal rest. One does not simply work, one fights against themself, against the dark as the embers of the mind burn away into a trickling crawl.

There is no pain like that of the hospital light, that serves as the marker of day in a world bereft of light, rooms lit artificially by the folly of man. The coming of light begins to sear away at your tired, shattered self, and shards of broken sand are wiped away in the light, burning at your screaming eyes. The light is no longer that of pleasant dawn but the taunting menace that laughs at you as the world wakes up while you were left awake in the dark. It has a brusqueness and a harshness that seems nothing like the soothing dawn one remembers. You struggle on and on, dearly hoping for the end and it eventually comes.

But as you walk outside, the familiar sleepy morning is now not a beginning, but an end. You wonder how you can sleep through the entire passing of a day. But you do. And it only ever feels like a loss. And the strangeness you notice when you return to relieve the day team, foreign ghosts in another world that mirrors you in lights to your shadow, you can only feel a strange sense of loss that you never feel when it is the other way round. Because the night shift is a ghost shift in the twilight. A strange world that no-one really lives in but simply feels, another world tucked away in the dark, where things only ever seem to happen in paper folders of memories and histories of people past, forgotten, in ghostly scrawls and scribbles, stains of dark on light white.

 

Dr. Oscar To

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