Duke Hospital after dark

There’s something special about seeing places that are usually hustling and bustling completely devoid of energy, the helter-skelter nature of a teeming thoroughfare transformed into silence and quiet. My experience working nights at Duke Hospital was no different.

As part of the pediatrics rotation in medical school, one of our responsibilities is to work several nights in the hospital. Using “nights” is admittedly a bit of a misnomer, since you arrive at 6 p.m. but often stay until 11 a.m. the next day to present the patients you helped to admit overnight, so it amounts to more of a night and a morning. But my assigned shifts happened to fall during Thanksgiving, meaning that I benefited from a holiday-shortened week.

When you’re preparing to completely invert your sleep schedule, people have a lot of advice for how to contort your circadian rhythms while minimizing collateral damage. I’m not sure if any of it is very useful, but the prevailing words of wisdom I got were to stay up very late the night before and sleep in the morning of your shift. So since I had to report to the hospital Sunday at 6 p.m., the idea would be to stay up very late Saturday night and then sleep in on Sunday. Of course I tried this strategy but completely messed it up, barely keeping my eyes open until 1:30 a.m. Sunday morning and then promptly waking up at 6 a.m. as my body has programmed itself to do. Attempted naps in the afternoon were unsuccessful, and I resigned myself to relying on adrenaline alone to power through the night.

As someone who had never pulled an all-nighter before, I couldn’t help feeling like a bit of a rebel as I walked over to the hospital from my apartment. I was fortunate enough to share the night shift with one of my dear friends from medical school, Ethan, who had helpfully brought snacks along to cultivate a sleepover vibe in the resident workroom. There, we joined up with the two night team residents to receive signout from the day team, where every patient on the general pediatric floors is briefly summarized and major action items highlighted. Then the day team was off, leaving us in a windowless workroom that would serve as our home base for the next 18 hours or so. 

For the first few hours, up until midnight, I can recall a fairly lucid series of events. The senior resident’s mother had ordered Enzo’s delivery to the hospital, which turned out to be five boxes of cinnamon bites with one small cheese pizza. This kind gesture has forever implanted in my mind a firm connection between Enzo’s cinnamon bites and sleep deprivation that will endure for the rest of my life. Then the flurry of night tasks began — traveling to the emergency room to interview patients who were deemed sick enough for admission to the hospital, welcoming patients transferred from the ICU who were deemed healthy enough to receive a lower level of care, then back to the emergency room again.

Once 2 a.m. hit, things started to become a bit of a blur. Wandering around empty hospital halls was eerie. Once-busy corridors in the hospital were starkly empty. Dark corners became liminal spaces. Time grew immaterial. It could be 9 at night or 6 in the morning for all I knew. Maybe this was the time of night where the secret horses came out and galloped through the hospital. 

Once 5 a.m. rolled around, that’s when fatigue really started to set in. The temptation to sleep in the middle of writing patient notes was tantalizing. As a proud non-coffee drinker, I thought of turning to caffeine but quickly banished the idea. Incidentally, on my night shift later in the week, things were slow enough at this part of the morning that the residents allowed me to sleep for a bit at 4 a.m. This resulted in me waking up at 4:45 a.m. feeling more disoriented than I had ever felt in my life, wandering through the hospital halls in a fugue-like state trying to find my way from the medical student call rooms to the pediatric resident workroom. So maybe not getting any sleep wasn’t so bad after all.

The day team returned at 6 a.m., a jarring reminder of the fact they had gone about their evening activities and gotten a full night of sleep in the time we had been flitting around the hospital. 8 a.m. marked the beginning of morning report, a daily conference where a pediatrics resident presents an interesting case and audience members ask questions to attempt to get to the correct diagnosis. The timing of this conference is impeccable to ensure that the exhausted night team is caught head-bobbing the entire time as they drift in and out of consciousness. 

Finally, it was time for morning rounds. This is when the entire pediatrics team, both day and night, go from room to room and discuss each patient’s history and formulate a plan going forward. Medical students take point on patients they helped to admit overnight, and after having been awake for a full 24 hours, having to lead a discussion in front of a patient, their family and the medical team seemed a bit intimidating. The day team is often kind enough to round on the patients admitted overnight first so that the night team is free to leave and get some sleep instead of staying for the entirety of rounds for the day. 

Working nights in the hospital was such a fascinating experience. Even though my sleep schedule was severely jarred, I got to see a whole different side of how the hospital operates. While clinics shut down and daily operations grind to a halt, nights still have emergencies to tend to, sick patients to care for and doctoring to be done. Of course I had far less of a stake in those experiences than my supervising residents, but I gained such an appreciation for the night team’s work, which I had often taken for granted.

After that first night, there was simply nothing like the feeling of walking out of the hospital around into the blinding sunlight. No part of my body had any idea how to interpret the stimuli it was receiving. I ran into a good friend of mine, Madhura, on the way out and simply did not recognize her until she called me by name and I stared at her for 10 seconds. When I got home, I wasn’t sure whether to brush my teeth since it was the middle of the day. But it seemed like the right thing to do, so I did. And then I went to bed.

Nathan Luzum is a second-year medical student and a member of the DSPC Board of Directors. His column runs on alternate Tuesdays. 


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