The Quiet Focus of a Hospital at Night

I was at the hospital late one night last week, seeing a patient in the intensive care unit. It’s oddly relaxing sometimes to be at the hospital late—not as much hustle and bustle, and no need to fight for a chart or a computer. There were just a few on-call interns and residents clustered around the charts, and a group of night nurses who were ordering takeout for dinner. A quiet night.

The scene reminded me of the many nights I spent in hospitals during my medical training. I began my internship before residency programs put the brakes on 80-plus-hour workweeks. Our regular schedule was every fourth night or every third night on call.  On on-call days, we’d get to work at 6 a.m., work through the night, and then work the next day until the work was done. Most days, that was 5 or 6 p.m. Then we’d go home, sleep, and come back again 12 hours later for a “regular” 12-hour day.

Although I was perpetually exhausted (I’m still catching up on sleep), in some ways the nights were the best part. Somehow the focus is sharper at night. There is little paperwork to do—no discharges, no transfers. Any test you order at night must be an essential one.

Most importantly, you develop a sixth sense—one of my colleagues called it “spider sense”—when something is really wrong. The frequency of serious problems at night (perhaps 1 in 20) is higher than in the day, and you must constantly decide just how sick someone is and whether the situation requires urgent attention or can wait. Having that kind of exposure over three years of training hones skills that are called on much less often with patients in the daytime—when maybe 1 in 100 or 1 in 1000 is really ill. If you did only outpatient training, you’d see one really sick person per week, month, or year (depending on your specialty), and you probably wouldn’t learn to catch those cases.

I finished up my evaluation around 10 p.m. The interns and residents were settling in to write up some notes; the nurses were back at work. And since I’m no longer an intern or resident—or an obstetrician or emergency room doc or other “nighttime” professional—I went home, to bed.

(PHOTO: 123RF)

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