Night Shift: How do I get you out of here?

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“What can I do to get you out of here?” The familiar question from the bright-eyed day shift doc at 7 a.m. as I finish my night shift, the same question I asked my bleary-eyed colleague when I’m the one coming in. It is a specific night-to-day question, not the “you ready to sign out?” we say at 3 p.m. It acknowledges the toll of the night shift.

By a scheduling quirk, I was the first in my system to receive the COVID vaccine. The public relations people, applause and interviews were awkward — I was glad I didn’t wear pajama pants — but in the following days I was grateful for the chance to celebrate the moment. If the pandemic is a bad night shift, the vaccine feels like a way out.


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In the first month when my martial arts school went virtual, I found stress relief running, searching for early crocuses shouldering through the dead leaves. The warm summer did not end the pandemic and like you, reader, I juggled shifts with conference calls and virtual meetings about PPE, protocols and capacity. A parent’s health crisis (nothing brings an incident command meeting into sharper focus than when it’s your loved one waiting for the ORs to open back up), friends’ businesses closing/opening/ closing again, a nurse with COVID on dialysis, another who survived ECMO, my kid’s track season cancelled or paramedic students gone virtual. Every day was a microcosm of the stress around the world.

Friends left garage-scavenged N95s on my porch until the sterilizers came online. We all went back to school. Local EM docs and intensivists started a WhatsApp chat and my phone blew up with a hundred messages a day. First with patient anecdotes, early research, 3D printer plans for intubation boxes and new strategies to save lives and protect each other.

Then, later research, better data, optimism that the protocols for mild, moderate or severe COVID were improving outcomes and fear as hospital capacity strained. We read autopsy reports about micro-coagulopathy. I was heartened and awestruck by the data-sharing fervor of my critical care colleagues. Nobody in the chat ever complained or threatened to quit even as they vented fear or frustration. I’ve never been prouder to stand with them.


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When the days grew colder and shorter in December, the hospitals fuller, my mood darkened. The steady stream of patients continued, some with mild cases who needed a work note, some with chest x-rays that were terrifying. Getting the email that the vaccine was now available for the 1a group in Wisconsin was a champagne-popping moment.

In the past few days, the proud vaccination selfies of EM friends around the country have made me so happy. The anti-vaccination misinformation? Less so. I strive to respond to well-meaning friends and family who send me “the truth about COVID” with ACEP links and kindness. I remind myself they are coming from a place of genuine fear and concern even if the utter mistrust feels like a slap in the face.

But as I drove home after a recent nightshift, grateful for my colleague’s “what can I do to get you out of here?” at 7 a.m., I reflected that we have a lot more to do to get us out of this pandemic. Emergency medicine physicians are the perfect ambassadors for this vaccine. We establish instant rapport with patients in the worst of circumstances. Sometimes after ketamine, but still. We have thick skins and have been called every name in the book.

Yet by the end of the visit (most) patients trust us. We explain why antibiotics aren’t needed for the URI (again). We do a lot of life-style coaching that may not be followed that visit, that week or that year. But we know for some people, it takes on the third or fourth try and they stop smoking or start taking their BP meds. Maybe we need to go back to school on vaccines and cover the basics with our patients.  “You felt achy and had a fever after your last flu shot?  That’s great!  That means your immune system is working.”


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Emergency medicine physicians are the perfect ambassadors to build a kinder world. We see the toll of homelessness, violence, underemployment and patients living on the brink of one more mishap. How do we better advocate for our communities?  Even if we don’t have all the answers (I certainly don’t) we can start by telling our patients’ stories.

We know what it’s like to come in after a rough night shift. The mood is ugly and exhausted. The trauma bay needs a restock and a deep clean. The condolence cart is shoved in the corner of room four with stale coffee and untouched sandwiches. “What can I do to get you out of here?”  This pandemic, this longest of night shifts, revealed things we knew. The safety-nets are frayed. There is a well of mistrust in public health measures. There are deep divides on a myriad of issues. There is work to be done to find common ground.

I believe dialogue is the first step. Sometimes folks will dig in their heels the more evidence they are shown. A nudge is more effective than a shove. Especially now, when nerves are raw. I believe anyone in the restaurant industry or running a small business had a far worse 2020 than me. I know that my anti-vax Facebook friends want health and safety for their families. There is some common ground. I take the time to engage because I know they have influence in their communities. Maybe I can nudge their view. So far we are still virtual friends.

Sometimes leadership is given to you whether you want it or not. On my first deployment with the Army, I was in a planning meeting with a lot of NATO staff. They wanted the opinion from “the American doctor” on an issue. As heads turned toward me I looked over my shoulder for someone else, someone more doctor-y. Gulp. It was a learning moment for me and I hope what I said at the time was helpful.

When the hospital admin wants an EHR upgrade champion or a sepsis order-set super-user, I will probably hide under my desk. But we need to lead in this moment. We need to lead on vaccine safety, scientific literacy and strengthening our communities.

Be kind to yourself. Be kind to each other. Stay in the good fight. And keep posting those vaccination selfies.

ABOUT THE AUTHOR

Dr. Johnson practices emergency medicine in Milwaukee, serves as EMS Director for her hospital, Medical Director for the MATC Paramedic Program, and is a Lieutenant Colonel in the US Army Reserves. She is the author of ROOM FOUR, a dramedy of emergency medicine.

1 Comment

  1. Love this and totally agree “be kind”. We are experts at understand and empathy (not always sympathy) for our patients and we can translate that to our friends and help to nudge those we can.
    Thanks

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