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Night Shift: The Second Wave

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“Are you ok?” my wife asked as I slogged silently from the front door to breakfast table adorned with my diet food bar breakfast.

“Boy does that ever look delicious,” I said sarcastically. “I’m not sure I can eat all of my wonderful breakfast this morning.”

“Very funny,” she said seeming to enjoy my suffering. “If it’s any consolation, your big belly is starting to shrink. You no longer look like you’re 38 weeks pregnant. Just like you’re maybe you’re ‘beginning to show,’” she said patting my belly. I stuck my gut out even further just to irritate her as I made a face. “Seriously, you are starting to look better. What’s with the long face?”

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“They cut the doctors coverage hours during the pandemic because the patient volumes dropped. Now the patients are coming back and the physician hours haven’t caught up. Some people, especially some of the nurse found other positions, and now they don’t staff all the beds. So we have ‘every available’ room full, but the ER is still only half to three quarters occupied. The patients are piling up in the waiting room for hours. And when they get back to the ER and see empty beds they are really pissed.

And administration is telling us to go into the waiting room and triage to see patients. But that’s not safe. They can see the tracking board from their home computers, maybe even their phones, and they call up and harass us to do something that is unsafe. It’s a mess.”

“Thank goodness you’ve backed off on your number of shifts each month,” she said sympathetically. “You’re way too old to keep up this pace. You should just quit completely.”

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“You’re not understanding,” I said with frustrated gratitude for her sympathy. “This is not just about me. The young guys are working 10 times as hard as me. They are doing the really heavy lifting on the number of shifts as well as the patients per hour. I see a lot of them putting off their charting til after the shift is over so they can see more patients. Then spending hours of unpaid time to catch up charting.”

“Oh to be young again,” she said. “I remember you working long strings of shifts. Remember that time you worked 14 twelve hour night shifts in a row?”

“Yeah, and it almost killed me,” I said remembering the nightmare. “And I probably killed some patients, too. I wouldn’t wish those days on anybody.

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But like I said, this isn’t really about me. I’m not burnt out working long hours. I’ve done that before. There’s a kind of fatigue, a weariness that has set in post COVID that just hangs over the ER staff.

They all worked their butts off during the pandemic. And it wasn’t just the long hours. People were really concerned for their own health and the health of their families. The masks, the respirators, it was all so ‘wearing.’ And I think that all the rah-rah stuff that surrounded being a front line provider really set people up for a giant let down.”

“Yeah, I remember reading about an ER doc last year who took her own life. The people around her said she was a wonderful person. It was such a tragedy.”

I just shook my head sadly remembering reading about the heart wrenching story. “And it seemed like we were getting past it and the variants started to appear. Do you remember that time we were in the eye of a hurricane down in the Caribbean?”

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“Do I remember it?” she was glaring at me. “You almost killed us sailing right into a Category 1 hurricane.”

“I didn’t sail us into the hurricane,” I explained for the thousandth time. “It built right on top of us. It started out as a tropical low, then built into a tropical storm, then into a hurricane.But do you remember, it went from pitch black skies and a 105 mile an hour winds with 10 foot seas to complete calm and clear skies?”

“You told me the storm was over,” she said shaking her head with that look I’ve seen so many times.

“We were in the eye of the hurricane…for about two hours. Then the back wall of the storm hit us.”

“That’s when we had to abandon the boat and spend the rest of the night huddled in a restaurant that partially washed out. And what is your point in remembering that ‘wonderful’ vacation?”

“Just that when the storm hit us, it was wild and exhilarating…,”

“Maybe for you…”

“Ok, so it was frightening…”

“I was scared out of my mind. I thought I’d never see my babies again,” she said squinting her eyes.

“Ok, ok, I get it. But it really wasn’t the front wall of the storm that did that. It was after we had been through the eye and we thought it was over. When the back side of the storm his us we were tired and scared and pissy.”  By the look in her eye I could tell that she was still pissed at just the mention of the experience. “Well, that’s what I see in the staff. They are battle weary. They’ve had enough. They got a taste of relief. And now they are back in the battle again. It’s just pretty damned depressing.”

“Is there anything that can be done?”

“People need to take time off to decompress if they can, is one thing. But we definitely need more staff, especially nurses. And let us decide how we need to protect ourselves and what we want to prescribe to the patients. It’s all gotten so political. I heard that the federation of state medical boards was advocating that doctors lose their licenses for talking about the pros and cons of vaccination on social media. They would call it ‘misinformation’ or ‘professional misconduct. It’s gotten crazy.”

“Do all those doctor/nurse appreciation days help?”

“Maybe for some people. But I think people are pretty tired of even that. It all gets stale after a while. Whatever it is has to be real. And a lot of that stuff seems so canned. Like administrators serving lunch when you would never see them otherwise.

“You know, I think that a lot of it boils down to being able to tell our stories and have someone listen with judgment or recommendations. After all it’s just a job. Everyone has a job. Everyone has stress, disappointments, unmet expectations, you know. We’re no different. We’re just a little closer to the eye of the hurricane.”

“Are you telling me I need to sit and listen to you talk about your job for hours?”  She was giving me that ‘not gonna happen’ look.

“No, you could do other things,” I said with a wink.

“You’re not talking about what I think you are talking about, are you?”

“A couple of eggs, instead of this diet stuff?” I said with a sly, imploring smile.

“Oh,” she said with some relief. “I can fix you all the eggs you want. And how about some bacon?  Bacon makes everything in life better.”

She knows me so well.

ABOUT THE AUTHOR

FOUNDER/EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than 30 years, working exclusively night shifts for the past 20 years in emergency departments across the country. During that period, he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of Plaster Publishing.

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