Archives of The Cheerful Oncologist, Volume 2

…when heated in the chase,
so longs my soul, O God, for thee
and thy refreshing grace - or least two hours of uninterrupted sleep.

Let’s cut to the chase here: doctors who spend their apprenticeship not following some colorful Dr. Johnson-like character around the bustling alleys of London but toiling every third or fourth night away from home, awake most if not all of the night endeavoring to make at least a token attempt at keeping patients under their care safe from the Grim Reaper’s midnight rounds, become cranky over time. I say cranky, which is the most euphemistic description I could think of - other more truthful adjectives could have included dejected, sloppy, deceitful and angry. The graveyard shift is a trial by fire for young doctors. It can stretch the limits of fortitude by the nefarious way it insinuates into the daily schedule, viz.: after working all day to manage their patients’ “health care concerns” (as the glossy HMO pamphlet might say), these interns and residents stay at the hospital, usually without a fresh change of clothes, and work all night. Then as the first peach-and-champagne-infused rays of the morning sun sift through the window shades of their patients’ rooms, they get to relive the thrills of yesterday by raising the curtain on the same show just finished a few gongs of the clock earlier.

Some readers forced by great aunts to digest the classics will discern a pattern in this marvelous schedule designed to mold young mushy medical students into sharp, killing machines - oops! Sorry, must have been thinking of the movie “Tribes” rather than that one with George C. Scott in it, that influenced this budding paleontologist to decide to preserve old fossils rather than dig them up.

As those who labor under the full moon delivering everything from baby-to-mom or drunk-to-emergency-room know, strange and disturbing events occur during the night shift. Arguments between patrons of beloved taverns turn ugly, grudges are settled - sometimes with imaginative efforts of improvisation. I remember some of the outcomes of these scuffles, such as the woman who signed in wearing a carpet knife as a left earring, or the man who, after receiving a blast of 20 gauge shot point blank, could have auditioned for a role in the next Batman comic as the villain “Half-Face“.

Gruesome memories, these - but that is just the eruption from the graveyard hours, which occurs (thank heavens) infrequently. What really saps the spirit at 2-o’clock in the morning is the dull, continuous rumbling of interviewing sleepy patients. Let us recap - we know why the doctor is here, but why is the patient there? And why at such an annoying hour? I have fought to stay awake while admitting someone in the middle of the night, especially if they look upon this encounter as a golden opportunity to recite the mesmerizing details of their life, as if they were Scheherazade tickling the ear of the king of Persia. Not only does such loquacity drag out the mission of young doctors, it dulleth th’ edge of husbandry so much that sharp decisions are no longer automatically made, but are weighed against the attractive alternative to running down x-rays or performing a lumbar puncture, namely getting some shut-eye.

There is a way to combat this recurring nightmare of bad breath, greasy foreheads and slumping murder-victim-like into unit secretary chairs. It requires almost the same amount of foresight and discipline that got our boys up the cliffs at Pointe du Hoc, plus a little bit of that wonderful good luck floating around the universe. The secret is to design and follow a crisp routine faithfully - never wavering from it unless trapped in a firestorm of patient crises. The schedule varies from team to team, but can be outlined basically as follows:

5:30 P.M. Eat a hearty dinner, at least one worthy of praise from Lief Erickson and company.

8:00 P.M. Go to bed. Yes, that’s what I said - provided the patients are all tucked in and no black cloud looms on the horizon, don’t waste time watching the latest spectacle of televised tommyrot, or hang around the nurses’ station drooling over the Clara Bartons assembled there. Go to sleep, my lovely child - for who knows what pandemonium lurks ahead. The night is young - make good use of the sheets while you can.

1:00 A.M. Do what is commonly called the “lightning admission” - get the patient worked up and tucked away but fast, then jet back to the call room. Hopefully the case will be a routine and uncomplicated one, such as WADAO (Weak and Dizzy All Over). Pleasant Dreams!

4:50 A.M. It’s too late, baby, now it’s too late - you’ll never get your work done in time to jump back into the bunk so switch to Plan B: start drinking that java now. Two or three cups ought to be enough to get the old nervous system out of the phylum Porifera and back to the challenges of the coming day.

The graveyard shift cannot be conquered unless one defenestrates the beeper, bars the door and takes a chainsaw to the telephone, which might lead to an avuncular visit from the chairman of the residency program followed by a transfer to possibly a less attractive residency program. The infernal shift can be managed, though. With a sense of self-deprecating humor combined with the elusive ability to put oneself in another’s shoes, anyone can get through the night of work and still be able to tuck into a piping hot fruhstuck without nodding off into the midst of the plate. And if the gods of darkness smile not upon thee - despair not! Those who rattle their brains all night caring for sick folks can greet the dawn (if not their relief help when they ask the familiar question “How’d it go last night?”) with the battle cry of the survivor:

BOHICA!!