to sleep, perchance to dream; revisiting nights

The letter N in B.O.N.E.R. doc stands for nocturnal. I and my brethren work the night shift in the ER. Most groups of ER docs have some type of advancing schedule. To cover the ER 24/7, the day is split into 2-5 shifts of varying lengths. One would work 1-2 weeks of the early shift and advance to the later shifts in sequence. My group has two docs who work only the night shifts, yours truly and my brother, Zorba. We cover all but 2-3 nights each month. I work my nights in blocks of three in a row. In between these shifts I try to sleep. If I am lucky I can sleep for 2-3 hours in the morning when I arrive home, and another 2-3 hours in the late afternoon before returning to the hospital. Nurses, techs, EMT's, paramedics, police, fire fighters, and others follow similar schedules. Night workers are sometimes paid a bonus for "volunteering" to work nights. Often the most junior members of an ER group get stuck with the majority of the nights, and as one ages, the number of nights is reduced.
The problem with working nights is circadian rythyms; no, not the noisy insects that hatch every 17 years. These variations in hormonal, neurological and even digestive activities are hard wired into all animals. Challenge them at the risk of disfunction and physiologic harm. The litany of side effects from impaired or inadequate sleep include heart attack, stroke, reflux, depression, increased risk of cancer and most disturbing, a shortening of one's life expectency. That's right, working nights shortens our lives. There is also the stress on a marriage and family life, when one spouse is either not home or trying to sleep when the other spouse is on the opposite schedule.
There are advantages to working nights. The most obvious is a lack of management supervision. Bosses sleep at night. Only the peons labor after 11:00 PM. This independence breeds a spirit of cooperation. An "us against the world" mentality. We become our own weird, cranky and chronically sleep deprived family. The day folk can't relate to our special needs. Black out blinds, white noise machines, strange eating habits, and an unnatural passion for coffee are some of the adaptations we employ to cope with sleeping during the day and being awake at night.
The real problem is that we constantly switch back and forth between the day world and the night world. I have just finished three nights working. I slept for 2 1/2 hours this morning, and am struggling to stay awake til 10:00 PM. I will probably sleep 8-9 hours. I actually set an alarm for 7:30 AM so that I can rejoin the sun people including my saintly wife and the rest of my family and friends.
Patients are unaware of circadian rythyms, to their detriment. Heart attacks, strokes and other medical disasters are most prevalent in the early morning hours, due to changes in levels of hormones in our bodies. The patient in severe respiratory distress at 6:00 AM is being cared for by doctors and nurses who are also at the low point of their physiological functioning. Night workers have a much higher rate of car accidents when driving home in the morning than the general public. You can't defeat mother nature.
The emergence of the ER as a 24 hour walk-in-clinic has made nights even more difficult for the B.O.N.E.R. doc. In my 30 years of night shifts I have gone from the occasional patient followed by games, crafts and even naps, to nonstop patients and a perpetually full bladder. A successful night is one in which the ER is less backed up when I leave, than when I arrived. Seeing someone with a minor back ache at the end of your shift, because the patient needs a note to stay out of work, sucks what little nugget of humanity remains at 6:00 AM.
So please, if you have an appointment that same day with your family doctor, don't come to the ER at 3:00 AM, for your one month of "fill in the complaint", because you just can't wait til 11:00 AM for your scheduled appointment.
Good night and pleasant dreams.....