Moonlight

The harvest full moon passed this week and I had to work a night shift, or "moonlight" that night. It was a bright, beautiful moon and I enjoyed it as my car rounded the windy bends of highway that connect my house to the community hospital where I bring home the money we need to feed the family and pay our mortgage. On that night, I did some soul searching about this whole system of training and near-poverty I've lived in for so long. Without much extra money, my wife and I have done very well. We are used to coupons, and we have family that is generous with us, takes us on vacations and has us for dinner or takes us out every now and then. In fact, we are thrifty and frugal without being cheap and bitter. We're happy people.

But as the clock turned to 8:20pm and I entered the garage of the hospital for a 10 hour shift, I had a darker thought and lamented, for a moment, something more valuable to me than money: sleep. You may or may not know this, folks, but your doctor has slept much less than you have in this lifetime. Really my troubles began in medical school. There I pulled an average of one all nighter every 2 weeks starting in my second year. I was no speed reader, and I was often awake just catching up with reading. In my third year, on rotations, the sleeplessness was officially job related. 3rd year medical students are on the same shift schedule as their interns, and a q3 (every 3) day call schedule meant no sleep every 3rd night. That's when I discovered the true goings on in a hospital at 2am and the meaning of fatigue.

2am is what I've always referred to as the "witching hour." A myriad of things go wrong at 2am. Blood pressures fall, chest pain gets worse, patients stumble out of bed, bleeding gets worse- somewhere in those early morning hours interns earn their stripes- and 3rd year medical students watch. 2am is also the strangest time of day in a hospital. Awkward characters are sometimes seen wandering around the halls- it's the hour when the computer system mysteriously goes down, when the cleaning people wash the floors and make them extra slippery. One patient of mine turned sheet green at 2am. My patient at the VA murdered his roommate with a pillow because he was convinced he was a German enemy soldier at 2am. I came to loathe 2am in medical school- and it has held its promise as the strangest hour of the day.

Suddenly it's daytime, and 2pm, for those who are up all night, is another sort of bizarre. Lunch is over, the morning coffee which gets you to lunch is long gone- and every inch of your body wishes to curl up and sleep. But as an intern, 2pm was lecture time, or time to round in the afternoon. 2pm is when you need to be bright, awake, alert, spirited- to get everyone through the afternoon. But 2pm is, for those who started the previous morning at 7am, 31 hours into the day. 31 hours is a long time to think. 31 hours is too long. Your thoughts are mush. Mistakes happen at 31 hours unless you carefully slow down- cool your own brain a bit and go delicately through each motion. I became an expert at this, moonlighting and working the day before and after, in residency. I needed the money to stay afloat. And slowly, those shifts took their toll. It was last year when my wife announced that the hair on the side of my head was turning grey. At first I was angry- defensive: "I'm in my 30s, that's what happens." But then I saw her look- one of compassion and sadness. We both knew it was the sleepless nights and nothing more.

That night, at my little community hospital, I admitted 10 patients. I answered over 15 calls from nurses on various floors about sick patients. I intubated a patient in the intensive care unit and kept him alive on blood pressure medications and antibiotics. At 2am I was walking down the 5th floor hallway when I caught a glimpse of the moon. It was high now, and brighter than any I had ever seen. It was smiling at me, and laughing at me, and somehow lighting my spirits. It was as full as I was of energy and it was as reliable as I was striving to be. I thought about that moon until 6:30am, when I finally handed the pager to my well-slept colleague, coming in for a normal, 10 hour day. I fought back jealously as I gave my signout- each patient summarized meticulously. I was amazed that I remembered them in that state of half slumber.

Then I slowly made my way down the stairs, out the long corridor towards the parking lot, got in my car, and drove to work.