I always find ‘day in the life’ blog posts really interesting, so I thought I’d write one about a night shift I did recently in a run of 5, looking after 7 wards of a busy teaching hospital as an FY1 (a first year junior doctor straight out of medical school). It might shock you, it might horrify you, and you might well feel like some coffee or a nap afterwards 😉
I wake up after sleeping all day after the last night shift. It takes 3 alarm clocks to get me out of bed, and I don’t feel in the least bit refreshed. I’ve barely slept, because even with a black out eye mask and ear plugs, sleeping in the daytime is deeply unnatural. To the kettle!
I text James and let him know what I’ve made for dinner and left in the fridge for him, and after bolting down mine as ‘breakfast’, it’s time to leave to commute to work. I feel groggy even starting the drive to work; God knows how I’ll feel on the way home. I try to ignore thoughts of tiredness causing car crashes and enjoy the views on the way to work, whilst I glug down coffee number two since waking up.
After changing into scrubs and trainers for comfort overnight (and in case of the very likely spills of bodily fluids), I meet up with the junior doctors finishing the daytime shift and collect my bleeps for the night from them: one general bleep so any wards on the wing can get hold of me, and the crash bleep for that wing of the hospital, reserved for emergencies like cardiac arrests and seizures. Neither can be turned off; when they go off, I must go where I’m needed.
We exchange a few jokes about how terrible the daytime has been, they hand over any jobs that need doing overnight for their patients and any particularly sick patients I should be aware of, and they trudge out of the door, exhausted after another 12 hours with little in the way of breaks, food or water.
I attend the acute handover meeting, where I find out we only have half the number of senior doctors on overnight that we need; the shifts are increasingly difficult to cover, and locums aren’t always available. I leave, worried that if I need senior support overnight, the registrar will be in theatre, and only phone advice will be available.
I finish doing my ‘jobs round’ of the first two out of seven wards I’m covering. I try to get round all of the wards early on the shift, to do the routine jobs like prescribing IV fluids and analgesia to last the night for patients who need them. I meet the other FY1 doctor who is on the twilight shift, and we divide up a few jobs between us, to make the most of his time before he leaves at midnight.
The first bleep of the night about a sick patient comes in. Her observations have worsened over the past hour, so the routine jobs stop and I go to review her. She is in hospital with a serious kidney infection, and it seems her condition has worsened. Fortunately, she has had all of the relevant tests done, so after speaking to the on-call microbiologist and changing her antibiotics, giving her some more fluids and some IV paracetamol, she starts to stabilise. I leave her to carry on with the jobs, as my bleep has gone off 5 times whilst I dealt with her.
Two new patients are admitted for planned surgery tomorrow, so I try to clerk them in quickly so I don’t have to wake them up later. I take a quick history from them, examine them, organise the relevant blood tests for the anaesthetists, prescribe their regular medications and injections to stop them getting a DVT, and I’m done. Fortunately they’re two straightforward young patients, here for reasonably minor surgery, and are quite well at the moment, so it doesn’t take too long.
I catch up with the FY1 finishing the twilight shift, and take a few jobs and patients to be aware of from him, before he goes. This is my least favourite time, because suddenly the workload doubles and the bleep goes crazy.
First bleep: the parents of a young girl want to know why she is still waiting for her operation to remove her appendix, when the surgeons said she was going on the acute theatre list. I speak to my registrar, who confirms my suspicions that somebody sicker needed operating on first, so the young girl has been bumped down the list. I steel myself, and go and talk to them. Fortunately, they’re intelligent, caring parents who are reasonable and listen to my explanation for what has happened and why. I apologise for this being the way it is, explain she unfortunately needs to continue to be nil by mouth, and briefly examine her, more to provide reassurance than anything- her observations are fine, but these brief interactions make a big difference. I review her charts, and make sure she has enough IV fluids to keep her hydrated, the right antibiotics to stop her condition worsening, and plenty of painkillers so she’s not overly uncomfortable- small touches that don’t take long, but make all the difference. She gives me a hug and says I’m the nicest doctor ever. Moments like that make it all worth it.
For about 10 minutes, the bleep goes quiet, so I grab the chance to make a coffee and sit down in the doctors’ office to drink it, gather my thoughts and chase some test results. No chance! The bleep goes off again: a patient who has not long come back from theatre is short of breath and her oxygen saturations are dropping. Fortunately it’s a quick visit from me: I review her charts, listen to her chest, sit her up and put her some oxygen on, as well as ordering her a portable chest x-ray to be done. It’s quite normal for this to happen, so nobody is too worried. Her numbers improve, and I leave her, making a note of her details on my list so I can check her X-ray results soon. I return to the office, and aside from a few bleeps about paperwork and admin to do, I have an uneventful 30 minutes to myself, and can finish my cuppa and catch up.
The nurses start to get a little antsy again, with several different wards bleeping me because patients need fluids and painkillers. These jobs aren’t urgent clinically, but they are to the patients and the nurses looking after them, so I try to dash around and get them all sorted out.
The bleep finally goes quiet again, so I retreat to the doctors’ office for ‘lunch’. I munch my way through my sandwich, checking patients’ blood results again, and am chilled and happy until I spot a big drop in the red blood cell numbers for one patient. I pop to the ward he is on and grab his notes and start to read. I find out he’s on blood thinning drugs, and had a CT scan earlier in the day showing possible bleeding.
I look at all the rest of his results, and try not to panic. His observations are stable for now, but for how long, I don’t know. I get him an IV injection of Vitamin K, to slowly reverse the blood thinners, but I suspect this isn’t enough. I speak to my senior, who confirms my suspicions, so I set about ringing the consultant haematologist to get some Octaplex authorised; an infusion of blood clotting factors that costs over £2000, and almost instantly reverses blood thinners. She agrees it’s suitable, so I sort out the paperwork and have it urgently portered over from the blood bank and administered. I also organise an emergency CT scan, which I have to accompany him to as he might crash, and two blood transfusions. It’s a hectic few hours, and it’s the most tiring part of the night shift when the urge to sleep is ridiculously strong. I breathe a sigh of relief as the radiologist compares his new scan to his old one and confirms that he’s not actively bleeding. Aaaaaaaand relax.
And the best eye bags award goes to…
Another bleep, this time that a 92-year-old lady with a potential bowel obstruction has started vomiting what very much looks like faeces.
I rush to see her, and in my haste to examine her abdomen, don’t realise she has advanced dementia- until she gives me a right hook Rocky would be proud of. Assessing my jaw to make sure it’s not broken, I have to revise the plan; she’s unlikely to tolerate a naso-gastric tube, passed down the nose and into the stomach, allowing us to empty the stomach and stop the vomiting, which is what we’d normally do. The registrar tells me to use a bit of sedation if I need to, but if I do, she’ll aspirate some of that nasty vomit into her lungs if I use enough to allow me to put the tube in. The nurse looking after her and I put our heads together and hatch a plan to help her- she has no IV access, so we give her anti-vomiting drugs via another type of injection, and try to calm her down. She gradually stops vomiting and settles down, thank god- it was pretty distressing all round!
As sure as nights make you sleepy, for some reason ill patients spike temperatures at around 6am, so I rush from ward to ward checking it’s nothing more serious than IV paracetamol and antibiotic doses being due. Sure enough, the temperatures slowly start to come down, and the patients start to look a little brighter. It’s nice when solutions are simple!
7am is a glorious hour on a night shift for two reasons: firstly, it’s only an hour until you finish, and secondly, nurses change shift at 7am, so they’re all in handover and the bleep goes quiet. Bliss! I start to sort out an organised list of important things to hand over, organised by which team each patient ‘belongs’ to, so I can find the right people to hand them back to. It’s a satisfying part of the shift, because if all goes well, it’s quiet and it means I can gather my thoughts, sort things out and hopefully leave on time. At about 7:45am the daytime FY1 doctors arrive, so bit by bit, I hand the patients over. The ones who have done their night shifts congratulate me on surviving; the ones who haven’t yet look terrified at how exhausted I am. I pop and get changed back into my normal clothes before formal handover to the day team.
Handover meeting- at last! I sit through the acute team handover, fairly zoned out, as the night FY1 doesn’t have much to contribute to this, until one of the registrars nudges me to tell me if I’ve handed over my bleeps and my jobs, I can leave- result! I shuffle back to my car, VERY carefully drive home, and after some toast, a hot chocolate and some Kalms, head straight to bed to sleep for my next shift, eye mask on and ear plugs in.
So, now you’ve read that, what do you think about the extensive contract changes Jeremy Hunt is trying to impose on junior doctors, where working hours like that (I did 84 hours of night shifts in 9 days) become the norm, and all for a £6000 or so pay cut? A little off topic, I appreciate, but blogs are all about what’s going on with someone at that point in their life!