This last week I’ve worked entirely night shifts, running from 10pm – 8am. I’ve always been someone that stays up fairly late and only sleeps for short periods, so I always thought that nights wouldn’t be that big of a task. I was wrong. The entire process is completely different, my night shifts follow on from a run of day shifts so I had to completely invert my sleep cycle over the course of 1 day in order to be functional. Similarly, I finished work on Monday morning (after Sunday night) and start again on Wednesday morning – regardless of how you work it you end up losing the Monday and only having 1 day off between weeks.
I managed to make it through nights with what can only be described as copious amounts of coffee, more food than I thought I could eat, the lighting being perpetually midday in ED & a little bit of fear/excitement. Overnight in the ED there are two registrars, three residents (not including paeds) and me + a tonne of nurses. Sure, every major decision is still run by the Registrar if possible but there’s more chance that you won’t be able to – i.e. if you’ve started working up a 85 year old patient with a fractured neck of femur + ?subdural haematoma with fluctating level of consciousness while the Registrars are both busy in a resus dealing with a difficult airway. It also really makes you wonder what would happen if the ?abdominal aortic aneurysm vs ?aortic dissection that you’re taking to CT at 4am actually ruptured or dissected – there isn’t really anyone else right there in CT other than you, a nurse and the radiographer.
I struggled with a few patients this week and I think over-investigated others. Some I struggled with because they had problems that I didn’t know much about, a few because they were Nepali non-english speaking people and no translator was available and others that were patients that we outright couldn’t figure out. These last set of patients had been investigated to our limits and really didn’t have anything to go on as to why they had pain, why they were septic or in one case why a normally healthy patient suddenly a hypokalemia of 1.8 (still don’t know, they’re in ICU). A lot of them ended up being bad referrals to the medics or surgeons.. Overall I felt like a lot of things I did this week could have been done better, but I guess that’s the point of internship.
The most important thing I recognised in this last week was that tiredness really, really impacts how well you think and act. It wasn’t until I got confused trying to eat my breakfast following my last night shift that I began to wonder how I was suturing up a large hand laceration earlier that night or even how I managed to drive home safely. The latter is something that I think I’m going to reassess, maybe a taxi home on the last night is a better option than driving myself.
I’ve also managed to get back involved in a bit of research during my days off and will probably write up a post on it later – we’ve been using doppler ultrasound to measure diastolic/systolic function of mice following Irukandji & Chironex Fleckeri envenomation(jellyfish in FNQ). It’s been a great experience so far and we’ve got some great data that hasn’t ever been recorded before & helps explain a lot of the significant human case studies following envenomation – i.e. heart failure in healthy, young adults stung off the reef. If I get the time I’ll write up a post on my thoughts about research during medical school, how I feel about the honours system and how I approached it throughout my time as a student.