Sleepless in the Java Sea

I am no stranger to staying up all night.

I don't recall ever partying beyond the wee small hours. Not that it never happened. I just don't recall. I do remember once in med school waking up on the bathroom floor the morning after a party, but that was not technically partying all night since I was, in fact, unconscious. First and last time for that prototypical life experience. Ugh.

I pulled a few all-nighters writing papers or studying when I was in college and med school. As an English major I oddly got my best grades on those late night, last minute just-start-typing papers. Perhaps I write better when I don't have time to overedit myself. (See upcoming post on my "ScriptFrenzy" adventure.) In med school, however, my understanding and retention of complex scientific information always came out inversely proportional to the hours spent studying after midnight. I made it through medical school in spite of those last minute all night cram sessions, not because of them.


The vast majority of my sleepless nights occurred because I chose to be an emergency physician. Twenty-four/seven availability of immediate life-saving expertise is a fundamental aspect of that specialty. So, just as one who chooses a Navy career should expect some sea duty, an aspiring "ER Doc" should expect night duty. Unfortunately, there are exceptions to that rule in both professions, "sailors" who never go to sea (many, alas, are doctors) and emergency physicians who find a way to never pull a night shift. In either case, those outliers are neither to be respected nor emulated.


When I was young ER Doc in our specialty's salad days the current body of knowledge on circadian rhythm disruption was still developing. Not that I cared. Like my colleagues in that burgeoning specialty, I was a cocky young adrenalin junkie with testosterone to burn. Manfully we powered through strings of consecutive 12 - 14 hour night shifts, not only to meet the specialty's demands, but also to prove that we had the right stuff. One could not boast of being an ER Doc without first being tried in the crucible of human misery and tragedy that occurs more often after midnight: "Knife and Gun Club" trauma care, drug overdoses, poisonings, the full panoply of alcohol excess, long neglected end stage disease. These often afflicted the dregs of the human condition, desperately errant souls who ventured out only under cover of late darkness to end up in my ED and to keep me not only awake, but strangely professionally fulfilled.


Not all who sought this circadian-challenging profession succeeded. Arriving early one morning for my scheduled day shift after a new hire's first night, I came upon the distraught young physician sitting on the ambulance drive with his head cradled in his hands. In a nether-worldy voice he rasped, "I. Will. Never. Set. Foot. In. There. Again." He did not come back. I was only too happy to pick up my share of his night shifts for the remainder of the month.


Last night I pulled my first all-nighter in many a year. The need to synchronize activity with a distant higher headquarters required my presence at several teleconferences and briefs after midnight. Although many of my colleagues do this sort of thing from time to time, this week's activity involves most of the staff. "Just like a string of ED night shifts," I reasoned. "No problem. I'm a veteran."


Two unforeseen factors rendered this particular excursion into the wee-small hours less professionally satisfying than those ED shifts of yore. One is simply age. Those adrenalin-rushing, testosterone-burning night shifts occurred during my mid-thirties to mid-forties. (The variance, I hasten to add, is in recovery time not capacity.) The other, larger difference is the nature of the stimulus. Last night there were no airways to secure, no hemorrhage to control, no gastric tubes to place, no complex arrythmias to convert, no lacerations to sew. There were simply redundantly talking heads on giant VTC screens, and monosyllabic droning voices in my earpiece. I'm sure that the folks sitting around various remote conference tables, fully rested, fed, and caffeinated, found the lofty discussions stimulating. I probably would too under those conditions. But post-midnight to this grizzled old ED Doc they were as dull as dirt. Not complaining, just saying. Sure could have used a good trauma case at about 0300.

Well, I get to re-engage tonight, so I should probably get some rest. Unfortunately, someone just decided to take a grinder to the deck right over my pillow. So I'll go for a run on the deck instead. That should be good for an adrenalin surge.