I have never managed to sleep the day before a night shift. It makes no sense to my body, to suddenly try nap during the day. And worse: if I let myself lie in bed too close to the beginning of a shift, eventually waves of sleepiness will start to roll over me. I’m cosy, warm, my mind is finally beginning to wind down, and just when I’m about to drift off… BAM. The alarm goes. You know that feeling when you have to drag yourself out of bed on a cold dark winter morning? Like that, but overlaid with that nasty kind of jolt you get when you’re yanked awake from a dream by a loud noise outside, and your heart is racing and you feel frazzled and on edge.
That first night is always the worst, physically. Coldness sets in around 2am, boring deep to the bone, and no number of extra layers can keep it out. Finger tips turn to ice (- hands were already colder than ever -), the ribcage tenses in a vain attempt to ward off the shivers. The next few hours are never-ending. There’s still so much time to go, so much time in which anything could go so wrong, before finally six thirty rolls around, and the end begins to come hazily into sight.
I usually sleep for a reasonable chunk of time that first night. Nowhere near enough, given that by the time I make it into bed I’ll have been awake and on my feet for well over 24 hours, but enough to feel super human the next night, in comparison. It’s not healthy rest. You lie, the sound of the day blaring in through your windows, wired with that post-handover rush of adrenaline, your thoughts racing with decisions you made, events of the night, patients who were sick, patients you got called about for advice, suddenly scared you’ve missed something, questioning whether you remembered to order those labs, and then all of a sudden your mind flicks off, and you plunge into a deep unrestful sleep, waking maybe five or even six(!!) hours later, starving and exhausted. After that, each shift is followed by progressively fewer and more broken hours of sleep, as the body gets over that initial exhaustion, fighting its internal clock to stay awake during daylight, or too drugged with doubt and fear to let sleep enter.
Sometimes I awake with a pulsating headache – especially when the night was busy, or I was scared, when I forgot to drink enough fluids, or was too preoccupied to do so, or when I had pot noodles to try warm up. On those days I head straight for the bathroom and swallow paracetamol and ibuprofen – the longer you leave it the worse it gets. Sometimes I wake to the smell of cooked food, dinner time, but wait it’s breakfast, and I simultaneously feel sick and starved, my mind confused, not knowing where it is or what it wants any longer. Showers help. And so does human contact. A hug, a chat, anything that feels briefly normal for a second.
Sleep deprivation takes all of your doubts and fears and magnifies them ad eternum. If there is anything you feel insecure about, anything making you anxious, your mind will sink its teeth into it and refuse to let it go. Night time is a scary time to work in a hospital. A lonely, empty time. There are far fewer staff around. Things get noticed later, when you need to act fast, and there is no one more senior around to guide you. Your mind goes to the worst case scenario, out of sheer necessity, and tries to work backward from there: what do I have to do to avoid this, what is the minimum I have to ensure to know that this won’t happen, what else could go wrong? And only then, finally, how else could I make this better? But sometimes someone yells at you, or a patient dies unexpectedly, and then you can’t rest until you have replayed the situation from every possible angle. What did I do wrong? What should I have done? Was it my fault? There is no reasoning with sleep deprivation, no reassurance can be enough. You can’t escape your own mind.
But there are good moments too. Like the softness of the evening when you set out for work, or the sharp cool freshness of morning when you finally finish and step outside. Like the way in which the sun rises golden through the windows, falling in huge shafts down the corridors, squeezing through blinds. Like the camaraderie between colleagues – nurses and surgeons and the ED guys, maybe even the radiologists – no one really wants to be at work at that time, most people are a little less sharp, a little more kind. Like the miracle of the first cup of tea you make – bringing so much warmth and energy (for all of five minutes aha). Like the smell of cooked breakfast coming from the Caf.
Mad to Live 