Wednesday, December 14, 2011

Guest Post: Ruminations on Shift Work from a Mother in Pediatric Emergency Medicine

An emergency medicine physician’s schedule is inherently flexible. I can quickly switch a shift with a colleague to accommodate emergencies since there are no patients to reschedule, trade random hours of coverage in order to make it to a school function, pick up my oldest son from school earlier than the other “late day” kids when I have an early shift.

Almost thirty minutes into the resuscitation, the room has gone quiet except for the ding of the monitor alarm. This five year old victim of smoke inhalation from a house fire has a good airway, two good lines, has received several rounds of epi, fluids, even the useless calcium and bicarb and there is no change. His pupils are fixed and dilated. “Time of death 13:52.” my voice breaks the silence. I walk out of the room and wait for someone to find his mother. She was out when the fire broke out.

I finish notes, try to wrap up my shift. His mom arrives and I sit with her and tell her the news as she cries silently. I hold her hand and then the social worker and chaplain take over. I silently leave the room, sign out to my colleague, and leave to pick up my son, also five, from school down the street.

When I arrive, he runs to greet me and the sudden force of his hug knocks my hair into my face. I smell smoke. I have to hold him longer to get control of the tears that are welling up in my eyes.


Overnight shifts are great for the working mom (who is used to sleep deprivation anyway, right?) Now that the baby sleeps better, they hardly know I’m gone. Their dad can get breakfast ready and I can do last minute lunch prep and kid dressing when I come home after my shift. Then I catch some sleep in a quiet house while the oldest is in school and the baby is with our nanny.

Thirty minutes before the end of my shift the radio alert sounds. I hold my breath as the nurse answers - a 6:30 AM radio call is either a radio check or a dead baby. Unfortunately, today it’s the latter. CPR is in progress. We ready the room, draw up meds, check the laryngoscope, and wait. I review drug doses and intubation technique with the resident and all the while I am just grateful that there’s another hospital closer to my house than the one I work in, because it means that this baby is not my daughter.

She arrives and is stiff and cold. Livedo has set in. We make an effort but mostly to dot our i’s and cross our t’s and give the family time to arrive and bear witness to our efforts. We care, we tried, she is important, we are sorry...... but she is the same age as my daughter and later that morning during my protected sleep time I just lay in the bed and cry, holding one of her blankets to my face.


Shift work is one of the features that is supposed to make emergency medicine ideal for the working mom. But shift work in the pediatric emergency department isn’t really shift work after all. I hope that as I accumulate years of experience that I can compartmentalize better and not “take it home with me,” but that’s not looking so promising since I can’t seem to concentrate when I know that my kids are in someone else’s car until I hear they’ve reached their destination safely. I hope that it’s just because my kids are so young and that as they get older I will worry less - but I know that’s not true as I call the pediatric oncology fellow for her opinion on a teenager with pancytopenia and a mediastinal mass. Perhaps all I can do is somehow convince the universe that bearing witness to the suffering of other children and their families is suffering enough, and then maybe the universe will protect my own children.


*patient details changed to protect patient privacy

5 comments:

  1. Interesting post! Most of my colleagues who do shift work have said the same thing, whether its being a hospitalist with very acute patients, ICU work or event adult ED feel that they bring home the baggage. Although its always so hard with kids, dealing with acute adults also constantly reminds us of our own mortality and mortality and illness of parents and family members.
    Anyways, thanks for all that you do for the children! You're a hero!

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  2. Beautifully written post, thank you. You are who we all want when our kids need you.

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  3. Moving anecdotes - thank you for sharing. That would be impossible for anyone not to bring home, and with the high acuity of emergency medicine, it's unavoidable to have these dramatic and heart wrenching experiences.

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  4. Thank you for your post! I am so grateful for docs like yourself to take care of these tough cases. I'll be starting my peds residency next year and am strongly considering ED fellowship-- I wonder if you see your colleagues having a similar experience with working the ER? Do you regret the decision, wish you had done gen peds (or something else) instead?

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  5. @Anna, I don't regret it and I am generally really happy in my job. There are just some moments when the emotional stress is high (which I tried to capture here) and if there is too much of this at one time I really feel it. In the grand scheme of things I wouldn't change my decision, but I also realize that I need to be mindful of how to take care that I don't burn out. And I'm surprised to have that sentiment since I'm only 5 years out of fellowship. Who burns out this early??

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