I am post-call, yet again. Which is short-hand for the mild-to-moderately disabling condition my family knows too well at this point -- foggy-brained, labile, cotton-mouthed, impatient, irritable, overwhelmed by the smallest unexpected twist in the plan. I have difficulty making decisions, even tiny ones. I eat way too much, my body confused by the question of whether it needs sleep or food. Instead of answering an important email or using this precious time while my child is at school to sleep, I watch a movie I have watched 40 times before and scroll mindlessly through the perpetually unfulfilled promise of the internet, catching myself a hundred times as I almost nod off and drop my phone onto my own face. I feel like a pint of ice cream with only a film of sticky soup remaining at the bottom: not good for much. My body aches. My mind, if such a thing is possible, aches. My view into the future is suddenly bleak, and even though I know that all these sensations and thoughts and feelings will resolve after a good night's sleep, I have to live through them all day and they are not pleasant.
I love nights in the hospital. A quiet purpose takes over -- the formality of the day softens and people are focused on what is most important. I am united with my patients' families in their sleepless vigil. I have had some of my most profound moments of intimacy with my patients and with the practice of medicine between the hours of 7pm and 7am. People are born and die at all times of the day, but at night there is an aura of primordial magic to it, both light and dark -- the baby's first cry as my ears are still ringing from being woken up by the delivery pager, the mothers sharp sobs as she holds her sick child for the last time. The night feels like life's secret workshop and despite all the sorrows I have witnessed there, I have loved my time in its shadowed chamber of turning gears.
But lately, I feel like the nights are killing me. It takes me longer to recover. My fatigue and disorientation stretch into my post-post-call days. I can never establish any kind of routine. My schedule is never the same twice and the nights fall on different days and in different configurations and it feels like I am inventing my life from scratch every single week. On paper, it doesn't look so bad: I "only" work overnight about 3-4 times per month and 1-2 of these are 24 hour shifts. But the weeks when I don't work a single night feel so much better, like I am finally climbing out of the canyon. I eat better. I exercise regularly. My family is able to settle into a consistent routine of time together in the evenings. I get to play the piano and talk to friends and read books and taste my food. I feel like myself again. And then another night looms and I slip back into survival mode -- the life of just trying to get through to the other side in one piece.
In order to give up nights, I would have to give up the ICU part of my job which would feel like a huge loss. The muscle of acute care that is strung taught and strong across my frame would atrophy. I would miss the real-time critical thinking through the most pressing problems of physiology. I would miss the sense of internal strength that comes from running towards instead of away from disaster. I would miss my colleagues so much. And most of all I would miss the patients so much. I know there would be other patients and other satisfactions, but I have stroked so many little heads amidst the wires and tubes and lines and a part of my heart will always be hovering over an isolette, cheering a tiny life into the future.
Is it even appropriate to step away, I wonder? I harbor some machismo about the self-sacrifice of nights and call and when I imagine giving it up my inner voice says things you might expect a drill sergeant to say to a new recruit. In other words, not nice things. I compare myself to people who have accomplished incredible things and who seem to sleep much less than I need to -- surgeons, authors, CEOs, innovators, politicians, my colleagues who have even more children and even more responsibility. And I think to myself: Was I put on this earth to sleep? Why, I wonder, do I need rest and consistency and slow mornings and the Goldberg Variations over a hot cup of tea and the colors the afternoon sun makes in the trees to feel like myself when others can be animated solely by the imperative of their work? What, I wonder too many times a day, is wrong with me? Or perhaps more kindly framed: What right do I have to prioritize my own needs over the potential to serve the needs of others? And then other questions, usually held in shadow, emerge: Does the poet part of me deserve the same airtime as the doctor part of me? What if I love being more than doing?
As you can see, the question of nights has become about more than than the question of nights, which makes it all the more difficult to decide on the right course of action. For the moment, I have shifted my responsibilities for the coming academic year and will be doing less time in the ICU and by extension fewer nights. I will see how that feels. Likely, no choice will ever feel 100% right, but I hope that a bit more sleep will allow me to attend more closely to my own intuition, that a little piece of that primordial magic will glow in my own life and light the way.