I used to be able to use some cognitive behavioral therapy to tune into why I would get so grumpy at work. Identifying the offending incident and depersonalizing it kept me fresh for the next hurdle to approach. I guess that the hurdles don’t get any fewer or lower as I progress in my career. In fact, it seems that they multiply at an inconcievable pace. Last night was no exception.

I arrived at work relatively fresh after a few days off. But naturally as fate would have it, things were immediately almost overwhelming. I arrived at 11pm, to pick up charts that had been waiting since 9pm. A mother held her head in her hands, exhausted from waiting. Families paced nervously for a physician to show up in the room. And nothing went quickly. I was unable to reach anyone who had petitioned for an involuntary admission on a psych patient, and he refused to tell me anything. How can I knowingly sign off on the committment after reading a few lines of chicken scratch? The psychiatrist asked me innumberable questions, to which every answer was the same…”I don’t know, he refuses to tell me.” That time sink kept me away from the rest of the rack of charts that were buiding up.

Our new computer record system left me in the dark, as the nursing staff no longer write down vitals or even chief complaints. But when a patient presents with chest pain, don’t you think that cheating just a little by writing on the cover sheet that the patient is having pain would be beneficial? Just a little bit?

So now enters the trauma wherein myself and the staff doc get sucked into the trauma bay for 45 minutes leaving the intern alone to try and catch up. While in the trauma, he preps me on a sick patient arriving that he wants me to jump on right away…but he’s been so busy with the intern that he doesn’t even know about my first four patients of the night.

Instead of things slowing down in the wee hours of the morning, I continue to get barraged from all sides…phone calls, nurse requests, patients demands, and the involuntary patient getting chased down by the police demanding that he recieve his rights (which had already been given).

By 7 AM, instead of having a nice tidy department to hand off to my colleagues, I had six active patients, all signed out to the morning crew. Nothing went smoothly last night, except the metal worker who got a sliver of metal in his eye. I plucked it out under a microscope using a fine needle. It was the easiest thing I did all night.

The worst part of the night shifts is having to sleep while the sun is out. Maybe tonight I’ll just hook myself up to some intravenous vitamin D. If I got addison’s or wilson’s disease, I could look as tan as if I’d been out in the sun. Toxic shock or scarlitina would give me that fresh baked sun burnt look. A little bit of welding without glasses would give me UV retinitis (snowblindness), and I could pretend I got it while climbing one of the seven summits. I guess there are all sorts of ways to pretend I’m seeing the sun.

If I don’t learn how to tune back into the cognitive therapy that helped me survive my intern year, I think I am going to implode.