Notes From the ER logo Did You Know

When Death Approaches


Desperately, I try to appear interested and concerned. I wonder if my struggle shows as I silently battle my nemesis. I try, but fail to empathize as each agonizing minute drags by.

Four o'clock in the morning and the young man is earnestly telling me the details of his cold that started two days ago. He's worried; could it be a sinus infection? Pneumonia, perhaps? I ask him a few questions and then I ask why he chose this time to come to the ER. He tells me that his nose was stuffed up and he couldn't sleep.

Ah, sleep... just the mention of it is intoxicating. It beckons me. My eyelids sag in wishful anticipation. A yawn creeps across my face. Nothing would be better than to close my eyes, if only for a few moments--

NO! It is really poor form to fall asleep while talking face to face with a patient. Besides thinking I don't care very much, he should be worried about any medical advice I offer.

Although I do have a few "customers" like this, most of my late night patients really do have valid concerns and that makes it easier to care, to stay focused. In terms of my alertness, the best nights are busy and my patients are seriously ill or injured. The adrenaline is flowing, my mind is in high gear, and soon the night is over.

Sleep deprivation--it is a fact of life in my line of work. Two to three nights per month I, and each of my partners, pull the night shift: nine PM to seven AM. That nighttime availability is a crucial part of the service we offer, both to our community and our fellow physicians.

The whole concept of the ER and 24-hour medical care is relatively new. Forty years ago, the only hospitals where physicians worked at night were those with residency programs for physicians in training. Private physicians still made house calls to determine whether a person needed to be brought to the hospital.

The emergency room was literally just that--a room, usually near the entrance of the hospital, where the sick and injured were brought in the middle of the night. Often, a person would have to ring a doorbell to summon a nurse to open the door. She would decide whether to call a doctor or make the person wait till morning.

Since that time, the concept of emergency medicine as a full-fledged specialty has evolved. Along with that evolution, the "room" has now developed into a full department of the hospital. We have round-the-clock access to some incredibly sophisticated equipment to aid in our work as physicians.

People ask me how I do it and I respond that I don't really know. I just do it. It's not easy. It's not pleasant. But I can do it. Some people's bodies seem to be set up differently to endure this kind of stress. Pilots, truck drivers, soldiers--many professions demand the ability to stay awake for prolonged periods of time.

There is definitely a price to pay for fooling with my body's clock. My family can tell some funny stories about my falling asleep on my plate, in movies, etc. But there's also the dangerous side. In eleven years I've fallen asleep at the wheel of my car only once. No one was seriously injured, but it scared the hell out of me.

I also worry about what price I may end up paying for doing this to my body over the years. There is good evidence that the long-term effects put me at greater risk for a whole range of illnesses such as heart disease, cancer, and dementia. My response is to do good things for my body--exercise, a healthy diet, family time. Hopefully this attempt at balance will allow me to maintain my health, enjoy life, and continue my career for another ten to fifteen years.

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