I just finished my first of 3 weeks of night for this rotation. I’ll do this 3 more times before next July. I’m so ridiculously tired right now but it’s 11pm and my body clock is all messed up so I’m just going to journal for a while while the melatonin kicks in.
I was a bit anxious about how much awake & home time I’m missing as a parent. And this is only the 2nd week of school. I’m already gone by dinner & bedtime, I’m not home yet most mornings when they leave for school. I tried to prep the kids as much as I could, but as they are 15 and 17 now (D’s birthday is in 2 days, A’s was on Labor Day), they know much more than I do and have assured me that I am, in fact, overreacting and quite foolish. (insert eyeroll emoji here)
Halfway through the week we had a demonstration that adolescent brains are not the same as adult brains. Independent of each other on the 3rd or 4th day of my week, during the after school period we have together, they both made incredulous comments about my schedule. And the amount of sleep I’m (not) getting. I chose to find it heartwarming that they noticed and not irritating that they didn’t believe me the dozen times I tried to warn them about it before the rotation started. But we’re all on the same page now, it seems.
The work itself has been amazing. It is rare that I have time to sleep any amount that really matters. Maybe a 5-10 minute power snooze with my head on the table. Sometimes I do so much, I can’t keep patients straight (obviously I take good notes and rely on my team to help me, I don’t actually get anyone’s care confused!). I did 3 c-sections one night. Another night I was in the main OR doing urgent gyn surgery for 5 or 6 hours (ectopic pregnancies and septic abortions and torsed ovaries). Some nights I just managed sick people and didn’t do any deliveries or surgeries. And then there was a night that we had (on either side of midnight) 2 women roll in and deliver babies very quickly. As the 2nd year, I usually get the sicker patients, but when the intern on the team is a relatively new family med intern and we have to deliver a preemie baby for someone who’s been in the hospital 15 minutes, that counts as complicated enough to be in my wheelhouse. At night we sometimes take care of some things the day team didn’t have time to get to - consenting postpartum patients for tubal ligations, reading the daily fetal monitoring for patients who are in hospital for many days or weeks, following up on hypertension/pre-eclampsia management changes.
This week I decided that I’m going to try managing my pre-eclamptic patients with treatable BPs with nifedipine instead of labetalol. The science is basically the same but the meds are dosed a bit differently (1-2 times a day vs 2-3 times a day, 2 dose options vs a large range of doses) and I’m wondering if starting with nifedipine will enable us to shorten length of stay and titrate an effective treatment faster than starting with labetalol. This is one of those things we call “practice variation” which means there’s not a good reason to do one over the other, but individual doctors still have preferences.
I have the weekend off, a little bonus to working nights. I’m very happy to have 48+ hours off in a row after a week of 5:45pm to 8am work (bonus on Fridays - didactics until noon). 2 more weeks of this then I have an Outpatient rotation which is a luxurious 8-5 job!
One of the ways I’m coping with the arduous role of a 2nd year resident (really the workhorse year of our program) is by breaking the year up into fractions. Recently I “celebrated” the completion of ⅙ of the year. This week marks the 4th of 6 weeks of this rotation so I’m two thirds of the way through. Breaking things into smaller manageable chunks makes the whole year stretched out before me a bit less daunting.
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And I just finished my last week of nights for this rotation. I’ll do another 3 weeks of nights in 7 weeks. After that I have a longer break and then there will be 2 more 3 week stints in the spring & summer. I am consoled by the fact that though I have 12 weeks of nights this year, I only have 7 next year and 5 the year after that. It all comes out in the wash. “It’s a 4 year program” is one of the truisms we use to remind ourselves of patience with our own learning and to get through the times when our schedules are harder. I’m very tired and I miss my kids. They’ve done a great job but taking care of themselves - a lot of frozen lunches, yogurt and bowls of cereal. The dog has been walked, the homework has been done (or so I’m told) and life has gone on. With the night shift schedule, there’s not really enough time to do anything other than come sleep and have about 20-30 minutes to do something else - shower, eat, see the kids. Pick one.
Labor & Delivery has been an amazing place to work the last 6 weeks. The team I was working with gelled really well and I cannot express how much I have learned, what a better doctor and surgeon I am now. I’ve taken care of some really sick women and participated in some amazing births. I’m a lot faster at doing c-sections now and I was the person who did things for the intern when they couldn’t manage - breaking water, checking a difficult cervix, helping to make a plan for a patient with an unusual presentation. More often than not, I’m able to deliver the fetal head in a c-section (this is harder than you’d think) and I rocked c-section breech birth maneuvers several times. I still need a lot of help and there were some times I had to turn to my chief to do things for me - breaking water, making treatment plans, some hard surgical stuff. I was present with women when they delivered babies born still and took care of some sick women who ended up losing their uteruses or being told that pregnancy was now a life-risking endeavor that they should not undertake again.
Next week we have a short week of filler stuff - all our rotations don’t divide evenly into 52 weeks so we have several “freak weeks” - at the end of the year when the graduating chiefs aren’t around, during orientation for the new interns, this week when more trainings happen and 2 weeks over the winter holidays. After that I have 6 weeks of outpatient clinic - heaven is a job from 8 to 5!
