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The Night Shift

Posted Oct 14 2008 5:00am
Posted by Dr. Jane Doe.
I'm on the night shift at the moment. Here in New Zealand junior docs generally do a week or two of nights as part of their rota for whatever service they're attached to. You are on days Monday to Thursday of the week you start nights, and you have Friday off during the daytime, go in at 22:30 Friday night and work till 8am. You do seven nights in a row here, which can be harder than I'd thought, especially as it is preceded by a week of days with really only 24 hours off duty in between finishing days and starting nights.

There are several links on the hospital website giving advice to juniors on how to cope with the nightshift, as well as an actual chapter full of tips on how to avoid fatigue, how to sleep during the day, etc etc in our handbook that we all get given when commencing employment.

Coming from Ireland, where junior docs in the majority of specialities do 36 hour shifts at least once a week and often more by way of keeping out of hours staffing going in hospitals, I was used to marathon shifts and coping with extreme fatigue, physical discomfort and mental stress for a relatively short time.

So when faced with a mere week of nights, I was SO cocky. I was like "I've done 56 hour shifts with no sleep at one stretch in a MUCH more hostile environment than this! I'm hardcore! I'm Full Metal Jacket. I don't need no stinking advice on how to cope."

Well it turns out I was Jack's exhausted pituitary.

The night shift system, while INFINITELY better for doctors, and DEFINITELY better for patients, has its own hurdles, and you need a different and more complex coping mechanism for getting through a week of night shifts than a 36 hour extended shift, as I discovered the first week of nights I did, back a few months ago.

The first week I was exhausted by the fourth night. I felt nauseous all the time. My stomach was a wreck. I wasn't really sure when to eat and what to eat when. I would come home and make something like scrambled eggs and toast, which I would never normally have at breakfast time, because I felt like I should be having something with protein seeing as how it was technically my dinnertime. I snacked all the time, but with the nausea and constant stomach upset I actually lost a fair bit of weight that week. I was delighted. My waist was tiny which would distract nicely from my baggy eyed grey and saggy skinned face. By the sixth night I felt sort of freaked out and got palpitations everytime the bleep went off. My nerves were shattered. I was irritable as hell. Slept like crap every day and not for very long either. Constantly felt like I was getting a cold that never fully developed.

I found myself doing my old trick that I used to do back in Ireland when I was really really tired and didn't have a hope of seeing a bed for the night. This sounds really dumb, and it is, but if I had a long stretch of empty hallway ahead of me as I was going somewhere, I would shut my eyes as I walked down it because I got to rest my eyes for a minute that way.
I swear it helped, even though once or twice I opened my eyes to find I was getting weird looks from very soft stepping security staff that I hadn't heard were there. The shame.

The second time around, I don't know why, I felt a lot better than I had done the first time. My partner blacked out the windows in our room completely with ultra heavy floor length curtains. I had whatever I felt like for breakfast/dinner whatever, when I got home in the morning, usually something light like a bagel and some fruit. I still didn't feel amazing during the shifts but could cope pretty well and felt alert enough that I didn't feel I was falling asleep when I was walking around.

This time around, I feel like I have cracked the night shift code. The first day before I started I stayed in bed until 2pm and slept damn well too. I started taking high strength B vitamins and about 3000mgs of vitamin C a day as well, every day (for some reason your immune system seems to be a little lazier when you're on nights and people tend to pick up colds and bugs more). I would come home and stay up for a few hours and drink nothing but green tea and water once I got home. Had some fruit every morning before bed. Would go to bed about 11am and sleep until about 7pm every night.
Would get up, have some high protein food for dinner around 8pm, have a shower around 9pm, and go to work at 22:30. Only while at work would I let myself drink caffeinated drinks. I'd have my lunch at 4-5 am exactly halfway through my shift, and take a brief catnap at around 6:30 if it was quiet.

All week I have felt EXACTLY the same as I do when I work during the day. Actually, there have been times when I've felt MORE alert than I do sometimes during the day. I think it's the B vitamins and relative lack of caffeine, and the total lack of any junk food or glasses of wine in the evenings during the week. The staying up for a bit and getting up only an hour or two before work is definitely better too.

So for any Irish docs thinking of coming out to Oz, NZ, or even the UK, anywhere in fact where they do night shifts instead of insanity marathons, just a quick tip-it IS harder than it sounds. Even though you are used to warcrime conditions, a bad 36 hour shift ends in less than two days. A week of nights goes on for a week. You can't cut corners. You have to stay feeling okay enough to do your job for a whole week. One girl from Ireland came out here recently and volunteered to do 12 nights in a row for some insane reason because she thought it would be easy peasy after what she'd been used to. She was KNACKERED by the end of it. Actually by the middle of it.

My tips for feeling AMAZING on the night shift are the following:

1) Start taking high dose B vitamins. None of these wussy multivite things. Take one of the formulations specifically designated "Anti-Stress", they appear to have astronomical amounts of all the B vitamins. For some reason they appear to make one less jumpy, less irritable, and more alert. They have zinc too, which in conjunction with high dose vitamin C, prevents colds and 'flus and dramatically shortens their duration and severity if you get one.

2) Have a light healthy easy to digest snack before going to bed in the morning. Don't listen to people who tell you that will be like your dinnertime. It so isn't. Fruit, yoghurt, cereal, bagels or wholewheat toast seems to be the best. Remember, your stomach will be a little dodgy when you are doing nights for some reason. It is easier to sleep when your dodgy stomach isn't trying to digest something heavy.

3) Stay up for a while before going to bed in the morning. Have your breakfast, check your email, watch tv, read for a while, whatever. Ideal time for calling people back home also. Some people told me they go to bed as soon as they get home, and then get up early in the afternoon so they can still enjoy the day. Fair play to them, but I tried that and it felt like the equivalent of having been up since 2am before heading to work at 8 on a normal day. Keep your schedule as equivalent as possible to what it would be if you were on days. You wouldn't go to bed straight away when you got home on a normal day. You need time to wind down first.

4) Some people use coffee to stay awake during the night shift. This isn't such a good idea. Your body naturally doesn't want to fall asleep during the daytime when it's bright, and having circulating caffeine in your system makes it harder to fall asleep during the day. It can be hard to do without it if you are a total caffeine addict, but it seems to be better for sleeping.

5) BLACK OUT YOUR WINDOWS COMPLETELY. This sounds obvious. It is obvious. I was so convinced that I was able to sleep no matter what the first time around, however, that I didn't realise that daylight really screws with your pituitary, and you sleep poorly and not for very long, if at all, when you can see even a bright strip above the curtain pole.

This is probably the most boring post in the whole world ever, but I'm just so happy I've found a way to feel great while doing a 70 hour week of nights that I just had to share. Sorry for the boredom. I'll post something controversial and exciting the next time.

In the meantime, I'm going to drink 750mls of still water, take 1000mgs of Vit C, an anti stress B, and go to bed for a 9 hour sleep in a room that is darker than the middle of a black hole. And wake up feeling fantastic.
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