Night Shift

Oh my poor blog, I’ve really been ignoring you lately! This time though, it’s not due to lack of ideas but has to do concretely with the fact that I’m having to get used again to something that I (foolishly) thought I had left behind me over two years ago – night work.

A few weeks ago I posted here about a major change happening in my work life and mentioned that the new project I’ve been entrusted with would involve me taking leave of the basic eight to five, Monday to Friday work rhythm I’ve had for the past few years. This is a change I wasn’t looking forward to, although it has advantages as well as disadvantages. It’s often quite positive to have time off during the week when everyone else is working – it’s a lot easier to manage many things in life which don’t have to do with work, organisational things like changing your telephone provider, for example, or even cleaning up the flat (something I often just don’t feel like doing at the weekend). It can also be very nice to spend some days consecutively working eleven or twelve hours a day and then have three or four days free at one stretch.

The trick is, of course, to make sure that this actually happens and that’s a bit of a problem at the moment, because, until the end of June, I’m simultaneously winding up my old day-care job and starting building up my new one, which would (according to the original plan, by the beginning of August) involve me with a small team taking over the intensive care, eighteen hours a day, of a very sick young boy in his own home. Right now we don’t yet have the team together, but the boy and his family need support immediately, which means we have to work with what we’ve got. The fact that his continued presence in this life depends on the problem-free functioning of a respirator means that he has to be continually monitored. His parents, understandably, see the highest priority here during the night-time hours and so my goal this month and next is to cover as many nights as possible. But, as I don’t yet have enough people in my team to really do this properly, it means that I have to do a lot of the nights myself.

It’s been one of those really screwed-up situations where the care company which preceded us suddenly stated, with only a week’s notice, that they simply would not be coming any more so that we were faced with taking over the whole project from June 16. I managed, thanks partly to a very flexible colleague, to organise things so that there are only three nights in June where the parents have to cover the nights themselves (two of these have already happened) and in July we’ve got someone for every night (if nothing goes wrong).

It also means that I’ll be doing 17 11-hour night shifts in July. Well, that’s the way it goes. I’m telling myself that the positive aspect of this is that I also have fourteen days off next month. As the Monty Pythons put it, “Always look on the bright side of life!” And in August things look much better. But right now, it has led to me taking over quite a number of nights immediately.

It’s not that the night-shifts are so physically strenuous. Unless you happen to do weekend nights in A & E, this is often the case in nursing. The strain of night work is different. You’re working against your normal rhythm. Humans are diurnal creatures and our body clocks are programmed accordingly. Even if you’ve managed to sleep ten hours before going on nights, your body isn’t so easily fooled. At around three in the morning it starts to insistently signal that being awake at this time is not normal and that it is not happy with the situation. If you’re working on a ward with a couple of colleagues it’s not too bad because there is the possibility of quiet conversation (as long as they’re people you get on with, but that’s another story!) and there’s always something to do. But where I am, I’m on my own, my patient is, happily, pretty stable at the moment and he seems to sleep (as he’s in a persistent vegetative state[i], this is not always clear). If anything serious goes wrong, the various machines give an acoustic alarm, but frequently he will show signs of discomfort – for example, if he develops bronchial congestion (something which happens quite often but can be easily relieved with a suction tube) – before the respirator signals that there are potential difficulties. So if I want my patient to remain comfortable I have to keep a fairly constant watch. In a darkened room. At three in the morning. And I’m sitting in a fairly comfortable armchair.

After the first night, I went out and invested in a good LED flashlight. I can combat sleepiness fairly well by reading, but for that I need light, light which won’t disturb my patient. I’ve quickly learned to pace out the various other things I have to do during the night, preparing medication, checking supplies, etc. so that I can do them when I feel the sandman getting the upper hand.

At eight in the morning the shift is over. I’m dead tired but a beautiful summer morning is some consolation. The days promises to be hot, but now there’s still a beautiful freshness in the air and this morning, Saturday, things are still quiet. I take the time for a well-deserved cigarette (the last one was before the shift started) and get into the car. In half an hour I’ll be home.

And then to bed. Well, not immediately. I’m sleepy but feel I need a bit of time to wind down. Drink a cup of coffee (that’s not going to stop me sleeping in this state), check my mails, scan the newspaper headlines online. And then, off to sleep.

Which is a problem. Not falling asleep, that happens within minutes of my head hitting the pillow. But my traitorous body-clock knows that it’s daytime and will wake me around noon and then, once the initial exhaustion has been combated, sleep will not come easily again. Anyone who has ever flown across the Atlantic or Pacific will know the phenomenon; it’s called jet-lag. When you work nights, it’s something you have to deal with constantly. I know a few colleagues who have chosen a radical solution; they work only nights and organise their life-patterns (including the periods when they’re not working) accordingly, but that price is much too high for me. I work to live and not the other way around.

So you wake up after about three hours and sleep won’t come again. The important thing here is not to panic. The fact is seditiously whispering at the back of your mind that you’ve got to put in another eleven hours tonight and that if you don’t sleep some more the night is going to be bloody hard. I’ve found the best thing to do is to get up for an hour or so, potter around a little, maybe read for a while and then go back to bed. I can usually sleep then for another couple of hours. But – at least in my case – the more nights I work, the more the sleep deficit increases. It’s something you learn to live with. I don’t get an awful lot of other stuff done during the period when I’m working nights.

The last night before you have time off usually compensates for a lot. I find elation increasing from about three a.m. onwards. Tomorrow I won’t have to do this. The fatigue endorphins have a paradoxical effect; I know I’m tired but there’s a kind of lightness about it, a slightly hazy, vaguely stoned feeling of relief.

And then home again. One more battle remains to be fought with the internal body-clock. Usually the relief, the easing of pressure means that I can sleep like a log today, maybe even eight hours long. This is not a good idea. I’ve got to fight the jet-lag the other way now, otherwise I’m going to stay on night-rhythm. So I set my alarm for one o’clock and force myself out of bed. Once I’m up, it’s ok and I usually even discover that my energy levels are back up; up enough to write this (and even simultaneously watch Uruguay beat South Korea in the World Cup)! And, in all probability, I’ll be able to sleep normally tonight – maybe a little later than normal but tomorrow is Sunday and I don’t have to get up early.

Life is good. Not always easy, but good, nevertheless.

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[i] http://en.wikipedia.org/wiki/Persistent_vegetative_state