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Night float had always been this mythical monster to me, an intimidating prospect that conjured up some of my greatest fears about a residency rotation – jet lag, nocturnal clock, lack of continuity with patients or a day team, multiple pagers, and multiple admissions every night. Maybe it was the uncertainty of the unknown that had seemed so daunting.
Somehow, after three admissions on my first night, I found myself still awake, yet exhausted and on my way home – I had made it. As the nights went on, my internal clock adjusted a little more each day. I became more comfortable and familiar with the night team nurses and more efficient with admissions through sheer necessity.
I missed the moments I had with patients and families on day rotations, though, when I had developed rapport with them over the course of their hospital stay. By the time I had wrapped up admissions and pages on night float, the patients were usually asleep, and there wasn't much of an opportunity to connect with them.
Nevertheless, there were still incredible patient encounters at that Veterans Affair hospital, which provided unexpected sparks and carried me through my 2 weeks.
For example, one patient in his 70s with multiple comorbidities came in with edema; he had end-stage cancer, and a stroke had previously incapacitated his wife, who was now in a special care facility. You would never have guessed this patient had been dealt such an unlucky hand, as he was dressed in rainbow overalls and expressed to me how he's felt grateful ever since so many of his friends in Vietnam never made it back home from the war.
Another patient in his 90s had been feeling lethargic for a few months and went to the emergency department; his white blood cell count was in the 30,000s, and the smear was positive for blasts. When he received the news that he could have leukemia, he took the assessment in stride and calmly asked if he could still go on his morning walks. He then smiled and proceeded to reassure me that everything was going to be OK.
And for an inexplicable reason, for the rest of my night's rotation, I truly felt that I would be OK, and I was. If this patient could face his mortality the way he did, I could face the rest of my night rotation.
I have always admired my patients whenever and wherever I met them. Even when the days were long, the patients inspired me and motivated me with their strength and how they handled the challenges they faced. This was especially true with the veteran population, who had already gone through so much before presenting to the hospital. Though fewer of these moments were on a night rotation than on a day one, the moments were still there. And they were still special each time.
This mythical monster, night float, was hard, but I had done it and given it my all. Nights were very different from days, but the key to finding joy in the work remained the same: along the way, I remembered to take a step back and appreciate the raw humanity present in every patient encounter.
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