All things considered, we didn't get hit too bad with by Covid in the Midwest. Well, with the exception of Michigan. We actually lost a family member while I was on night float. My mom dropped that bomb on me at the end of my shift and it was pretty upsetting. I had trouble sleeping during the day.
The way night float works in my program is 12 hour days, 6 days a week for 4 weeks straight. It's hellish and 0/10 would recommend. So even though the volume has not been as heavy as usual and you won't find me complaining. It really helped that the public tried to stay out of the hospital unless they were truly ill and needed to be admitted. We still had the occasional "headache" in the ED. But, for the most part everything I read had real pathology. You can call me a nerd but there's still something exciting about seeing acute appendicitis. I'm sure this will wear off over the years.
So let's get down to it. Here are my rules for night float:
1) Sleep during the day before your first shift.
This may be difficult to do depending on what rotation you are coming from. You should still try. I think I got 1-2 hours of sleep and was SUPER tired. But it helps to condition your body. Gently let it know that this is how things are going to be. We're just going to casually ignore all the safeguards like Circadian rhythm that God put in place and just sleep during the day. Then we are going to stay awake during the quietest hours of the night. And above all, we will not give into insanity. Right? RIGHT?!?!
2) Try not to sleep during the night shift
Find the drink that will keep you awake. Most days a cup of black tea in the morning does it for me. As a rule, I barely touch coffee. But on night float you better believe i'm throwing back a McDonald's frappe every night. I tried some crappy store bought stuff and wasn't getting the buzz I needed. I'll say it again. FIND WHAT WORKS. NO SUBSTITUTIONS.
If you still can't stay awake, 15 minute power naps are fine but I strongly recommend against getting into deep sleep. On normal radiology shifts, deep sleep is difficult since you are in charge of all the imaging in the ED and in-house. In my experience trying to switch back to a day schedule, these 2-4 hr "sleeps" send my sleep schedule into a tailspin. For the record, I do not condone alcoholic beverages at work.
3) Invest in blackout curtains
This likely will not be your only night shift so be prepared to break these bad boys out at least once a year for the foreseeable future. They block a lot of light but they also help to muffle sound because they're heavy. They can be kind of expensive. I'm the queen of balling on a budget and I live in an apartment so I'm not keen on putting holes in the wall. Consider metal finish heavy duty command hooks (~$12) and a lightweight rod (~$5) for hanging curtains (~$10-20). I got what I needed at Walmart the day before my rotation started. What sleep you do get you will want to be quality sleep. Too much light will keep your brain from getting into deep sleep.
4) Bring plenty of things to do
Remember how I said case volume was down? There was one night I only ready 6 studies the whole night. Unbelievable. On a normal night there is already an ebb and flow which anyone in the hospital knows. Things slow down between 12-3 then start to pick back up. I got by with my crafts and textbooks. I would try to do questions or read 5-10 pages a day, then spend some time designing, crocheting, and working on cases for Instagram. Best believe I also queued up some audio books for the month. It helps the night go faster. And you're at danger of falling asleep if you don't stay stimulated.
5) Develop a schedule in advance
This doesn't have to be complicated. I wrote out a month schedule and divided the nights into before and after midnight. After midnight, particularly in the 12-3 am quiet hours, it is normal to get tired. So while I have exams to read, I study and listen to music. Ride out all that energy. Equally important is making time for exercise, even just 10-20 minutes. I can be pretty lazy but sitting for 12 hours is not fun. I tried to do this in the quiet hours to give my energy a jump start. Body Project has some good beginner videos. It's about all I had the energy for anyway. I also had some specific goals on knit/crochet projects I would try to finish over the week.
6) Eat Mindfully
A HUGE problem I have is emotional eating. I eat when I'm bored. I eat when I'm stressed or tired. I really had to curb this bad habit overnight. It helped that the cafeteria is closed overnight and getting food delivery was more difficult. So I tried to have one cooked meal every night and plenty of healthy snacks. Some days I just wasn't hungry because of the stress and would set reminders to eat an apple. Do what works for you but focus on nutrients. Your sleep schedule will be suboptimal so we need to support our immune system the best we can. Green smoothies are a great trick I use to get nutrients.
Pro-tip: a little bit of acidic lemon or pineapple juice cuts out most of the bitter green taste.
7) Drink plenty of water
The human body is essentially a complex house plant. You need sunshine. Welp, you're not gonna get much of that. You need air. Hospital air not the safest thing during COVID so you'll be breathing your own recycled air behind a mask. You need water. So I tried to drink as much of it as possible within reason, especially since your other needs may be subpar. Your brain also functions better when you're properly hydrated. Radiology on-call shifts require constant thought and quick decisions. So make it easier on your brain and keep the water flowing. 40 oz a night was a minimum and I would shoot for 64 oz. But, let's be honest, in medicine, you can't always get to the bathroom when you need to. If I got to go twice, I felt lucky.
8) Guard your health
I'm what I would call "intermediate" risk for COVID. I have some commodities but i'm not immuno-compromised. Well, I had to go evaluate an infiltrated line (sometimes the saline or contrast in the IV blows the vein and gets into the tissues) to make sure there wasn't vascular compromise. Before I walked over I explained this was my first time with a COVID patient and would like some guidance with the personal protective equipment (PPE) policies. When I got there I was given attitude and no guidance as to where to find the PPE. In retrospect I should have just refused or coached the tech through it from the window like my attending recommended. If your health is not 100%, let someone know early so they can make arrangements. COVID and other infectious diseases can kill you just as easily as the patient. Be your own advocate.
9) Stay mindful, stay grateful
Try to remember why you do this. Between all the stupid and/or rude phone calls you may get from other services and the lack of sleep, it's easy to have a short fuse. I have a great overnight tech most nights. We can vent to each other about questionable imaging choices and discuss cases. I made him a Purl Soho bandana cowl just for helping me get through that month. Tell your team that you appreciate them. It goes a long way. Being able to assist in patient care is a privilege and all healthcare workers have a great ability to affect outcomes for the better.
10) Cut yourself some slack
You will likely make mistakes and your house will go to hell in a hand-basket quick. There's only so many places you can direct your energy, especially if you don't have anyone helping you at home. Let the extra stuff fall away and focus on what is essential for you to get through.
It's really difficult when no one is awake while you are. And then, with the few hours you may have awake during the day, everything is closed! Try to do something social. Call or text someone during the day. Go for a walk so you can see other people and reassure yourself that you are not the last man alive.
Quiet roommates are a must. I was not so blessed. I'm also not blessed with reasonable reactions to sounds while i'm sleeping. I can honestly say that I've slept through a 6.0 earthquake while I was in Guatemala -_-
Despite this, I have no trouble waking up to the sound of my roommates peeling an onion. Yeah, I don't get it either. If you have any questions or comments on how you get through nights, regardless of department, leave them below.
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