Maintaining Sanity on Night Float.

Wednesday, August 21, 2019

My sister recently started her sub-internship on night float (side bar: my sister is in her last year of medical school?! Cue the quarter life crisis) and it brought me back to those good old days when I was a wee intern….

And didn’t sleep, froze my butt off every night, and jumped out of my skin with every page, even the ones that were just asking for a Tylenol order. 4 years later, I have a weird appreciation for working in hospitals at night- the quiet hallways, being able to chat with patients and their families uninterrupted, and getting so tired you start laughing at the most nonsensical things with your senior resident. I figured I’d write this out for my sister (if she reads this blog, she might be too cool for this kind of thing. LOL) and any other new interns or almost-interns about to dive into their first experience working nights at hospitals.

Get comfy. Night float shifts are often long, lasting anywhere from 10 to 14 hours. Many nights you’ll be on your feet a lot, and won’t be spending a ton of time sitting or resting, so good shoes are key. Many healthcare workers swear by Danskos; a well-fitting pair will last you for ages ( one nurse I work with has had hers for 7 years,) but make sure to try them on before you purchase, as each pair is handmade and therefore will fit slightly differently. I personally have loved wearing my Allbirds and have also used my running shoes in the past; both worked fine for me.

Another thing people don’t realize off the bat is that hospitals are cold, and they get even colder at night. I would walk into work wearing fleece leggings pretty much from August through mid-June. A fleece or zip-up jacket plus cozy socks and you have a semi-tolerable work environment. Some of my colleagues even had a hospital blanket stowed in their lockers.

Have a sleep strategy. I have never been a good sleeper. I am one of those people whose brain likes to play the game of ‘lets dive into your most cringe-worthy memory or deepest regret!’ as soon as my eyes shut, and breaking routine can really exacerbate my insomnia. I generally had two approaches to sleeping on call- I would prioritize trying to get REM sleep in at least once; at my hospital I had to follow up on midnight and 4 am vital signs, which meant I could sleep for 4 hours in between if my brain would settle down or I was tired enough. If sleep wasn’t coming easily, though (like, say, if I was having the recurring nightmare of the code pager going off and my legs turning to jelly. That was a fun one.) I would hammer out some work- either easy readings, life stuff that I’ve been procrastinating on, or mindlessly running through a few board prep questions. About half of the time these activities were boring enough that I’d eventually nod off.  

There were definitely nights I wasn’t going to be able to sleep; you just have to accept that you’re being paid to work no matter what, and that being paid to sleep is a kind of bonus perk that happens once in a while, but isn’t guaranteed. This mentality helped keep me from getting too stressed out if my grand plans didn’t work out.

Another semi-related tip for interns: do your own night rounds. You certainly don’t have to see every patient, but walk through each unit shortly after nursing sign out to check in, see what’s going on, provide updates and change or correct orders as needed. I would even bring a computer around with me to change orders in real time. This does two things: first, it shows the nurses that you are attentive and care about their contribution to the patient’s care plan. Getting friendly, recognizing names and faces and even engaging in small talk really does go a long way. Second, it reduces the number of pages you will get at 2 am to change that Tylenol from round the clock to as needed, or other non-urgent matters. 😊

Time your caffeine boluses. I tended to be sensitive to caffeine. It made me jittery and jumpy, and would occasionally exacerbate an essential tremor that came out of nowhere in residency. I would usually drink a half cup of coffee before work, then, depending on how the night was going, either plan to lie down and sleep and have another coffee or tea before signout, or on PICU nights when I knew I’d be up, time an 11 pm- midnight coffee to keep me going until signout.

Maximize your home rest. I think of this as two parts- creating a cozy environment to sleep in regardless of time of day, and balancing the need for sleep with the need to maintain a normal circadian rhythm. For me this usually meant blackout curtains and ear plugs (you’d be surprised how noisy it can get during daytime hours at home) plus a 3-4 hour nap, then getting up to do errands or enjoy some sunshine, have dinner, and go to bed early so I was rested enough for the next day. I always found days that I slept much longer than 4 hours led to trouble sleeping later in the evening that could worsen my insomnia for days.

Others I’ve worked with have used working out right after call to ensure they get really good sleep, taking melatonin, or just pushing through the day and going to bed early in the evening. The bottom line is you have to figure out what works for you, but in general if you go into REM sleep for too long, your brain is going to be confused and think you need to be awake every night.

New Year's 2016, celebrating with sparkling grape juice in the pediatric ICU
Have fun. No, really. While there are definitely plenty of rough nights to be had in residency, there's also some true camaraderie to be had on night shifts. Some of my deepest conversations with colleagues and coworkers occurred on night float. Some of us had ‘family dinners’ where all 9 people on the floor teams at night would order Thai food and hang out/chat for half an hour. Sometimes we got together and watched Harry Potter marathons on the fuzzy-screened box of a TV in the heme/onc signout room. A curmudgeonly older nurse would break character on Saturday mornings and make French toast at 4 am for anyone passing by. For one intern’s birthday, we raided the supply closet, made her a birthday crown out of the weirdest supplies we could find, and celebrated with ginger ale mocktails served in plastic pink cups at midnight.

Hope this is at all helpful to someone, and best of luck to all the new interns who started this summer and the sub-interns trying on this role for the first time!

Israel: Jerusalem

Monday, August 19, 2019

After a long and

I was operating on less than 2 hours of sleep for our day trip to Jerusalem, so I'll keep this one short, mostly because I don't remember much of it, haha. I think the smartest thing we did was get up at crack of dawn to catch a 'sherut' (shared taxi or van- more here on different ways to get to and from Jerusalem) into Jerusalem in time for a 7:00 am divine liturgy at the Church of the Holy Sepulchre. To participate and receive holy communion, watching tendrils of smoke lace their way through light and darkness in the lofty Greek chapel, was something I'll never forget.

The rest of our time at the Holy Sepulchre was a mix of fascinating, reverent, and feeling like we were being herded around like chattel. There were SO many different groups of pilgrims it made it hard to move around, although it was nice to see so many people coming to worship and pray. If we had one take home lesson from our experience, its that a lot of these religious sites should be visited as early as possible. By 9 am it was hard to feel serene with the level of crowds that had amassed.

Other than the massive crowds, our experience was great. Jerusalem is definitely a less secular city than Tel Aviv, and we really enjoyed wandering through the various quarters and exploring a place that's been occupied by people for so many millenia. My only other piece of advice is to do research online- this trip was a last-minute tag along for me to one of Peter's work trips, which meant we didn't know a ton going into it. For example, we totally missed out on seeing the Dome of the Rock because there's only a couple short periods each day that its open to non-worshippers (you can find the hours here.)

Hopefully someone finds this interesting/useful for their upcoming visit to Israel and Jerusalem. I'll try to post one more time before my classes start up again.  

Small Changes

Saturday, August 17, 2019

About 3-5 years ago talking about 'clean living' and 'single use plastic' would get you immediately pinned as 'crunchy.' Fast fashion like Forever 21 and Zara was at its peak popularity, and no one thought twice about that straw in their drink. Even I would have looked at you sideways if you told me plastic-less soap was the way to go.

Thankfully, its become more mainstream to be conscious of the environment and the rapidly developing climate change. People are realizing, slowly and inconsistently, that the consumer, need-to-have-it and buy-what-I-want attitude, is not sustainable. Over about a year, I've been trialing a few small changes in our lifestyle to lessen our impact on the climate. We are FAR from zero waste, but we are trying, learning, and striving to be better, and every little bit helps. Here's what we've done that works well for us; maybe some of these things will fit in your lifestyle, too:

- Adopt the planetary diet. This one wasn't a stretch for us. The Orthodox Christian diet typically cuts out meat and dairy about half of the year, and the times we do eat meat it's rarely beef, lamb, or other types of meat that have heavy carbon footprint. Also, the planetary diet is just good for you- the majority of your plate really should be leafy greens and vegetables, whole grains, and non-dairy proteins such as beans and pulses. Plus it's partly based on the Cretan diet, which my husband and I are obviously big fans of :) Here's a little more information, if you're curious. And if you're up for going completely vegetarian or vegan, great! Even better. Just make sure your diet is balanced, and talk to a nutrition specialist to make sure your diet contains all your needed vitamins and minerals.

- Reduce single use household items. This one definitely reflects a "do what you can" approach for our house. Both my husband and I work pretty long hours, so making our own cleaning products wasn't really an option. But we could easily replace our paper towels with reusable cloths, plastic ziplock bags with glass tupperware and wax cloth wraps, and also stopped using plastic when shopping altogether. Its been a process- I don't always remember to bring the small bags for fruit and veg to the markets. But anything was better than doing nothing altogether. We got these cloths, these wax wraps and pretty much all of our bags come from Trader Joe's :)

- Let go of fast fashion. This was a hard one for me. I grew up in an affluent community. Shopping was the reward for good grades, the way we killed a Saturday afternoon, and a form of stress relief when things weren't going great. I started small- I started paying attention to labels; I stopped buying non-organic fabrics or clothing that I couldn't guarantee was ethically sourced and fair trade (The Reformation, for example, or Amour Vert. There are literally dozens these days.) This year, I made a resolution to only buy used clothing, and only when I needed it. This has been amazing for my physical space and for our budget. My closet isn't filled with things I haven't worn in years, and I only make a purchase when its really necessary and/or I've slept on it for awhile. Do a quick google search for the nearest Goodwill or vintage shop in your area; there's also a few instagram accounts that sell vintage clothing online.

- Don't get it to go. This one's hard. Sometimes you just get a straw without asking, and if I'm working an overnight shift and forgot my traveling mug, not purchasing coffee just isn't an option. But we try to remember to specifically ask for no straws whenever we can; I have a few metal ones at home and this great portable one was a gift from a coworker. There are also awesome travel bamboo cutlery sets which I highly recommend :) And if I'm meeting someone to sit down for coffee, I either bring my own container for iced drinks (I don't know why you can get a ceramic mug when you sit down at a coffee shop but all iced drinks come in plastic??) or just skip the drink altogether.

- Green your vacation. This is a tough one. Peter and I love traveling, but flying and many other aspects of travel really aren't that green. Taking more local trips is a great way to avoid the impact of flying and get to know your area. When we did take our big trip to Hawaii, we made a point to volunteer. We attending an event for the Ocean Friendly Restaurants foundation, and tried to eat only at restaurants listed on their website. There's also a couple of great nonprofits that host beach clean ups, you can check them out here. And we ultimately volunteered at a sacred historic site with Maui Cultural Foundation. We found all of these nonprofits through Instagram and a quick google search; I'd highly recommend taking a look before you travel and seeing how you can lessen your trip's impact on the environment.

- Get politically active. This is something we need to be better about. But I try to keep abreast of political issues affect the environment by following this person on instagram, and donate to our parks foundations when we can. I also follow a few Native American activists, since some of the biggest threats to public lands are often occurring on sacred land. While we usually can't travel to protests, we try to keep abreast of big issues affecting sacred land  and sign petitions when they're circulating.

- Think about the next step (but don't get overwhelmed.) We recently switched to plastic free shampoos and conditioners, but when I looked around for container-free stores the nearest one was an hour away. We'd love to own a hybrid or electric car, but since I just finished payments on my current car, so that will have to wait a few years. If you looked at this whole list it probably looks really overwhelming. But we started doing these things a few small changes at a time. If you're interested in doing your part, don't get overwhelmed- just think about what changes will be feasible, and start there. You can do it :)

If you're not sure where to start, here's a couple of bloggers I find very helpful and inspiring:

- Joy Felicity Jane - great vegan recipes and good tips about sustainable living in the city
- Michelle for Good-  a mix of lifestyle content with ethical fashion and sustainable living
- The Good Trade- great general resource for sustainable fashion, lifestyle and home tips.

Hope that was helpful! If you do something else to leave less of a carbon footprint, please feel free to share in the comments. We can all learn from each other.

PS none of the links above are affiliate. These are just products I've really liked using and people/websites I've found useful in the path to live more consciously.