The Non-Morning Person's Rant

It's only been two weeks since I officially signed my life over to the innocent-looking hospital down the street, and yet it's amazing how much two weeks on the wards can seem like a veritable era. Gone is the scared, flustered newbie who spent most of the first week running in circles and trying not to set off the emergency fire alarm while scurrying up stairwell 3a. Now, my extreme directionally-challenged self having mastered where the cafeteria is and identified access points from all hidden stairwells, I only run in circles when trying to find such incidental, archaic locations as the pharmacy, X-ray, the patient's room, okay, maybe the hospital lobby. But all is well, because at least I know where to find caffeine at any hour of the day. Like a moth to a flame...like an ant to honey...like me at a DSW shoe clearance sale...it's true love.

Two weeks is even enough time for me to reminisce fondly about the time when I Never Felt Sleepy, or when My Alarm And I Were Friends. Now, the mornings go typically like this: I typically jolt awake in the morning at 4:19 a.m., rustled from such fiftul dreams as the one where the hospital suddenly grows menacing, toothy jaws and evilly grins at me as I cower in a corner whimpering, clutching my stained white coat over my head as the stormy air begins to rain ugly Dansko clogs and unsigned progress notes. (And you wonder why they spend so much time at orientation devoted to "When A Physician Needs Help.") I growl at my cell phone alarm as it cheerfully sings "Hello World" every 5 minutes. As a pleasant reminder that it is indeed time to wake up, my pager begins to beep at 4:24 a.m. (my backup alarm) followed at 4:28 a.m. by the static of my clock-radio alarm (my backup-backup alarm) that for some reason I can never get to actually play anything remotely musical. I slowly wake up in the process of turning off the various alarms - enough, at least, to pick a matching pair of unappetizing sickly green scrubs (and by "matching", we mean: I pick a top and a bottom. Success!) and remember how to exit my apartment and find my way down the street to the hospital.

"Maybe being an intern will help you to become a morning person," my mom suggested one sunny, carefree morning in late May as I padded down the stairs in my cow-print pajamas, at the decidedly undisciplined hour of 11:30 a.m. I nodded vaguely, notions of "setting an alarm", "sleepy" and "the sky before sunrise" appearing as abstract concepts belonging to a bizarro world - where, for example, your father might shower you with praise after you buy that extra pair of tan knee-high boots, where all Muggles could Disapparate at whim, or where chartreuse spandex could be cute. (No. Don't even think about it.) The thought of waking up early flicked across my mind then like a thin wisp of cumulus cloud traveling over the cheery sun of vacation, but it quickly evaporated against the aroma of Mom's Brunch, a meal so complete it could be featured on the back of a cereal box.

In many ways, my journey to medicine chronicles the battle waging between my circadian rhythms and Regular Business Hours. I'm telling you, it's a conspiracy against poor moi. Evidence: who had the bright idea of shifting the clock artificially forward for 8 months of the year? (Ben Franklin: I blame you.) Did someone think, "Hmm, I'm not sleepy enough when I wake up at 5 am. So why don't we actually turn 4 am into 5 am, so that we all feel sleepy when we wake up at the new 5 am, which is actually 4 am in real time?" I ask you, are we all masochists? Am I the only one who signed the Official Petition to End Daylight Saving Time? (Am I the only one who is basing my choice of presidential candidate based on who has a most pro-abolishing-daylight-saving-time record?)

Anyway. Digression aside - blame the wandering mind on lack of sleep - if Regular Business Hours is a challenge, the world of medicine takes the concept to a whole new level. Think of RBH as the little "0.5-Kilometer FunWalk for Kids" with lots of lemonade and refreshments and bounding puppies in the park. Then the world of medicine is like running an ultramarathon in Death Valley. You'll crawl out of bed at 4am, pull 30-hour shifts, spend the day running around corridors frantically trying to remember what you were running around the corridor to do...and then, at hour 29 of staying awake you might be expected to respond to a code, intubate a patient, do a spinal tap or place a chest tube, analyze an abnormal lab result, admit a new patient. All this, even when the next morning you might be scheduled to give a lecture on the health evils of sleep deprivation. We physicians are a logical bunch.

But even as my battle wages on, and my debt of sleep begins its slow and steady accumulation, there is one funny thing I've noticed. It's that even at hour 29 of an exhausting day, when you're beginning to see mirages of floating pillows and warm bubble baths, something happens when you are in front of a patient that needs help...and they're looking at you. It's like a jolt more powerful than the most potent Red Bull-green-tea-spirulina concoction (ew), that sharpens and heightens every sense and instantly obliterates the fog in your mind. You suddenly realize that this is what you've worked for: this is why you sat through the endless tests in medical school and studied away while your friends slept in on the weekends...this is why you scurry around the hospital daily for hours paid less per hour than minimum wage....this is why you finally get out of bed at that ungodly hour of 4:23 a.m. There is something that instantly snaps your mind to attention, that instantly makes you wake up when you see the life in front of you that you are about to touch.

And yes, sometimes that life you are about to touch is just a question of telling a patient, for the 139th time that evening, that there is no more morphine in the hospital and no, you are not authorized to prescribe marijuana even though, yes, you are in California. Or spending 10 minutes trying to nod with what you hope is empathy and interest as a patient eagerly describes the diurnal variation in the character of his bowel movements and engages in a discussion on the esoteric difference between "mucoid" and "loose". (Sorry.) But sometimes, it's rushing to a code on a crashing patient and saying things like "Give him 1 amp of D50 stat" and knowing that that's the right thing to do. Sometimes it's sitting down in front of a terrified patient who asks you, "What should I do, Doctor?" and letting the beauty of medical knowledge guide you and enable you to coherently explain, to soothe, to help ease the pain and worry. Sometimes, it's looking at a set of lab data or imaging studies or physical exam findings and realizing with a flash that you know what's going on, and you know how to fix it.

Sometimes, it really is about saving a patient's life, about - warning: corny alert - making a difference. And I guess that's what, in the end, is really my wake up call.