4AM Night

It’s 4 AM. The hospital—once a lively and bustling place with residents responding to codes, nurses checking vitals, physical therapists helping patients walk—is now deadly silent. I stare out of the window into the darkness. Its eerily quiet. I think to myself, only 3 more hours until I am done with my night shift and get to crawl into bed. I am counting the hours.

My phone beeps and I look down. It’s a message from my resident. “New admit in the ED with SOB. Interview the patient and present to me.”

I chart and read about her history. She has breast cancer with extensive chemo and radiotherapy. I think to myself maybe it’s the Doxorubicin that’s causing her shortness of breath (SOB). I take mental notes to present pertinent information to my team. As I approach her room, I think of all the information I need to get from her to form a proper differential. What are her current medications? What is her cancer prognosis? What is her past medical history? Does she have any family members with cancer? All these thoughts pop into my mind as I walk toward her room in the ED.

I knock and enter the room. “Hi! How are you today,” I ask, trying to sound enthusiastic and engaging. I enter the room, and abruptly stop. Before me, I see a frail woman gasping for air. Her eyes sunken in. She is unable to move. She is in distress. She is exhausted. This isn’t what I pictured when I read about her. Holding her hand, is her husband, who slowly looks up at me with his eyes swollen and red from tears. “Can you please help her?” he implores. “We will try to figure out what is happening and help your wife,” I reply and quickly gather the information that I came for.

I walk to my resident and start presenting the patient. We admit our patient to the medical floor and stabilize her. She can breathe now and is no longer gasping for air.

Another hour goes by. It’s 6 AM. Only one more hour, I think to myself. The sky outside changes to a warm pink and yellow. I am feeling hopeful. I think about my patient and all the pain that she is in. But I’m feeling optimistic. She’ll be okay; she’s in a hospital after all.

Suddenly, I hear “CODE SPEED. 6^th FLOOR.” So, I sprint down the hall toward the elevator. As I approach the room, it looks familiar. To my disbelief, there she is. I look up at her vitals—blood pressure 90/50 and tachycardic. I look down at her mouth, which is slightly open, gasping for air. Her eyes are wide. She is scared. “Help me,” she gasps.

The rest is a blur. EKG leads are put on. The strip is read—supraventricular tachycardia. One dose of Adenosine is administered. She is even more frightened. No improvement. One more dose of Adenosine. She’s looking around. She sees 10 people, but no familiar faces. She is afraid. We continue to administer medication. One hour goes by. Her arrythmia improves and a sigh of relief escapes my mouth. I see my relief mirrored when I turn around and look into my residents’ eyes.

What a shift. I think to myself. I go home and go about my usual routine: brush teeth, sleep, and wake up 5PM for another night shift starting in 2 hours. Just another night.

Back at the hospital, as I approach my resident, I see him scrolling through a patient chart. I greet him good evening. “Your patient passed away,” he tells me. I look over his shoulder. It’s her chart. He is reading her death summary. I am shocked. “It was her time,” he responds after he sees my face. I am at a loss of words. I don’t know what to think. I had gone home. I had continued with my usual routine. Meanwhile, a patient of mine passed away.

Minutes go by. “One new admit,” my resident turns to me. We move to the next patient chart.

I chart and read about their history. I think of all the information I need to get from them. I continue with my usual routine.