Call Secrets of the OR #4- Every call shift will end… Tomorrow!

The shift will end
Tomorrow
Bet your bottom dollar
That tomorrow
There’ll be sleep!

Just thinkin’ about shift end
Clears away the cobwebs
And the sorrow
’til there’s none!

When I’m stuck in a shift
That’s long
And forever
I just stick out my chin
And grin,
And say,
Oh.

The call will end
Tomorrow
So I’ve got to hang on ’til tomorrow
Come what may!

Tomorrow!
Tomorrow!
I will sleep
Tomorrow!
Sleep’s only a shift away!

Apologies to Martin Shaman and Charles Strouse for co-opting and re-writing their hit “Tomorrow” from the Broadway musical Annie.

As a night shifter, I know that sleep is very important. And some nights we don’t get a lot of it. But that is the nature of the call shift. Sometimes there isn’t a lot of sleep, and sometimes it is a full night of it. You have to be able to roll with the schedule.

The first thing my university advisor asks when she sees me is “How’s the sleep? Are you getting enough of it?” Yes, Dr. Advisor, I am getting enough sleep. I have data points to share if you are interested. Maybe I should make it into a graph for show and tell purposes.

That being said, and knowing that not everyone tracks your own sleep patterns, there are some things that can be done in your sleep environment to prepare yourself for good sleep.

Is the room cool enough? A University of Texas sleep specialist, Dr. Okeanis Vauu, reported that sleeping in a cool dark room is recommended. After all, our brain wants a cooler temperature while we sleep. This information is from a UT article on sleep after the spring forward time change.

But it is definitely appropriate for sleeping after a call shift.

The dark room during the day may be harder to accomplish. I have purchased black out curtains until I am blue in the face but they are never dark enough. Next I found and purchased black out blinds that you cut to size. I cut and installed these after the first month I was on call.

Instant bliss. Not to mention cooler.

In the summer, I also put up heavy curtains in the adjoining bath because of the afternoon sun that 1) heats up the small room, and 2) is blindingly bright.

My husband works afternoons/nights and is glad for the additional window coverings.

We don’t have children to get off to school or children at home. Unless you count the cat, who insists that I get out of bed by 0800 every morning, whether or not I’ve worked the night before. But I have heard that can be a barrier for some.

Sleep when you can. Some people can go right to bed when they get home and this is a good habit to get into.

Because you never know when the next case will pop up. There have been times that I’ve been home and in bed for 15 minutes and the darned pager went off again. And I head back to the hospital for another case.

Thankfully those kind of nights are hopefully far apart. And if it is a string of late nights just remember that day shift will be in a 0700 to relieve you so you can go home and sleep.

No bad pattern lasts forever. Some last longer than most but that’s call life.

I find it best not to focus on the sleep you’re missing but instead focus on the good sleep you will get the next day because you won’t be responsible for day cases. And the hospital won’t be ringing you up with add ons.

Remember, there is always a shift end. There is also a finite amount of time that the case volume can hurt you and stop you from sleeping.

These tips are coming from a call afficionado: make your room as dark as you can, and make your room as cool as you can. Fans are a good help here.

And take the afternoon nap when you are able to. Especially if the house is still and silent because everyone else is away at school or work.

Pay attention to your sleep hygiene and practices while on call. Well, any night really, but especially on call.

Call is only a sleep debt if you want it to be.

School Me Saturday 9/21/24- above all else, take care of your health

Being a student is hard.

Like, really hard.

I understand and am suffering along with you.

However…

That is no excuse for not doing the minimum to care for your health.

Eating, hydration, and exercise. Oh, and sleep.

I know that shrinkflation has hit the grocery stores hard and it is sometimes hard to find time to eat, but do your best.

Eat a salad a day, or at least a vegetable. Less fast food and more at-home eating is also key.

I get that fast and easy will win sometimes. Just not every time.

Hydration. Drink that water. Hydration can impact all of your systems. And I mean ALL of them. Make sure you drink water first thing in the morning and try to make it the last thing you drink at night.

Exercise. Go for a walk on the Pomodoro break. Or do desk exercises. There are a lot of really great desk exercise videos and books out there. Your bone density will thank you. And bone density will be important for all the years you plan on living.

Sleep. This is the one that is the easiest to slide on. Aim for seven hours of sleep a night at a minimum. I’m not going to say no screens before bed because I read myself to sleep every night but minimize the engagement with the screens.

After all, you only get one body. Make sure you take care of it.

It’s raining men

It’s raining men and women. Because gravity is a thing and a real force to be reckoned with. Gravity doesn’t mean to hurt us, it is just doing what a force of nature does without caring what we pitiful humans think. Gravity, if it was sentient, would not spare a thought to making people fall.

However, as fragile humans, we have to think about it. How many times have you seen an edge of a sidewalk that has come up because of root action by the nearby tree and thought to yourself “Gee, someone better alert people about the uneven ground? I’d hate to see someone fall.”

Anyone? Just me, then. Cool.

The slip, trip, and falls were the largest percentage of staff injuries last year. Because gravity has it in for us. If it were sentient.

However, and I know I’ve written about this before, there are things that you can do to improve your chances of not getting hurt. Exercises to improve your balance will always be important. Maintaining muscle mass, not only as a cushion but as a way to foster reflexes will always be important. Because if your reflexes are fast enough, you can catch yourself before you fall. Knowing HOW to fall is paramount. I can’t tell you how many times we’ve had a patient with both wrists broken because they put their hands in front of them or behind them as they fell.

Gravity, much like time, is an immutable force. However, you can certainly take care of your vessel by maintaining balance, and reflexes, and learning the proper way to fall.

Maintaining your bone health is also very, very important. If you don’t have an adequate substructure, it doesn’t matter if you have great balance and great reflexes, an injury is more likely to lead to broken bones. Weight-bearing exercises and a good diet will help with maintaining the strength of your bones.

And women. Sigh. After menopause, women lose bone strength, because of estrogen loss. Estrogen plays a very important part in bone turnover.

My advice to you so you don’t end up on the operating room table.

protect your bones by eating a well-balanced diet.
Learn how to fall.
Ask your doctor if there is something that you can do to decrease bone loss.
Weight-bearing exercises are your friend to support the maintenance of your bones.
balance exercises are also very important to maintain your balance to decrease falls.

Bone density loss is a fact of aging. Protect yourself.

Because gravity doesn’t give a shit.