5 Things I Learned About the Human Body from Working 24-Hour Shifts
The body is resilient, but what happens when it starts to break down?
Medical school is hard enough with the amount of studying and test preparation. Working 24-hour shifts brings a whole new challenge to the table. The exhaustion alone can make the strongest of us start hallucinating.
During my obstetrics and gynecology rotation in medical school, I worked several 24-hour shifts. I was excited walking into my first shift. Working a “call” shift is a stepping stone for any medical student and feels like a right of passage. Many residency programs still utilize long 24-hour or even 36-hour on-call shifts to cover all of the patients arriving at the hospital.
The big difference between residents and medical students is that they get special rooms to sleep when work is slow. I, however, didn’t have that luxury.
After these grueling shifts, I inevitably learned a lot about how the body deteriorates under stress and without sleep.
1. Adrenaline Does Wonders, Coffee Does Not
My first shift ended in a blink of an eye. From 7AM until 6PM, the halls were quiet on the obstetrics floor. Some women can spend up to 20 hours in the first stage of labor, which is perfectly normal. Any longer than that leads to an increased risk of infection for the mother and baby.
After 6PM, the chaos began. 2 women started delivering, and 2 others had complications requiring C-sections. With only 2 doctors around and myself, I was thrown into the operating room as a first-assistant. The adrenaline was high. I love surgery, and being a first-assist on delivering babies is a good feeling.
That night, we did 7 C-sections. The experience was wild. In and out of the operating room every half-hour without a break. I loved it! 6AM, now 23-hours since I had arrived at the hospital, I still felt good. The night had gone by quickly, and the patients were doing well. Not a single cup of coffee.
The next two 24-hour shifts were the polar opposite. I assisted on a couple deliveries here and there during the day, but the night was quiet. 9PM — became my coffee break, 12AM — time to grab a caffeinated diet-coke, 2AM — hydrating from the amount of caffeine I’ve taken in.
The caffeine simply doesn’t work after being awake and alert for 18+ hours. Imagine sitting, trying to stay awake for the next patient, but your eyes are shutting and then… your heart starts to pound, you get cold sweats, and your mind races as to what could be going on.
Also, what I didn’t realize is how my metabolism works when we don’t sleep.
After midnight, 15 hours into my shift, I was starving. The obstetrics department is terrible at snacking. Pizza, donuts, wings, desserts galore, were scattered all around the break room. I lost all self-control. I needed carbs and sugar.
Moral of the story, if you need to work for 24-hours, make sure you’re busy enough to keep the adrenaline high and the caffeine low.
2. You Can’t Control Your Eyelids
Your eyelid muscles are supplied by a nerve that you can voluntarily control. However, there is an additional tiny nerve that supplies the same muscles, but it is part of your “fight or flight” system. When you’re tired, our bodies have less of the “fight or flight” response, so our eyelids naturally droop.
Obviously, when you’re tired, you can still keep your eyes open by concentrating. During the quiet nights of my shifts, 3AM was by breaking point. My mind went into a fog, and I didn’t know whether I was awake or dreaming.
My eyelids drooped so low that the effort to keep them up felt exhausting. I felt like if I blinked, then I would fall asleep and miss something important, so I tried not to. My eyes quickly dried out in the hospital’s air-conditioned air. The burn set in and a glance at myself in the bathroom mirror revealed — what appeared to be — an accurate depiction of a zombie.
I’m sure there were times when I dozed off without knowing from the pure mental fatigue. You need your mind to keep the eyes open, but at some point, that starts to go.
3. Napping is the Devil
On the third, 24-hour shift, the doctors and nurses were impressed with my stamina. The night was slow again, so they told me to take a nap and that they’d text me if any patient was going to deliver.
Bad idea.
As medical students, we’re the lowest person on the totem pole. It’s always hit or miss assuming that anyone will tell you when something interesting is happening.
My 30-minute nap was full of paranoia. I rested my eyes, but my mind was hyperaware. I “woke” groggy and feeling terrible. I also noticed my body releases more oils when asleep, so I needed to scrub my face before rejoining my team at the front desk.
I think napping is a great idea, especially if you’re the point person (resident or physician). You can feel safe knowing that if any patient does need help, you’d be the person being paged.
The lesson here is that you need a clear mind to nap, regardless of how tired you are. Otherwise, it’s a waste of time and counterproductive.
4. Post-Shift Dreams
The drives home after a 24-hour shift were scary. I didn’t feel like I was going to pass out, but my sense of time and direction were severely impaired.
When I came home after each shift, I would whip up a large breakfast, inhale my food, take a quick shower, and hit the bed. The best sleep occurs after a 24-hour shift.
Usually, I’m a fidgety sleeper. My significant other can tell you that I toss and turn most of the night. But after a call-shift, I sleep like a log. In fact, after I woke up, I felt a paralytic type of weakness throughout my whole body.
It felt as if my brain wasn’t ready yet to control my body, and it was asking for more rest. Also, I noticed that I had zero dreams. Oddly enough, I thought I’d have some of the wildest dreams, but that’s not true. I either slept so deeply that I couldn’t recall, or my mind simply shut off from exhaustion.
The post-call sleep is what I miss the most from that experience.
5. Homeostasis is Strange
Homeostasis is what keeps your body’s regulatory functions balanced. It’s why our body temperature hovers around 98.6F. It’s the reason for the delicate balance of electrolytes, and it serves many other utilities.
One way that homeostasis is thrown off when your tired is through temperature control. I noticed that I had hot and cold swings randomly throughout the night, even when it was busy and my adrenaline was pushing me through.
Also, I noticed that secretions of body fluids changed, particularly in my mouth and eyes. My mouth became bone dry (even though I was hydrated), and my eyes were tearing for no reason. In fact, one of the nurses asked if I was crying during a conversation. I promise you, I wasn’t, my eyes are just so tired that they’re leaking.
What a wild experience that 24-hour call-shifts were. I’m positive I’ll have more of them as I head into residency, but I’m glad I got this learning experience out of the way.
