survival the night shift......

I still remembered the 1^st night I did my shift as a houseman. The thrill and excitement was handling patient was a new experience for me…After years of working, managing patient’s complaint in the night had been a reflex for me. Use the shortest time to get to the key point, managed the complaint and get back to sleep ASAP was the key to survive. Once, a senior had shared with me a cue to good sleep with me. He told me there was this resident who would do a night rounds in the ward around 11pm and after ensuring everything was managed he retired to his call room and  he would get a good sleep most of the time.

I never practice what he had said but I still think that it should be practicable. Last week, Lem told me about what the ward night shift physician done. All three of them had left respective note in the nursing station. The note was if BP more than ??? and give drug so and so , if Fever more than ??? then give drug so and so and much much more other “IF..THEN” order. A good move and they would be less disturbed by the nurses. Individualized of management according to various doctor but not according to the patient's condition....

The nursing director had later complaint to the boss and boss had stopped the action. I shook my head and told Lem after all this of year of doing night shift, I dare not do so as it is clearly violate the law.

I told Lem, those guys will not stay for the nightshift as the night shift ward job is stressful as well….I had a bad feeling about this and preparing to go back to the past life of covering the ward.

age of maturity and age eligible for driving license...

 I had this 18 years old young chap who fell from his bike with a gal as the backseater. Both of them had minor abrasion wound over their left limbs. It was 6:00am in the morning and I had good sleep thanz to the night shift attending physician covering the ward.

I had asked the phone number of his parents and called up.

“Good morning, sorry for disturbing in such an early morning… are you Mr A, father of A jr.?

“Yeah…what is the business…?”

“I am Dr lywuu of F hospital and your child had fallen from his bike on his way from KD to KHH….. he had sustained bla bla bla…”

“What on earth, ain’t he suppose to have ? class today morning…..”

Typical slipped out from hostel and brought she-classmate for an over night in the famous KD beach 50 km down south of our hospital… Most of the chaps will spent the whole night there and rode their bike in a “not enough sleep” zombie mode back to KH city early in the morning…some unlucky one would rammed their bike while day dreaming in limbo or too tired to react to some emergency condition and landed in my shift….



One of the crucial element of ED management is communication. Proper communication with the family and patient is always a key to avoid medico-legal problem. For an adult, the ED physician just need to well explained the medical condition to the patient, and then discharged the patient. But for youngster like the chap, communication with the guardian is vital. Imaging you had a 18 years old patient with traumatic knee injury who can still walk, after clearing him from any knee fracture, you just dischaged the patient. Unfortunately, the patient collapsed hours later in his house and a traumatic intracranial bleeding was diagnosed in another hospital. The family would definitely stick to your axx like a no head fly - why didn’t you examine his head and do some thorough studies before you discharge him? . For youngster who had not attained the age of majority it is crucial to speak to the family either face to face or talk via the phone.

In actual fact, half of the youngsters are reluctant to let guardian acknowledge about their condition. And many of them just couldn’t understand why the law allows them to get a motorbike license at the age of 18 but the age of majority is 20. Sometimes I would insist the parents to come over and fetch their children in person if the youngster had difficulty of walking or other risk who required further observation or admission....

There was a few times I had to threaten the youngster to surrender them to the police just to get their parents phone no….Most of the parents was polite and I could feel their worried and disappointment when their children met such accident…

I remember one of my lecturers had taught us that a child of age 3-5 would think that he is the king of the world and he is capable of everything…. But nowadays, lots of youngster thinks the same, they never know their limitation….

separation of ward and the ED

Call had become better nowadays… We had no longer had to cover for the wards complaints. The management had gotten a locumer initially. An internist with his own clinic down south, he had come for interview months ago and had retracted last minutes before he comes to work. He had however changed his minds probably due to temptation of cash.

He had done a few calls and complaint to K that the pay was too low. We were quite surprise when K told us his price. It was only 1/4 of our pay… queer feeling when I heard the figure; I wandered if I had to earn those hard earn money years later….well, keep up the faith as experience is the real asset that was gifted by the LORD…

K had gone to the management few times regarding night shift attending for the ward. Complaint from the ward had truly disturbed us as from time to time there are these “emergencies must visit patient” condition took place simultaneously in the ward and ED. Any of delay of management would lead to a life disturbing medico-legal case( multi-million medico-suit rarely occurred here in Taiwan, but the court running is very tiresome and torturing). I had nothing to say as I am definitely support the change.

Calls were better since then as I got to sleep the “morning call hours”. The “morning calls hours” is around 4-6 am as the patient started to wake up and nurse started to take vital signs. Lots of complaint is noted and it is the worst hours as one would be very tired after the long night shift.

But still, we had to covered for procedure and other critical condition in the ward…

night shift of the ward..

After few weeks of struggling about going for the training, I had finally settled down for another 10 months of works. Well, I had adapted well lately and more time to spent with the family.

More and more doctors are hired and we had a load of specialty to consult but I did not benefit much from it…most of the doctor are around in the daytime and as night shift attending physician, I could rely on my own most of the time.

K had complaint about covering the ward during night shift. According to his contract, his job is limited to the ED however since his arrival 2 years ago, we had been covering the ward. However the in patient had increase about 2x and the loading had become worse and worse lately. K had threaten the management that his contract ends in December and if we are still require to cover the ward, he would…..

The hospital had managed to get a clinic internist down south to cover the ward. He had come a few times and was reluctant to continue. K had chatted with him and found that he was paid less then 1/4 of our pay per night. He requested a higher fee (and still it was about 1/3).

The boss is still negotiating with the other attending physician and surgeon about doing the calls as the locumer could only cover part of the shifts.

All I want is fair and square…