STAIRWELL REFLECTIONS | Steffi Gauguet
It is still pitch black out there on the other side of the window in my favorite corner stairwell of this hospital tower. The one mostly made of glass where you get a glance of the world beyond these esteemed walls of this large academic pediatric hospital. The darkness should be no surprise. It is about 3am or so I remind myself. Twenty-three hours down, only about eight more to go. Before I get to go out there again. Free for a few hours before my next shift starts. This one is a 24h shift. But that translates into being here for about 30 hours more realistically. With all the signing out and finishing up notes and making sure I passed on everything important about every patient I cared for this shift.
I am climbing the stairs up the three flights from the main intensive care unit I work on to another one, where I need to evaluate a sick girl with pancreatitis who might need more care than that unit can provide. I know this kid is very sick and I need to hurry to see her. Every minute counts. Her blood pressure is uncontrollably low, her organs are shutting down, she is about to crash.
I am rushing inside my head. As I have the entire day and night. The kids are sick here. And there are lots of them. Things need to happen fast. There is not time to dilly-dally and reflect on the time of day, how I might be feeling, or how the weather is looking outside today.
But I find my steps up the stairs to be slow, heavy, tired. I breathe deeply. One speckled-vinyl-covered step after another. My body so tired I could sleep right here if only I allowed myself to sit down. My eyes gritty with exhaustion.
I find myself drinking in the little bits of outside world I get to see. That’s why I like it here. I get a reminder there is a world beyond the patients’ rooms, the monitors, the sterile hallways. I remind myself I chose to be here. That I have worked for years to get into this particular pediatric critical care fellowship. I knew what I got myself into, how intense the workload was, and how tough and grueling the hours would be.
I am breathing in the darkness. In. Out. Briefly letting myself think about something else than my patients, their vital signs I need to check on, their lab values I need to review asap, the new meds I need to order, the relentless barrage of pages I need to answer right away, the parents that needed to be updated hours ago, the nurses I still need to talk to urgently, the residents I should be teaching along managing the patients, the orders that need to be placed, the notes that need to be written later, the phone calls needing to be answered, the decisions that need to be made, constantly, hurriedly, confidently, quickly, again and again and again. All. The. Time.
I faintly can make out a grey cloud slowly streaking along the dark sky. That’s what I feel like, I find myself thinking. Grey, slow, tired. Of no real substance. I don’t remember when I last ate a bite, sat down, or even peed. Maybe this feels so much harder today because we just had a lecture on the effects of sleep deprivation earlier this week. They are required to teach us what consequences our lifestyles have and then make us do it anyways. Once a year, we get to hear how bad it is for us humans to sleep so little. How after being up for nineteen hours, your brain functions as if you had blood alcohol level of 0.05% or worse. How you are much more likely to poke yourself with a needle during a procedure, how much less likely to actually do the procedure well, even though you might be thinking you can do it just fine, how much more likely you are to fall asleep at a red light, or worse, get into a car accident on the way home. Long term, you are much more likely to have mental health issues, develop Type 2 diabetes, gain weight, make poor food choices, and develop cancer. There are many more negative effects of sleeping so little and so irregularly, but those are the ones swirling through my head at this moment, while I try to force myself to keep going.
A crazy and all-too-obvious thought enters my mind: shouldn’t we, as physicians know better and live better? Shouldn’t we be the ones standing up for our own health and live by example? Why is this so messed up and so wrong on so many levels?
I catch a glimpse of my reflection in one of the windows and for a brief moment am startled that I am not alone in this staircase after all, before I realize this much older looking, hunched over shadow of a person is me. She looks so old, so exhausted, so deflated.
The vibration of the hospital phone on my hip jerks me back to reality and reminds me to push all these unnecessary thoughts aside. I snap back into my reality. I need to figure out how to help this teenage girl to overcome her shock state. What tools we have left to help her survive. What I could possibly say to her parents to explain how serious this is without losing hope.
I take two steps at a time now. Almost running up the stairs. One last look over my shoulder into the darkness outside. One more breath of the freedom I so desperately crave and so willingly gave up for this training. All thoughts of how much I need to sleep floating away. Just like the dark grey cloud I now can no longer see.
Steffi Gauguet is a Harvard-trained pediatric intensive care physician at UMass Memorial Children’s Medical Center. When not taking care of critically ill children, she writes, runs, skis and tries to raise her three rambunctious kids into kind and responsible people.