Guest Post: Ruminations on Shift Work from a Mother in Pediatric Emergency Medicine

An emergency medicine physician’s schedule is inherently flexible. I can quickly switch a shift with a colleague to accommodate emergencies since there are no patients to reschedule, trade random hours of coverage in order to make it to a school function, pick up my oldest son from school earlier than the other “late day” kids when I have an early shift.

Almost thirty minutes into the resuscitation, the room has gone quiet except for the ding of the monitor alarm. This five year old victim of smoke inhalation from a house fire has a good airway, two good lines, has received several rounds of epi, fluids, even the useless calcium and bicarb and there is no change. His pupils are fixed and dilated. “Time of death 13:52.” my voice breaks the silence. I walk out of the room and wait for someone to find his mother. She was out when the fire broke out.

I finish notes, try to wrap up my shift. His mom arrives and I sit with her and tell her the news as she cries silently. I hold her hand and then the social worker and chaplain take over. I silently leave the room, sign out to my colleague, and leave to pick up my son, also five, from school down the street.

When I arrive, he runs to greet me and the sudden force of his hug knocks my hair into my face. I smell smoke. I have to hold him longer to get control of the tears that are welling up in my eyes.

Overnight shifts are great for the working mom (who is used to sleep deprivation anyway, right?) Now that the baby sleeps better, they hardly know I’m gone. Their dad can get breakfast ready and I can do last minute lunch prep and kid dressing when I come home after my shift. Then I catch some sleep in a quiet house while the oldest is in school and the baby is with our nanny.

Thirty minutes before the end of my shift the radio alert sounds. I hold my breath as the nurse answers - a 6:30 AM radio call is either a radio check or a dead baby. Unfortunately, today it’s the latter. CPR is in progress. We ready the room, draw up meds, check the laryngoscope, and wait. I review drug doses and intubation technique with the resident and all the while I am just grateful that there’s another hospital closer to my house than the one I work in, because it means that this baby is not my daughter.

She arrives and is stiff and cold. Livedo has set in. We make an effort but mostly to dot our i’s and cross our t’s and give the family time to arrive and bear witness to our efforts. We care, we tried, she is important, we are sorry...... but she is the same age as my daughter and later that morning during my protected sleep time I just lay in the bed and cry, holding one of her blankets to my face.

Shift work is one of the features that is supposed to make emergency medicine ideal for the working mom. But shift work in the pediatric emergency department isn’t really shift work after all. I hope that as I accumulate years of experience that I can compartmentalize better and not “take it home with me,” but that’s not looking so promising since I can’t seem to concentrate when I know that my kids are in someone else’s car until I hear they’ve reached their destination safely. I hope that it’s just because my kids are so young and that as they get older I will worry less - but I know that’s not true as I call the pediatric oncology fellow for her opinion on a teenager with pancytopenia and a mediastinal mass. Perhaps all I can do is somehow convince the universe that bearing witness to the suffering of other children and their families is suffering enough, and then maybe the universe will protect my own children.


*patient details changed to protect patient privacy