Change of shift

At 6:15AM on a recent morning, I called my wife from the hospital. I needed to hear her voice and check on my kids. My 24-hour shift in the emergency department was ending, and I was shaken and emotionally drained. It was unusual for me to call instead of simply driving home, but my wife was in the midst of her morning rush to get herself ready for work and my daughter for kindergarten. She knew I was tired, and sensed from my questions that I was angling for a detour to the beach for few hours before I came home. Okay by her, as long as I picked up Devon by 4 PM. “And wear sunscreen,” I heard her say over the noise my 14month-old son made in the background. “He’s fussy,” she said, “he woke up early with a fever and threw up.” I wasn’t especially worried because my wife is also a doctor, but Dane had never been sick before. He likely had caught his sister’s virus. But that day it was different. I needed to come straight home and hold my son in my arms. I work in the ED at a rural hospital, where I am the sole doctor in attendance. This shift had begun uneventfully, as did most days. Patient volume is modest, with variable levels of severity. I see lacerations, broken limbs, infections, chest pain, and so on. Most patients are stable, some need admission to a larger facility, and others are “treated and streeted.” Most care is fairly routine, and my small staff performs with efficiency and compassion. We have all seen critical patients over the years, from cardiac arrests to trauma. Despite our experience, we are aware of our limitations and of the C H A N G E O F S H I F T