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"Falling Asleep at Every Traffic Light"
Less-than-conscientious workers find it easier to go unnoticed at night. Cornell Morton, a mechanic who suffered disfiguring burns over 35 percent of his body in 2003, spent more than three months in a burn unit at a Houston hospital. He remembers one night nurse roughly waking him, which was especially painful because of his excruciating condition. Adding to his anxiety was the burn unit's policy of no overnight visitors, so he could not be comforted and protected by his wife. "I was totally paranoid every evening, dreading that nurse would walk through the door."
Another factor contributing to night shift errors is the military-style hierarchy of the medical establishment, which discourages advocacy by underlings. Night staff are often loath to wake up a senior physician if they have a concern about a patient. Helen Haskell says it was her impression that as Lewis's condition clearly worsened, "residents and nurses were hesitant, to put it mildly, to disturb anyone who was not at the hospital. This included the so-called chief resident, of whom the intern was clearly terrified. The chief resident, actually a senior resident on his pediatric rotation, was apparently equally determined not to disturb the attending physician."
Says Nurse Williams: "I would never have a problem calling someone. I figure it's the patient that matters. But some people are more timid by nature, and more hesitant. And if they have less experience, they often don't know when they should be calling."
Finally, fatigue is a major contributor to night shift errors. Hospital staffers work notoriously long hours -- 24-hour shifts and 80-hour work-weeks are common for residents and interns -- and fatigue tends to be worse at night. Last September, for example, a Harvard Medical School study showed that interns on the night shift injured themselves twice as often as those working during the day.
Researchers also found that people who had worked 24-hour shifts had the equivalent performance level of someone with a blood alcohol content of .10 -- legally drunk.
A retired obstetrician who did not want his name used remembers harrowing commutes after long hospital shifts: "I recall falling asleep at every traffic light on the way home. The cars behind me would honk to wake me up. My feeling is that no one in hospitals, including administration staff, should work long hours that will in any way compromise the health of patients. I believe the health industry is behind other industries in this respect."
Even in the finest hospitals, with topnotch surgeons, the night shift can be a lonely and frightening place. In late 2003 journalist Melinda Henneberger was recovering from breast cancer surgery in a special ICU ward at UCLA Medical Center. "My husband wanted to come with me, but I finally persuaded him to stay home, thinking how much scarier it would be for our two kids if we were both gone," she remembers.
"But my best friend, Mary, did fly in from Oregon, and thank God she did. I was on the table for 12 hours, and when I came out, they put me on a morphine drip. Nauseated, I'd start to vomit, then choke. I was thirstier than I'd ever been, but I couldn't drink anything. Mary was there to feed me ice chips and hold me up when I choked. A few times, we pushed the button for help, but no one responded for quite a while. Sometimes they never came at all. If I'd been on my own and choking, I'm not sure how I would have made it through the night."
A spokesperson for UCLA says that the hospital "assigns one nurse for at least every two patients in the ICU both night and day."
Melinda says that the night shift staffers at UCLA were kind and caring but appeared to be overwhelmed by patients needing attention. "I could hear other patients crying out for help that didn't seem to come," she recalls. "It was horrible listening to them."
Amazingly, later in the week, when Melinda was able to move around, she stayed up at night feeding ice chips to another patient. "It took me half an hour just to get across the room. I was still in a great deal of pain and moving pretty slowly," she recalls. "The whole thing was Dante-esque. My advice to anyone going in for surgery anywhere would be, By all means, get somebody to stay with you through the night."
"Lewis! Lewis!" Back in room 749, Lewis is "coding" -- medical slang for going into cardiopulmonary arrest. Finally, the hospital responds with its full resources. Staffers flood the room, and 11 physicians descend on Lewis, frantically trying to stabilize him. Helen, joined by her husband LaBarre Blackman, a retired teacher, and their young daughter, Eliza, "stand in the hall in disbelief, watching this scene as if from a bad TV movie," Helen later writes in her diary.
Helen is terrified that Lewis has suffered brain damage, but she is utterly unprepared when she is called into a room by the lead surgeon on the resuscitation team. It is 1:30 in the afternoon on November 6, 2000. The surgeon introduces himself and says simply," We lost him."
"I had no idea he was near death," says Helen. "We brought in a perfectly healthy child." An autopsy revealed that Lewis had bled to death internally from a perforated ulcer, which was likely caused by the painkiller Toradol. By the end, much of his blood had drained into his peritoneal cavity. A more experienced doctor -- especially one familiar with the dangerous side effects of Toradol -- might have recognized the symptoms early enough during the night to save him.
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