“The night is the hardest time to be alive and 4am knows all my secrets.” ― Poppy Z. Brite
It is 4am and I finally had to succumb to the foolish belief that I would be able to drift off again. I can’t, get over it and get out of bed. It is like the cobwebs of my mind are drying up and dropping old memories into my conscience. Those conscience realizations are keeping me awake. It’s the 4am that is interesting.
In my healthcare days I preferred the night shift. For the bulk of people who don’t understand or give any thought to the concept of the 24/7 workweek a night shift in a hospital traditionally goes from 11:15pm until 7:30am. That period between 4 and 6am was always the hardest. Most of the night duties are finished so that’s charting time and napping time.
I worked in the emergency department at the now defunct Calgary Holy Cross Hospital, the only inner city hospital of the day. In the rush to strip away healthcare costs the Alberta government did away of the only inner city hospital and now Calgary holds the dubious distinction of being the only major Canadian city with no inner city hospital. And yet they are now in the process of redeveloping the inner city by adding housing for an additional 30,000+ residence. I may be over simplifying but that kind of residential density requires a full service hospital, not just a walk-in urgent clinic. Anyway, not what I’m writing about.
And let’s put the TV version of an emergency unit or hospital concept to bed. The Holy Cross was nothing like New Amsterdam or the home of “The Good Doctor” the San Jose Bonaventure Hospital. For the record, and I like The Good Doctor, the outside shots of Bonaventure Hospital is actually the Surrey City Hall. I’m just saying the Holy was not a television hospital where you seem to have four doctors involved with every patient. That only works on TV. I swore after they cancelled St. Elsewhere that I would never get myself engaged with another hospital show but almost 40 years later I changed my mind for the two shows I mentioned.
I worked for a very unique team, the Psychiatric Assessment Team (PAT). The Holy Cross was the only hospital to provide this type of 24 hour service and I preferred the night shift. Our office was in the emergency department and we were aligned more with the emergency staff than the psychiatric staff. We were, in every way, part of the emergency department. The doctors loves us because we could save them hours by doing the time consuming “psych assessment” and the nurses loved us because part of our responsibility was the difficult job of supporting the loved ones of those patients who has passed away or the harshness required to confront the parents of an obviously abused child. Yes people die in emergency, a reality of that type of work and, yes, parents can be very abusive while clutching to the belief that we were uninformed idiots. Communication is, not only an art form, but also a science so there was no pulling the wool over our eyes.
I preferred the night shift because 1. I was removed from the politics of healthcare you saw during the day (for three years I was the local president of the nurses union “United Nurses of Alberta” UNA so I had no options but to be involved in the politics) and 2. you saw a much more interesting group of patients. I preferred the challenge of the psychotic decompensation of a chronic schizophrenic over the attention seeking suicide attempt of some passive-aggressive personality disorder.
I have nothing against personality disorders but my preference is for a genuine delusion over a temper tantrum resulting in a botched (usually deliberately) suicide attempt. Personalities disorders were just beginning to be recognized and diagnosed in the late 70’s, early 80’s so they were a relatively new phoneme to psychiatry.
It was not uncommon for a disorder like that to seek admission rather than deal with the root of their issue. For that reason, a suicide attempt did not guarantee admission otherwise you were feeding into the psychopathology of the disorder. Based on my own experience only about 5% of attempts were admitted with the rest given follow-up appointments for crisis interventions work. Interestingly only about half ever showed up for those interventions. I’ve had my share of assisting in the restraint of an overdose attempt patient while a lavage tube was inserted, not a pleasant procedure. I have also had many good shirts ruin by the regurgitated “activate charcoal“, a black substance that doesn’t wash out very well. I never had to worry about that with a good schizophrenic assessment. The regular OD visitors, besides their heavily bloated medical file, you knew was experience at overdosing because of the large helping of pasta they had scoffed down along with their pills. The glutinous nature of spaghetti made the lavage process much more difficult but not insurmountable. We would just have to use a larger tube for the pasta to get sucked up in.
Anyway we also had our regular schizophrenic’s. Schizophrenia is a life time disorder and nighttime is one of their favourite time slots. One of the regulars (for the sake of this article I will call him Jim) had a habit of showing up around 4am. I enjoyed Jim due to the monotony of that time period and the fact that he was a pretty good guy. Having him present at that time of night was very convenient since the 4 to 6am time slot was a boredom killer time. Most things were done and staff were getting tired, ready to wind down, go home and get some rest in preparation for the next night. Anyway Jim would show up around 4am, wrapped in binder twine with a length of rebar tucked in the binder twine like a sword. He was pleasant but noisy. It is not uncommon for a schizophrenic in a psychotic state to speak very loudly as a way to drowned out their voices. Audio hallucinations are one of the most common.
He also liked me so would often call first to see who was on in psych assessment. If it was me he would present. I’m convinced that deep down even the most psychotic have a part of their brain trying to be healthy. His story was always the same. He had been feeling pretty good and those pills the doctor gave him made him feel “fuzzy”, not an uncommon analogy in those days. Psychotropics have come a long way. So he had gone off his meds, decompensated and was now in the process of “ascending” to fight the battle of armageddon. He was about to save the world but he knew “I” had a secret potion that would make him invisible to the enemy. That potion was an injection of largactil which would calm him enough to get him admitted and back onto his medication regime.
The other good time night patient was a manic depressive in a full manic state. Manic’s tend to be very bright people who will also go off their meds because they miss the excitement of being manic. They don’t miss the downs that can come with the depressive part of the disorder but they are prepared to roll the dice and hope for the manic though process. Assessing a manic is challenging. It’s like being in a debating club with a bunch of speed freaks. They are quick, they are bright but they to tend to lose focus so you can trip them up. That was the kind of patient you hoped for around 5am. They would keep you going until the end of shift.
So here it is 6am in the morning and I can’t sleep so I have been writing about the post sleep thoughts left in my brain. Not sure if this is unpacking old memories or simply my way of expressing my concern over the new Kenney governments approach to healthcare.
There is a link here, dread. 6am on the nightshift was the hour of dread. You would sit there with sweat on your brow hoping no new patient would present at 6am. If a patient presented before 6:30 the night psych staff had to deal with them. This could often mean you weren’t going home at 7:15 since, if you were looking at a potential admission, you had to see the case through to conclusion. I could be stuck in emergency until well after 9am. After-all, the inpatient unit was also going through staff change and were never prepared for an admission until after all of the early morning routines had been concluded.
It was psych assessments responsibility to stay with that patient until they got to the unit. You couldn’t hand them off to the day person since I had to do all of the pre-admission history notes. If a patient presented AFTER 6:30 you could kind of duck this issue pending the arrival of the day staff. That same dread I now feel in anticipation of what the Kenney government is indicating in potential cuts to healthcare. A system that is little more than the Thanksgiving Day turkey carcass compared to what it was 30 years ago.
So now that I have made it through the disquieting mist of that 4 to 6am of a nighttime hospital shift maybe I’ll stretch out in the recliner and see if I can catch a nod. Night is the hardest time when nightclubs, bars or work are absence. Have a good one