The Nine Shifts: A Triumph: The Clayton Sontheimer Story

The ER in St. Louis Children's Hopsital is an interesting place. We work twelve hour shifts and usually only work 2 or 3 days in a row. Sometimes we trade days with other residents and work more days in a row to get larger blocks of time off. Usually 5 days in a row is about as much as anyone will do. There are urban myths in the program about people who have worked 7 or 8 days in a row. I recently traded some days with another resident so I could have a couple of days off before going to Dallas for the weekend. I had been working 8 pm to 8 am shifts, so I wanted to try to get my body used to being awake in the day so I wouldn't be useless on my trip. As it turned out, I ended up with 7 straight scheduled days in the ER. These 7 shifts also happened to be the 1 pm to 1 am shift, which is, by public opinion, the worst shift. 12 hours of pure craziness. Never one to settle for average or even impressive, I decided to trade again to total 9 shifts. Based on my research, this will be a record among current residents. This is my story.

The Nine Shifts: A Triumph: The Clayton Sontheimer Story

Author’s note: the experiences and encounters of The Nine Shifts story are all true. Names have been changed when appropriate to protect patient identities.

Glossary:

POD -- a geographic grouping of exam rooms in the ER, residents are assigned a POD and they usually see see all the patients in those rooms. Most of the PODs are grouped closely around the doctor's work station.

EBV -- the virus that causes mono, also known as the kissing disease

H&P -- history and physical

Pre-shift 1: I awake with a strange mix of trepidation, anxiety, and a sense of general awesomeness. I realize that I have all of the tools and talent to overcome any obstacle. Somewhere in the distance, inspirational music plays. I also realize that this will be a bad hair day since the airport stole my hair gel because it might have been a bomb. Sadly, this isn’t the first time that has happened.

Shift 1: I start this experience in self-discovery pod’ing the 30s. Granted, when I came my pod was full so I figured I could relax until people dispo’ed their kids. But no! Jared wants me to see kids out of my pod. My brief foray into the teens is much more medical than I was prepared for – a Kawasaki’s disease and a teenager with fever for 19 days (but not lupus, POOP! ). Finally I get back to my pod, ready to rock. Nothing too out of the ordinary – a couple of psych kids, a non-accidental trauma, a couple of pelvic exams, nothing I can’t handle. The highlight was probably an 11-year-old with ongoing symptoms from EBV about 2 months after infection. At the beginning, I tell him that my goal is to say poop as many times as possible during the H&P. I said I average about 15. We had over twenty in less than five minutes. It progressed to the point where we would greet each other with the word poop. That kid is awesome. At hour 11, I realize that I haven’t eaten so I eat my sandwich. I don’t have time to eat the chips.

Post shift 1: I ride home in the fog. It is very creepy. I fall asleep on the couch watching the Cosby show.

Pre-shift 2: I wake up early as Theresa calls me to ask if I have seen an email she sent me. I then ask who I am talking to. Twice. Then I ask what email. Then I mumble something and go back to bed. On the ride to work, I experience chest tightness. Upon arriving, I realize that I didn’t bring my albuterol. It will be sorely missed.

Shift 2: Like a desperado or ninja, I work alone. Sentenced to toil away in the anonymous depths of the 3-6 pod, I work like a man possessed. Unfortunately, the man possessed has poor balance or sense of self in space. This manifests itself as sometime midshift I run my head into a door frame. No blood. No tears. Only the gritty determination to go on. I deliver a little bit of ER magic. Despite a large volume of patients, I don’t admit a single one. This culminated with me strongly disagreeing with an attending who wanted to admit a kid who was drunk. I totally sent that drunk kid home -- let him be hungover on his own time. As the shift goes on, I realize that my head is pounding worse and worse. I’m not sure if it is a migraine, the start of sinusitis, or symptoms of my concussion. I don’t have time to figure it out. The frustration of knowing that one of my patients from shift 1 came back unsatisfied with my care is cancelled out by the fact that it’s the kid who says poop. I don’t treat him, we only shout poop across hallways at each other. At some point, a radiology technician comes to congratulate me on one of my decisions. I give her a hug. At hour 11, I realize that I haven’t eaten so I eat my sandwich. I don’t have time to eat the chips. At hour 12, I realized that I didn’t use the bathroom the entire shift. I also realize that it isn’t for lack of need but that I blocked out my natural bodily sensations.

Post-shift 2: I ride home in a cold rain. For the first time, I sense my own mortality. I am both frightened and amazed by it. I take a couple of puffs of albuterol. I feel my lungs open in sweet, sweet, ectasy. I cherish the rich night air filling my lungs. I fall asleep on the couch watching the Cosby show.

Will Clay succeed in his quest for awesomeness? Will he be overcome by insanity or illness? Will he ever get to eat his chips? Will he ever be able to fall asleep in his bed again? Stay tuned for more updates on The Nine Shifts: A Triumph: The Clayton Sontheimer Story.