The halls are quiet, the lights dimmed, the incessant ringing of telephones has fallen silent, patients slumber in their rooms, nurses sit and chart, waiting for the inevitable patient call light to glow once again. Then it happens: the overhead announcement that slices through the night like a knife.
“Code blue, code blue!”
As the code team scurries to the room, they start the protocols. However, they are waiting for someone—the conductor of the symphony, if you will. Who will answer the call? Who will whisk down the hall to take the podium? Will that patient’s primary-care physician (PCP) come? The cardiologist, maybe the pulmonologist?
No, there is one person who walks the halls at night when all others are asleep (even the ED doctors, though awake, are consumed by crowded emergency rooms and cannot help). This person is the nocturnist.
What is a nocturnist, you ask? Well, among the many titles, job descriptions, and opportunities that being a hospitalist can entail, being a nocturnist is the one that shines in the dark of night when everyone else is fast asleep. A nocturnist is a hospitalist who works the night shift. As a resident, you might have nightmares about the many nights you’ve worked, the assembly line of patients, procedures, and cross-cover calls you’ve processed.
Nocturnists are the lone wolves of the night. They wear many hats and encounter a milieu of incessant admissions, more cross-cover calls than you can swing at, more grumpy, sleepy consultant phone exchanges than you would like, and endure the chronic fatigue of a person 20 years older than their actual age. But deep down in the muck of it all, there is something about the night shift that keeps a nocturnist coming back night after night.
Nocturnist in Charge
Working as a nocturnist is the last, purest form of practicing medicine. This position affords you the perfect opportunity to get back to the patient-doctor relationship because you are not rounding on other patients, juggling staff meetings, or battling a slew of other staff pining for your patient (i.e. case workers, physical therapists, consultants, etc.). Therefore, you can spend an adequate amount of time getting to know your patient without feeling rushed.
As far as admissions are concerned, there still are those days when you feel you need more hours in a day and two extra hands to take on the flood, but as the physician in charge, you have the ability to better triage these patients and defer to a specialist if needed. It’s not like those residency days of admitting whatever they call you for.
In addition, you have the opportunity to really hone your medical skills and procedural skills, because you are the specialist at 3 a.m. There will be times when you have to make decisions without the luxury of an immediate consultation; that has its pros and cons, but it definitely makes for an exciting Friday night. Consequently, you usually are the first point of contact for the nursing staff at night, so you have the ability to formulate relationships with nurses like no other physician can, because you are there with them, side by side, handling all the emergent (and often nonemergent) cross-cover calls. The nurses learn to trust you and you them, and there is a sense of camaraderie that forms from that trust.