In the beginning of my career, I called shifts as being either busy or slow. I soon realized that there were some problems with this simple classification. Some of the busy shifts were fun and rewarding and some left me drained and contemplating a career as a hermit poet.
Then I realized, it wasn’t the number of patients that I saw per shift or even the complexity of their problem that determined the warm and fuzzy vs psychotic depressive feelings that I would have at the end of a shift. No, there was more to it than that.
I looked at the facility, the shift, the hours worked, the stage of sleep deprivation. I looked at the ED staff and co-workers, at the patient population and the hospital staff. I looked at the hospital administrative staff. I could not come up with a dead-on-target source for the difference in the 2 types of shifts.
And, there are exactly 2 distinct types of shifts.
On one, nothing is easy. No matter how simple or straight forward the patient’s problem is, no matter how obvious the solution seems, nothing is easy. Maybe the patient needs admission and is agreeable up to the point that I have done all the phone calls, paper work (yes, we still have to use pen and paper in 2018), computer entries and discussions with staff, family and physicians and after spending about 30-40 minutes focusing on this one patient, they decide to go home instead. Or, decide to be transferred to another hospital requiring me to repeat the entire 30-40 minutes or more, to accomplish this. Or, reveal a previously undisclosed critical symptom that must be evaluated causing the process to start all over.
And that is just one of thousands of examples I could give for the problem shift.
On the other hand, some shifts have no hiccups, are fun and challenging. They may be balls to the wall busy, extremely complicated medically but everything works like I am King Midas touching things turning them into gold left and right.
So I came up with the classification of dominoes or chaos. Surely, you can figure out which shift is which. And for the next 25 years, I used this classification. Being able to put a name to it and understand where I stand in the cosmos of Emergency Medicine on a particular moment is kind of stress relieving. It helps me deal with walking through the swamp full of alligators.
But recently, I have changed the classification.
Now I say I’ve had a domino day or a common core math day.
Weary
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