10 PM.

“Don’t leave,” the middle-aged lady in the ER says to her husband, “Don’t leave me until I get the cat scan.”

She’s got cancer in her liver, in her bowel.  We need to find out if it’s in her brain too.  She’s not exactly young but she is too young for this.

The only good thing about the night shift is that I don’t feel obliged to tell her she probably has less than a year left.  That can wait for morning.  I’d rather not have to double her sleeping pill dosage tonight.

11 PM.

“What meds are you on now?”  I ask a new patient with shortness of breath.

“I stopped taking my meds,” he answers matter-of-factly with arms crossed behind on the starchy hospital pillow.

“How long ago?”

“Right after my triple bypass six years ago.”

[Insert sound of me mentally slapping myself in the forehead here.]

“The cardiologists are going to start you on some new meds then,” I tell him.

“I guess I may have to stick with it this time.”

“Only if you want to live longer.”

MIDNIGHT.

“Do you know what year it is?” I ask an aging narc addict.

“Two-thous… zzzzzuh,” she answers lethargically under her oxygen mask.

I turn to the nurse, “I’m ordering Narcan, Flumazenil, and bipap before we end up tubing her.”

“Oh, before you came, she wanted me to ask you for a sleeping pill,” the nurse dutifully informs me.

“…”

1 AM.

The serpentine and engorged veins on the next old lady’s abdomen actually have a name, “caput medusae,” meaning “head of Medusa.”  To me, they’ve always looked more like possessive spidery fingers.  It’s a sign of liver failure or abdominal cancer.  Like their namesake, they’re uglier in person, I guess.  Aegis.

She tells me her resuscitation wishes, “I’ve had a good life.  Just let the good Lord take me.  I want to go but my sons don’t want me to.  They would just cry.  I keep tellin’ them – You better not cry.”

She’s near eighty.  I imagine her sons must be at least fifty.  It’s not the first time I’ve spoken to someone who was honestly ready and willing to just die, but each time, I can’t quite fathom it.  It’s awe-inspiring and sad.

2 AM

The 70-year old man is shocked, just shocked, that he is sick for the first time in his life.  He could pass for fifty easily, he’s that fit, and his beard helps to hide his age somehow.

“My wife, she’s fourteen years younger than I am.  She lines up her pills every morning.  I never wanted to be like that…,” he says, sad at the notion that he’s mortal too.  Sad that the same two rules that apply to everyone else, death and taxes, apply to him as well.  There’s a conceit and immaturity, despite his seven healthy decades, that hasn’t been dented until now.  It strikes me as disrespectful somehow toward all the really sick people I’ve seen over the years.  I mean, Christ, man … you’re seventy.  Seventy may be the new fifty, but people are still dying at fifty.

“I just won three sets of tennis in a row and now, I’m here,” he muses in his hospital bed.  (Yeah, well, at least it wasn’t golf.)

What do Death, the IRS, and Santa Claus all have in common?  They have a list, and they check it twice.

Back taxes are a bitch.

3 AM

“Any fevers or chills?”  My own words echo in my head as I lie down for five minutes.

Too hot or too cold.  Two extremes of hell.  The Rapture or The Apathy (you’ve never heard of it because no one’s cared enough to write about it).

It comes around 3 in the morning, when body temperature hits its circadian low.  The wraith’s hour.  You felt it finishing those last minute reports in college, or cramming for Monday morning quizzes in medical school.  Or the call nights during residency.  But those were just warm-ups compared to how it feels now.  It’s never this cold while up all night at home (stupid Xbox achievements).  But add a little anxiety, stress, and mortality, and it’s cold from the inside out.

4 AM

“Heya, got an interesting one for you here,” the ER doc says over the phone.

Fuck you.  Nothing is “interesting” at four in the morning.

5 AM

“You called?” the security guard asks outside the call room.

“Yeah, my card won’t let me in,” I shrug and shiver a little.

He looks at the “Sleep” sign on the door and chuckles.  How can anything be funny at this hour?

Inside I wonder why every hospital is stocked with the thinnest, coldest blankets imaginable.  The cost of having industrial strength washing durability, I answer myself.

My dark prayers are answered and the beeper stays relatively quiet for a couple hours.

7:05 AM

I pass the beeper on.  “No one died,” I say still half in this world, half in the next.  Lumber outside.  Squint.  The sunlight … it burns.