I work as an emergency vet, and people often wonder what exactly I do all night long. They wonder what it’s like to stay up all night. They wonder whether I work every night. They wonder how I am able to sleep during the day. But mostly, they wonder what goes on at that emergency clinic during those long nights.
Working nights requires a major tweak to one’s circadian rhythms. It’s not natural, and I won’t lie and say that it’s easy. However, one grows accustomed to it. When I started working nights I would down three or four Rockstars every shift. Now I get by with a few Diet Pepsis. My shifts are usually busy enough for me to run mostly on adrenaline.
When you work nights, you must sleep during the day. This is very unnatural, and society’s bias toward diurnal human activity also is a major hindrance. Naturally, I sleep with the blinds drawn. A fan in the room is helpful for drowning out the ubiquitous weed whackers, horns, and other daytime noises. I also am a fan of a note taped over the doorbell — there are few things worse than being awakened in the middle of your sleep by a delivery person or a religious proselytizer.
It is best to work several nights in a row, so that one can maintain some sort of regularity in one’s schedule. It is then necessary to have several days off to recover, make up lost sleep, and get back onto a normal human cycle. So, to answer one question, I do not work every night. If I did, I imagine I would be dead within a month.
So what goes on at the emergency clinic at night? The nature of emergency work means that no night is ever predictable. When I was in day practice, I would check the next day’s schedule to see what sorts of appointments and procedures (such as spays and dentals) were on the books for the next day. That’s not possible at the emergency clinic. One can’t know in advance what will be coming in the door (although I do know that I won’t be doing any routine spays or dentals because they don’t qualify as emergencies).
My shift starts at 6 p.m. and usually lasts 14 hours, until 8 a.m. During the first hour or two I generally receive a number of patients who are transferred from family vets for overnight care. These might include animals recovering from major surgeries or animals that suffered emergencies during the day and received treatment at their family vet but aren’t yet well enough to go home.
Also, from 6 p.m. until around 11 p.m., the clinic tends to be quite busy receiving emergency cases that have not yet been treated. People might come home from work and be greeted by a sick cat or a house full of vomit and diarrhea. I therefore spend most of this time triaging and examining patients, discussing prognosis and treatment options with owners, and writing treatment orders for the technicians to work on. (Emergency technicians, by the way, are an incredible bunch of people, and they are an essential, professional part of the veterinary team. The techs at my clinic are amazing in their skills, proficiency, and efficiency.)
I see all kinds of emergencies, but some are more common than others. In cats, gastrointestinal problems (vomiting and diarrhea) are the most common thing I see. Injuries and abscesses also are frequent, especially in outdoor cats. Older cats often are presented for metabolic problems such as kidney disease or complications of diabetes. Urinary problems, including life-threatening urinary obstruction, often trigger emergency room visits. Respiratory distress, usually caused either by heart disease or feline bronchitis (asthma), is also common and is always a serious emergency.
At around 11 p.m. people start going to bed, and the case load usually starts to drop off a bit. When that happens I work to complete procedures (such as lancing abscesses or repairing lacerations) and write my medical records.
Most people are asleep from around 11 p.m. until around 6 a.m. Therefore, many of the new cases I see during this time are the result of a problem that has caused a cat to awaken the owner. Cats with urinary obstruction or aortic thromboemboli (also known as saddle thrombi, a disastrous complication of heart disease) often vocalize loudly and awake their owners. Certain neurological conditions and toxicities also cause cats to howl. Some cats wake their owners with repeated vomiting and therefore end up in the ER.
Sadly, the middle of the night also often brings an influx of outdoor cats who have suffered severe trauma. These cats often have been hit by cars or attacked by dogs during the day, but have not managed to drag themselves home until late at night. They then wake their owners by vocalizing outside a door or window.
The early morning often brings a renewed influx of patients as people wake up and realize that their pet has become ill overnight. Again, gastrointestinal upset is the most common thing I see — heavy sleepers might not realize their cat has been vomiting all night until they step in it in the morning. These end-of-shift admissions are challenging, because we have limited time to work on them before the shift ends. However, my overnight technicians have rock solid skills, and we usually get the job done.
Between 7 a.m. and 8 a.m. many owners arrive at the hospital to pick up their pets. I spend most of this time discussing how the night went and what is expected for the future for each individual. I am sorry to say that a higher-than-average number of euthanasias occur during this time, since owners often decide not to continue treatment if their cat’s condition has deteriorated overnight.
Although my shift officially ends at 8, I often stay until 9 or 9:30 finishing records, discharging patients, and tying up loose ends. Then comes one of the most challenging parts of my day: driving home during rush hour on the Bay Area freeways after having been up all night. I tend to stick to the slow lane, and I allow a very large distance between me and the driver ahead of me. Then it’s time to eat a quick breakfast, grab as much sleep as possible, and start all over.
Nighttime emergency shifts are challenging and intense, but they’re also exciting. They’re definitely not for everyone, but many of us wouldn’t want to do anything else.
Other stories by Dr. Eric Barchas:
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