The morning after I arrived in New Mexico was beautiful and warm, a pleasant change from the Northeast winter. I was entering my second year of emergency ultrasound fellowship and about to teach a point-of-care ultrasound course to health care providers working for the Indian Health Service (IHS).
On that first day, as my colleagues and I were powering up the ultrasound machines and connecting the video projector before class, an IHS physician entered the room and asked if we could teach him how to perform an ultrasound-guided peripheral IV insertion. He said that many of his patients had difficult IV access and he was hoping that learning this skill would reduce the number of central lines he had to place. When we informed him that a skills station dedicated to ultrasound-guided peripheral IV insertion was scheduled for later that morning, he apologetically replied that he could not attend because he had just completed an overnight shift in the ED and had another shift that evening.
As fellow emergency medicine physicians, we sympathized with his situation and were impressed with his desire to learn a new skill after what he described as a busy overnight shift. As we prepared a gel-block, IV catheter, and ultrasound machine, we talked with the doctor and were immediately struck by his kind and passionate demeanor. We learned that he had been practicing for about 30 years and now mainly worked overnight shifts because he preferred the regular schedule. I assumed that as a nocturnist, he worked fewer hours than his colleagues, as is typically the practice in the urban academic hospitals where I have trained. But when we asked how many shifts he worked per month, he replied that he typically works 22 overnight shifts a month, but last month he worked 27 shifts. My colleagues and I stopped what we were doing and the room fell silent. Had we misheard him? He then explained, without a hint of resentment, that he worked the extra shifts because the ED had been short staffed.
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