Dr. Melissa Yuan-Innes: A Novel Night Shift Experience

While working as an Emergency Room physician and hospitalist in Eastern Ontario, Dr. Melissa Yuan-Innes is also achieving success as a novelist. Her latest medical thriller, Graveyard Shift, is set on a very eerie night shift in a fictional Montreal hospital. Here, this modern Renaissance woman talks about her own night shift experiences, the pressing problem of violence within hospitals, and how she balances resuscitation, writing and rotating shift work.

What was your inspiration for Graveyard Shift? 

There was a crazy case at one of the hospitals I worked at. In the end, a police officer came and took care of it and we avoided what could have been a disaster. But, when I thought about what could have happened if he hadn’t done that, I knew it was my next book. I was already writing a book set on an airplane, but I wanted the next book to be about this domino effect where everything goes wrong, one thing after another, all set up in the beginning. The idea at its core was from a real case.

Often the Emergency Room doctor is the only physician in the entire hospital [at night]. Honestly, I try not to think about it because it would be paralyzing.

I appreciated how you used details about night shift to create obstacles for your characters. How do those same obstacles affect your real life work as a physician on night shift?

It’s a given that you are almost all by yourself with almost no resources on night shift. Everybody’s tired and you’re doing the best you can. For example, I work at a small hospital with no x-rays at night. The only labs we run at night are the ones nurses can run in the Emergency, so just basic things like CBC, electrolytes, INR, trops, calcium. That’s it. You’re not going to get anything else. So our hands are pretty tied. 

That’s why when people come in and say, “Well, I just wanted to come in now because it’s a shorter wait,” they don’t understand that we just can’t handle things the way that we do during the daytime. 

At one point, the book’s protagonist realizes that she is the only physician available and the responsibility feels crushing. Is that a feeling you can relate to when you work night shift?

Of course. Often the Emergency Room doctor is the only physician in the entire hospital [at night]. Honestly, I try not to think about it because it would be paralyzing. At one hospital where I worked, we were being called to deliveries as well, so we were covering Obstetrics, ICU, the Emergency Department, and anyone who happened to code in the parking lot. It just wasn’t physically possible and it was dangerous for us to be trying to cover that much. 

Photo Credit: Ladouceur PHOTO

A lot of frontline healthcare workers are hit and kicked and we don’t talk about it because we try to be patient-centred and very understanding.

Your book addresses the issues of violence within hospitals. How do you think violence on night shift affects staff? And how do you address it as a physician?

I try to be very proactive about potential violence within the hospital, the same we try to prepare for codes in general. I remember one night shift when a very serious case was coming in – someone who was very violent a few days prior.  So I said, “Who is willing to get my medication?” And one nurse volunteered. “Who is coming in with me to the room?” Another nurse volunteered. “Do we have a bed on psych?”, etc. I just try to get everything organized and then go in. When I meet the patient, I start with, “Why are you here tonight?” I try to be very calm because if you’re aggressive, they immediately respond to it and it’s over. 

There is a line in my new book when a nurse says, “I’ve been kicked, I’ve been punched, I’ve been strangled with my own stethoscope – it’s not my first rodeo.” That is a direct quote from a nurse I work with. A lot of frontline healthcare workers are hit and kicked and we don’t talk about it because we try to be patient-centred and very understanding. And while we’re doing that, people who are in the healthcare field are being hurt and we should be addressing that. 

You dedicated this book to Dr. Elana Fric and used it as a platform to speak candidly about Intimate Partner Violence. Tell me more.

There was a Toronto family physician named Elana Fric who was very well-respected. She was a leader in the Ontario Medical Association, a mother of three, and a marathon runner. She was someone who a lot of people loved and looked up to. She was killed by her husband two days after she served him with divorce papers.

As a physician, I already knew about intimate partner violence, which is what we now call domestic violence. The idea is that the Emergency Room especially is a place where you find victims of violence and intimidation and you should be intervening if you can. But it’s not an easy thing to do. 

What I have done since Dr. Fric’s death is broaden my questions. I used to ask people if anyone was hurting them if I suspected violence, but I now I’ve broadened it because the best test is one you give everybody. So now when anybody comes in with an injury, I say “Is somebody hurting you?” 

I will also be donating part of the proceeds of this book to Dr. Fric’s children and some local anti-violence organizations. We have to protect vulnerable women in our society. One way to do that is to give funds to organizations that already exist and know what to do but just need more cash flow.

The idea is that the Emergency Room especially is a place where you find victims of violence and intimidation and you should be intervening if you can. But it’s not an easy thing to do. 

As a wife, mom, physician and writer, how do you find balance while working rotating shifts?

As a hospitalist (in-patient physician), I try and get everything really set up during the day. I view being a hospitalist like being the mayor of the village. I have a certain number of patients – my villagers – and they all need something from me. So I go in and meet them and try to figure out what they need and try to address that during the day. Of course, at night there are still crises but it’s not as bad.

Night shifts in the Emergency Room are tougher. So I am absolutely ferocious before and after my night shifts. I tell people, “Don’t call me!” I put up signs around my door that say “Shhh, sleeping!” If I need to, I’ll get an Air BnB outside my house because I don’t want my kids talking loudly where I can hear it. I’ve even asked my husband to set up my tent outside for me so I wouldn’t be in the house.

I really do hate night shifts and the disruption before and after. The only good thing is that I will usually try and eat something I like and read and relax before – I use it a reason to take better care of myself. It’s some “Me Time” that I’ve cleared. I also try to write more before to stockpile words. 

I wish people were more proactive about protecting their sleep and thinking about it like an emergency.

Any advice for new night shift workers?

I wish people were more proactive about protecting their sleep and thinking about it like an emergency. Sometimes people tell me, “I’m post-call, but my kids’ friends are over and jumping in the pool so I need to get up because that’s dangerous without me.” And my response is: “Never have extra little children in your house after a night shift!” 

For me, it’s about looking after yourself. I am ferocious about it. People who know night shifts are quite respectful about it. For example, I’ve had a doctor’s office e-mail me because they didn’t want to call in case I was working night shift and that was really cool.

But other people don’t get it, so you should silence your phone and turn off all notifications. In the last few years, I’ve sometimes taken medication to really knock me out.

Finally, will night shift workers be scared to work their next shift after your reading your latest book?

They might, but they also can take comfort in knowing that it cannot possibly go as wrong as it does in Graveyard Shift

Follow Dr. Melissa’s literary adventures on her website [click here]and sign up for her newsletter. Her latest medical thriller Graveyard Shift will be available November 1, 2019. Find out how to grab your copy [click here].

Photo Credit: Ladouceur PHOTO

How to Schedule Sleep for Night Shift

It’s pretty simple. The best sleep schedule is the one that works for you! Everyone’s sleep needs and circumstances are different. The main thing is to get enough sleep.

Sometimes I read articles on how to sleep while working nights that dogmatically dictate a certain sleep schedule. But, realistically, the same thing just doesn’t work everyone. And if you’re new to shift work or have been struggling to get adequate sleep, you might need to try a few different sleeping patterns to see which is best for you.

You need to figure out what works for your body and circumstances and then stick to it consistently. This will let your body adjust and help you build some routine into your life. It will also help you sleep during the day more easily by training your body when it should be asleep vs. awake.

How to build your sleep schedule

Take the time to plot out exactly what hours you need to sleep, either digitally or on paper. Mapping out your sleep plan will help you find potential flaws in your well-intentioned ideas. When plotting out your sleep schedule, consider:

  • Your scheduled shifts (8 hrs? 12 hrs? start time? end time?)
  • Your individual sleep requirements (7 hrs of shut eye? 9 hrs or more?)
  • Your family responsibilities (children to be dropped off/picked up?)
  • Social engagements (PTA meetings, dinner dates, etc.)
  • Other commitments (soccer practice, doctor’s appointments, etc.)

Sample sleep plans

Want to see the schedules of some of my co-workers? These different sleeping schedules show you that successful daytime sleeping doesn’t need to look exactly one way to be effective.

The fitness buff

Some of my athletic co-workers follow this schedule:

  • Leave work as the sun rises, eating breakfast before they go
  • Work out at the gym & shower
  • Hit the sheets by 10 a.m.
  • Sleep til about 5 p.m. or 6 p.m.
  • Eat dinner
  • Head into work

These folks admit that this only works for them if they go directly to the gym. Stopping at home is deadly for as it inevitably leads to crawling between the sheets and never making it back out.

The school sleeper

Many of my co-workers are parents. Here’s how they work their sleep schedule:

  • Leave work
  • Get home in time for the breakfast parade and lunch-making lineup
  • Pop kids on the bus and/or deliver them to school
  • Head straight to bed
  • Sleep until school is over
  • Do homework and eat dinner with the kids
  • Give bedtime kisses
  • Head into work

If you need more sleep than this schedule allows, it may be possible to arrange after-school daycare or babysitting.

The split sleeper

I have other co-workers who cannot stay asleep for one long spell during the day. These folks do the following:

  • Leave work
  • Eat breakfast
  • Head straight to bed
  • Sleep for a 3+ hour nap
  • Have lunch / putter around / do some housekeeping
  • Sleep for another 3+ hour nap
  • Drive to work
  • Eat dinner in the staff room and head into their night shift

My schedule

Here’s what works for me:

  • I have a small breakfast near the end of my shift.
  • I head straight to bed after work and sleep for several hours.
  • I invariably snap awake at 1 p.m. so I drink a tall glass of water and pad around my apartment for a few minutes.
  • I get back in bed, do some reading and head back to sleep until late afternoon.
  • I eat dinner, grab a large coffee, and drop off my dog before heading into work. (I try to get to work 15 mins before shift start to settle in and relieve my coworker early.)

Could any of those sleep plans work for you? Do you already have a sleep schedule that works for you? Please share below so we can learn from each other!

Sleep Schedules for Shift Workers

A 10 Minute Staircase Workout for Night Shift

Here we go! Try this workout session that takes less than 10 minutes. All you need is an empty stairwell – so it’s perfect for night shift.

  1. Warm up for two minutes by slowly walking up and down stairs.
  2. Run up the steps as fast as safely possible for 20 seconds. Head back down slowly.
  3. Walk the hallway for two minutes.
  4. Run back up the stairs for another 20 seconds. Head back down slowly.
  5. Walk for two more minutes.
  6. Run the stairs for a final 20 seconds. Head back down slowly.
  7. Cool down with three minutes of stair and corridor walking. 

How to Stay Awake During the Night Shift

Staying awake for your entire night shift is probably the difference between keeping your job and losing it. In school, you might have pulled the occasional all-nighter to finish an assignment or crunch for an exam. But the experience of working the graveyard shift, night after night, is entirely different.

If you’re a lucky duck, you may have designated breaks and a comfy place to crash for a cat nap during the night, but you’ll still need to figure out how to stay awake and alert most of the night. And of course, it’s easier to stay awake when there is lots of action. It’s the slow nights without much to do that present the real brute of a challenge. Here are some tips on how to pull it off.

Stimulate your mind

If you’re faced with lots of downtime, find ways to keep your brain busy. Keeping your mind busy is the best way to avoid accidentally snoozing.  Bring crosswords, sudoku, or other brain teasers. Listen to podcasts or energizing music. Work on a personal project, plan a vacation, browse the flyers, figure out your weekly meal plan, etc.

Engage with other humans

If you have coworkers around, chat it up. At my work, we have our best chats in the wee hours of the morning while we are struggling to keep our eyes open. Chatting makes the time fly until we have more work to do, or the day shift arrives to relieve us.

Keep it lit

A well-lit workspace plays a big role in keeping awake all night. If you work in a dim work environment (eg to keep patients asleep in a hospital ward) then at least take your breaks in full light to perk you up.

Drink lots of water

It’s healthy and it’s a natural diuretic. All that peeing can actually help you stay awake! Drinking lots of water will also help your body run at optimum levels and is especially important if you’ve been sipping coffee, which might dehydrate you a bit.

Keep moving

Move around as much as possible. Perpetual motion fights off that urge to go to beddy-bye. Kick it up to the next level with some on-the-spot fitness. Climbing three or four flights of stairs will kick up your heart rate and give you a great boost to awake. 

Chill out

Warmth can make you feel cozy and comfy and snoozy. Keep your work area a tiny bit cool to keep awake. I liked to dress in layers to accommodate fluctuating temperatures. A small desk fan circulating cool air can be helpful too. Sip cool drinks if you feel sleepiness start to overcome you.

Freshen up

Breathing in fresh air is an instant pick-me-up that can last for hours. If you can get outside during your shift -even for just a few minutes- the outside air can freshen you up. And the change of scenery is mentally refreshing.

Eat carefully

Eating meals high in carbs and low in protein can make you feel extra sleepy (think bagels, doughnuts, muffins, etc). Avoid too much caffeine, heavy meals, fast foods, sugar highs, high-fat snacks from vending machines. They offer little nutritional value and can make you extra drowsy. 

Chew minty gum

Freshen your breath and give yourself a little jolt of awakeness with a fresh stick of minty gum when you feel yourself nodding off. Spicy cinnamon gum works well too.

Sleep enough

It might seem obvious but it’s worth repeating- if you get enough Zzzzz’s during the daytime before your shift, then you won’t be as plagued by sleepiness during your shift. Check out my article Daytime Sleeping for the Night Shift for more help.

DYK? Some of the worst man-made catastrophes have been attributed to mistakes made on the night shift: the BP oil leak in Gulf of Mexico, the Exxon-Valdez oil tanker spill, the nuclear disasters at Three Mile Island, the nuclear disaster at  Chernobyl and the cyanide chemical spill in Bhopal, India. Avoiding critical errors is an important reason to stay alert all night long.

How to Stay Awake on Night Shift

How to Eat Clean while Working the Night Shift

Is it just my workplace, or is it standard practice to have delicious, deep-fried, sugar-laden options ushered in during the middle of the night shift? When my stomach is growling? And my resistance is lowest?

There are also generous coworkers who do middle-of-the-night coffee runs and deliver my sugary, syrupy macchiato. Not to mention the home-baked goodies that grateful patients have dropped off. And the siren call of the vending machines. Every. Single. Shift.

If your meal breaks are either hard-to-find or often interrupted, then healthy grazing is the best way to stay fuelled.

If you don’t have healthy snacks prepared, it’s too easy to start snacking on muffins, doughnuts or the pizza your coworker is sharing. Those kind of night shift diet choices start to take at toll after a few weeks, months, or years of shift work. Here’s some ideas that just might keep you out of the 3 a.m. doughnuts.

1. Plan ahead

Prep work will pay off big time. So before you disappear into the relentless grind of back-to-back night shifts, take a few minutes to get prepared with some go-to healthy foods.

  • Wash fruit
  • Chop veggies
  • Whip up some smoothies (store them in the freezer)
  • Make hard-boiled eggs
  • Cook grains (quinoa, brown rice, etc.)

2. Pack snacks

Prepare for your shift the same way you would prepare a little kid’s lunch. Because by 2 a.m., we all start to feel like a overtired, very hungry toddlers. Beat the temper tantrum by filling several small resealable containers with appealing, healthy snacks.

  • Carrot, celery and red pepper sticks with hummus
  • Cheese and crackers
  • Plain yogurt with crunchy granola and raspberries
  • Oatmeal muffins with fruit & nuts
  • Quinoa salad with chopped fresh veggies and vinaigrette
  • Healthy granola bars
  • Peanut butter energy balls

3. Stay hydrated

Staying hydrated is a simple way to keep you feeling awake and ward off hunger pains.

  • Get a couple of good refillable water bottles and fill them up – add some lemon wedges and mint leaves for a zesty refresh
  • Invest in some high-quality tasty teas to stash at work or in your bag – make a hot tea when you’re tempted to sip a sugary hot drink to stay awake. (And if you’re like me, I get really cold in the middle of the night and need something hot to warm me up.)
  • Make a quick berry smoothie or green smoothie and stash it in the fridge until you’re ready for it. It’s portable nutrition that will fill you up without causing a sugar crash.

4. Treat yo-self

You don’t want to feel deprived or like you’re missing out on the fun. By packing one or two small treats to enjoy during your shift, you’ll have already set limits before you dive head-first into the fresh box of donuts.

  • A small bar of dark chocolate
  • Healthy cookies (yes, they exist!)
  • Chocolate-covered raisins or almonds
  • Vanilla or rice pudding

5. Use freezer bag slow cooker meals

Prepare some freezer bag slow cooker meals on your days off. Put them into the slow cooker when you get home in the morning after your shift. Go to bed, and supper will be ready for you when you wake up. Pack up some leftovers to bring to work for a midnight dinner.

Need some recipes to get started with this idea? Grab a copy of my Slow Cooker Freezer Bag: Complete Guide + Recipes for all the tips, tricks, and recipes you need.

Night Shift Diet Healthy Eating