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.
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].
