Winter 2008-09
After Dark
Shining a Light on the People
Who Make BIDMC a 24/7 Operation
Public areas full of noise and activity during the day – lobbies and hallways – become so quiet at night you can hear the steady hum of the air handlers. In garden beds outside the West Campus Clinical Center, crickets sing on a humid autumn night.
At 7 p.m., cars come and go in the garages, scrubs pass scrubs on the sidewalks. Open one door and you go from the cool dark outside to the bright lights and frantic pace of the Emergency Department – from deserted hallways into the bustle of the overnight labs. Noise and light levels may be lower on the critical care units and there may be fewer staff, but the activity level is steady and swift.
Many staff chose to work at night because it complemented a working spouse’s schedule and child care accommodations. Shift differential pay, free parking and less congested commutes were other factors. But long after school or family schedules make working at night less necessary, staff stay for other reasons – like working independently, enjoying less politics, the responsibility for handling the big and small emergencies, and the camaraderie of co-workers.
Finding happiness working after dark can be a struggle. Night shifts affect personal relationships. Food is always a focus – there is no cafeteria after 11 p.m., so staff must bring their own food or order out. There are mixed feelings on having no overnight cafeteria – some say it is very upsetting. Others say they don’t miss having a cafeteria.
Take a walk around during the evening and night shifts and what you’ll see, hear and find is the same dedication to patient care as their daytime counterparts. But there is a difference. It’s like Donna Colpitts, Lead Respiratory Therapist, told us when we met her late one night, “It’s a different kind of chaos at night,” she says. “Some people don’t like the stress of working days because sometimes there are so many staff that it is hard to spend time with the patient. At night there is more autonomy, fewer of us running the show.”
Shadowing BIDMC's Night Owls
7:15 p.m.
Archilles Brillant leaves the east campus en route to the parking lot next to Research North. He is the weekday 3 p.m. to midnight shuttle bus driver. The sounds from Mix 98.5 FM play on the radio as he drives down Brookline Avenue with only two passengers aboard. It’s starting to get dark and the lights of the Citgo sign shine in the distance. “Sometimes you get tired, but it usually goes by fast,” Brillant says.
8 p.m.
Public Safety starts locking down the medical center. The Farr Building and LMOB are locked-down with access controlled through employee IDs at the main entrance of the West Campus Clinical Center. Over on the east campus, the Carl J. Shapiro Clinical Center is locked and card access for employees goes into effect at the main Feldberg entrance. “People come here for medical treatment, but we’re in a unique position because we have to maintain safety,” says Lt. John Dristilaris, Public Safety. “It’s a balancing act.”
8:29 p.m.
The Public Safety officer in the ED calls for back-up to deal with an intoxicated patient who has just been brought in and is making threatening comments to the staff (Code Purple – a psychiatric emergency). Dristilaris along with Sgt. Eric Gonynor rush to the ED to join other officers already on the scene. There are six officers, two nurses and several other employees trying to explain to the man, Charles, that they are there to help him by taking his vitals and testing his blood and urine. He is very confused and keeps shouting. Eventually, he allows the nurses to treat him.
9:02 p.m.
Charmaline Black, Operator, Service Response Center, looks at her computer screen and sees that a patient information call is coming in, “What is the patient’s name? When did he come in? How do you spell the last name? OK, I’ll connect you.” Then a steady stream of calls follows...
9:24 p.m.
Two hours into her shift, lead Charge Respiratory Therapist Donna Colpitts is already trouble-shooting. One of her therapist’s computer passwords isn’t working, she is tracking down needed equipment and she has to finalize the next shift’s schedule earlier than usual so she can call a waiting therapist at a reasonable hour to let him know if he needs to come in – he does.
Up to 11 therapists are working in the ICUs, ED, PACU and units managing ventilator patients, attending triggers and codes and administering complex respiratory medications.
9:35 p.m.
Holly Schrupp, MD, Senior Resident, Emergency Department, notices a patient with a neck brace on a stretcher in the hall (car accident victim) seizing. She calls for help and the entire team comes rushing over. They turn the patient on his side to reduce the risk for aspiration in case the patient vomits and wheel him into one of the trauma rooms. He finally stops convulsing after a few minutes. Shortly after he stops seizing, they remove his clothing and begin a standard trauma assessment.
Marijuana is found in the patient’s pant pocket. He’s asked if he’s taken any drugs and he says, “Yes.” The patient suffers from seizures and drinking and drugs aggravate his condition. The patient is stabilized in about 15 minutes.
11 p.m.
Public Safety shift change, Dominoes delivers pizza.
11:05 p.m.
A knock is heard at the back door of the Pharmacy in the basement of the West Campus Clinical Center. The ED team is back from First Aid duty at Fenway Park and is returning a box of drugs kept on hand in case of emergency. Pharmacists Roy Daley and Chris Zullo have just come on duty and are busy at their computers processing prescription requests; some will be dispensed through ATMs (slang for the Omnicell machines in the units), others will be sent via the tube system, and some will be delivered on foot. Meanwhile, Janice Alami, Pharmacy Technician, dons protective clothing to enter the clean room where she will spend an hour or so filling IV orders.
11:34 p.m.
Central Processing Techs Lloyd Tull (33 years at BIDMC), Courtney Jones and Rosalyn Price, are preparing carts for the next day’s surgeries. CPD is where surgical instruments are cleaned, sterilized, and packaged for surgery. “The whole procedure of preparing a cart takes about 2½ to three hours,” says Jack Field, Manager, CPD West. “Once the cart comes back from the OR we have to wash, assemble and then sterilize everything. Some might think it’s very formulaic, like loading a dishwasher, but we have to be very precise in the work we do.”
11:47 p.m.
Sheila Barnett, MD, Anesthesia, Critical Care and Pain Medicine, has just placed the second epidural of her shift with an expectant mother in Labor and Delivery on Feldberg 10. Barnett is one of three attending anesthesiologists who work the overnight shift covering the East and West ORs, ED and L&D floors.
“We probably get a new patient every hour,” says Barnett, whose shift started at 4:30 p.m. and will end at 7 a.m. “We’ll do more than 10 epidurals and probably three to four c-sections tonight, and there are patients all night in the operating rooms.”
Midnight
Neil Lynch, Team Leader on third shift for Environmental Services, gets a “dirty bed” page and calls one of his staff to respond. Lynch walks through the West Campus Clinical Center doing a quick inventory of multiple projects his staff will do at night – cleaning halls, elevators, offices and procedure areas, buffing and waxing the floors. “There’s lots of square footage in this building,” he says. “The night staff is dedicated and hard working – no one is sitting around eating bon-bons.”
Other tasks:
- Prep mops for the day shift
- Exchange needle boxes for new ones
- Set up room for early morning resident meeting
- Deliver linens or full carts to floors
- Check laundry hampers and chutes
12:09 a.m.
Nursing staff on Farr 10 are having trouble with an agitated 101 year-old woman who has been kicking, punching and biting staff since early afternoon. The woman suffers from dementia and doesn’t speak English, which makes communication with the staff more difficult.
“She’s the cutest thing on earth, just like your grandmother,” says one nurse. “Except for the kicking and biting.” Psychiatry is called for a consult, but since they won’t arrive for at least an hour the woman is given a sedative. With the help of Alison Small, RN, Administrative Clinical Supervisor, three nurses restrain the woman while the sedative is given.
“The biggest myth about the overnight shift is that it’s easier because the patients are all sleeping,” says Small. “Patients don’t sleep at night because they’re too sick to sleep.”
12:10 a.m.
A nurse accompanies a patient with liver disease from the ICU to the CT scan room near the Emergency Department. The patient, in a lot of pain, needs a timed scan. With few words, the CT team comes together – Technologists April Callahan, Joe Jenkins, Wendy Johnson, Jonas Okoye and Evening Supervisor Tomica Barnett.
The team lifts the patient on to the table, then divides as one double checks the patient’s ID, one prepares the IV medium, another prepares the imaging equipment and yet another talks with the nurse in the anteroom.
Techs and nurses leave the room and watch from the anteroom. As the test begins and the IV contrast is administered precisely, the heart rate goes up. The concerned nurse instinctively starts to go to the patient’s side, but the techs remind her not to go into the room. “Wait; wait,” they say quietly, then, “OK.”
When the procedure is over, the team moves easily to the tasks of removing linen and preparing the room and the computer for the next test.
12:15 a.m.
Leonard Habiyakare, Parking Lot Attendant, Main Garage, sits at his booth near the elevators waiting for customers. He works from 11 p.m. to 7 a.m., but is busiest from 11 p.m. until 2 a.m. “I’m pretty comfortable,” Habiyakare says. “I am inside. I have a chair and I get to see people going in and out.”
12:30 a.m.
Steve Wright, Public Safety Officer, is manning the Feldberg lobby desk making sure only authorized personnel are coming in. Troughout the night, he and other officers will rotate stations around the campuses. He likes this rotation because it allows him to check all of the buildings and meet other BIDMC employees. “Keeping busy makes for a nice shift,” he says.
12:37 a.m.
Transporter Gremar Matias receives his next patient transport assignment. He checks in at the ED desk and is directed to one of the exam rooms where he dons gloves as he introduces himself to the patient and tells her he will take her to her room. He checks her name bracelet and asks the patient her name. As he leaves the ED, he comes to a joint in the floor and says quietly to the patient who can’t see it coming – “Here comes a bump.” It is a gentle warning he repeats several times during the trip – on and off the elevator and in the halls.
12:45 a.m.
Mohamed Fofana is the overnight lab courier. He works from 11 p.m. until 7 a.m., and has worked this shift for the past seven years. He travels between both campuses using a small shuttle bus to carry lab specimens, blood, equipment and pharmacy materials.
He has regularly scheduled pick-ups and drop-offs in addition to being paged when departments need him.
1 a.m.
There have already been three births since 7 p.m. in L&D on Feldberg 10 – both naturally and via Caesarean section. Eight more women are in labor. Usually, the floor sees between five and six births a night. “It’s like fishing – some nights you get three and some nights you get none,” says Sara Derick, RN, Labor and Delivery. The camaraderie among the nurses is evident. Some have delivered each other’s children.
1:15 a.m.
Code Purple (psychiatric emergency) is announced for a patient on Farr 5. Less than a minute later six security officers are lined up outside a room while a nurse and resident try to calm an agitated man who wants to leave the hospital. The patient is homeless, with substance abuse problems and suffering from badly infected toes. Staff worry he is in no physical shape to leave the hospital – he can barely walk without assistance – although it is his legal right to do so because he is mentally cognizant.
“Isn’t it better to have a nice warm bed than to be out on the streets?” asks Cindy Bigalow, RN. “Won’t you please just stay until morning? Then, after breakfast, if you still want to leave you can leave.” Back and forth it goes for about 10 minutes while the on-call medical resident that night examines the infection. The patient has been given 10mgs of valium every hour. “You’ve got a lot of medicine in you, don’t you think it would be better to stay the night,” asks the resident.
Bigelow convinces the man to stay and offers more medicine to help him calm down and sleep. The resident prescribes 10 mg of haldol from Pharmacist Roy Daley who is part of the Code Purple response team. After consultation, Alison Small, Administrative Clinical Supervisor, turns the Code Purple into a Trigger event, requiring that the team determine a course of treatment and monitoring schedule for the rest of the night. Psychiatry is called for a consult and the resident is required to contact the attending physician at home to discuss the case (yes, at 1:30 a.m.).
1:20 a.m.
“Research efforts to translate leadingedge advances to our patients as fast and safely as possible do not stop after dark,” says Program Director of the Harvard-Thorndike Clinical Research Center Alvaro Pascual Leone, MD, PhD. “Many studies can only be done after dark.”
The research he refers to – the impact of sleep on a person’s memory and the effect of sleep deprivation on the body’s immune defenses – both hold the promise of important discoveries.
While the bulk of the human testing is done during the day shift, the two nurses who staff the Clinical Research Center (CRC) on the overnight shift play key roles in the overall process. “Our night nurses not only provide care for CRC inpatients, but also are busy arranging the set-up for all of the many lab samples that will be collected during the upcoming 24 hours,” says CRC Nurse Manager Linda Godfrey-Bailey, RN.
Each nurse also manages a “portfolio” of clinical studies for which he or she is considered the “expert,” working closely with the team of researchers to coordinate the activities and procedures that need to be accomplished as part of that particular research study.
1:22 a.m.
Nurses Genevieve Cloghessy, RN, Helena Sun, RN, and Genevieve Thomas, RN, have become a close-knit unit working overnight shifts together on OR-West. “There are a lot fewer resource people around at night so you have to depend on each other more,” says Cloghessy. “We have to stay alert and be ready for every emergency.”
When not involved in emergency surgeries, these nurses do a lot of prep work for the next day shift. “Usually, we’ll do between two and four surgeries per shift; five at the most,” says Sun. “We get traumas, open fields, stabs, bleeding, appendix, bowel obstructions, a bit of everything.”
1:30 a.m.
It’s time for the monthly two-hour testing of the back-up emergency electricity generators for the west campus, located on West Clinical Center 8. Lead Electrician John Martini adjusts his ear plugs and pulls the switch. The two huge yellow engines lurch into action, build to a roar and fill the mechanical room with a strong breeze.
Second shift and overnight Maintenance work is a dizzying array of nightly, weekly, monthly, quarterly and annual checks, preventive maintenance and testing, along with projects like putting in a new outlet or painting the halls. Responsibilities include air, electricity, water, heat, cooling, medical gases, fire alarms, lighting and emergency lights, doors and elevators, painting, vacuum, pneumatic tubes, plumbing and more. Of course, there are always the immediate needs like plugged plumbing or a malfunctioning door that one of the mechanical section staff who are on both east and west 24/7 must attend to.
“At night, you have to be able to work together to get things done,” Martini, a 10-year night veteran, says of his colleagues who make up the overnight maintenance team.
1:57 a.m.
After hearing a few groans, the cry of a baby is heard from one of the delivery rooms and a baby girl is born, making this the fourth baby of the night.
3 a.m.
D&D rounds (Staff refuel with a run to Dunkin’ Donuts.)
3:20 a.m.
On Farr 2 an elderly male patient is sitting among the staff at the nurses’ station, quietly rocking back and forth and talking to himself in a confused, hushed voice. Asked if it is a common practice to have a patient at the station, a nurse explains, “If they’re happy and they’re quiet and you can get your work done, you’re golden.”
3:46 a.m.
Two CC6 nurses jump to help a colleague prepare a room closer to the nurses’ station for a middle-aged woman with Down syndrome who has become disoriented and agitated. “Why are we moving her?” asks a third nurse as she joins in to help. “Because the room is open and this way we can all keep a closer eye on her for the rest of the night,” answers the first nurse.
4 a.m.
Twenty-three of the 25 beds in Deaconess 4’s Psychiatry Unit are full, including one patient who has been here for six months. “Most stay an average of between five to 10 days,” says Anna Farrow, RN, one of three nurses staffing the unit tonight.
5:30 a.m.
Rick DiScipio, MEd, CSCS, NSCACPT, unlocks the doors to the Tanger Be Well Center. DiScipio arrives at 5 a.m. to get the gym in order before the first members come in to workout at 5:30. In the mornings, DiScipio usually takes care of administrative tasks and class curriculum duties. He also holds personal training appointments. By 6 a.m. there are about 10 people on the floor using the weights, bikes and treadmills.
5:45 a.m.
Kitchen staff begin preparing breakfast. That means east campus Chef Gary Santilli begins cracking eggs – lots and lots of eggs.
Room service for patients is cooked to order so to get ready for the influx of meal requests the early morning staff get the coffee brewing and begin prep work for the French toast and eggs. The first breakfast orders begin coming in at 7 a.m. As the patients start calling down, room service tickets start to print. A timer is started when an order comes in to ensure the food gets delivered within a 45-minute time frame.
“It’s a little symphony that all comes together,” says Dan Hughes, Food Services Manager-East. “The reason it all works is because the staff care. They know that if it doesn’t get done the patients and staff will suffer.”
6 a.m.
The last two hours of the overnight shift in the laboratory on the West Campus are the busiest of the shift, as evidenced by the steady “thumps” of the plastic tubes dropping down through the two pneumatic tube systems. “The daily phlebotomy draw begins at 5 a.m.,” explains Corey Ferreira, Chemistry Team Leader, Third Shift. “This means all blood samples from inpatients on the west campus begin arriving via the pneumatic tube system about an hour or so later.”
By 6:30 a.m., the vials of blood specimens, cloaked in paper computer printouts and secured with rubber bands, are arriving in groups of 10 and 12 within the pneumatic tubes – nonstop, one after another – whoosh/thump, whoosh/thump.
8 a.m.
Calvin Taylor, Information Services, is nearing the end of his midnight to 8 a.m. shift as the sole member of the IS team working overnight at the Renaissance Center. As a security measure, the opening bars of the theme song to the classic Western film, “The Good, The Bad and The Ugly,” announce the arrival of day crew members. Taylor smiles and waves.
A 33-year veteran who began his career as a data entry operator for the former New England Deaconess Hospital, Taylor has been working the overnight shift for the past 15 years. His tasks include taking over for the Help Desk, aiding staff who get locked out of important clinical programs or files, overseeing bill and payroll printing jobs, and always being on the look-out for system failures and problems.
Working the overnight shift gave his wife, Corine (who works days), and him the ability to always have one parent home when their two children were growing up. “The kids didn’t always like it that way, but that’s OK,” Taylor says with a hearty laugh. “Calvin Jr., is doing his second tour in Iraq and our daughter, Tamara, who wants to be a doctor, is getting her bachelor’s degree in MRI imaging.”
