One hour before the shift starts
Hit snooze. Hit snooze again. Break alarm clock with fist. Sleep until last possible moment. Think about showering but don’t. Wear same clothes as previous day. Mmmm, eating would be delicious, wouldn’t it? Skip it. No time. Exercise robust arsenal of curse words as you fight traffic on your way to work. Feel palpitations. Achieve peak levels of dread. Yawn so big jaw locks open. Park next to moron who doesn’t know how to park.
The first hour
Previous shift hands off your panel of patients and laughs. Ask questions. Why so many patients? Why is there so much left to do? Why is he or she still here? Why do I still work here? Stall. Find caffeine source. Bolus it in unholy quantities to create artificial state of alertness. Pass on cafeteria breakfast in favor of sadness. Open up patient charts. Open up Facebook and email. Scroll through Facebook and email. Ignore patient charts. Replete potassium.
The next four hours
Create plan of attack. Then fail miserably due to BS in its many shapes and forms. Patients missing. Patients demanding. Patients falling. People calling. People paging. Everyone’s upset. NPO patient is eating. Anticoagulated patient is bleeding. Code Blue. Code Red. Codes of all colors. Overhead reminder about something no one cares about. Multidisciplinary meeting that each discipline would rather do without. Computer system fails, freezes, or, worse, is upgraded. You hear from people you don’t need to hear from. You don’t hear from people you need to hear from. Fill out paperwork for things that don’t require paperwork. Pick your favorite painful confrontation: face-to-face with an administrator or peer-to-peer with an insurer. Constipated. No patient care is actually provided. Your troponin safely ranges from 0.10 to 0.95.
The next one hour
Yearn for lunch. Read work email about that innovative new piece of nonsense that administration wants to implement against everyone’s will. Gossip. Guess which co-worker resigned this time. Commiserate with colleagues over your job reaching glorious new levels of disappointment. Consider stealing food at random conference. Laugh at some viral post on a social media site; it usually involves a small, furry animal. More gossip.
The next five hours
Stare at work list that now resembles a Jackson Pollock painting. Cry. Curse. Vomit. Throw inanimate objects. Throw animate objects. Go through ten-minute meditative exercise of entertaining other career alternatives. When blood glucose drops below 60, consume lunch at a rate that guarantees aspiration. Snap at co-worker. Develop flank pain due to kidney stone. I forgot to pee! The Note Formula still holds true: # of hours left in the shift + 6 = # of notes left to write. Random bad outcome. Someone leaves AMA. Someone stays AMA. Unexpected discharge. Several thwarted discharges. Litany of F bombs. Get the Narcan ready. Dream of a nap. Restraints and Haldol, please! Fall asleep at work station. Wipe drool off face. I’m constipated. Again, no care is provided. Explain to friends and loved ones once more why you’re stuck at work. That or curl into fetal position and suck thumb aggressively. Engage in bitter self-loathing.
The last hour
You’ve done nothing; scramble and make it look like you did a ton of stuff before the next shift comes on. Hallelujah! Sprint out the door. Use leftover curse words on miserably long commute home. Pretend to be productive at home; fail with flying colors. Retreat into introverted shell. If narcolepsy sets in, fall asleep in work clothes. If not, artificially induce sleep: drop two Benadryls into a glass of red wine. Oh wait! Remember something that you forgot to do. Worry you might lose sleep over it. Minutes later: pass out like a freaking champ.
Repeat this routine daily to achieve maximum dissatisfaction.