My head is pounding. I almost never get headaches.
I am halfway through my shift. It is 2 am and I am just not feeling it.
I haven’t had a normal night’s sleep in about a week.
This new rotation in the schedule is besting me.
I am not proud to admit it, but at this point, I’d rather be at home sleeping.
It took me years to learn how to do this and people need my help right now.
I really don’t have time for this headache.
Why? Because. Just like you. It’s the way I am wired.
I don’t take much time to think about my own wellness.
An unfortunate downside to my wiring.
Tonight, it feels like I am laying my own wellness at the altar of medicine.
The science tells me that I will have processed hundreds of decisions and been interrupted no less than 120 times by the end of this twelve-hour shift.
Along with the fatigue and headache, I begin to worry that I will make a mistake.
My instincts tell me that my decision quality is rapidly declining.
The rest of this night shift depends on me listening to what my brain is trying to tell me this very moment.
I pause for a few minutes. I need some time to just clear my head.
I take a breather.
But it doesn’t last long at all.
Suddenly I am called to the bedside of a patient. I had to deliver bad news to him earlier tonight. The CT found a mass in his bladder and it looks like late-stage cancer, but it’s not him the nurse is worried about.
Instead, the nurse is worried about our patient’s wife. She is feeling lightheaded and having chest pain. Now she too becomes one of our patients. Her ECG is severely abnormal and given how sick she appears I call the cardiologist who takes her to the catheterization lab.
I found out later that night she was suffering from ‘Broken Heart’ syndrome.
I’ve seen Broken Heart Syndrome only a handful of times in my career and I am always moved by the relationship between the brain, emotions and the heart.
I read a short article in JAMA a few weeks ago that provided a glimpse into the connection. Here’s the gist of it.
Diminished connectivity between the heart and several central neural networks may be essential in understanding ‘Broken Heart’ syndrome, also known as Tokutsubo cardiomyopathy.
In reading the article I learned about a neural subnetwork I hadn’t known about before and it may help me get through this tough night shift.
In school, I remembered learning about the sympathetic and parasympathetic neural subnetworks of the central nervous system, but I did not realize there was a another neural network that is equally important.
It is called the Brain’s Default-Mode Network (DMN) and over the past ten to fifteen years scientists have only begun to gain an inkling of understanding about it.
The brain default-mode represents a dance between different brain regions that spring into activity when a person is in a state of wakeful rest.
In those moments when I wander off silently or daydream, blurring the outside world out of focus, part of my brain kicks into hyperdrive. In those moments the brain may very well be restoring and preparing me.
My brain in its default mode is processing prior experiences and anticipating future events. It’s as if the human brain is equipped with its very own simulation system.
And in fact, one of the subsystems of the brain’s DMN has been dubbed the simulation subsystem. Go figure.
Tonight’s shift feels like it’s kicking my butt, but how I navigate my decision-making tonight is, at least in part, tied to how I have anticipated these conditions in the past.
In moments of profound fatigue and vulnerability, I am depending on prior training to get me through the rest of the night. Prior training that will help me get through the unique circumstances I encounter tonight.
Then, it hits me!
Those moments when my mind wanders off, in between patients, maybe less about losing focus and more about my brain working the way it is designed to work.
This night shift is all about survival. The human brain has remarkably evolved to handle shifting demands in our environment. Being able to modify our behavior to achieve an outcome, as variables change, and avoid danger is an adaptive trait known as cognitive flexibility. In contrast, there are parts of our clinical work that become second nature to us. This information comes to represent a behavior closely linked to memory and specific contexts allowing us to respond more efficiently and sometimes faster. These instances represent cognitive stability.
Cognitive stability and the ‘autopilot’ part of our decision making seem to be closely tied to the brain’s DMN allowing us the “ability to integrate memory-based information, generating top-down associative predictions under stable environmental contexts for automated, fast, and efficient decision making.”
The DMN is our autopilot when we are in a task-free resting state. For some people that’s a walk in the park, but for us its the walking equivalent of working a night shift. It could be I need to let my mind wander from time to time to help me make it through this night shift. A way to combat cognitive fatigue and the stress of adapting in a rapidly changing environment.
Interestingly, broken heart syndrome is not the only condition associated with diminished connectivity to the DMN. A similarly diminished connectivity to the DMN has been observed in those suffering from PTSD, a growing concern for healthcare professionals ranging from EMTs, paramedics, and nurses to physicians.
At MedCognition we think about this sort of thing, a lot. We created an immersive holographic training tool for medical simulation that is affordable, portable and realistic.
Why? Because nights like this come for us all and getting through it will depend on preparation and having the best tools to make a difference before they come.
Your work on the frontlines of healthcare matters. You are the best. PerSim® can make you better.
Visit us at www.medcognition.com to learn more.