New York is the city that never sleeps. But this renowned insomnia would not be possible without the more than 200,000 men and women who work the nightshift – the fry cooks and coffee jockeys, train conductors and cab hacks, cops, docs, and fishmongers selling cod by the crate. Inverting the natural rhythm of life, they keep the city running as it slows but never stops.

In our book, NIGHTSHIFT NYC, we tell the stories of New York City nightshift workers. This ethnography of the night investigates familiar sites, such as diners, delis and taxis, as well as some unexpected corners of the night, such as a walking tour of homelessness in Manhattan and a fishing boat out of Brooklyn. We show how the nightshift is more than simply out of phase, it is another social space altogether, highly structured, inherently subversive, and shot through with inequalities of power. NIGHTSHIFT NYC presents the narratives of those who sleep too little and work too much, revealing the soul of a city hidden in the graveyard shift of 24-hour commerce when the sun goes down and the lights come up.

But there is more to the story than found its way into the pages of the book. Here you'll find more stories of the night in New York City and around the country. And we hope you will add your own stories and comments in the months to come. Stay tuned and check back often...

Tuesday, February 17, 2009

Nap Time

Though we came across many profoundly tired workers during our year on the nightshift, none were as tired as Dave. He was a second-year resident in charge of a cardiac intensive care unit for the night. We met fourteen hours into his 27-hour shift. He couldn’t remember what he was about to do, he could barely speak, and he was in charge of some of the hospital’s most vulnerable patients.

The Accreditation Council for Graduate Medical Education (ACGME) constantly seeks to issue regulations that balance limiting the number of hours residents can work with the time-honored tradition of extended shifts. In 2003, the ACGME limited residents to working no more than 80 hours a week. But last fall, they noted in a letter to Health Affairs that residents of certain specialties were still working – and, some argue, needing to work in order to provide the best care for their patients – beyond those limits.

In a recent issue of Health Affairs, Elizabeth Gaufberg, an assistant professor of medicine and psychiatry at Harvard Medical School, cites her own experience as a first-year resident. One night in the ICU, suffering from a postnasal drip that kept her awake even on nights off, she looked around and realized that all was calm. It was 3:47 a.m. “Every patient was stable, all notes written,” writes Gaufberg. With nothing to do until morning rounds at 6 a.m., she prepared to sleep. Moments later, a cardiac resuscitation code was called for a patient somewhere else in the hospital. If they survived the resuscitation, Gaufberg knew, they’d be transferred to the ICU: her quiet, stable ICU. Sleep deprived beyond measure, she found herself wishing the patient would not survive. “I said a silent prayer,” writes Gaufberg, “that the patient would die and retreated to the call room.” She slept. The patient died. Gaufberg was forever changed. “There were many other moments in residency that challenged my compassion, my humanity. Most of them occurred when I was soul-numbingly tired. But somehow I was always able to remember and hold that moment as a terrible touchstone—that moment in which I wished a patient dead.”

On December 2, 2008, the Institute of Medicine released a report proposing additional measures to limit residents’ “duty hours,” including required naps between 10p.m. and 8a.m. and a limit of 4 nightshifts in a row. A New York Times editorial on December 9 joined other experts and activists in criticizing the proposed requirement for residents to take a five-hour nap in the middle of a long shift. “That mandate seems impossible to enforce,” they wrote, “and few residents are likely to get five uninterrupted hours of sleep. A ban on shifts longer than 16 hours seems preferable.”

It’s a complicated problem to solve. And expensive. But the 80-hour limit in the US far exceeds the number of allowable duty hours in other countries. It’s 72 hours in New Zealand, 52.5 in France, and less than half – 37 – in Denmark. I, for one, wouldn’t want Dave watching over me if I had to be in the cardiac ICU, unless he’d just had a long nap.

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