What do sole overnight ER docs do all night?

11 p.m. That’s when my usual shift begins at the emergency department of the Georgian Bay General Hospital in Midland, Ont. I started worked evenings and overnight not long after I started working here as a resident in 1998 at age 41. I was one of only three doctors who were selected for McMaster University’s inaugural three-year residency program in emergency medicine and family practice residency. I considered myself lucky to get into that pilot program, not only because of my age but because it combined the two things I’m most passionate about: emergency medicine, and helping people in need of medical attention. Read: So what do plastic surgeons do all day? I already knew that because I’d spent 16 years working as a paramedic here in Simcoe County, Ont. before going into medicine. I grew up—and still live— in the town of Penetanguishene (just Penetang to the locals), a five-minute drive from the hospital. Sports were my thing as a kid, and playing for Penetang’s Junior ‘C’ hockey team was the high point of my athletic career. After high school I went to Humber College in Toronto and did the one-year ambulance and emergency care program. When I graduated in 1977 I was only the 68th emergency medical care attendant in the province. I spent my first six years in nearby Orillia, where I was notably seconded to the provincial air ambulance program and did some rotations in Sioux Lookout in northwestern Ontario. I also instigated some regional projects like mapping nearly 1,000 square miles of emergency routes for ambulance, fire trucks and the OPP, and equipping ambulances with teddy bears for injured children. I was married then to Carmen Duvall, my childhood sweetheart and a nurse. After our daughter Julie was born, I took a job with the then-private Midland ambulance service and we moved back to Penetang in the early 1980s. Being a paramedic is physically demanding work and there was little coverage or job security back then if you got injured. As a backup plan, I thought I could go into teaching, so I started taking part-time courses in medical anthropology and geography at York University in Toronto. Around the time I graduated in 1993, I took an advanced support course on resuscitation here in Midland with Dr. Peter Cameron, a local family physician. When I beat him on the exam, he told me I should go to med school. He was only joking, but it turned on a light in my head. Everyone said I was crazy, but I applied to med school at McMaster—the only one that fit my life and career—and I got in! Returning here years later as a licensed physician was interesting to say the least. Most of the doctors and nurses here knew me as a paramedic, and it took some adjustment for them and me. I think I won people over with my team approach to medicine, and the fact that I’m calm under fire in critical care situations. Being a paramedic taught me to always think three steps ahead so there’s no panic. Panic is the enemy in any emergency. As a doctor, I see myself as the team manager when handling critical care cases. I try to hurry things up slowly. Even now nurses tell me that I get things done calmly, without any yelling. In addition to working in emerg, I practiced family medicine at Dr. Cameron’s clinic in Midland. I also worked part-time at the medical clinic on the Ojibway First Nations Reserve on nearby Christian Island. I’d go out there once a week on the ferry when it was running, or drive over on the ice road in winter. It was only a 20-minute drive but it was always an adventure. Cars could and did go through the ice into the deep waters of Georgian Bay. When they did, the word was that if you had electric windows, your car motor would stall and you couldn’t get the windows down to get out. Fortunately the old GMC van I’d driven since med school had manual roll-down windows. But even today, I still order roll-down windows for all my vehicles. Back then I also set up an early recruitment program—a first at the hospital—that brought in med students for two- to four-week stints. It was eventually absorbed by the ROMP (Rural Ontario Medical Program) program. I also part of a team that helped to develop national competency guidelines for Canadian paramedics. Those efforts earned me the 1999 Ontario Premier's Awards for Health Sciences. By then my daughter Julie had left for university (she became an occupational therapist and works here at the hospital), so I started offering to work the evening and overnight shifts of my colleagues who had young families. I quickly acquired a liking for it. One reason is that there’s a higher average of people who are really in need of medical attention, which is why I do this. The atmosphere is better at nights too. There’s less administration, less arguing and more team support. And patients are much more appreciative of the care you provide. The challenge though is getting critically ill people to the right specialist, and getting CAT scans and other tests done. 1 a.m. From now until 7 a.m. it’s single doctor coverage at our hospital. We are a small but comprehensive facility in cottage country that provides womb to tomb care for the local population but also cottagers and visitors, especially during the summer months. We get ambulances and walk-ins all night long, and the occasional emergencies on the floors we look after and the ICU. It can be hectic and adrenaline-filled, but that’s what I like about it. We deal mostly with fevers and chills and coughs, but it is interspersed with serious emergency cases like cardiac arrests and trauma from drowning or accidents involving cars, motorcycles and snowmobiles. We treat minor trauma, but for major we stabilize and either fly on helicopters to Toronto or, when the weather’s bad, by land. I’ve done a few of those trips by both land and air, once as far as Buffalo. 7 a.m. It’s the last hour of my shift, so it’s time to start phoning the doctors of all the people I admitted overnight to ensure proper patient disposition and follow-up care so they get sent down the right road and don’t fall through the cracks. I consider those calls to be the most important part of my overnight shifts, which I usually do for four or five consecutive nights. 8 a.m. Once the handover is done, I head home to my wife Kim, a nurse from Midland who I met and married a decade ago. I used to go home and do a workout or run, which helped to keep me in shape to play hockey in local men’s leagues and with our hospital team, the ‘Huronia Junkyard Docs’. But these days I prefer to read and relax and sleep during the day. I just turned 65 and I had both of my hips replaced with an anterior approach in early March in Toronto. I plan to start back to work on April 20. I’m looking forward to it because I’m bored to tears. I’m looking forward to retirement in a few years. Fortunately, the future is looking bright for this region in terms of medical manpower. One reason is that, since 2014, our facility is recognized as a satellite teaching site for the Northern Ontario School of Medicine. An initiative started by my colleague Dr. Phil McGuire and I, when I was the hospital’s chief of staff, it gives kids from here a better chance of getting into medical school. The fact that we’re the southernmost campus for NOSM also gives med students a chance to discover our fabulous region, and many graduates come back here to practice. 8 p.m. I eat supper before my shift and prepare a snack—either a piece of fruit or a sandwich— to bring with me to work. I almost never eat the food I bring to the hospital though, because things are just too busy. 10 p.m. I usually read or relax for an hour before my shift. Then it’s off to the races!

What do sole overnight ER docs do all night?

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