I went into an all night pharmacy recently, after getting off of work at 10 p.m. I had to pick up a prescription for my endless, insomnia-inducing cough. Walking up to the counter, I was bathed in the smell of cigarette smoke, carried on the coats of patrons. Eight of us stood by the counter, outnumbering the staff by 100 percent. I checked in and waited for my prescription to be filled. And in the eyes of the pharmacist and technicians, I saw exhaustion: physical and emotional.

It’s a 24/7/365 world out there, and nowhere is it more evident than in anything related to health care. It’s easy for me to think doctors are the weariest. But that’s arrogant poppycock. I’m only a cog in the great wheel. Pharmacies dispense medicine all night because people are sick and go to the hospital all night. Nurses comfort the sick and ambulances run all night long, in weather and situations that make even the postman shudder.

In addition, when it comes to safety, firefighters rescue the imperiled all night and police officers risk their lives and enforce the law at all hours. Power company workers repair lines and road workers keep highways flowing as rail workers run the trains on time, and air traffic controllers watch the skies. And none of it stops at 5 p.m. Airmen, sailors, soldiers and marines keep watch all night as well, in dangerous and inhospitable places.

We sometimes forget that packages are moving across country while we sleep, driven by tired drivers and pilots, sorted by fatigued men and women in shipping departments. God bless them; people are processing orders and doing tech support all night by phone and computer. Many restaurants, especially the kind frequented by those listed above, prepare, serve and deliver food throughout the watches of the night. Gas stations, hotels and convenience stores are always open and staffed by the weary.

The list goes on and on. But the truth is, we have created a world in which some group of people always has to be awake at night. There’s really no going back to the time when the lights went off at 8 p.m and we were all in our beds waiting for the rooster to wake us to another rested, bucolic day of agrarian simplicity.

Anyone who has worked at night, for any length of time, knows the toll it takes. I have spent more than my share of nights awake, working in the ER. I’m proud of that. I have learned to power through, to make the right decisions. Nevertheless, a few long nights and I’m weary to the bone; I hurt all over and I feel dizzy. My 50-year-old body crying out for deep, restorative sleep. It’s not just me; studies on sleep deprivation paint a grim picture of the physical and mental problems associated with fatigue.

I knew what I was getting into as a doctor. But all too many people find themselves on nights, in industry or public service, because the new guy gets nights. And doesn’t get days until someone, or several someones, leaves or dies. Yes, it’s a job. They’re glad to have it. Certainly, too, some people just seem designed for nights. I’ve worked with them. They’re happiest working “third.” They’re probably vampires.

On the balance, though, almost everyone would rather work in the daytime or evening. Not only because we feel lousy when we’re tired. But because there’s a magic to being home with the ones we love. Tucking the kids in bed, sleeping with our spouses, locking the doors and turning off the lights — those are gifts to treasure. It’s hard to replace those things with white noise, fans, and blacked-out windows.

All of it is more pronounced during the holiday season. Admittedly, I sometimes enjoy the hospital at night, especially when it slows down, and we can turn on a little music. And there is a beauty to driving to work in the darkness and coming home as the world wakes up. Still, it’s sweeter to be home with lights around the tree and Christmas movies on the television.

Everyone who doesn’t work at night could just be a little kinder and a little more sensitive to those who do. If you have to call someone out, give them a tip or a snack. If you order in a restaurant, be a little kinder, a little gentler. If the problem you have can wait until morning, let it. The men and women awake all night are there, yes, and it’s their job. But a slow night is a rare wonder.

And especially for all those who risk their lives at night to keep us safe, warm and comfortable, we should all say a special thanks and prayer for safety. Because being up all night is interesting, and sometimes profitable.

But it’s almost never preferable. And I speak from experience.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test and Life in Emergistan.  

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