I wake when the sky begins to darken. As the sun buries itself beneath the horizon, the hospital beckons.

Nights bring a kind of calm. I find that wakefulness, while others sleep, grants me something sacred — time, untouched.

Circadian rhythms align us with light: The sun guides us through our days, the moon lulls us to sleep. Night shifts cast aside any semblance of schedule and orientation. At dusk, my body starts to ache, roaring against night. The quiet joints in my fingers begin to throb. My muscles twitch in silence, yearning for movement, while my bones creak, protesting activity. Loudest are my thoughts: my mind sears in upheaval against the inhumanity of staying awake despite the darkness. Whispers of delirium rumble from within. We sacrifice so much of ourselves in caring for others.

When all is dark, fatigue fills the void. Like smog obscuring my mind’s eye, an oblivion of exhaustion sets in. I feel nothing, only numbness.

Deep within the sensationless void, intoxicated by a crisp crescent moon, my mind clears. In these small hours, my thoughts sharpen. I question whether my body is rebelling against something greater, and a sadness sets in. It gnaws at me, this ever-present instinct, a kernel of doubt nudging my illusion of happiness.

Doubts tremble beneath the surface, animated by darkness but quiet in the bright of day. The forbidden comes to light: I can’t deny the secret fantasy I have had for it all to end, simply and suddenly. The thought flickers every so often, inextinguishable. A lifetime seems incomprehensible.

Deep-rooted fatigue becomes painful as the grip of weariness tightens. I feel the weight of the mundane, unwieldy, and formidable. Everything near seems far away. My thoughts are incomplete sentences—running on and on with no end in …

Sigh.

How come I can no longer feel delight?

I shiver. The world is colder at night.

Slowly, I settle into the restlessness of an ever-moving mind, awaiting the calm. I trace the curvature of a now-waxing crescent moon. Earthshine, they call it. The moon casts a shadow upon itself, self-imposed darkness. I, too, feel at times as though I am living underneath my own shadow.

A clarity of sorts rises with the sobering sun, and I find myself strengthened by the light. I look up, in admiration of dawn, suddenly filled with unparalleled gratitude for being.

Trisha K. Paul is a pediatric resident. This piece was originally published in Pulse — voices from the heart of medicine.

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