Graveyard Shift

It’s well past midnight at the central station of Enloe Hospital’s emergency room. Two nurses are taking a 30-second breather, reviewing the large white marker-board where patients’ conditions are recorded. Next to each bed number is a code indicating the patient’s primary complaint—most commonly URI (upper respiratory infection), AP (abdominal pain) or ETOH (alcohol poisoning). Other codes are more self-explanatory: FALL; VOM +.

According to the board, a new patient has just arrived in bed 7: ASSAULT. It’s not entirely clear, but he may have been brought to the hospital by his assailant.

“So, are they, like, buds?” asks one of the nurses.

“They were like buds,” deadpans the second.

And then, click, the pause is finished. The two nurses spiral off toward different beds, back into the flow of their work—trying to stabilize a patient whose heart is beating irregularly, taking the vital signs of a toddler with a high fever.

Some of the nurses on staff tonight are in the 11th hour of a 12-hour shift and will finish at 2 a.m. Others won’t get home until after sunrise.

Most of Chico is asleep at this hour. But throughout town, dozens of public-safety personnel—police officers, firefighters, nurses, dispatchers, paramedics and physicians—are working the graveyard shift. Some of these people love serving in the dead of night; others are just biding their time until they can be reassigned to a “normal” shift. All of them face a unique set of challenges: long stretches of boredom and fatigue punctuated by rushes of adrenaline and emotionally draining encounters with traumatized citizens. And when they leave work, they’re never quite on the same clock as the rest of town.

For all of these reasons, the graveyard-shifters tend to form tight bonds. They often socialize with, and sometimes marry, each other. Even in tiny moments—as when the two nurses paused to share a little dark humor in front of the marker-board—the intensity of these bonds is palpable. These people trust each other to share in life-or-death tasks.

The primary physician on duty in the ER tonight is Dr. Cory Boyles, whose shift runs from 9 p.m. to 7 a.m. On the eve of his 43rd birthday, Boyles seems both unpretentious (short beard, easy slouch, tennis shoes and large, hangdog eyes) and intensely professional. He walks briskly from bed to bed, pausing intermittently to file reports, order lab tests and consult with other physicians by phone.

Around midnight, Boyles visits a newly arrived patient, a middle-aged woman who has come to the ER suffering from severe abdominal pain. Boyles leans against the wall and quickly asks her a long series of questions: Have you had your gall bladder removed? Has the pain fluctuated, or has it been constant? Does it radiate up toward your chest? How much alcohol and caffeine do you normally consume?

During this briefing, Boyles seem to operate simultaneously in two different gears. His voice is clear, relaxed, musical, but his hand is maniacally taking notes as if he were cramming for a final. He’s calm and fully engaged with the patient, but the instant he begins to make his way out the door, his eyes grow a little colder. You can see that he’s calculating how to juggle his next 10 tasks, how to care for the seven patients under his watch without dropping the ball.

“I have a very serious routine for prepping for these night shifts,” says Boyles. “I’ll shut the door and sleep from 2 [p.m.] until 7 [p.m.], and then I’ll come on board two hours later.” (Overhearing this, a nurse taunts Boyles: “A five-hour nap? What a wuss!” This is the kind of banter that keeps emergency-room staffs sane.)

“Some people don’t sleep at all before a night shift,” Boyles continues. “And that works for them. You just need to find your own way of dealing with fatigue.

“And at the end of the shift, I just go home and hang out with my family. I’ve got a couple of kids who are just the best.” As he says this, Boyles is busily filling out paperwork, ordering a series of lab tests—but he still pauses for a beat when he mentions his children and manages to convey real feeling here. (On cue, another nurse steps in to needle him: “No, no, Boyles. You forgot about my kids. My kids are the best.")

Boyles also has a secret weapon: a guitar. When conditions permit—once or twice per shift—he takes a five-minute break and retreats to the ER lounge to strum on his guitar, which he bought dirt-cheap from a pawnshop some years ago. These brief interludes allow Boyles to recharge his brain and to maintain his balance.

“You’ve got to have a sense of humor to do this work, especially late at night,” he says. “It’s always a balancing act. You need to care about each patient enough to do your very best for them, but not to empathize so much with their suffering that you lose your concentration. That’s the art. If you’re too easily wounded, you can’t carry on. But if you harden yourself too much and you become cold, then you also can’t do this work effectively.”

Tonight, Boyles has to perform what he calls the job’s most emotionally difficult task: speaking with the grieving family of a heart attack victim, a man who was beyond hope before his ambulance reached Enloe. This man had no known history of heart disease or other serious illness. “Unexpected deaths are the worst,” says Boyles. “At least with things like cancer, families have had time to prepare. When you talk to the family in a case like this … you just don’t have any answers.”

Most uncomfortable of all is that Boyles’ visit with the family needs to be highly compartmentalized. He can offer them a few minutes and no more—he still has a half-dozen patients to tend to. (Meanwhile, a social worker on Enloe’s staff has arrived and has made herself available to the family for counseling.) In what must be a mind-numbing sequence of tasks, Boyles goes in quick succession from speaking with the grieving family to filling out lab paperwork to visiting a young man with a minor ear infection.

Across Magnolia Avenue from the emergency room sits Tom Schaub, a night helicopter pilot for Enloe’s FlightCare program. His shift runs a full 13 hours, from 6 p.m. to 7 a.m. This is a light time of year for the program, so Schaub is often able to get some sleep. But if a call comes in, he can be across the street, flight-suited and in the elevator, within two minutes.

Schaub is 53, with a benevolent smile and a formidable head of curly gray hair. He learned to pilot helicopters in the Army over 30 years ago and has been flying for Enloe since 1988. “I love this job,” says Schaub. “It’s the mission. The mission is just so pure.”

The FlightCare program covers a radius of roughly 60 miles in all directions from Chico. Some calls involve rescuing seriously injured victims from hiking mishaps or car accidents; others involve transporting patients from small area hospitals to Enloe for specialized treatment. “Over the years, of course, I’ve gotten to know people at the Highway Patrol, the Forest Service, firefighters. We all know each other, and we all know the area. When certain calls come in over the radio, there’s an ‘ah, shit’ factor—you know that if it’s a certain spot on Route 70, for example, that it’s probably a serious accident. Some places just have a bad history.”

The FlightCare program is itself going through a very difficult time. On the evening of Sept. 22, the Enloe helicopter crashed while attempting a landing in Butte Meadows, killing longtime pilot Ron Jones and injuring two flight nurses. The aircraft was destroyed, and the program is now using a temporarily leased helicopter. Schaub is leading an effort to raise $750,000 toward the cost of a permanent replacement.

“There were 60 days of hell after the accident,” says Schaub. “We were all grieving, and we went into a safety stand-down, reviewing our procedures very intensively every day. It’s just now that we’re starting to get over it.”

Tonight Schaub is sitting at his desk in the small pilot’s station, finishing up some paperwork. He’s also hosting his 7-year-old grandson, who is intently playing Sonic the Hedgehog. (His babysitter unexpectedly took ill today.) Schaub and his wife have cared for this grandson for two years, while Schaub’s daughter has completed Air Force training overseas. For Schaub, working nights has worked well for his family life.

“My wife is a nurse across the street at Enloe,” he says. “We met late one night, on Valentine’s Day 1992. I’d just flown in a victim of a car accident up near Chester, and she was the trauma nurse on duty. We’ve been able to arrange our shifts so that we see each other a lot, and also so that most days at least one of us can take care of my grandson.”

Schaub’s workdays follow a fairly regular routine: He arrives at 6 and consults with the day-shift pilot, reviewing any maintenance issues or difficult flights. He goes online and checks the weather forecast. And then, weather permitting, he’s prepared for duty. “From 6 until 2:30 or so in the morning, we tend to get activity-type calls,” Schaub says. “People who’ve been driving too fast or who got into something at a bar. And then after 2:30 it’s the late-nighters: people who’ve just collapsed. Cardiac cases.”

Boyles, meanwhile, says that the cycle he notices most is days of the week, not hours of the day. “Thursday, Friday, Saturday nights are intense,” he says. “A lot of Chico State students seem to be majoring in alcohol. Halloween, St. Patrick’s Day, we’ve got people lined up in the hallways, and we’re having to put adult diapers on them.”

Next door to the pilot station is Enloe’s dispatch center. Working the graveyard shift tonight, alone, is Robert Sutton, a large jovial man in his 20s. With the aid of a big bank of computer monitors and radio transmitters, Sutton is responsible for dispatching Enloe’s seven ambulance units. The radio stays busy, but still, it can be awfully quiet here.

“You need to bring things to do here to stay awake,” says Sutton, who has a country-music radio station playing at low volume. “But not reading. Reading will definitely tend to put you to sleep.”

“This is my sixth year here,” he continues, “and I’ve been doing nights since the beginning, and I still don’t really feel used to it. I’m waiting for a slot to open on day shift.”

It’s almost 2 a.m., and the radio is growing quieter. “We’ve had a couple of hit-and-run accidents tonight,” says Sutton, “but not much right now.” He spends part of his 11 p.m.­7 a.m. shift completing statistical reports and making sure that each ambulance call has been sent to the proper insurance company for billing.

The most painful hour of Sutton’s career was, he says, the night of the FlightCare accident in September. He had just gotten off duty when the call came in, but of course he stayed on to assist with the crisis. “That’s the kind of thing where your mind just goes on automatic, and you’re reviewing emergency procedures—when and how to notify the FAA, and so on.” Making matters worse, it was hard to maintain solid radio signals to the Butte Meadows area where the crash occurred. “Even our own ambulance crews, it was hard to keep contact with. It was very tough. But everyone stayed calm and did their jobs.”

Difficult though Sutton’s routine might be, at least he can go home after eight hours. Compare that to the lives of the paramedics and emergency medical technicians who work for First Responder in Chico. These folks work 48-hour shifts, sneaking in a few hours of sleep whenever they can.

“There hasn’t been a real problem with fatigue,” says paramedic Marci Arano late one evening, in the 40th hour of her shift, sitting in a paramedic way-station on East Eighth Street. “You just need to address your weaknesses and recognize your own signs of stress. I’ve learned how to sleep for a few minutes at a time in the jump seat in the back of the truck.”

This way-station is a small house shared by Enloe and First Responder paramedics, one of four scattered throughout town. The house is comfortable, but it would be a stretch to call it homey. The mattresses on the beds are bare, and on the kitchen walls are a dozen official workplace posters from the California Department of Labor: “Your ‘Time Off for Voting’ Rights,” and so on.

Tonight Arano, a muscular woman in her mid-20s, is relaxing between calls with her paramedic partner, Tim Greenblatt, and a trainee, Jarrod Page. They’re watching a Sharks game on cable TV, and Page is completing some paperwork stemming from the day’s earlier calls.

“The main thing is,” Arano says, “if you’re going to work a 48-hour shift, you’d better get along with your partner. You find out the funniest things about someone at 4 in the morning—fetishes, family secrets. Luckily, everyone here seems to have a good sense of humor.”

“We get to know almost everyone in the Fire Department,” she says. “When a 9-1-1 call goes out, they send a truck first, and we’re right behind.”

Greenblatt adds: “And we get to know just about everyone in the Enloe ER—nurses, doctors, receptionists.” Asked whether Enloe’s atmosphere is different at night, Arano says, “The night shift can be more laid-back. You don’t have as many administrators or whatnot there. And they’re always playing jazz music in the ER at night.”

Arano and Greenblatt are both young, and neither has a family. “I just have a dog,” says Arano. “So I’m kind of training. And even there it can be tricky to find someone to take care of it for two days at a time.” But they say that despite the 48-hour shifts, paramedic work can be compatible with raising children. “If you have the right kind of spouse and the right situation, it can work. This has been the big baby and wedding year at First Responder.

“Although there was this one story not long ago: [One of our colleagues], who’s been doing this for 13 years, has a young son, and one day that boy peed in his dad’s boots when he realized that he was about to go away for another 48 hours.”

Greenblatt says that he might be a lifer: He hopes to do paramedic work for many years. But Arano is a little skeptical. “How long have you been doing this job, eight months? I thought that, too. Wait until you’re a few years into it.” For her part, Arano hopes to move on to police work, perhaps crime scene investigations.

This, they say, is an increasingly common pattern: People do paramedic work for several years during their 20s, while their strength and energy are at their peak, and then move on to other kinds of public-safety jobs.

If Greenblatt someday decides to train to join the Chico Fire Department, he’ll be cutting his shifts in half. Our local firefighters work a mere 24 hours at a stretch. On a cloudy afternoon, Captain Frank Garrison of Station 2, which sits on East Fifth Avenue, just around the corner from Enloe, is working on paperwork during a quiet moment between calls. He’s been at this station for over a dozen years, and he’s obviously extremely comfortable in this domain.

“We have a pretty standard routine here,” he says, “and we’ve all learned to deal with fatigue over many years.” During the daylight hours, from 8 until 5 or so, his crew works on processing reports and maintaining their equipment. And then at night, during down time between calls, each member of his crew tends to withdraw slightly into himself. “Everyone has a different way of decompressing after a tough call. Some people want to lift weights; others can just go back to sleep right away.”

One of the toughest kinds of calls to come back from, Garrison says, is a false alarm. “You’re sort of resting at night, and then the call comes in. You’ve got the lights going on the truck, you’ve got your adrenaline pumping. And then sometimes you get there and it’s just sort of … nothing. The other night we got to a call and the person said, ‘Oh, I was just trying to make sure that you were real.'”

Garrison says that firefighters have solid relationships with other public-safety workers, especially on night shift, but that these bonds aren’t as deep as they used to be. “A number of years ago we had very tight relationships with people at Enloe. But the system is just a little bit different now. As the city has grown, and as the need for services has grown, we’re not actually in and out of the ER as much.” In other words, First Responder and Enloe’s own paramedic crews are more likely to transport patients into the hospital.

Garrison was once married to an Enloe nurse, and he says it’s natural for such people to gravitate together. “Nurses, police, fire, paramedics—we all deal with the same types of issues. Not only the weird shift schedules, but facing human trauma. We tend to communicate with nurses well. They’ve seen people with their arms shot off, for example, so we understand some of what goes on in this job.”

Working odd hours can have real benefits for family life, Garrison says. Firefighters have several days off in a row, so they’re sometimes able to play major roles in child rearing. “I can tell you as a father, I have a lot more time to spend with my kids during their non-sleeping time. Of course, now they’re teenagers, and their doors tend to be closed,” he quips. “But over the years, it’s been a serious advantage. I’ve really gotten to know my kids.

“On the other hand, there are costs. We work holidays. There’s maybe two years, three years in a row when I’ll work Christmas. You’ll miss birthdays periodically. I’m missing my son’s first wrestling match of the season today.” And working opposite shifts is never easy on a marriage: “My wife had to be at work at 7 [a.m.], I got home at 8. There’s just a lot of saying hello in passing in the hallway. You lose communication.”

At 11 on a Sunday evening, Officer Richard Hartman is setting off on his graveyard-shift patrol for the Chico Police Department. He’s a tall, soft-spoken ex-Marine who looks younger than his 30 years. The graveyard shift runs from 9:30 p.m. to 7:30 a.m., but the first hour and a half is devoted to the evening briefing and other administrative tasks. Around 11, the cars get rolling. Hartman checks the computer monitor installed in his car, reviewing the calls that are currently “live.” Then he performs the mandatory check of his car’s rifle and shotgun, making sure that they’re clean and loaded.

The department has a complex system for assigning shifts. The officers’ schedules are divided into three-month blocks. At least once every three years, every officer must do at least one three-month stint on each shift—the day shift, the swing shift and the graveyard. Beyond that basic requirement, shifts are assigned according to seniority.

For Hartman, the graveyard shift works well. “My wife is a hair stylist, so she works days. And we have two small kids. I work when she doesn’t work, and she works when I don’t work. So we don’t have to pay for child care, but we also don’t see each other much. That’s the tradeoff. It’s kind of bittersweet.”

Much more than fire or medical work, policing is a radically different experience when done at night. “On graveyard,” says Hartman, “we get many more in-progress crimes. During the day, you tend to be pursuing investigations or doing quiet patrols. But at night, especially on weekends, the stuff we’re dealing with is happening right now.”

The evening’s first calls are low-key: Three young men have been spotted trying car door handles in a north-side neighborhood. A man flags Hartman down on Normal Street, saying that he saw someone crouched under the steering wheel of a parked Cherokee down the street. (This turns out to be not a person but a large pit bull, which isn’t pleased to have a cop’s flashlight shining in his face.) A “bolo” call—"Be on the lookout for"—about a young man who may be suicidal. Juveniles are allegedly smoking drugs in an apartment on 21st Street.

A single car responds to most of these calls, but other officers will generally circle around the area, so they can be close by if anything goes wrong. “There’s definitely a feeling of heightened alertness at night,” says Hartman. “We all look out for each other, make sure everything’s OK at every stage.”

As we cruise down Humboldt Avenue, I ask Hartman about his social life. “Almost out of necessity, my wife and I tend to socialize with other cops. If your days off are Tuesday, Wednesday, Thursday, those are not the nights when most people are oriented toward going out on the town. On the other hand, I also try to force myself to go hang out with people who aren’t cops. If you’re just talking cop talk—for the most part, that’s not normal conversation. Many of the people I come into contact with on the job are leading very distressed lives, and it’s good to remind myself that the whole town isn’t that way.”

Like Boyles, Hartman says that the central balancing act of his job is to care about the people he comes into contact with, but not so much that he gets thrown off kilter. Once in a while, Hartman says, he can be drawn in deep: Not long ago he and his colleagues visited a severely distressed meth-lab home and referred three children to Child Protective Services. “One of those kids, my wife and I were ready to adopt,” he says. “It was just so heartbreaking. Luckily, there was an uncle in the picture, who was able to take in the kids. But if he hadn’t stepped in, we would have adopted. There was just no choice.”

Just after 1o’clock comes the night’s first adrenaline rush: “Four-fifty-nine in progress,” a call of a burglary at a small financial-services firm on the southeast side. Two bearded men in jeans and work boots have been spotted crouching in the back of the office. One of them is reportedly carrying a black bag. Along with two other cars, Hartman races down Park Avenue at better than 70 miles an hour.

When we arrive, Hartman positions his car about a block from the office, shining his car’s spotlights in various directions, to see if the suspects might be spotted in flight. Meanwhile, the other officers are assessing the scene. They see no sign of burglars and no sign of forced entry or open doors. And the “RP,” the reporting party who first called the police, who is himself bearded and in jeans, is acting suspiciously.

What was he doing in this forlorn corner of town at this hour in the first place? Hartman asks dispatch to check the man’s record; the word soon comes over the radio that this guy “has an extensive history of commercial burgs during the holiday season.” But, if he’s up to no good tonight, why did he call the police himself?

After 15 minutes of anxious searching, the police finally conclude that there was no burglary. The RP says that he was in the building performing his regular custodial job at his parents’ medical-training business, three doors down from the financial-services office. A series of phone calls confirms that this may be true—he does have legitimate access to his parents’ office.

But the police finally badger the RP into admitting that he’s on parole and that he shot himself up with methamphetamine six hours earlier. The police strongly suspect that he was here not to clean the place, but to borrow hypodermic needles. The RP looks downcast. The police officers, too, are looking at the floor. It’s a sad case. (This whole conversation takes place in front of the office’s door, which features a dot-matrix image of a smiling nurse wielding a giant needle.)

The police finally decide to bring the RP in overnight on a “parole hold,” since he’s violated his court-designated curfew. Tomorrow his parole officer will visit him and decide how to proceed.

Did the RP call in the burglary in order to invent a cover story for his own “borrowing” of his parents’ needles? Hartman doesn’t think so. He believes that the RP honestly hallucinated the burglars. That kind of paranoid imagery, he says, is a common phenomenon among advanced meth addicts.

This is the kind of call that comes only in the dead of night. And it conveys something of the labor that all public-safety workers commonly face: rushing into action to face a situation that isn’t quite as it first appeared. Being faced with people whom you’d like to help but can’t do nearly enough for.

Meanwhile, it’s time to head back toward downtown. In 10 minutes, the bars will close.