Face the Nightmare

Shakespeare. Act 2, sc. 2, l. Julius Caesar .

Cowards die many times before their deaths;

The valiant never taste of death but once.

Of all the wonders that I yet have heard,

It seems to me most strange that men should fear,

Seeing that death, a necessary end,

Will come when it will come.

A brave man dies only one death. The words are easy, but on this sleepless night, each time Josh closed his eyes, there was a nightmarish end of life of not only himself, nor those he loved, but strangers throughout the Earth.

He really should know better than to watch the news.

These recent disappointing months where hope of the war ending had dissolved into nothing but as clear as mud honest interactions was upsetting. The number of Chikungunya cases was increasing in East Asia. The painful disease, transmitted by infected mosquitoes usually has only mild symptoms with pain that do not need medical attention. But cases of fever, muscle pain, nausea, fatigue and a rash lasting more than one to two weeks, leading to debilitating joint pain and organ degradation were also increasing. Those pesky mosquitos were thriving with the humid climates.

His dream featured a giant zebra mosquito piercing the hand of a soldier in the Ukraine, and in the distraction, the soldier had met a tragic end. Others on the field were being injured as bombs and mosquitos attacked. Then he and his wife Sally were down.

Josh woke up sweating. It was not a surprise that he was having a nightmare. He had taken on a few extra shifts that added to the exhaustion that was part of the stress of the emergency room. He had become used to taking the Benzodiazepines and "Z-drugs" like zolpidem (Ambien), zopiclone, and eszopiclone if he needed to push harder than usual. He knew the pills were sometimes needed to ensure a good sleep to perform well in the shifts that alternated between day and night. And these days had been busier than ever.

He remembered when he had pushed hard to finish his med degree. Somehow people in the medical system are supposed to have superhuman powers and be able to function on 12-hour shifts. Add two hours for travel and God forbid any social activities with friends or the stupidity of having children that take up time that makes life worth living.

Nothing happened if he only took it for two days, but if he took on the third day, he was guaranteed vivid and disturbing dreams, including nightmares, upon withdrawal. It was the rebound effect in REM sleep, where dreaming occurs, after the medication is stopped.

Sally rolled over and caressed his chest. She knew the drill and felt for her man. Josh was exceptional, but lord almighty, he was a man, not some superhuman. She had watched him through the crazy hours of his residency, thinking that was the worst, but they had been running on a hamster wheel for over the twelve years they had been together. It starts to get old. There were times when the fancy house, cars and vacations have their pay back, but it was on nights like this, when the costs of working impossible to maintain hours and the increasing stress of doctor shortages, compromised the overall value of life.

Sally was a mental health worker. She knew for a fact that sleep deprivation negatively impacts mood, increases the risk of burnout, and can have long-term health consequences. But now she agonized as she watched her beloved ‘coming off’ of sleeping pills. He usually only needed them for two nights a week, but if there was cause for a third night of meds, as happened this week, the predictable dark night of the soul would follow.

Some people think Doctors can get used to sleeplessness or pride themselves on needing only 6 hours of sleep. They have had to train long shifts and hone their brains and discipline so that maintaining straight headed is second nature, however the reality is that there had been one too many occasions that too little sleep significantly impaired her man’s cognitive and physical performance at home. God help the patients who were equally exposed to an increased likelihood of medical errors, accidents, and reduced patient care.

Sally was swept into Josh’s dark night of the soul where haunting visions of simple mistakes were magnified in her imagination and transferred to Josh. Touch wood, nothing had ever happened. Josh knew himself well enough to know how to stay slow and steady. He could moderate himself better than anyone she knew. But Sally knew that tired look that comes from when the brain wrings itself out to keep enough fluids in the eyes to see.

Sally got out of bed. She wanted to be beside her man. He was a model doctor, and husband. He was always patient, yet demanding, and methodical in his actions. He was cut from a different cloth than many. He came from a medical family. He had worked harder than most of his colleagues. He also knew that there is always a price to pay. He had come to know and face his night terrors as did his father.

Sally was not so lucky. She worried about him. He would get up after his night terror and seem to function as if he was a robot. He would sit in the living room reading or put on headphones to listen to music or play a game until he fell asleep in hopes that he would not again be tormented by latent REM sleep that processed his jumbled-up reflections of 75 images / second that had accumulated over his 18 waking hours.

The increase in doctor and health care shortages was evident in North America and Europe. Family doctors were being replaced by nurse practitioners and general practitioners were becoming specialists.

The COVID pandemic was the tipping point that marked the system-wide crisis There was a workplace shortage and increased demand, caused by more patients with more complex issues. On average, workers clocked 8.2 hours of paid overtime and 5.8 hours of unpaid overtime per week that year — making up the equivalent of more than 9000 full-time jobs. With the rapid growth in population, the shortage was increasing even faster.

Sally went to the kitchen to join Josh. She offered him a choice, “Chamomile tea or hot milk?”. He smiled saying “Milk and a bit of honey”. Sally knew he was not unhappy that she had joined him. She put on the milk and wrapped her arms around him “ How about considering a switch to plastic surgery, I could use a bit of a lift.”

His mouth formed its little sideways grin as he chuckled then said, “ I’ve got a better idea. This last night terror was about the war in the Ukraine, which is not looking good. Doctors without borders could use us right now. A change is a good as a rest.”

As much as Sally was surprised by the suggestion, she knew both of them could play a role in facing the devastating impact of the conflict on civilians and the military forces, under heavy bombardment and running out of food and water. She embraced him and said,” We did not go into medicine just for the money.”

The process took a few months. Josh was told his placement might focus on surgery, trauma and intensive care needs driven by the conflict, or the worrying situation that was emerging for patients with chronic diseases such as hypertension, diabetes, asthma and heart disease who require key drugs and support. Sally would offer mental health support to children affected by the war. The preparations helped Josh recalibrate his focus. He had no problem sleeping at night.

That one particularly dark night of the soul helped Josh face his nightmares, formed from the bombardment of images of new diseases and wars that do not end. That one dark night of the soul helped both Josh and Sally change the nightmares into actions that could feed the hopes and dreams of many others.