The Sun comes up

Tonight’s going to be a great night! Or so I tell myself during my self TedTalk. I wake up at 2 p.m.—the glamorous hour of the graveyard shift goblins—to get ready for my last night in the Pediatric ICU for this month. I open my blinds, a warm, weirdly optimistic buzz to find the opposite: clouds and gloom. The sky obviously forgot how to sky today. A calendar reminder pops on my phone to kindly inform me that I have a blind coffee date with a Mom-approved electrical engineer who, based on our texts, might actually be 14. Still, hope dies hard. And apparently, so does my ability to say no to my mom’s emotional blackmail.

But hey, maybe he’ll grow on me. Like a rash. I did the thing and called to say, “I can do coffee, but only 4:30 to 5:30 p.m. I have to be at the hospital by 6 for my ICU shift.”

Cue confusion. “Wait—you actually have to stay at the hospital all night?”

“Yep, that’s what a night shift is.” As I explained in detail. If only you read my texts I wanted to add.

“I thought they only called you in if stuff happened?”

“Nope. I’m a resident. We don’t get ‘on-call.’ We are the call. You don’t have any family or friends who are doctors?” I felt like my questioning his ignorance was valid. We’re brown. We're either doctors or engineers.

“I do,” he responded, “But I don’t really ask about their schedules.” Shocker. He hadn’t asked a single thing about mine either. Still, there I was, sitting in front of him, trying to conjure whatever benefit of the doubt still existed in my emotional pantry.

The conversation started off better than expected—until he said his favorite character from How I Met Your Mother was Robin, “because she’s hot.” From there, it sort of spiraled into the shallow end. I like HIMYM too, but I also like...depth? Do I get the ick too fast? Am I the problem? He clocked my vibe and tried to steer us back to medicine—only to immediately say the wrong thing again. “I thought doctors had chill lives and made bank,” he says, more confident than curious.

“Doctors do make bank—because their lives aren’t chill. I, however, am a resident. I don’t make bank. I make... overdraft,” I say laughing at my own joke like it’s a Netflix special while he doesn’t even crack a smile. “I’m joking.” I had to clarify. Maybe we’re just not hitting it off.

I love medicine, but I don’t want to live in a doctor bubble—I want to experience more of life, which is why I’d rather not end up with someone in the same field. Dating a doctor isn’t easy, though—we’ve seen things, we joke about worse—but I like to think there are evolved, non-doctor humans out there who can handle and maybe even appreciate, my full, delightfully twisted self. Just staying delusional.

At minute 45, I make my escape.

As I pull into the hospital garage, the buzz returns. I love the ICU. It breaks your heart and rebuilds your faith in equal measure. It's where medicine is both science and miracle. And when those tiny patients get better—it feels like the whole universe just took a deep breath.

“You’re early,” says Sonya, my best friend and day shift partner-in-chaos. Date crash and burn?” I sigh and roll my eyes.

“Well, as I was trying to leave, I think he was trying to kiss me. Except he was too far way so I saw his lips puckering from a mile away. Thankfully, my face stopped him mid-flight.”

“Um, ew,” she replies, correctly.

I drop into the chair beside her and sigh again—this one with more disappointment than I intended. “Anyway, I scared him off by talking about trauma and death in the ICU.”

She gives me that half-laugh, half-smirk she saves for when I accidentally weaponize my personality. “How was your day?” I ask.

“Eh you know, weaned some vents, came off some drips, the usual.” Translation: it was a good day, so maybe I’ll have a good night. She launches into sign-out, a detailed handoff of all the tiny humans we’re keeping alive.

As we’re finishing up, the attending physician walks up to the desk. Dr. Ivory may be the most effortlessly composed person I’ve ever worked with. “Hey! Good morning to our night crew,” she greets us. “We’ve got an admit coming from an outside hospital—status epilepticus, got a keppra load and a buffet of benzos. She’s going to be stabilized in our ER first so you’ve got a bit.” Translation: kid who’s been seizing for way too long. She turns to my friend and says “Sonya go home, it’s almost 7. Don't you have to be back at 6am?” That sends Sonya speed-walking out like she’s sprinting from bad decisions.

I do a quick chart check and start my pre-rounds where I physically check on all the kids at the beginning of the shift to get a baseline status but I also like to check in with the bedside nurses. The nurses are every residents life lines, especially in the ICU.

“There are a few newly graduated nurses tonight so I’m trying to get everyone to be a little patient,” the charge nurse whispers as I go from one room to another.

“Of course, Nat. Who’s got who?” I respond.

“One of them has room 12 and 13. The other one doesn’t have anyone right now and is just helping out but she’ll probably get the new one,” she tells me. I give her an are-you-sure look. She shrugs. “Hopefully the ER stops her seizures.”

As both of us are walking into room 5 to do our assessments, the nurse comes out wiping away tears. “Minh, whats wrong?” Nat enquires.

“Mom and dad are still crying in there. They haven’t stopped since they made the decision. I’m sorry, I know I shouldn’t have gotten emotional” the young nurse replies.

“How can you have not?” I comfort.

Noori, our sweet frequent flyer with a constellation of genetic anomalies, is not going to make it. Today, her parents faced an unthinkable choice—whether to keep her on life-sustaining machines, knowing she can’t survive without them, and she can’t live in a hospital forever. Even on her best days, Noori needed a tube in her neck to breath, another in her stomach eat, and a wheelchair to move. She’d respond with soft movements, occasional smiles—but with so little brain tissue, we never truly knew what she understood. Still, how do you say goodbye to a smile, no matter how uncertain?

I watch her parents, wrapped in each other’s arms, drowning in tears, and think—life doesn’t always throw punches. Sometimes, it hurls boulders you can’t dodge. And walking through them bruised is the only way. Having someone to hold onto in that storm makes all the difference. I crouch beside Mom and gently rub her back, saying nothing. Because really, what could I say that would make any of this less unbearable? She softly told me that they decided to pull the plug at 5am- just before dawn, while it’s still dark, so it feels like she’s only sleeping.

I linger a few moment longer than usual, then move on to the next room—because that's the job.

By the time I finish checking on all my patients, it’s 9 p.m., and the hunger pangs kick in. I hover at the edge of the nurse’s station, debating whether to grab something quick or wait to see if Dr. Ivory’s going to order food for the team like she sometimes does.

But then the new admit rolls in—and she’s nothing like what Nat and I were expecting: she is still seizing every 30 seconds. She already has a breathing tube taped to her mouth and a vent hissing beside her. It’s hard not to stare. Harder not to let it crack something open inside me. I park my oversized rolling computer outside her room and start typing furiously. As the resident, that's literally my only expected job: listen to the medications, nursing instructions and ventilator settings that people are screaming and enter the orders in the computer for everyone to access. I am the scribe of crisis, and that’s just the beginning.

“Let’s give her a phenobarbital bolus and start a Versed drip. We’ll need rocuronium, too—she’s going to need procedures,” Dr. Ivory calls out from inside. My fingers freeze. The drip protocols. The muscle relaxant orders. I haven’t had to use them in weeks and now I can’t find them. I fumble for my phone to call the night pharmacist when a voice cuts through my spiral.

“Order isn’t in. I’m scanning it as an emergency,” the new nurse yells—no time for introductions tonight.

Dr. Ivory looks out at me, sharp but not unkind. “We’ll need a chest X-ray for tube placement. And an art line.” She says it to the room, but really, she’s talking to me. “I would’ve given you the procedure but it looks like you’re still catching up.” Ouch. That one stings. She knows how much I want to be here—really be here. This is the work I want to do for the rest of my life. But right now, I'm just the hands on the keyboard.

“We can’t keep her paralyzed forever—we need to stop the seizures,” she continues, already five steps ahead. “Call Neuro. If they don’t pick up, start a fosphenytoin drip. Versed’s not touching this.”

That’s the thing about the ICU. No matter how bad it gets, there’s always a plan. A plan that flexes and stretches and reroutes a dozen times—but a plan, nonetheless. I wish life worked that way. I wish every missed opportunity, every failure had a clean algorithm to fall back on. But when you keep falling behind—when the things keep slip through your fingers —it’s hard not to feel like maybe the plan just doesn’t include you.

They did 3 procedures on the kid, an arterial line, a lumbar puncture and re-intubation- I participated in none of those. How many disappointments am I going to count tonight?

Neuro finally calls back with the helpful insight that we should “start a fosphenytoin drip.” Her seizures ease up slightly, flickering now instead of crashing through her. Still not gone. “If this continues,” Dr. Ivory says, “we might have to suppress her brain with propofol. But let’s exhaust the other antiepileptics first.” And just like that, the plan adjusts.

This kid has a novel’s worth of past medical history, so my charting is going to take a while. I glance at the clock—11:30p.m. “Twenty minutes,” I tell myself. Just me, this computer, and my commitment to documentation excellence. But, no. “Let’s round,” Dr. Ivory calls from the other end of the PICU.

I take a dramatic pause to acknowledge my growling stomach, sigh at my screen like it personally betrayed me, then gather my papers and jog over. Luckily, night rounds are more informal.

Once that’s done, I roll back to our new patient’s room and assume my usual documentation stance—squatting outside the door like a raccoon rifling through trash.

“Did someone steal all the chairs in the PICU?” a deep voice floats toward me.

I don’t even look up. “Hi, Tyronne. No, we’re just broke. The cardiac ICU hoards all the furniture and the funding.”

Tyronne—the CVICU charge nurse—is tall, smart, smooth, and the rarest species in peds: a straight man who uses SPF and is under 35. Which makes him exactly the kind of distraction I don’t need right now. My fingers keep moving, but my brain is suddenly... buffering. “How are the CV babies?” I ask, eyes still glued to the screen.

“Not as good as they could be, since they don’t have a talented resident taking care of them.”

That gets a smile out of me. After the way Dr. Ivory dressed me down earlier, I’m not immune to a little ego CPR. I roll my eyes, but I don’t hate the compliment.

“Also,” he adds, voice dropping an octave. “ I would love to make those eyes roll backwards.”

My fingers freeze. “Sorry, what?”

He looks concerned. “Whoa—what’s wrong? I said, I hope Isaiah doesn’t go backwards. We just took him off ECMO.”

Oh.

Right. Isaiah. Post-op congenital heart kid. Major complications. And I heard… some R rated nonsense. I am so unwell. This is what happens when you play Sabrina Carpenter’s Nonsense on loop. “I—I’m sorry. I hope he stabilizes. That poor kid’s been through a lot,” I mumble, trying to shove my embarrassment back into the emotional closet.

My phone buzzed—sweet mercy in ringtone form. It’s my intern, Adela, from the general peds floor. How did I forget she existed?

“Hey, sorry to bug you but I didn’t want to wake the attending. Can I run a new admit by you?” she asks before I have a chance to say sorry for not checking in.

“Of course,” I say, standing up. “I’ll meet you in the work room in two.”

“Oh buddy, this kid needs the PICU,” I decide the moment my stethoscope hits his wheezing chest. I ask the Respiratory therapist to start a continuous albuterol and promise to stay bedside before she can remind me it’s against floor protocol. I call the grumpy floor attending, Dr. Fioni, then Dr. Ivory—who’s busy putting in a chest tube across the hall—and she tells me to handle it.

By the time Dr. Fioni comes up, agrees with the plan, I update the mom, and Nat arrives with the PICU team, it’s already 2:30 a.m. I finally turn to my intern for a quick teaching moment.

“Also,” I add, “I know Dr. Fioni can be intimidating—and yeah, he’s probably already back in bed—but don’t hesitate to call the attending if you're truly worried. That said, you handled this really well. Good job.” I know that a little compliment can do a lot for a doctor in training. Before I can acknowledge her “Thanks,” our pagers go off—high-pitched, urgent, and unforgiving. The kind of sound that makes the whole unit freeze for half a second.

Me and Nat are among the first to arrive since we were in the unit already. Inside the room, a nurse is doing chest compressions and the RT is keeping the kid breathing with a manual bag. I freeze. “Someone tell us who this is and what happened!” Nat shouts, already logging into the computer.

“Ten-year-old boy, came in with severe stomach pain. Mom declined surgery. He was still awake at midnight vitals. Lost his pulse about a minute ago.”

“Any meds given?” Tyrone asks.

“Morphine, about half an hour ago.”

Nat glances at me—it’s my cue.

I urge my feet towards the head of the bed. “Pupils are sluggish but reactive,” I hear myself saying. I scan the room, hoping Dr. Ivory will walk in so I don’t have to be the only doctor in the room. No sign. My eyes fall on the monitor with the heart rate of 20. My voice barely rises above a whisper: “Code dose epi and atropine.” The RT hears me and repeats it louder. I take a breath. “I’m running this code. Most likely hypovolemic shock. Let’s give a boluses of albumin, prep norepinephrine and epinephrine drips. And I need an abdominal ultrasound—stat.” Who’s talking? That can’t be me.

“Epi in,” the nurse says.

“Two minutes—pulse check,” I say with more confidence than I feel. And it goes on.

Somewhere in the chaos, I notice Dr. Ivory quietly walk in and take over compressions. Our eyes meet, mine with worry, her’s with a stoic approval.

“Pulse is back,” I hear as my own heart restarts. I step out, before someone witnesses me bursting into flames, and I squat by the wall, head spinning. After, heaven knows how much time, I see a protein shake and a caffeine chocolate bar hover above me. I look up—Tyronne and Nat connected to my dinner with proud smiles on their faces.

“Thanks” I mutter. My voice cracks.

“You were a star, and the kid lived,” Nat says premeptively.

“For now,” Tyrone adds laughing at his own joke. We both shoot him a look.

“What time is it?” I ask my friends.

“3:30 a.m.”

Panic hits. “Who's doing the orders? The transfer paperwork?”

“Relax,” Nat says. “He’s going to emergency surgery. It’s their problem now. And day team’s in three hours. Go nap.” My turn to shoot her a look. I can’t nap, I have notes to do and orders to put in.

I want to talk but the words wont come out. I want to cry but the tears won’t run down. I want a hug but I don’t know you to ask.

We stand there in silence for a few more minutes before my phone rings. Someone needs something in the PICU, and it’s back to work.

It’s time—time to pull the plug on Noori’s lifeline. Will I ever get used to this? Should I? The room is quiet, except for the hum of machines and the quiet sobs of her parents. Not a single tear from the rest of us. Are we trying to be strong for them, or have we just… hardened? I don’t know. All I know is that this is the job—and not everyone is called to it.

Just when I’m sure the night has no end (let’s be real I thought that at least ten times already), I see Sonya walk in. My body slumps in relief. It’s finally 6 a.m. I sign out with the last joule of energy I have left. And then I step outside. The door swings open, and I feel the sun I was craving warm my face.

I guess the sun finally came up.