Monica arrives in the Surgical Intensive Care Unit (SICU) for her 7 p.m. to 7 a.m. shift. She works in Bay 1, General Surgery. Bay 2 is for cardiac patients, Bay 3 is for neurology surgery patients, and Bay 4 is the Intermediate Pulmonary Unit. Bay 1 provides care for a variety of patients, including general surgery, liver transplant, otolaryngology, orthopaedic, gynecology,and trauma patients. Each bay takes overflow patients from the other areas when beds are full.

Bay 1 has 10 beds, and usually between four and six nurses work in the area overnight, based on patient needs. Each nurse chooses which patients she will care for (nurses can pick their patients based on patient needs, nurse staffing and skill level; generally nurses try to stay with the same patients for continuity). Monica chooses two patients. One has abdominal abscesses (pockets of infection); the other patient has a fracture at the sixth vertebrae and is now a quadriplegic.

Upon checking in, Monica receives patient reports and learns that she is "in charge" for the night. This means she will take calls for new admissions from the admitting residents, facilitate admissions and discharges that occur during her shift, count narcotics, and prepare the report for the morning shift. This duty alternates between nurses each night. Most importantly, all charge nurses function as key support for problem solving.

The others nurses working tonight are Sharon Doden, Mary Rauch, Sam Thibodeaux, and Amy Valesh. "The nurses who work here have usually sought out this type of environment," Monica says. "They like the demands and challenges of the critical care setting."

At around 8 o’clock, Monica checks her patients’ vitals, including heart rate and blood pressure. At 8:20, a few people arrive for the last 10-minute visiting session of the day. "We have a set schedule for visitors, but we can vary that depending on the patient’s and family’s needs," Monica explains. "We usually only let two or three people visit each patient at a time, but we make exceptions based on the situation."

By 9 p.m. it’s getting dark outside, but Bay 1 is still bright and full of activity. Someone suggests that as it gets later, UI Hospitals and Clinics goes from a "big city" to a "small town" feel. Monica agrees with this analogy. "There are lots of medical students and teams of doctors who follow trauma patients during the day," she says. "At night, people go home and it’s a bit more relaxed–but still very busy."

Five minutes later, Monica re-checks the patient with the abdominal access who also has a blood clot in his arm. The problem is treated with a drug called heparin. During the day, the pharmacy is located right down the hallway from the SICU, but at night, nurses rely on a satellite pharmacy located a floor below. Monica orders heparin through the tube system that shoots her request straight to the pharmacy.

At 9:55, a doctor comes in to see if Bay 1’s extra bed can be used for a patient coming from the OR after removal of a spinal tumor. Normally this patient would go to Bay 3, but that area is full tonight.

At 10:10, the heparin arrives through the tube system. At 10:25, after changing the patients’ tubing (something done every three days to reduce the risk of bacteria buildup), Monica administers the heparin.

At 11:29, the new admission arrives. He will be under Sam’s care. The patient had a very large spinal chord tumor resected. Six people work on the patient, attaching him to the various monitors, getting his labs and x-rays, and covering him with a heating blanket. Monica helps Sam secure a connection; he thanks her and says, "She is my guardian angel." Monica answers, "In this environment, we all work together as a team."

By 1:20, things have gotten dark and quiet. Most of the patient room lights are off, and the main light in the SICU is dimmed. The nurses, now speaking in hushed voices, continue to watch over their patients.

Quiet time is not guaranteed overnight. Sometimes the SICU doesn’t slow down at all. But on this night, UI Hospitals and Clinics really has become another world–a bustling health center settled in for a few hours of rest.