It’s 3:00 AM and you’ve been at the hospital taking care of patients and being on-call for 20 hours straight. You’re tired, you’re grumpy, and you’re hungry. So you go to the physician’s lounge searching for something to eat. The only food you can find is a stale donut from the morning before. During 6 years of residency and fellowship followed by 30 years practicing critical care medicine, I spent hundreds of nights in the hospital, almost always after working a regular workday earlier that day. And from those nights on-call, I learned how to resuscitate a stale donut.
People who work night shifts have to develop unique survival food skills. After 6 o’clock PM, the cafeterias close, the coffee shops close, and the gift shops (purveyors of chips and snacks) close. You’re on your own to forage what you can find from the previous day’s leftovers. The good news is that there are tricks that can make those leftovers palatable, although they will never be epicurean delights.
Donuts are the quintessential physician lounge food. The hospital realizes that it has to do something to show that it is a physician-friendly workplace and donuts are the perfect offering. They’re cheap, readily available almost everywhere, and come in convenient boxes of 12. They are cost effective, too. For less than $1 a piece, they will give hospitalists that sugar rush that helps them get done with morning rounds faster. Faster morning rounds means patients get discharged earlier in the day. Earlier discharges means greater hospital profits. By spending $3,500 a year on donuts, the hospital can probably save $50,000 in operational expenses. But donuts are morning rounds fuel and are not designed for night call. By 3 o’clock AM, that last donut in the physician lounge is about 24 hours old and has been sitting out desiccating all day and all night.
Fortunately, there is a solution. Physician lounges are not gourmet kitchens but most will have a microwave. Five seconds on high for a small donut and 15 seconds for a large donut works wonders. They won’t be like Krispy Kremes fresh out of the donut oil but they’ll be the next best thing.
After the donut, the second most common physician lounge food is the bagel. The problem with the donut is that the sugar buzz you get from it wears off in 2-3 hours. The resulting crash at about 10 o’clock AM requires a break for either another hit of sugar or a cup of coffee. Being mostly carbohydrates, bagels do not result in the mid-morning sugar crash that donuts do so bagels are best suited for surgeons and anesthesiologists who can’t take a sugar/caffeine break in the middle of an operation but need sustained energy to get them through until lunch. The wise hospital administrator will stock the physician lounge with both donuts and bagels every morning. But by 3 o’clock AM, the previous morning’s bagel is now as hard as a hockey puck.
Once again, food science comes to the rescue. Wet a paper towel with water and squeeze it mostly dry. Microwave the paper towel on high for about 10 seconds then wrap the bagel in the warm, damp paper towel and microwave it an additional 15-20 seconds. However, it must be eaten warm – if you wait until it cools, it will be even harder than it was in the first place.
There is a second option for bagels that are so stale that they cannot be fully resuscitated in the microwave. Take a lightly damp paper towel and wipe it over the top of the bagel. Sprinkle it with coarse salt. Let it dry for 5 minutes. Now, it’s no longer a bagel, it’s a pretzel.
Columbus is the home of Cheryl’s Cookies, the maker of individually wrapped iced sugar cookies. Our hospital would buy them by the box for special occasions like doctor’s day or holidays. By being individually wrapped, they will stay fresh for weeks but their popularity means that they have a very short half-life in the physician lounge and are generally gone by noon.
Making cookies a viable on-call sustenance requires strategy and planning. Cookies are generally dropped off in the physician lounge in the morning, just when the night call physicians are checking their patients out to the day shift physicians. The secret is that iced sugar cookies freeze incredibly well. So, keep an empty frozen dinner box in the physician lounge freezer, preferably something that no one would steal, like Lean Cuisine Goat Liver and Kohlrabi Puree dinner. Squirrel away a couple of cookies in the box in the morning and no one will find them until the next time you have an overnight call again.
Half-eaten bags of microwave popcorn are ubiquitous in physician lounges. Maybe the doctor who made it couldn’t eat the whole bag or maybe got called away for a patient emergency. Sometimes at 3 o’clock AM, that partially eaten bag of popcorn is the only food left in the lounge.
The best way to resuscitate stale popcorn is by heating it up on a baking sheet in a regular oven. But physician lounges do not have regular ovens so we again have to turn to the microwave. Put the stale popcorn in a bowel and cover it with a damp paper towel. Microwave on high for 30 seconds. If it still seems stale, give it another 10-15 seconds.
Admit it. You’ve reheated left-over pizza in the microwave at some time in your life. It is a measure of true desperation. Many pizza aficionados will tell you that if all you have to heat up pizza is a microwave, you’re better off just eating it cold. If you have a toaster oven in the lounge or if your microwave has a convection oven mode, then you’re in luck – 10 minutes at 350 degrees will make it almost as good as new. If you must use a microwave, then put a mug of water on the plate with a slice of pizza and cook it for 30 – 45 seconds. It won’t be great but it will be marginally better than if you just microwaved the pizza by itself.
At 3 o’clock AM, coffee has one purpose and one purpose only… it is a drug. This is not the time for a foo-foo coffee drink and there is no place for a no-fat butterscotch and pumpkin spice double mocha latté with extra whipped cream. Coffee should taste terrible when you are on-call so that you only drink it as a last resort when you are falling asleep typing your last admission’s history and physical into the hospital computer system. Ideally, coffee should be at least 12 hours old, heated up in the microwave, and drunk black with no sugar or creamer. It should not be soothing and instead should harsh enough that the taste alone serves as a sleep-deterrent.
Unfortunately, many hospitals have gone to providing instant brew K-cups in the physician lounge. The result is that any doctor can get reasonably good-tasting coffee, anytime of the day. The solution is instant coffee. These are now available in individual packets designed for use with 6 ounces of hot water. Instead, add 1 packet of regular instant coffee and 2 packets of decaf instant coffee to 6 ounces of water. This will give you the right amount of caffeine but taste sufficiently awful, particularly if you buy the cheapest generic instant coffee you can find. If it doesn’t taste bad enough, there are always left-over condiment packets laying around the physician lounge – try adding a half-packet of mustard or mayonnaise to the coffee.
As tempting as it is to rummage through the physician lounge refrigerator for uneaten food at 3 o’clock AM, this can be particularly hazardous. No one ever cleans out these refrigerators and forgotten food can stay forgotten for years. The hard boiled egg may be from 1997 and the half of a left-over tuna sandwich could have been made when you were still in high school. Moreover, it is poor etiquette to eat some other on-call doctor’s dinner. If you have multiple call nights in a row, take a picture of the opened refrigerator with your phone’s camera on the first night. Anything that hasn’t moved after 3 days is fair game. But stick to visibly non-rotten fruit and unopened yogurt that is not past its “use by” date.
- Emergency surgeries. When an on-call resident has to assist with an emergency surgery at night, it can be tempting to drink a cup of coffee or a can of caffeinated soda just before the procedure. Don’t do it. You’ll have to pee before you finish dissecting out the gall bladder. A 1-ounce espresso has three times as much caffeine as a 12-ounce cola and a 2-ounce energy shot has more caffeine that 16 ounces of coffee.
- Pregnancy. Night call food foraging during pregnancy poses unique challenges. Caffeinated coffee is generally off the menu and you’re trying to only eat healthy foods in order to have a healthy baby. The solution? The waiting room candy machine. A 2-ounce Snickers bar has 5 mg of caffeine, just enough that you won’t feel guilty about it. In the middle of the night, the chocolate is more soothing than zen. And the peanuts have a lot of fiber so that you can convince yourself that a Snickers bar is really just as healthy as a serving of vegetables.
- Potato salad & chicken salad. Don’t eat it. Ever. After these foods have sat out at room temperature for a few hours hours, there is an increasing risk of Staphylococcal food poisoning resulting in nausea, vomiting, and diarrhea within 6 hours. You see mayonnaise, I see bacterial culture media.
- Easy Cheese. Is there a can of Easy Cheese in the lounge refrigerator? The stuff is designed to help armageddon survivors out-live zombies and lasts for about forever. Go to the waiting area vending machine and buy a bag of Doritos. Put them on a paper plate and spray liberally with Easy Cheese. Microwave for 20 seconds. Now you have nachos. NOTE: don’t put the Doritos bag into the microwave – it has a foil lining and will spark and burn in the microwave.
Cooking shows and celebrity chefs never talk about night-call cuisine. But for physicians and other healthcare workers who roam the hospital halls at night, lounge foraging is a major component of the daily diet. Although not as complicated as resuscitating a patient in cardiac arrest, resuscitating a donut is nevertheless a critical survival skill at 3 0’clock AM.
September 8, 2022