‘Extreme Sleepover #5’ – a night in the life of a shift-working medic and clock biologist

In the fifth of a series of reports contributed by Cambridge researchers, medic and scientist Ak Reddy describes the challenges of disrupting our circadian programming.

It’s 2 am. It’s the intensive care unit, seeking my input on a patient who has meningitis (bacteria infecting the lining of the brain). The patient has deteriorated because of a complication that we sometimes see in this condition."
—Dr Akhilesh B. Reddy

We’re all slaves to time, and that’s no understatement. I’m in a handover meeting, about to begin a weekend on-call as a doctor. The team discusses all of the patients and what the plan is for the next 48-72 hours. From previous experience, I know that things on the wards change quickly and so this information will be out of date in the next 24 hours. But that’s the job; patients get sick and you have to react fast to make sure that they are treated effectively. I have a quiet evening, getting a couple of calls from various hospitals about problems they’re having with patients under their care - but nothing out of the ordinary. I settle into bed at about midnight, expecting a ’quiet night’. Unfortunately, bacteria don’t respect my downtime.

I’m abruptly woken by the buzzing of my mobile phone. It’s 2 am. It’s the intensive care unit, seeking my input on a patient who has meningitis (bacteria infecting the lining of the brain). The patient has deteriorated because of a complication that we sometimes see in this condition. About a minute into the conversation with the doctor on the other end, I realise that I need to go into the hospital to take a look at what’s happening. I get there and organise an emergency brain scan. An hour later, we have the results of the scan; as I suspected, we need to organise a brain shunt to release the pressure that is compressing the patient’s brain. It’s now 4 am. Rather than driving home, I decide it would be better to try to sleep somewhere in the hospital. I end up in the Doctor’s Mess, on the last remaining bean bag, in between an array of fatigued on-call medics. As it turns out, I’m glad I stay - within an hour, I need to assess a stroke patient for clot-busting treatment. It’s a typical night on-call.

As I drive home, I recall the lectures I heard a few weeks before at a scientific conference. One set of authors had found that shift-work and jet-lag can cause serious problems with a person’s metabolism and can sometimes predispose to cancer. I’d also heard about an interesting study on junior doctors and their lack of responsiveness while driving home after a sleep-deprived shift on-call. How apt. Not only was I actually experiencing this for myself, but my research also focuses on these types of problems.

My laboratory works on the molecular mechanisms of the biological clock (also known as the circadian clock), which are the cycles of physiology and behaviour that govern the daily life of organisms, from bacteria to humans. These incredible in-built mechanisms allow us to anticipate and adapt to the solar cycle of night and day. We now know that disruption of our circadian programming through neurological disease, old age, and even shift-work, is a growing cause of significant morbidity.

As any clock biologist will tell you, researching the biological clock requires a commitment to working at odd times of the day. Surely enough, after recovering from my weekend on-call, I am thrown straight into another disrupted night. When we do clock experiments, we have to take samples ’around the clock’, often for 3-4 days on the trot. This time, although lucky to be taking mostly daytime samples, I have to do one of the night shifts, taking skin cells (called fibroblasts) from a petri dish and freezing them down. Laboratories aren’t the best place to catch 40 winks. However, I manage to fall asleep in my office chair at about 3 am. Another buzzing awakens me. It’s my mobile phone alarm this time: the 4 am time-point needs taking. A night in the life of a clock biologist...

Akhilesh B. Reddy

Ak Reddy is from the University of Cambridge’s Department of Clinical Neurosciences and the Institute of Metabolic Science, and a fellow at St John’s College. He splits his time between the research laboratory and clinical medicine as a Consultant Neurologist at Addenbrooke’s Hospital, Cambridge. His laboratory studies the biological circadian clock and sleep, and their relationships to metabolism at the molecular level, and receives funding from the Wellcome Trust, the European Research Council and the European Molecular Biology Organisation.

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It’s 2 am. It’s the intensive care unit, seeking my input on a patient who has meningitis (bacteria infecting the lining of the brain). The patient has deteriorated because of a complication that we sometimes see in this condition."