At eleven P.M the nursing night shift arrives.  The charge nurse enters through the main door and the four nurses sit in the nursing stations and discuss the seven patients in the ICU.  The charge nurse leaves and within the next fifteen minutes the night shift evaporates to a small kitchen at the front of the unit near the main door.  They lock the door and draw the shades.  The fluorescent tubes glow within and the smell of coffee permeates the ICU. Dr. Wracks is alone, and on call as a surgical resident at the Amityville general hospital.  The clock shows 12 A.M. and his orders are to cover the surgical floor, the obstetrics gynecology surgical unit and the pediatric oncology unit here.  No one is in the ICU except Dr. Wracks. Sit with the comatose patients and watch the heart monitors. Watch intently.  Adverse reactions evidence on the EKG.  The heart monitors display their green lines and a red-light pulse with each heartbeat for each patient on the verge of life or death. The respirators puff at inspiration and gasp at the expiration as a filmy foggy mist exits the respirator regulators.  Dr. Wracks orders are to survey the patients and report any neurological disturbances that might herald death such as decerebrate posturing and agonal respiration through the thoracic muscles.  Normal breathing is diaphragmatic and using the accessory muscles of respiration signals anoxia and a consequent cardiac arrest.  Decerebrate posturing happens when the brain does not receive blood any more. Then the patient curls unto themselves and dies. Alongside the most critical patients is a crash cart. The crash cart is a metal box full of syringes, needles of varying sizes and a myriad of heart drugs, mostly epinephrine. The lights are low and one fixture pulsates with a dying light.  Dr. Wracks has to note this and tell physical plant at first light.  Dr. Wracks never really felt at home at the ICU because everything, all parameters were taken away and placed in God’s hands. During the day Dr. Wracks would have to rush in and take an arterial blood gas of a respirator patient and bring it to the cigarette smoking technician locked within a little room down the hall with three machines and a coffee urn. He would take the blood, blow smoke at Dr. Wracks, say thanks and then close the door.  The rest was in God’s hands.  Tonight, the fifth pathway student is alone, as he is always alone and left with a thankless job.  Every man must know his limitations and his limitations are that this body requires much sleep that he has not gotten in six months. He is on call every third night and call begins at 11 P.M. He must visit all units at least once during the shift and catch what sleep he can.  Dr. Wracks never really sleeps because fate wakes him up before he enters REM sleep and he is never satisfied.  Most surgical patients require a sleeper medication and those pre-operation and post- operations are at risk for respiratory arrest if Dr. Wracks give too much.  The anesthesiologists caution him before to be prejudicial and withhold medication. The patients moan and look at Wracks with wide scared eyes and beg to be put to sleep.  Oxacepam does not work as the books state.  Dalmane is the only thing that works and 5 mg may not be enough and the patient begs for more; Dr. Wracks signs a requisition and give five more.  The nurse administers it in his presence.  Wracks leave and try to get more sleep. He is tired of smoking cigarettes and drinking coffee, especially at night because he becomes irritable and short tempered. he exits to my call room, close the door, and barricade it with furniture so no one can enter silently.  Sleep is always short and a nurse bangs on the hardwood door until Wracks emerges. Now is the second run through the hospital and the Wracks enters the ICU.  It must be two AM, and the lights are dim, and the respirators puff, the monitors skew and the red lights blink.  Sometimes He imagines a dying patient turns to me and smiles out of the corner of his eye. He turns around and they are asleep once again. The quiet deafens, the red lights blink and the respirators puff.  The nurses lock themselves in the kitchen. Another patient seems to open their eyes and beckon to the Wracks but when he turns around, they are asleep.  Once a human being is at deaths door, they ask everyone around them not to bring them back, and when there is an arrest, a surgeon moonlighting in the Emergency room appears and starts the procedures.  They inject epinephrine, calcium and more and use the shockers to start the heart beating again.  When the patient dies, they all seem to have a wan smile on their face because they know their will be no more, pain; anguish, despair, or disappointment and Dr. Wracks says a prayer and wish them God speed. Nothing is going on in the ICU tonight.  Dr. Wracks has not met God and he does not think he wants to.  The eerie glows and the shadows and the weird feeling that appears at night here are an effect of hopelessness and finality.  He exits the unit through the front door and wait in the hall for someone else to come out or enter.  No one does.  He is told to use the stairway at night.  The wracks do not know why. He does not want to know why.  Entering the pediatric Oncology section, he lingers as to make sure the poor children condemned to suffering are comfortable and not vomiting.  If they are, Dr. Wracks contacts the oncologist attending by hall phone and waits until they arrive. The kids are at rest and a single nurse sits in the station reading a book. She smiles at Dr. Wracks wave and walks by.  Back to the surgical ward on floor three Dr. wracks looks for a bag of tea and put a traveler boiler probe in the cup with it.  A tall man with a small black book enters the unit. He is greater then six feet and wears an expensive suit.  He looks at the book, then at the room number and enters a suite. Dr. Wracks follows him in.  He is sitting next to a surgical patient.  The Wracks walks over and examine his badge that he wears on his left lapel.  Everything seems to be in order.  He is a bonafide licensed member of the hospital. He looks at the wracks and gestures as he looks at my badge too. He does not know what he does but the credentials are in order.  Rocking the boat will get him trashed. He departs.  He enters his call room and barricade the door with furniture.  the watch says 3:30 A.M. He takes his pager and pulls the batteries out of it and set it on the bureau.   He hangs his smock on the door and crawls into a small bunk bed.  He pulls the covers over his head and says a prayer.  Now I lay me down to sleep……  Surgical rounds begin at seven A.M and dr. Wracks will be in surgery from eight A.M. to at least 2 P.M. non-stop.  he wonders if this is the life He really want and if he will make the cut. Sleep overtakes him again.  As he drifts off, he imagines he hear a hand trying to open the handle on the door. Then he is asleep.  The silence, the unduly silence pervades and detracts, the nurses hide, red lights blink, someone dies, someone lives, and in the quiet life begins again.  The ICU can wait, and the chief of staff who chose Dr. Wracks to command the ICU during his sabbatical is a fool.