MEDICINE | CLINICAL STORIES

Full Moon Shift: How a Tiny Fever Turned into Septic Shock in Just 6 Hours

A true story from the pediatric cancer ward

AI Generated Image.

Neutropenic sepsis is one of our greatest enemies at the Bone Marrow Transplantation Unit.

In most healthy people, a little fever doesn’t mean much. It is usually little more than a temporary inconvenience to be treated with rest, fluids, and perhaps a few tablets of paracetamol. But for patients undergoing Bone Marrow Transplantation (BMT), even the slightest fever can be a harbinger of catastrophe.

BMT is a high-risk treatment process used to treat certain types of cancer. Patients’ immune systems are intentionally depleted with toxic drugs in a process called ablation. At this point of extreme vulnerability, when the body has almost no meaningful defence left against infection, the stem cell transplant is carried out. The method employed, necessary as it is, carries enormous risk.

At this stage, minutes matter and delays can be deadly. This reality dictates the atmosphere of the BMT night shift. Nurses must check vitals obsessively. Doctors often react to miniscule changes with unusual urgency. A fever that would barely raise an eyebrow elsewhere can trigger blood cultures, broad-spectrum antibiotics, and sepsis protocols on a moment’s notice. The vibe is tense, to say the least.

This is a personal account of one such night, when we caught a small fever at the worst possible time.

5:15 PM — Professor’s Office

White fluorescent light washes over sterilized shelves filled with textbooks and the highlighted journals. Charts line the walls with dates and ticks. Folders piled up with protocols and exotic drug combinations.

Professor of Pediatric Hematology and Oncology — Department Head of Pediatric Bone Marrow Transplantation Unit.

Mr. Professor sits hunched over patient files with reading glasses sliding low, and his terrible burnt coffee gone cold. The window behind him reveals an exodus of healthcare workers heading home from a good day’s work.

Mr. Doc sits in his regular spot across the desk, backpack placed on his side, his body already aware of the shift before it begins. There is a quiet hum emanating from the artificial air coming through the roof vents.

The boss gestures at the list and starts talking without looking, going over each patient one by one.

“They’re generally stable. No fevers. Keep an eye out on S and A they’ll have chemo going through the night. Check on **S***’s mother’s biochemistry and hemogram results. We did the cell collection today but she’s okay too.”

He nods, steady as always. “Okay.”

Mr. Professor finally looks up, eyes too sharp for his age. “Are you good?”

A small breath. “I’m good. How are you?”

“Not bad!”

Mental health check complete.

They exchange the usual greetings, polite nods. Mr. Professor hands him the communication device and with it, the weight of the night.

Door clicks shut behind him. The night shift physician whistles and walks off to the service elevator hidden behind the main corridor.

5:25 PM — Enter Ward

Door slides open. Whistling continues. Nonsterile Zone.

Pause. Door behind him hisses shut. Whistling stops. Mr. Doc fixes his spectacles and takes a nice, deep breath. Second door slides open. Sterile Zone.

Night shift begins.

The controlled atmosphere hits immediately: the smell of antiseptic is everywhere as sounds of soft crying and the sharp hiss of oxygen flow come from down the corridor. Artificial air, artificial light, artificial life. Endless beeping. Service staff drags a mop along wiping the floor for the millionth time today.

The nursing team is fully Gen Z. Nurse H is flustered, immediately bombarding him with updates like he might run away. Nurse Z doomscrolls on her tele behind the counter, thumb moving lazily. Nurse M whispers through a mess of paper like she’s studying for finals.

“Hello kiddos, how are we feeling today?” asks the millenial who feels like a 70 year old.

Nurse H nods too fast. “Yes. I just wanted to let you know the 208’s breathing rate is 34.” Nurse Z barely looks up and responds with a thumbs up. Nurse M smiles nervously. “Hello doc, we’re feeling great!”

They don’t ask him how he is. Most of them never do.

He forces a light smile. “Great? That can’t be good.” Nurse Z quietly smiles to herself with experience. Nurse H smirks and looks shocked at not being responded to. Nurse M giggles, confused.

He walks into the hallway down to his cave at the farthest end of their world.

5:30 PM— Charting Time

Clean the desk. Change into scrubs. Drink water. Log in. Prepare.

His fingers glide over the keyboard. High school typing class paid off. The computer struggles to run the clinical software. It lags like it holds a grudge. He’s okay with it. The struggling machine helps slow things down.

Warnings. Alerts. Warnings. Explanations. Enter. Enter. Enter.

Scribbles on the notepad. Three different colours: blue, green and red. Only one sentence in red.

6:00 PM — Meditate

Mr. Doc stretches out on the sofa bed.

Three deep breaths in. Three breaths out. Feel it out.

Think nothing for 30 seconds.

Drink water.

6:01 PM — Rounds

It begins at the nursing station. Story time. Each nurse explains everything that happened with her patients since 8 AM. Mr. Doc asks an occasional question but mostly listens and nods.

This is followed by a round. Every patient is examined. Every room has a different situation. 201 needs to be motivated, 204 wants neutropenic pizza, 210 is asleep and 207 can’t get off her cell phone.

Everything is smooth. Everyone is fine.

Time floats in the flow. The mind is silent but alert.

8:30 PM — After Dinner

He steps out for a few minutes for his post-prandial walk. The city hums outside. A distant siren approaches. He chuckles thinking about his buddy in charge of emergency tonight. There is a smell of cold air and damp concrete. As he lifts his head to scan the weather, he sees it.

Full moon.

It shines menacingly down at him. Night shift doesn’t fear much, but a full moon is never good news.

He mutters to himself, “Shit. Here we go.”

The wind responds with a gust. He returns indoors, secretly morose.

9:05 PM — Soft Signs

Ring Ring.

Nurse Z calls in a calm voice. “S***** has a fever: 37.9. The rest of her vitals are good. And 204 has pain in his belly. I think he’s faking it.”

Instant nervousness ensues in the form of a tapping leg under his desk.

Neutropenic fever. It could be nothing. Keep calm and start the fever protocol.

“Start her on Cefepime. One gram. I’m putting in the order. Take cultures first. No contaminations please.”

“Paracetamol?”

“Yes…and no delays with the antibiotics please. She’s neutropenic. Her immune system is zero.”

“Got it.”

Leg tapping stops.

Control your thoughts. Control your emotions. Control your actions. Control your energy.

A crumbling mother in a headscarf grips his sleeve before he reaches the bedside, voice trembling. “Doctor, he is hurting. Please.”

A four-year-old in dinosaur pyjamas lies curled dramatically, then opens one eye suspiciously when Mr. Doc enters the room.

He bends to examine his tummy. “Where does it hurt, champ?”

The child whimpers dramatically and points vaguely at his entire torso.

Mr. Doc takes his time feeling out the abdomen. He watches the child’s face closely. As he pokes a little deeper, he suddenly bursts into giggles.

“Does it hurt or does it tickle?”

The mother’s shoulders drop with relief from tension she wasn’t aware she was holding.

He reassures her calmly. “Nothing to worry about. We’ll keep watching. This is probably just some bedtime gas.”

The little boy waves and giggles. He gets a doctor’s wink.

False alarm.

10:40 PM — Syncope

A watercolour illustration of fluid administration with vital signs in the background. AI generated image.

A sudden shout. “Doctor! She fainted!” They rush.

**S***, a teen girl, lies pale on the floor, as her mother cries in the background. Nurse H paces outside in alarm. Nurse M looks nervous and needs instructions.

“Let’s check her blood pressure.”

He checks the pulse. It’s not weak.

Nurse M reads back a normal blood pressure value.

“Did we start antibiotics on time? No delays?”

“Yes, right after the order.”

“Give her 250cc isotonic fluid. Vitals every 15 minutes. Let’s get her back in bed.”

15 minutes later, she is in bed and feeling better.

She stirs, “I just got up to pee and thought I died.” The mother breaks down crying again.

He replies gently, “Try not to get out of bed too fast. Take your time.”

Mother’s eyes glisten. He turns to her. “Are you okay?” She nods through tears.

As they step out, Nurse M comments, “Teenagers…”

Mr. Doc goes over everything in his head. Searching for mistakes.

Vitals are good. No fever. We started antibiotics on time.

“Keep a close eye on her vitals. Every 30 minutes.”

00:50 AM — Ordering Hours

He sits behind the computer screen. Endless clicking.

Confirm. Confirm. Justify. Explain.

He types furiously, like he’s fighting through drying cement.

Midnight tasks complete.

Time to get some shut-eye.

01:30 AM — FML

Ringing awakens him like a knife through his forehead.

Nurse H, “Hey doc, we took a urine sample at 12 and they told us every 4 hours so when should I take the next sample?”

“4:00AM.”

“Thanks!”

“No Problem.”

Stares into nothingness.

It’s part of the job.

“Can you get Nurse Z please?”

Crackles and ruffles on the audio.

“Does S**** have a fever? Blood Pressure? How is she doing?”

“Normal. Vitals are stable. She’s asleep.”

02:00 AM — Sleep Attempt Number Two

Back at his desk, his body is creaking and eyelids grow heavy. The 1am “breakfast” at the hospital cafeteria was surprisingly luxurious tonight. He checks his alarms again.

No news is good news.

Darkness.

3:00 AM — First Signs

The night shift physician types in medical orders. Redone in watercolour using AI to omit any possible patient information. (Original Image by Author)

Nurse M, “Hey Doc. Sorry to wake you up. S*****’s blood pressure is 80/30.”

“Are you sure?”

“I checked twice from both sides.”

“Fever?”

“36.7. She’s sleeping. Maybe that’s why."

“Maybe. Check again in 30 minutes. And do a manual too. Fever and blood pressure.”

Something is wrong.

3:05 AM — A Bad Feeling

Never ignore the premonitions.

“Hey. Let’s send a blood gas. How is she?”

“Okay. Yes she’s sleeping. I’ll check again.”

Nurse M is pissed off. She takes her time with the blood gas. “Teenagers are so dramatic, even while sleeping. Blood gas at 3 am…”

Moments later, Mr. Doc is at the nursing station looking nervous.

“Her blood pressure is 80/40. Shes asleep.”

He checks the previous day’s notes again and again. 80/40 makes no sense for her.

“Let’s go.”

He goes to the newborn ICU lab with the support staff. At this hour, this is the only place to get a quick blood gas. Right as they hook up their sample with the machine, it stops with a growl. Moments later, the dreaded message comes blaring on the screen. Calibrating.

Abnormal delays. It’s the full moon.

“Look doc they’re so tiny and cute!” squeals the support staff.

Mr. Doc nods but doesn’t look. He’s too busy with the moon. No need to pass this energy to the tinies.

After 5 long minutes the machine finally prints out the results.

Normal.

Something is not right.

3:15 — Sepsis

An AI generated watercolour portrayal of a nurse’s work in the med prep room.

“Doc. She has a fever. Blood pressure is 70/34.” Nurse M says. Breathing heavily.

“Start vanco now. I’m putting in the order.”

Should I wake him up? I know what to do.

There’s no point in taking a risk.

“Change the cefipime to meronem. I want blood pressure every 15 minutes. IV Paracetamol for the fever. Be alert. Be calm.”

He goes to check on the teenage girl. He performs his examinations and checks the vitals manually. Her mother’s shadow watches from the corner. Her silent terror is louder than any of the beeping machines.

S***** is not okay.

3:25 AM — Keep it Calm

Nurse Z picks up.

“Hey I’ve updated the orders. Tell Nurse M we can’t have any delays with the antibiotics please.”

“I sent her to get some sleep. I’m on it. Antibiotics are done. How bad is it?”

“No mistakes tonight. Z G.” They’re friends. Full name and no titles to say thanks for stepping up.

“I’m on it. Full moon tonight by the way…”

“Yep.”

We have an unspoken rule on the night shift. We don’t ever say the worst case scenario out loud. The team still needs to know when we have to be at 100% but there are ways to communicate urgency without triggering a panic. No matter how much a nurse hates her working conditions, most will step up when it counts.

3:28 AM — Sepsis Confirmed

“Hello doc. I’m calling from microbiology. You have a patient named S*****. We have positive signals from her red central line culture.”

“Thank you.”

A comic portraying late night communications between different hospital departments. Image made using AI.

3:30 AM — Disturb The Boss

Just call him.

Rings once.

“What is it.” Suppressed rage in his voice.

“Sorry to wake you up. S***** had a little syncope while peeing at around ten. Vitals were good. We gave her some fluid and she recovered well. She was anxious and panicked earlier and we didn’t think much of it. We took cultures and started cefipime at like nine because of a tiny fever but she was ok otherwise.

Her BP has been slipping for the past two hours. She looks septic. Pulses are weak. Hemoglobin is normal, blood gas is normal. I started her on vanco and switched to meronem just to be safe. I had a bad feeling. Just got a call confirming a positive signal in the red line. That’s just 6 hours.”

“Urine output?”

“Not bad. Her BP wasn’t great so i didn’t consider lasix. 700ml in 12 hours. Not bad, but it’s half of yesterday’s — going down. She doesn’t look good.”

“Start colistin too. Get a noradrenaline infusion going. Be very careful Haroon. You’re dealing with septic shock.”

“Okay.”

Fuck. Last name means it’s happening.

4:00 AM — A Close Eye

“How is the blood pressure?”

“67/33.”

“Fever?”

“Shes burning. 39.” replies an alert nurse Z.

“Double the noradrenaline dose. Ibuprofen for the fever.”

Not good.

5:00AM — Stay on it

“Blood pressure?”

Nurse H picks up “89/45. She looks great! I’m going to cut the dose yea?”

“No. Don’t do that. We don’t cut pressors based on a single good reading; we titrate carefully. Check blood pressure every 30 minutes. Send her labs early.”

He hangs up. Anger creeping through. Takes a deep breath.

She’s new. Easy. You used to be new too.

5:01 AM — Full Moon Energy

“Hey is this the night physician? I’m calling from the 5th floor we have a patient who is feeling very hot.” calls a nurse chewing gum.

“What?” he snaps.

“Yes the patient is feeling very hot but all vitals are OK. She insists on seeing a doctor.”

“Okay.”

He lets out a laugh as he steps into the blinding light of the hospital corridor.

5:10 AM — Hold the Line

After he exits the room of Patient Hot, he enters some anxiolytics for a very sweet nervous old lady while talking on the phone with his main team.

“Blood pressure?”

“70/30” replies Nurse M.

“Increase noradrenaline to 10ml.”

Later on, he checks on the teenager again.

Better.

Sleep.

06:00 AM — Alarms and Labs

Phone buzzes as the monitor lights up. Another ting, then another, then another. His mind is awake but his body lags behind. The light is blinding.

S*****’s CRP is off the charts, platelets are borderline, potassium is slightly off. He stretches and steadies himself. He adjusts fluids and electrolytes, confirms labs and writes in updated orders.

When the typing is done he looks at his hands.

These hands have been washed way too many times for one night. Thank God for wifey, who forced him to take moisturizer to work.

07:20 AM — Final Nursing Handover

Nurse Z’s face is frazzled, voice gone small. Nurse H looks like she didn’t realize what happened and lives on in La-la land. Nurse M clutches her protocol printouts like war medals.

“Hey Nurse M, good job tonight. You saved a life.” he says while nodding at Nurse Z who smiles back.

It was actually Nurse Z who did the saving but Nurse M needed to hear it. Nurse Z gets it and no grudges are held.

Nurse M lights up and says thank you. It’s her last shift. She quit a week ago. They will not see each other again.

He listens calmly and clearly, secretly exhausted. They summarize, openly exhausted. He wishes them a good day’s sleep and they do the same.

07:57 AM— Professor’s Office, Again

An AI generated watercolour portrayal of a morning handover.

He changes into civilian clothes: hoodie, jeans and sneakers with the backpack slung on. He walks slow, every muscle aware of gravity again.

Mr. Professor is already there, furiously charting through his morning rituals, glasses fogged slightly.

He knocks. Waits for a couple of seconds. Enters. Mr. Professor looks up. “How is she?”

“Not great. But not worse.”

He exhales a soft, almost amused breath. “Full moon,” he says.

Mr. Professor chuckles quietly, nodding in the shared language of tired doctors who don’t need dramatic retellings to understand.

He hands over with numerous mispronunciations which no one registers. Everything is understood.

“Good job. If you guys hadn’t caught it she’d be dead by now.”

“Crazy.”

“That’s how it is.”

Then he leaves, stepping out into morning light as the city wakes. His brain floats between the sidewalk and his cozy bed.

Love my job.

Patient S***** had her Bone Marrow Transplant on time.

Her mother never knew we saved her dying child that night. She surely felt it. But it was never said out loud.

Patient S***** was unable to eat for the next 3 weeks due to nausea and vomiting associated with chemo and the transplant.

She needed a tube to help her pee for a few weeks after developing some minor complications.

One night she started seeing ghosts. It took more than a week and some chemical modulation by Pediatric Psychiatry to fix that.

She was too weak to walk for another month. Then her legs started hurting and she was unable to move them from fear of more pain.

A month later, Patient S*** asked for a snickers bar. Her request was approved against house rules.**

Eventually, she was able to get on a wheel chair on her own.

Patient S***** was hospitalized in our ward for a total of 81 days. That’s 1,944 hours, which is 116,640 minutes or 6,998,400 seconds. She did not feel sunlight or grass during this period. She also went bald (temporarily) — following which, she cried for days.

Our guest was discharged in good health, cured of her cancer.

We hope to never see her on the inside of these doors again.

Yours truly till burnout,

The Night Shift.

A rendition of our Pediatric BMT Unit. Redone in watercolour using AI to omit any possible patient information. (Original Image by Author)