As a nocturnist, Thao Do, M.D., works from 7 p.m. to 7 a.m. From the evening to the wee hours of the morning, you can find her caring for City of Hope® patients long after their primary medical teams have left for the night.
While some might balk at the idea of working nights, Dr. Do loves her “mommy schedule,” in which she works 12 to 13 monthly shifts.
“The schedule really works for me. I can attend school meetings and events for my kids, and I rarely have to miss anything. I can be there for my family,” she said.
Although Dr. Do appreciates her current work schedule, she was not always a fan of working overnight.
“During my residency, I hated working nights. I thought it was not my kind of thing. But after I gave birth to my son, my husband suggested trying out the schedule again. He thought it might work with the new baby. So I tried it out, and I love it. I've been a nocturnist since 2019,” she said.
Dr. Do earned her medical degree at the University of Massachusetts Medical School, where she then completed an internal medicine residency. After completing her residency, she became a nocturnist at St. Vincent Hospital in Worcester, Massachusetts.
Because family is so important to Dr. Do, she knew that eventually she wanted to leave the East Coast to be closer to her sister and sister-in-law, who have both made California home.
With so many reputable medical centers in California, Dr. Do had a tough choice on her hands, but when she began the interview process at City of Hope, she immediately knew it was a special place.
“I could tell that City of Hope takes really, really good care of their employees, which is very impressive. Any questions I had were answered quickly, and everyone was very attentive. I felt appreciated, which made me feel like this is where I wanted to be so I could feel free to take care of patients and not worry about anything else,” Dr. Do said.
Medical Issues That Arise at Night
Nocturnists are tasked with adeptly managing various medical issues arising at night, often under pressure, while ensuring continuity of care for hospitalized patients. Some common health conditions that Dr. Do treats overnight include heart attacks, pulmonary embolisms, bowel perforations and intestinal obstructions. These specific conditions tend to happen at night for a variety of reasons.
Heart attacks and pulmonary embolisms commonly occur in the early morning hours due to physiological changes in the body during sleep, such as increased cortisol levels, higher blood viscosity and slowed blood flow, which can cause blood clots to form. The transition from sleep to wakefulness can also increase stress levels, further straining the cardiovascular system.
Digestive functions also change at night. Muscles in the intestines create waves of motion to pass food, liquids and waste through the gastrointestinal system. This process is known as peristalsis. At night, peristalsis slows down, increasing the risk of complications like obstructions, especially in individuals with pre-existing gastrointestinal issues.
“Cancer also makes it a little bit more difficult to navigate these issues,” she said. Sometimes, patients need to be transported to specialty centers for treatment of noncancer-related conditions — “but there are a lot of considerations to make before you do that,” she added. “Sending patients out can disrupt their cancer treatment and increase their risk of infection. It can also delay treatment. So, you have to think about all of that and move quickly.”
Choosing a Career in Medicine
Dr. Do thrives in these high-pressure, high-stakes environments, which is one of the reasons she chose a career in medicine.
Born in Vietnam, Dr. Do came to the U.S. when she was 18 and went to college to study chemistry. She thought she would become a chemist and work in a lab, but a trip to South Africa changed everything.
“It was almost like a mission trip, but we got to learn about HIV and AIDS in South Africa. We visited the multidrug-resistant tuberculosis hospital, and it was full of kids. Seeing all the work that the physicians in South Africa were putting in to help all these people who don’t have a lot of resources, it's very inspiring,” she said.
“I realized that when I was in the lab, I saw the same people every single day and worked on the same thing every day. There wasn't any kind of excitement. I want to meet new people every day. I want to see something new every day. That keeps me motivated.”
Luckily for Dr. Do, her work at City of Hope constantly presents new patients, medical conditions and challenges, and she could not be happier about that.
“I am so impressed with everyone at City of Hope, and my job is always exciting and never boring. I’m really glad I’m here.”