Four a.m. is often a magic hour. In emergency departments all over, chances are there will be a lull in, and respite from, the action at around this time. The main overhead lights of the ER will still be turned down to accommodate patient rest for a couple more hours before the change in shift. It’s a time when the doctor on duty can catch up on paperwork or other tasks, and maybe even steal a moment, as she sits at her desk, to watch the barest beginning of sunrise glistening through the windowpane. She squints as her eyes adjust to daylight and longs for the moment when she can walk out of the hospital inspirited by the light of a brand-new day. And for a couple of hours, she is reminded that she, too, is a diurnal human being.

In several hours, at 7 a.m., before I’m free to get in my car and drive home, I will take my place around a large walnut table with six nurses and two other physicians for the code meeting, where we will review issues regarding any medical resuscitations performed in the hospital. Together we will pore over the long code sheet, finding where the word atropine was written during a patient resuscitation on the telemetry unit last week. “The exact location of this wording is critical to saving lives,” said no one ever who actually saves lives. Nevertheless, after twenty minutes of our discussing the word’s location, I will endure a similarly inconsequential discussion about whether to move the space on the code sheet for “fingerstick glucose.” During a 4 a.m. lull on the night shift, I prepare my thoughts on these matters, thoughts that boil down to one question: Why are we meeting about this?

Tomorrow I will get the notification, the phone call or email that I hope will announce the promotion that will deliver me from being merely an attendee at such meetings to being the chair. Just under two years into the relatively minor administrative positions of director of departmental performance improvement and then ED assistant medical director, I was bored. The hospital had just created a new position for an administrator to oversee quality on a larger scale throughout its operations. It was a job I wanted and knew I would be good at. My ED chair couldn’t promote me any further within the department—the existing directors weren’t going to be leaving or dying anytime soon—and therefore supported me in pursuing the position.

I had assessed there might be more meaning for me, more potential for me to make an impact, when I was in charge of something. I knew that when I prescribed rest, ice, compression, and elevation to a patient with an ankle sprain or explained to a patient with tooth pain that there wasn’t an abscess or dental emergency, but that it was critical for her to follow up with a dentist for a detailed exam—when I did these things, I knew that these patients could hear me and that there was the potential for something important to be accomplished. I also knew that in no part of my medical training had I dreamed of spending hours contemplating how best to make sure blood cultures were drawn within four hours of a patient’s being admitted to a regular hospital floor with community-acquired pneumonia. Frankly, it felt unfair having to spend so much of my life as a physician ruminating over minutiae that didn’t actually improve people’s lives. There had to be ways for me to climb this administrative ladder meaningfully. I’d find out tomorrow.

Since graduating from my residency a couple of years before, I’d grown increasingly jaded and restless, and was not sure that working at an administrative level in a hospital was even what I wanted to do anymore. Yoga was helping me to cope and clarify. Gym workouts were helping, too, as was expanding my social circle. I had succumbed to peer pressure to join the online dating scene, in an effort to “get back out there”—this, specifically, did not help—but my entry into that world had been hesitant at best. It had nothing to do with fear; for the first time in my life, I was beginning to feel that I had found a certain comfort in my own skin.

The beautiful and unexpected gift of my thirties was that I liked myself no matter the bumps or blemishes, or the raucous laughter that erupted into snorts under the right circumstances, or the smelly farts from the yummy lentil soup I made (so delicious, but I learned to enjoy it sparingly). My aversion to online dating had nothing to do with the vulnerability of putting oneself on exhibition to thousands of strangers. To the contrary, I’d always found it fascinating to share a conversation with someone entirely unknown. I firmly believe that any interaction can be meaningful, even if only a brief exchange. No, I wasn’t afraid of online dating. I just wasn’t sold on its effectiveness. Yes, I was well aware of the compelling arguments of two friends who had met their current husbands online. (The same two friends later told me, independent of each other, that they would get divorced if only they had the energy to be single again, but they preferred to settle for an unhappy marriage as a means to ensure they could have a child before the “advanced maternal age” of thirty-five.) Given that I didn’t need “practice” in dating, the notion of wading through hundreds of online profiles seemed to be merely a way to settle for Mr. I-Guess-I’ll-Give-Up-Give-In-and-Make-It-Work-Somehow in a more time-efficient manner.

I knew also that, for me, a relationship could be only with a man with whom I recognized a soul connection. None of me feels that this type of link can be jury-rigged by any virtual algorithm, no matter how inventive Silicon Valley considers its calculations.

Still, eventually, I had relented, but I made sure to deploy the excuse of my tricky emergency medicine schedule to keep my involvement in the process (what amounted to a couple of months) only tangential. There was Rick, who had clearly posted a photo from twenty years prior and had a penchant for discussing beer and golf exclusively. (I disliked both only a little less than I disliked him.) There was Doug, who repeatedly reminded me that he was an attorney, no matter the topic of conversation; yet, when I finally bit and asked where he practiced law, he gave a verbose answer about the many ways one can be an attorney and not actually practice law, weaving in a discussion of his entrepreneurial interests. I felt my eyes glaze over as I listened to the man lie about his identity. And I can’t leave out Frank, who had obviously posted someone else’s photo entirely. He rambled on about his divorce from seven years before; how he had no hobbies, few friends, and spent all his free time co-parenting a teenager who appeared not to want to spend any time with him. It was for all these reasons that he figured he’d meet a companion through online dating. I politely finished my drink, stating, “Ugh, so sorry. I’d better rush home. I have to get to the ER tomorrow. I know it’s only six-fifteen p.m. now, but my morning shift starts super early . . . No, please. You stay and enjoy. I’m safe to walk home, and I walk pretty fast, so I don’t want to be rude.” I pushed my chair back to wriggle myself free from the booth. “Have a beautiful night,” I added, already halfway to the door.

Frank was the last. It was my experience with Frank that made it clear he should be the last. There were no regrets. And thankfully, all of them got away.

I planned to use the 4 a.m. lull to avoid responding to the latest two date requests and instead get the code meeting preparation out of the way. Of course, in an ER, downtime is never guaranteed at any hour. Just two weeks earlier, I had worked nonstop straight through the night. I hurried to send home the drunk who had come in ten hours earlier and finally gotten a purchase on sobriety. The CT report on my patient in Room 9 had confirmed appendicitis, so Surgery was called to claim its final patient of the shift. And I had to sew up a facial laceration on an elderly man before admitting a middle-aged woman with multiple rib fractures who had taken a spill down a flight of stairs during a seizure. The stable but hypotensive patient would certainly have to be seen by the next doctor, who was already fourteen minutes late for her shift—but who’s counting?