I wake before the alarm because I am afraid someone has died

Dear Delyara, I manage a residential home for elderly people, and my phone stays beside my pillow because emergencies do not respect office hours. For the last year, I have begun waking around 3:00 a.m. before the phone rings, convinced someone has died. Sometimes I check the staffing app, medication records, and overnight notes until sunrise. My wife says I speak residents’ names in my sleep. Last week, I drove to work at four because nobody answered the landline quickly enough. Everyone was fine. The night staff looked at me as though I had become the emergency. I am responsible for forty-two residents, seventy employees, relatives who expect perfection, inspectors who arrive without warning, and decisions that can become safeguarding investigations if one detail is missed. I used to feel useful. Now responsibility feels like standing beneath a ceiling I am personally required to keep from falling. I have begun imagining resigning, but then I picture the residents whose routines I know better than some of their families. Stress has made every person I care about into another possible call at three in the morning.