Going to Seattle for the SHEA/CDC Training Course proved to be very tiring. I flew JetBlue and had no flight delays or mishaps with the exception of a $7 blanket offer and lack of peanut snacks as someone on the plane had a severe nut allergy. I flew on late night flights to and fro, spent late nights in Seattle, and woke up extra early to get to the hotel that the course was being held. I have family in the area who wanted me to stay with them but apparently they didn’t really live in Seattle. Let’s just say, I cannot and will not commute hours to work each day. I can’t believe people actually do this.
Anyway, so I got back to the East Coast yesterday morning, went home to freshen up, and went to the hospital thinking I would be productive. Silly me. I returned home where I immediately fell into a deep slumber at 2 pm. I didn’t wake up for anything until 6 am today. SIXTEEN HOURS OF BLISS. That’s how sleep deprived I was.
It reminded me of post-call ICU/CCU days during residency. We had q3 call which meant every third day was a 6 am to 12 noon the following day (30 hrs) marathon and every sixth day was a day off. On call day -> post call day -> short day -> On call day -> post call day -> OFF day undsoweiter. Oh, how I lived for those OFF days.
I managed one day to sleep over 24 hours!! I got home around 1 pm on a post call day, fell asleep on the couch right away and didn’t wake up until about 6 pm on the OFF day. It felt so strange. What day was it? Had I missed work? Had I slept only a few hours or a whole day? How could I have slept a whole day, plus some? So I have to go to work tomorrow? You mean I’m on call again?!!! It was miserable!
OFF days were mostly for sleeping. Routinely, I would switch my phone back on and hear messages from family and friends asking why I don’t pick up the phone or why I don’t return calls. I would log on to the hospital system from home and not recognize half the names on the ICU/CCU census knowing that it continued to be busy at the hospital in my absence. Then I would dread yet another call day and ask myself how I got myself into this place in the first place.
I would check my mail and see a monthly reminder from my loan company that my $250,000+ medical school debt is still in deferment at 8% interest. Next envelope would be my bank statement revealing a direct deposit from my hospital of a whopping $1200 (rounded up) to cover the previous 2 weeks of work. Let’s see. I was making roughly $600 per week thus $7 – $8/hour with potential to go up to $15/hour on elective months (8a – 5p M-F) if I am are lucky enough never to get called in for emergency coverage.
This before accounting for insurance (health, dental, disability, car), rent, and food. Speaking of food, I would then open the fridge, stare into its bare and gloomy interior, and pull out my tub of ice-cream. I would throw some rice on the fire with whatever clean pot I could find. I would tell myself that I would eat my protein at the hospital tomorrow when I pick up those delectable but salty deep-fried chicken wings at the cafeteria. Sigh!
Sleep deprivation as a resident is no joke. I am a product of the modern era of “humanistic 80-hour work-weeks” for medical trainees. Yes! I am appreciative that I just missed q2 overnight call, standard q3 call the whole year, routine 36+ hour workdays, and other abuses of the previous era. When I was a third year medical student, I took q2 call with the trauma surgery residents for two weeks with my weekends off though, so I know I would have hated for my whole year or even a single month to have been like that. Senior doctors love to tell us young ones that we know nothing about sleep deprivation since we didn’t have it as bad as they did. True, but we still work hard and do so while we should be catching up on our sleep.
Have you ever woken up in the middle of the night and threaded a needle? No? You should try it one day. And, while doing so, you should remind yourself that countless fellows, residents, and interns around the nation have just been woken up from their attempted nap during hour 21 of their ACGME approved 30 hour shift. They’ve barely gotten 15 minutes of shut-eye and they are about to thread a catheter into your loved one’s jugular vein. Your loved one who just got admitted, who seemed to be doing well but just took a sharp turn for the worse, is about to get cut in the neck, right there in the vicinity of the carotid arteries taking blood towards the brain, right there next to the lungs … about to get cut by a human being who has worked 30+ hour days every third day for the previous 2 weeks more or less, and now has barely slept…
In each academic hospital, in each city, in each state, here in the United States of America a sleep deprived medical trainee is performing an invasive procedure on another human being. He or she is calculating how much fluids or how much of a medicine (deadly at high doses, inefficient at small doses as you would expect) to order a nurse to give. He or she is reading a chest x-ray to confirm the placement of a feeding tube s/he just re-inserted inadvertently into someone’s right lung before s/he tells the nurse to resume tube feeds – potentially pouring nutrient rich material into the poor soul’s lung – a hospital acquired pneumonia in the making. But don’t you worry. We are superhuman so most times we get the central line into the correct vein without an issue. If we don’t well as we are told by our seniors “if you haven’t dropped a lung, you haven’t done enough lines”. Such is medical education.
The 80-hour workweek mandated by the Accreditation Council for Graduate Medical Education (ACGME) states that residents cannot work more than 80 hours a week, averaged over four weeks. That’s why I sometimes did work 90+ hours here and there. Residents are to be on-call no more than every third night. But of course, if you just switched blocks, there’s no guarantee that you wouldn’t be on call on the wards on what would have been your OFF day had you still been in the ICU. Residents must have 10 hours off between shifts and have one day in seven free of all duties. But let’s not admit to our program directors that during these “free times”, we are dictating clinical notes, working on medical presentations, preparing for clinic, preparing for journal club, and catching up on other paperwork, some very mindless but apparently necessary for insurance companies.
All this, before we would actually try to study or keep up with the medical literature. I know procedure heavy residents such as those in surgery have it worse. Oh no! For pointing out to our program directors that we were working more than ACGME dictated will only remind our elders that we are indeed the whiny generation. Goodness, don’t we know that’s what real doctors do all across the country? How are we going to work in the real world when we no longer have all these safety blankets?
I am reminded of a study published in the New England Journal of Medicine in 2005. Extended Work Shifts and the Risk of Motor Vehicle Crashes among Interns was a nationwide prospective study of almost 3000 interns who completed a web-based survey on their work hours and incidents such as motor vehicle crashes. The results were that interns were 2.3 times more likely to report a motor vehicle crash after an extended work shift (>24 hrs) as compared to a regular shift. Every extended work shift scheduled in a given month increased the monthly risk of a motor vehicle crash by 9 percent.
Am I surprised? No.
Falling asleep at the wheel while stopped at a red light or moving in slow traffic is an experience we interns and residents have had at least once. I would bet major stakes on that statement. The now 4-year-old damage to the driver’s side passenger door of my Toyota Corolla though not sustained on a post-call drive back home to my bed occurred during a busy month.
I will admit that early in my intern year, in one of my first post-call ICU days I decided to drive 3 hours south on Interstate-95 to visit my family for the first time since beginning internship. Straight from the hospital. Thank goodness it was a Sunday. Within an hour of my trip I was finding myself driving in a different lane. Scary! I ended up pulling off to a rest area for a nap behind the wheel before finishing the trip with the music on loud and the windows down blasting cold air into my face. That was the end of post-overnight call long distance trips. Never again!
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