I’ve spent so much time in the hospital lately that coming out into the sunlight feels like culture shock: there is light like this around commonly?
I’ve figured out (belatedly, perhaps) that the hard part of call is only between midnight and 5am. That’s when the circadian rhythm really demands to slow down and go to sleep. Before, and even after, is not that bad. In fact, looking at the sunlight now makes me feel fairly wide awake, although I know i’ve missed so much sleep lately that if I don’t catch up on at least a fraction of it today, the rest of the week will be ruined.
Part of it, too, is the discipline we started learning back in grade school math: I don’t want to finish these problems, to pay attention and work all the way through, but I will anyway. At a certain point in the night, I really do not want to be there at all. It would be so delightful to simply walk away; not even out of the hospital, just into the callroom, and decide to ignore pages for an hour or two, or even just to ignore the jobs that ought to be done even though no one will page about it (checking labs and imaging ordered earlier, walking around to check on the critical patients, filling out some of the mountains of paperwork that have to be done at night because if saved for daylight they’ll overwhelm the team’s resources). But I won’t; I’ll keep going regardless of what I’d like to be doing.
There’s a point in the middle of an endless stream of traumas, one or two every fifteen minutes, where every single person in the ER looks at the others and says, “Why am I here, and why am I doing this?” And no one has much of an answer, so someone says something flippant, and we keep going. Or a patient threatens to leave AMA, and we all shrug: Sure, do us a favor, the door is that way.
Then there was the time I decided to put my head down on the desk for five minutes, and when the nurse came to ask me about something, I jumped so hard she was more startled than I was. I think I have too much of a startle reflex. I’d been half-awake the whole time, knowing it was a matter of minutes before someone needed something from me, and I still leaped to my feet. I’m usually a very solid sleeper, but I’ve trained myself to never really sleep in the hospital. I’m too worried about the consequences (to a patient, or to my career) if I sleep through a page. So I’m always half listening, and waking up every now and then to check the pager and make sure I didn’t miss anything. Which makes me rather unsympathetic to the new medical students and interns who do occasionally sleep through their pagers. I can have slept 4 hours in the last 48, and still jump up the second my pager goes off.
Those are bad numbers. Maybe I’d better go to sleep now. . .
August 3, 2008 at 7:45 pm
YES! Sleep, for the love of all that’s good and holy, SLEEP!
I love reading this blog, just wanted you to know how much I appreciate the time you spend keeping it up. As a fellow Christian woman hoping to follow a similar path, it’s both fascinating, and daunting to read. It whets my appetite for medicine, and reminds me what a long road I’m undertaking, both of which are needed at this point!
August 3, 2008 at 8:43 pm
Wow, how do you do it? I can’t put two rational thoughts together if I haven’t gotten my sleep.
I always enjoy reading your posts. You are amazing. Thanks for all you do and for writing about it!
August 4, 2008 at 7:44 am
I don’t want to sound old fogiesh, and I was just a student, but in 1986 the Surgery Residents took call from 8am Friday till 8am Monday, and didn’t go home Monday till everything was done. The only good thing was there was no cross-coverage back then, so they didn’t have to do anything with the other 2 surgicals teams patients, unless there was a code or something. Then they were on call Tuesday. Still, it only averaged out to every 3rd night call, so it was one of the easier programs back then.
August 4, 2008 at 6:48 pm
So can you tell me the truth about the common saying, that in the “old days,” when you were on call you got to sleep a lot? Nights at my hospital, you’re lucky to sit down for ten minutes, or maybe twenty on weeknights. Was there more free time/nap time under the schedule you’re referring to, or were they on their feet the whole time too?
August 5, 2008 at 12:57 am
“Or a patient threatens to leave AMA, and we all shrug: Sure, do us a favor, the door is that way.”
Of course this never works. I’ve noticed that the more someone threatens to leave the less likely they are to actually go.
August 5, 2008 at 2:06 pm
Even in the not so long ago (I finished surgery residency in 1997) we got little sleep. I averaged about 120 hours a week in the hospital. Most nights on call you were up most of the night. Doing scut, taking care of drunks, traumas, etc. Most traumas were blunt, so not much operating on them.
Now I’m the “attending”. I am not in a teaching hospital, but I still average 70-90 hours in the hospital depending on the week. I can have a good week and “only” be here 50 hours, but that’s not usual.