Mark vs Cancer

Sunday, June 04, 2006

To Sleep, Perchance to Dream

Who needs sleep?

I do, and lots of it. Without sleep, I don't function well. I get grouchy, sloppy, despondent, and my activity slows to a turtle's pace. None of those descriptors are what you want attached to your doctor when your life is on the line.

Even though recent laws have been passed that restrict resident work hours to 80 hours per week, the time honored tradition of the 30 hour shift still persists. For most people, a 10 hour work day is a long one. Imagine doing that, then doing it again, and then doing it one more time, back-to-back-to-back, without a break and under conditions of extremely high intensity, when any mistake on your part could result in the death of someone else.

Except for my residency colleagues, I don't think anyone else reading this can truly understand how difficult it is. It is something that can only be appreciated through experience. And we do it every 5th night. All hyperbole aside, we are not superheroes. We adapt, we learn to pace ourselves, we learn to prioritize, we sleep when things are (rarely) quiet. Thank goodness for epinephrine (a.k.a adrenaline) that kicks in in the clutch and makes our minds sharp when needed most.

Sometimes, when we're really dumb, we work extra hours to make a few extra bucks. For example, over Memorial Day weekend I volunteered to work at the Yuma, Colorado Hospital for a 72 hour shift. Yuma is a small town near Kansas with a 12 bed hospital. I did the same thing last year, and it was a piece of cake. I hardly worked for 2 of the 3 days, so I had high hopes for a repeat this year. I brought Elizabeth and the kids with me so that we could spend some time together.

We were all sorely disappointed, as a whirlwind of badness descended over Yuma, coinciding with my arrival for the weekend. Several major motor vehicle accidents, several major orthopedic fractures, a slovenly procession of drunks and deadbeats, a death, a premature labor, 6 patients transported emergently out of town via helicopter and ambulance, and 30 ER visits later, and I was about done for. I had nothing left in the old tank. I got ZERO sleep on Friday night and the badness just kept rolling in uninterrupted until almost 24 hours later. Mercifully, I climbed zombie-like into bed around midnight on Saturday night and proceeded to get about 6 hours of uninterrupted sleep, which refilled my tank enough for me to make it through the next 36 hours. By Monday evening, the hospital nurses were only half-joking when they asked me to never come back, as they assumed it was my bad mojo that had precipitated the weekend's carnage.

When we pulled out of town late Monday night, a feeling of exhaustion, relief and triumph swept through me. I had done a very long, legendarily difficult shift. I had made a few mistakes, but had also saved a few lives, rendering quality medical care to the good people of Yuma despite some adverse circumstances. And I had accumulated a litany of war stories which I have relived with my fellow physicians over the past week.

Which may go to the question of why we sign up for the sleepless, stress-filled nights, when there are plenty of easier ways to make a buck. Why? The sense of fulfillment, the underlying compassion for humanity (sometimes masked by the necessary cynicism), the sense of purpose, the adrenaline rush, the prestige, and the glory somehow compensate for the bloodshot eyes, the mental cobwebs, and the eleven years of preceding poverty.

Is it worth it? There have been plenty of sleepless call nights when I head down to admit another drunk criminal and I feel the gaping abyss of despair open beneath me that I would have emphatically stated no. But now on the precipice of completing my training, as the attributes and skills of a physician are permanently coalescing within me, I can retrospectively state, "Yes, it has been worth it. I have climbed the mountain and can understand the purpose of what seemed to be an endless trek. Veni vidi vici."

Now, if you'll excuse me, I need some sleep


Jeff said...

Your life and experience are both encouraging and discouraging for me. I don't look forward to the hardness ahead of me, but I can't wait for the highlights. Maybe it's the lowly lows that make the highs what they couldn't be in any other way. Maybe the pain now is part of the glory then, and vice versa. Maybe I'm in for a real whoopin'.

Tyler said...

I admire you doctors who work so hard for all those bucks you earn. I know that you deserve what you make and probably a lot more!

As I have said before, I am jealous of the constant challenge your job seems to give you. Mine is interesting and very cool from time to time, but I don't feel challenged very often like I did when I was still in school and I think that has the tendency to make me a little lazy.

Hopefully, you will not take a vortex of badness with you to Worland. Leave it with the good people of Yuma!

Tankfos said...

You are a good man and I have no doubt of your skills as a doctor. It must be quite the feeling to know that because of your sacrifice and training there are people still alive. Keep up the good work doc.

Why the girly butterfly at the end of your blog?

Wendi said...

FYI, Addy -- the "girly butterfly" is the logo of Lunesta (insert that weird trademark symbol here), which is a sleeping medication.

Mark -- I have boundless respect for your profession, but also for yourself for choosing to practice this profession in such out-of-the-way rural towns as Yuma, CO. Having lived (albeit briefly) in a town nearly as tiny as Yuma and in similar environs (Ogallala, NE), I can empathize with your experience to some degree...these little dorfs can sometimes be pretty dismal places, especially if one is dealing with people at their worst. And that, of course, is a major part of your bread and butter!

I have frequently been dismayed when I've heard about the hours that most docs (especially young docs / residents) must keep. While I understand that a good deal of "toughening up" is necessary, I have to question the wisdom of exhausting your medical professionals to the point where they could be sleepwalking through their rotations (and I'm sure you've questioned this as well, of course!). To me it seems sort of like a culture that initiates their young by putting them to death, although that may not be the most appropriate of metaphors.

In any case, I'm glad that you made it through this hellish experience with your sanity (and dignity) intact. You are a gentleman and a scholar, Doctor Foster. :-)

Dad said...

Well, I have to say I have been perplexed for some time by why the medical field seems to have this attitude that since "I did this 30 hour on call deal when I was a resident then, by golly, every new young Doc needs to go through it."
I know it is partially true that ones needs to go through the refiners fire in getting to the pinnacle of one's profession and undoubtedly, you have learned much throughout these marathons. However there must be a better way to train our doctors.
I think part of it is that no experienced Doc would do what the residents do, so there would be a huge gap in our medical service if residents didn’t do this kind of duty. Is that kind of true Mark? So they leave it up to the Residents to do this grueling job as no one else will. I don't know but I sure don't want a Doc on his 29th hour making a decision on my behalf that could be life threatening to me. Don't know what it does for the patient or the Doc to make decisions when you aren't physically or mentally at a good functioning level. Makes no sense to me, but that is the way it is and I guess that is the way it will remain.