And the intern slept on

I just finished my last EVER! Internal Medicine 30-hour call shift. Some of you are aware that I picked my internship program largely based on the number of 30-hour shifts because I correctly suspected these would be internship's most brutalizing feature. Of all my expectations regarding the past year, this one is the only one that was 100% fulfilled.

In a National Geographic article published last year about the science of sleep, Harvard sleep authority Dr. Charles Czeisler notes:

Going without sleep for 24 hours or getting only five hours of sleep a night for a week is the equivalent of a blood alcohol level of 0.1 percent. Yet modern business ethic celebrates such feats. "We would never say, 'This person is a great worker! He's drunk all the time!'"

[...]

"We know that one out of five first-year residents admits to making a fatigue-related mistake that resulted in injury to a patient'...'One in 20 admits to making a fatigue-related mistake that resulted in the death of a patient." When Czeisler came out with this information, he expected hospitals to thank him. Instead many "circled the wagons." He despairs of anything being done until U.S. employers get serious about insomnia and sleepiness. "My conviction is that one day people will look back on what will be viewed as a barbarous practice."

Amen! 30-hour shifts are the zenith of internship's inhumanity. While I spent many a late night and night float shift in the hospital to make up for fewer 30-hour shifts, I utterly cannot imagine having spent this year taking sleepless overnight call every 4th night. I'm just not made to stand up to that challenge.

I did, however, work 29 of 31 days until yesterday, which I'm not really made for, either. First, my body balked at my inability to come even close to a full night's sleep. It balked still more when I stopped making my 64 oz morning smoothies each day in favor of a few more minutes of sleep. Finally, my mood and will to continue gave in to the sheer ridiculousness of working 80+ hours each week with only two distantly separated days off in the last month. My normally good nature at work degenerated into an impatience for setbacks that promised to keep me in the hospital beyond the 80-hour weekly duty hour limit.

By the evening of my 30-hour shift, I felt so overwhelmed by the never ending work stream and competing demands of, well, everyone, that one of my co-interns gave me a spontaneous hug. A couple of attendings told me to hang in there. My PGY3 resident told me I had the face of someone who had been completely beaten down. I felt so close to giving up that I couldn't fake even a hint of optimism -- it was a new low for me.

The same resident later commented that he doesn't know what other programs are like, but he doesn't think it is possible for a resident to work any harder than we do in our program. We essentially work at the same frantic pace all day long every day with only the rarest brief lull in workload. In keeping with the adage that we're never given more than we can handle, this last shift was probably the easiest overnight shift of my entire internship despite a greater than usual number of cross coverage patients who required personal attention for urgent medical issues.

Around 4:30 a.m., my co-intern (who shares a schedule similar to mine with just a couple of days off in the last month) and I collapsed on the floor* of our conference room using bed linens meant for patients and blankets mashed into pillow substitutes. The cold, hard floor felt like heaven. I think our PGY2 resident must have seen how exhausted we were because he refrained from waking us around 5 am to do two late admissions. We slept nearly an hour, waking occasionally to field pages. "This is torture," my co-intern sleepily croaked when she had to get up to attend to a patient with chest pain.

My team rounded until after 12 and I ended my shift late to finish some discharge paperwork. I knew it would be impossible for my upper year resident to do it all, handle afternoon team issues, AND get out at a reasonable hour (and besides, he'd feel bitter as the paperwork was mainly for my patients). I drew the line at 31 hours and drove carefully home using loud radio and the wind in my hair to guard against dozing.

When I got home, I logged onto our hospital EMR system to do a little more work, had a snack, and passed out just as I was thinking about calling to make an appointment for a haircut. I could go no further. I comfortably awakened 18 hours later, which tells me I'd been a lot more worn out than my usual post-call self. Happily, I earned myself a Golden Weekend with this last shift. My recovery smoothie tastes even sweeter knowing I have just 6 more days of floor work before my last month of internship!

*My hospital lacks dedicated call rooms for overnight Internal Medicine residents not covering the ICU because we rarely, if ever, get even a few moments to rest between cross coverage responsibilities and hospital admissions.

Patrick Park -- Here We Are (mp3)

Wye Oak -- Civilian (mp3)