Thursday, August 16, 2007


One one of the rare occasions I was outside the cage hospital lately, I watched the "Bourne Ultimatum." Partway through the movie, the fearless protagonist is reading a stack of papers describing his own forgotten training and a line flashes across the screen: "subject has been awake for 56 hours." My first thought was "I could do that."

Q3 call is ridiculous. I'm in the hospital for 30 hours straight without sleep every third day. To think, as a medical student I assumed only surgery interns worked hard. At least they roughly keep to the 80 hour work week. And at my hospital anyway, they have call q5 on most rotations. Part of this may be the fact that my hospital is renowned for its medicine program, and the directors feel they have a reputation to keep up. But after two straight months of work in critical care, I'm noting the diminishing marginal utility of this particular learning environment.

Making matters worse is the fact that I am what is known as a "black cloud." Even among physicians, supposedly highly educated and purely scientific minds, there exist strong superstitions. A black cloud is a doctor who, when he is on call, has worse luck than the average. For example, last month, on the cardiac ICU team, my team admitted over twice the number of patients the other team did. And here on the MICU, the story is the similar. A positive side of this is the fact that my attending noticed it, and last time I breezed through presenting nine patients, he said "dude Nathan, you are like Superman."

I feel compelled to add that he's both a)from California and b)about a year out of his fellowship.

But where that was a motivation, and I was pretty energized previously, the flog is taking its toll. My motivation to read (or at least skim) an article or two on each of my patients before rounds has dropped off. Last night I fell asleep sitting up in my chair, in the process of typing a note. Where I was once understanding of being paged for even the dullest questions from nurses, I'm getting dangerously close to snapping out things like "that's exactly what I wrote in the orders, twice, and I just spent 30 whole seconds clarifying it in person."

Everyone is feeling it. One of the nurse managers pulled aside a senior resident the other day and told him he had to be understanding of the nurses aides, because they worked long hours. The guy shot back "You're right, they work four long 12 hour shifts a week, and the stress of filling the rest of their time with boys, alcohol, and sex must be incredible. On second thought, no, I'm not all that understanding. How about you tell them to do their damn job."

It wasn't the best way to remind the nurse of the truth, but I would have been tempted myself in the same position. But I'm greatly looking forward to my two week subspecialty block coming up in a month. No call, just two glorious weeks of sleeping through every night.


Thainamu said...

Sleep, Nathan, sleep!

(My son just got his USMLE scores back. He was happy with 251.)

Doc's Girl said...

Sorry for the rough patch, the bf told me about his first year of residency (we hadn't met then) and I was horrified. It was pretty much eat, sleep, work, rinse and repeat...!

I was also known as the black cloud in the emergency room I worked in. We'd always be twice as busy on the nights that I worked!

Alice said...

I am unenviously understanding of your position. At my hospital as well, I think the surgery interns have it better than the medicine folks. One thing our rigid regard for rules does get us is respect for 80 hours - kind of. We break it, but not as badly as it sounds like you do.

I don't know about nurses' aides, but the nurses I do feel sorry for. The ones on my floor get thrown around a crazy schedule: 12hr days for three days, 8hr afternoon shifts for two days, three nights, one day, two nights - whatever. The managers seem to shuffle them into holes at random; and even though they get a day off in between, it must be hard to take care of a family and stay sane with such an unpredictable schedule. At least we know ahead of time that we're going to be working 15 hours, or overnight.