* * Anonymous Doc

Thursday, January 20, 2011

I don't even know how I'm writing this, or what day it is, or what time it is, or whether I'm awake or asleep. I've worked like 60 of the past 72 hours, and it feels like I've worked 80 of the past 72 hours. Everyone in the program has a number of days during the year when we can be called in to do nighttime admissions if there's too much going on. Maybe it's payback for the post about passing off admissions to the night team. I mean, it's sort of perfect payback for that post when you get a call at midnight, when you're fast asleep, and are told to come in to do six admissions overnight, and then you have to do your regular shift on top of that. And then the same thing happens the next night, just as the mandatory 10-hours-between-shifts is coming to an end.

If this was my life-- if this was the permanent schedule I had signed up for-- I couldn't do it. Maybe some people can thrive on the lack of sleep, but I'm not one of them. I am not the person you want doing your middle-of-the-night admission, I'm just not. Whether you're the patient or the attending, I'm not the person you want. I yelled at patients. I yelled at someone for coming in at 3 in the morning with a cold, and demanding to be admitted. "You have a cold. Go home. You don't need a hospital. You are wasting everyone's time." Of course, the patient had no idea what I was saying, because she didn't speak English, and we couldn't get a translator at 3 in the morning, not even on the phone, so I have no idea what she thought I was saying, and what happened to her after we sent her back into the ER with directions to the outpatient clinic, where we made her an appointment for 6 hours later, when they opened.

You don't realize how many residents are sleeping with other residents until you work the midnight-8AM shift. It had been a good long while since I'd been on nights. I think the last time I did nights was in August. At night, everyone's guard comes down. You hear the gossip that you don't hear during the day. This one got sent to see the house staff's psychiatrist, that one has genital herpes, that other one might be getting kicked out of the program. No one talks about these things during the day. During the day everyone talks smack about the nurses and the support staff. It's only at night that everyone turns on each other and shares all the juicy stuff. So now I know that everyone's seeing some action except for me, because I'm sleeping, and blogging, and whatever it is I'm filling my pointless days with.

There are people who sign up for this stuff. Once we have our license, we can sign up for moonlighting shifts and make $75/hour to do admissions when there's overflow. They use the moonlighters first, then they call the people on emergency backup like I was, if they can't get a moonlighter or if the inflow is just too big. So I'm working alongside people making $600 for the night, and I'm making nothing. But I don't understand how anyone can think it's worth $600 to kill yourself and get no sleep for days. At least I was forced. They're volunteering. And no one's even paying any attention to the work hour requirements when you're doing a volunteer moonlighting shift, so you can have someone on the day team who just worked overnight, exceeding the work hour rules and running on literally zero hours of sleep. I got my ten hours in between thirty hour shifts, so I guess I'm not legally entitled to complain even though it is insane to work 60 of 72 hours. I was a zombie on rounds this morning. I didn't remember anything about anyone, whether I'd admitted one guy or another guy, what they had, what they needed, I couldn't even read my notes. And now my body has no idea what time it is, and I can't fall asleep.

I have like 22 hours now until I have to be back. That's enough time to catch up, I hope. Who knows. I don't know if I showered in the past three days. I think I did. I think I showered when I got home. But I don't know. There is toothpaste on the floor. I think I sleep-showered. I think I was asleep when I was in the bathroom when I got home. My phone is off. They cannot reach me. If they try and call me-- and they're not, because I'm off, but I don't even want to take the risk that someone makes a mistake and dials my number-- they will not get me. Good night, good morning, and don't go to the emergency room at 3 AM with a cold.


  1. That sounds awful. I hate that we do this to doctors in the name of training. It's inhumane.

    I hope you get some sleep.


  2. P.S. You're a doc so you surely know better than me.

    But I do so love children's Benadryl tablets. Just enough to knock me out without a hangover when I wake up.

    Helps a lot with steroid insomnia.


  3. Some friends who are in their clinical hours complained about their lack of sleep also, and I think residents get even less sleep each week. Makes me realize that I need to enjoy my last pre-clinical year to the fullest before I enter the inevitable exhausting night shifts.

    But don't you think that lacking of sleep will cause doctors to lose their focus on patients and might be risky for the patient safety? Is the duration of night shifts would worth the risk of malpractice?

    Anyway, hope you'll get your adequate sleep soon.

  4. Oh, things I have to look forward to.

    Last night my significant other woke up to a text that I thought was my alarm and was crabby to find out it was an invite for weekend plans - at 2am. My sig other didn't even remember it this morning. Which lead to the question - when patients/other doctors call me in the middle of the night when I'm (one day very far from now) a grown up doctor - What if I don't totally wake up and say things about a patient's care you can't even remember? How is this safe? How can we do this to ourselves? To our patients?