Saturday, March 31, 2007

The Hours

Any intern no matter how smart or stupid can quote the the hours regulation. 80 hours max per week. 24 +6 at a time ( 24 hours straight seeing new and old patients and 6 hours to tidy up loose ends) Any intern up to snuff also knows what a crock of shit it is.
Internship was once termed "the last sweatshop" in America, by the AMA no less, and that it still true today. In no other job do you have no right to quit, have forced uncompensated overtime, are denied lunch breaks, bathroom breaks, or the luxury of sleep. We have no protection from abusive bosses or nurses for that matter as shit runs down hill and at the bottom of every hospital is a pile of interns. Complain and you will be thrown to the wolves. There are no truly anonymous ways to fight back. Whistle blowers have been forced out of their residency programs or denied letters from their program directors to get their liscence. We are forced do to it in the name of patient care, because the patient comes first. Ahead of our families, ahead of our selves.
The hours are by far the most painful aspect of my life. I wake up before the sun comes up, before my daughter wakes up and trudge off to a world that will never be understood by outsiders ( though I appreciate you trying). Once there it is a whirlwind of lab results, progress notes, problem lists and admissions. Everyday you hustle, you sacrifice. Then before you know it, you look up and the sun has set, normal people begin the long trek home but not me. If I'm lucky I remember to call home before my kid falls back asleep, if not then I can't help but grieve for my husband who feels like a married single parent. In the hospital there is no distinction between night and day, like some twisted perversion of Las Vegas ( and by the way, what fuck ups happen at the hospital, stay at the hospital). All night long I admit new patients, follow up labs, answer phone calls about patients I have never seen, and replace electrolytes. The one thing I don't do is sleep. Or just rest. I deny myself a most basic of human needs. Before you now it the sun is rising again. I have to prepare for rounds, track down that x-ray, collect vital signs. It's so exhausting. My knees ache in the way that only someone who has been standing for twenty four plus hours can understand. My sense of balance is off because the most primative part of my brain is screaming to just get horizontal for 10 minutes. Even if I can't get sleep , I just want to be horiziontal, maybe even on a bed. After rounds end I start the difficult task of finding the car. Everyday blends into the next and its not unusual to see several post call interns searching for their cars. Like a Seinfield episode magnified by a hundred. Oh and the light. You're so tired that the sun is blinding, you literally can't see. After 24-30 hours of hospital light your eyes just can't make that adjustment. Some interns bring sunglasses. The drive home can be the scariest and most exhausting 20 minutes of call. I never change lanes because I just don't trust my abilities. It's akin to being a drunk driver (A recent study actually proved that being post call is equivalent to being legally drunk). When I get home my daughter smiles so wide, she does a little dance and claps. I try to stay up late enough to put her down for a nap and we sleep together. A little unconscious mother-daughter bonding. My husband gets her when she wakes up because I'm so tired I don't hear her. Sometimes she screams for me, she holds on to the toddler gate and screams Ma, Ma, Ma. The definition of being exhausted is ignoring your screaming child who just wants to see you after she's been waiting all day and all night.

Now repeat every third day, over and over again. For a year.

So why should you care, just one intern bitching about the hours. Because I fell asleep the other day. I fell asleep while driving. I was less than a two blocks from home, I stopped at a stop light and I had pulled my emergency brake (a learned trick to prevent roll back). I guess I set my head down against the steering wheel, I'm really not quit sure it's all a blur. But I woke up to the sound of a little old lady tapping on my driver's side window. Apparently a line of cars honking hadn't woken me up so this poor woman had to get out of her car to come see if I was okay. I can't believe I fell asleep. I can't believe that I was that tired. But what I really can't get my mind around, is that a half an hour ago, I was treating patients.


Anonymous said...

What I don't understand is...What is the point of this? Why do they overwork interns so much? What is it supposed to be teaching you?

After a certain amt of time of being awake and making decisions, I'm sure your judegement is off so how can this be good for you or the patients.

Anonymous said...

To this day, I remember my microsleep attacks on the freeway going home after call. I remember my first call night, which was also my first day of internship, when I didn't have time to change into scrubs or grab ten minutes for a shower until 4:00 a.m. and during which ten minutes, I was paged three times. I remember falling asleep in mid-sentence early one morning as I was giving discharge instructions to an OB patient. I had the most minimal personal life imaginable.

It stinks. I am sorry to see you having to go through that. Now many years later, I am still unconvinced of the value of being made to work like that. I am now a seasoned professional, boarded and re-boarded, and the process of training taken to the extremes is abusive in a way that few occupations, and none in health care, feel the need to emulate. Perhaps special warfare training comes close. None stretch that out to a year, though.

Summer is coming. Second year will be better. Heads up.

Dr Dork said...


Far too many of us have been there.

Dangerous not just for you, but for your patients, and the general public. Sack your medical association if they're not addressing this.

Best of luck,
(1/4 Irish Doc)

Judy said...

I'm really glad you fell asleep at the light instead of while you were moving.

Anonymous said...

Wow, great post. It really makes it seem more real...I keep reading all these blogs about the horrible hours in medicine and it makes me wonder what the hell I am doing thinking about quitting a good job to go back and suffer like this.

The part about your poor daughter and husband, how poignant. I can only think what my wife and kid would think if I continue down this path...

Thanks again for the post, glad to have you back!

Anonymous said...

whoa, someone said "special warfare training comes close" (sic) to being as hard as an intern.


you have it so bad in your air conditioned hospital and your cushy Nikes?

A job where you have to face the working end of an AK-47 is a world more difficult that your gravy train internship.

Anonymous said...

After a 52 hour shift without sleep as an intern, I took out a fire hydrant. Cost my insurance over $15,000 to fix. No wonder they dumped me!
A guy a few years ahead of me died after he made a lane change...under a semi! Post call of course.

scutmonkey said...

I heard several hospitals were going to start putting modafinil in the big sugar cookies with M&M's. You know which ones I mean.... Does anyone remember way back when they were pre-meds and how excited we were about the chance to be trained as physicians....

Anonymous said...

Hey i arrived hear randomly looking for inspiration (how do you know what the 'right' specialty is?), but I really wanted to say be safe and you will get through this. You're probably so tired and sick feeling that you can't believe me, but this will end and your daughter will forgive you. Just find a different way to get home if you're too tired to drive, your most important job is getting through this year alive.