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To Sleep, Perchance to Die

The best advice I got during residency–in Los Angeles, land of freeways–came from a senior resident. “When you’re driving home on the freeway after being on call, always drive in a middle lane, so when you fall asleep, the lane bumps will wake you up as you start to drift. There aren’t any bumps on the sides.” That tip probably saved my life, and likely that of many other residents as well.
I remember once, for example, in clinic the afternoon after having been on call the night before, giving up on asking a patient a question. The third time that I nodded off in the middle of his one-sentence answer, I was too embarrassed to ask the question yet again. Then there was the night I was trying to complete an admission note. I started nodding off and, two hours later, saw multiple pen streaks across the page and not a single additional word written. Or the time I was in the delivery room on the OB service, gowned and gloved and waiting my patient was ready to push. I kept nodding off, catching myself as I started to drop. The fourth-year OB resident (I was a family medicine intern) happened to look in and said, “Why didn’t you tell me you were so tired? I’ll scrub in–you go down to clinic.” No, clinic was not held in high regard on OB. Did I mention the Saturday when, after getting a couple of hours of sleep and thinking I felt okay, I went to the ATM machine to get some money and, despite having had the same PIN for about eight years, was unable to remember it?
I have very mixed feelings about the relaxation of regulations regarding continuous work hours for residents, even given the evidence from an actual randomized trial with surgery residents that the change didn’t kill more patients. “Doesn’t seem to kill people” is a pretty low bar to clear for policies that we know go against basic physiology and humanity. Should we really be subjecting medical personnel to something that qualifies as an “enhanced interrogation technique”?
Barry Saver
Seattle, Washington


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