Other Features: Teaching and Learning Moments
Sleep that knits up the ravell’d sleave of care,
The death of each day’s life, sore labour’s bath,
Balm of hurt minds, great Nature’s second course,
Chief nourisher in life’s feast. - —William Shakespeare, Macbeth (II.ii.36-39)
Medical students and residents think a lot about sleep or, rather, our lack of it. Yet sometimes I think we forget we’re not the only ones longing for clean sheets, a pile of pillows, and the welcome oblivion of darkness without dreams. Hospitals are full of patients trying to sleep too. I simply wasn’t expecting to become one of them.
“Did you sleep well?” the resident asked as he entered my room ahead of the entourage, in a tone that said, “Of course you did, you weren’t on-call over the weekend, beginning morning rounds at an ungodly hour on a lazy Saturday more suited to breakfast in bed.” I didn’t say anything then, but now I wish I had.
“No, I did not sleep well,” I should have told him. It’s hard to sleep when you turn out the lights and curl up with a pillow, alone in the darkness of a strange room filled with the hissing and beeping of the machines that will make sure you don’t stop breathing in the middle of the night. It’s hard to sleep when you try to roll over and the sharp pinch of the tubing snaking towards the needle in your arm reminds you just how much you’d love to pull the IV out, consequences be damned. It’s hard to sleep when someone (even gently) shakes you back to consciousness every two hours: first vital signs, then the Lovenox injection, followed by more labs, all just in time for the next round of q4 vitals. Sleep becomes truly impossible, though, when someone visiting the patient next door begins sobbing in the hall.
“Can you wake up? Please, just wake up,” this stranger cries in anguish as the nurse—my nurse, because by now I know her voice—repeats the question. “C’mon,” she asks, repeating the patient’s name. “Can you wake up for me?” There is no response to her question or to the other woman’s tears, and in the solitude of my own room, at first I feel guilty for overhearing such a private moment of grief for the mother or daughter or sister who is losing someone she loves. But then in the fuzzy logic of 3 am analysis, another thought occurs: What if that happens to me? And now I am wide awake. Upon my discharge several days later—thankfully still breathing and walking independently—I sleep for 13 hours without moving. Maybe it was the quiet or lack of interruptions involving sharps, yet I can’t help but think that this peaceful slumber also reflects the subconscious knowledge that I am home, that I will be okay.
And this is a lesson that I cannot forget. As a medical student, I have hundreds of sleepless hours in the hospital in front of me, but I will be sharing these long nights with hundreds of sleepless patients. I don’t need to ask—and when I am an attending, neither will my residents—because I already know. Nobody sleeps well in hospitals. The difference lies in the things that keep us awake.
Amanda J. Redig