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Life in Emergistan

Life in Emergistan

The Case for Being Constantly Tired

Leap, Edwin MD

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doi: 10.1097/01.EEM.0000513591.72531.79

    My ability to fall asleep anywhere, anytime is a longstanding joke in my family. The kids laugh, and Jan simply shakes her head. If I've been working and the room is warm when I come home, I will be out in minutes, if not seconds. I have been known to drift off mid-conversation.

    It might be argued that I am often overly tired. Some might even say that my fatigue is dangerous. Maybe. But there's another side to my remarkable power to sleep: I can wake up and function in an instant.

    Wake me up and tell me there's a strange noise outside, I'm on it. Tell me one of the children or beasts sounds sick? I can deal with it. Ask me the doses of RSI drugs needed? I can probably give the per-kg dose and do the calculations shortly after I emerge from a weird dream where a black cat is hissing at me.

    I suspect I'm not alone. Across our specialty are men and women who have a hard-earned ability to function when mere mortals would collapse into a weeping ball of exhaustion. The price of this skillset is high, however. I recall those first few call nights as a medical student when it was almost painful to be awake. There were times when I held retractors in the OR while essentially asleep.

    I can still recall an ICU attending tapping me on the shoulder when I was drooling over a chart on my desk, telling me to get at it. It was laughable how we would finally sit down during trauma rotations only to have the pager go off again. We ran down the hall to the next trauma, powered only by a thin vapor of caffeine, chocolate, youth, and sheer will. There were similar experiences during many other rotations and on night shifts in the ED.

    A Great Place to Have Gone

    I didn't realize it, but I was becoming tougher and more determined. I was discovering how to call up information from the depths of my memory through the fog of exhaustion. I was more able to perform complex motor skills in exhaustion through repetition and practice.

    It was good. Not always fun but good. As my friend said of his time at the Citadel, “It was a terrible place to go but a great place to have gone.” Because the hard truth of medicine is it just never stops. We owe it to future generations to prepare them. These days, the thought leaders of medical education are reasonably concerned about student and resident fatigue. I get it. We all certainly make more mistakes when we're tired. Worse, we can be injured or hurt our patients.

    Still, unless we develop android physicians (who, of course, will eventually murder us all), human physicians will have to be available and capable of endurance and fortitude in hard conditions. It doesn't have to be punitive or dangerous, but we must teach future generations to work despite fatigue. If we don't teach them how to work, how to stay awake, and how to instill habits of efficient behavior and thought in the most daunting conditions, we constrain their ability to respond to crises, small and large.

    No matter how compassionate or restrictive the rules on work hours are, medical school and residency will end, and emergency physicians will have to press on and do the hard work when needed.

    The Work Goes On

    When a coworker has a child, the work goes on. When flu, pneumonia, or fracture takes a partner off the schedule, the work goes on. When death strikes a partner or his family, the department doesn't close. When the bus wrecks and a partner calls for help because nobody else is picking up the phone, they will have to rise to the occasion from their warm bed, Mountain Dew in one hand and protein bar in the other, and face it.

    I'm proud of how strong my mind and body have become. I take it as a point of pride that I can work whenever I have to, and do the right thing even when I want sleep more than anything. I'm proud to be part of an incredible group of physicians who do this in far tougher conditions and much busier shops than I do.

    What I hope is that this ability, like so many great skills we pass down, will not be relegated to some textbook of medical history. It was earned through great effort, and it is a powerful weapon in our fight against death and disease, both of which stay up all night long.

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