The world is my bed

Sleep used to be like water, a refreshing break from the toil of daily life, a quencher of thirst from the dry monotony of our days. Now it's become the air I breathe, wherewith at every opportunity that arises I take a breath, fearful that the next moment I may find myself under the flood of consults and chores, unable to breathe.

We began the year able to go home post call and sleep for only a few hours, then feel fully refreshed and able to spend the rest of the day making up for lost time. Now I come home, barely making the 10 minute drive without dozing off at the wheel, and at times pass out for five minutes while parked in my parking spot before I can find the energy to climb the single flight of stairs to my apartment. The cumulative fatigue of the 50ish 30 hour shifts in addition to our 12-18 hour operative days is has begun to take its toll. I've always been notorious for falling asleep during class, but now I'm falling asleep during signout, while I'm talking. Today I shut my eyes for a moment in the OR lounge while my colleague was on the phone, only to wake surrounded by anesthesiologists and no one from neurosurgery to be found. It's been a while, but so far this year I've fallen asleep standing up during our floor rounds, and as scary as it is, there have been a few times I've fallen asleep while standing in the OR (don't worry, nothing happened).

People might read this account and say that's exactly why we need to enforce stricter duty hour regulations, that the new 16 hour shifts being implemented by the institute of medicine is appropriate and necessary to prevent physician fatigue. I've always found it funny that the institute of medicine, and not the college of surgeons is trying to force feed these work hour limitations on the world of medicine and surgery. We train during residency to work under these conditions of fatigue and sleep deprivation because that's how the world is. Some of our surgeries can last longer than 24 hours (I've been on service for one that went 32 hours). There are redlines and emergencies that come in at all hours of the night, and care not for how much we've slept or how long we've been working. By taking away the grueling training of residency by limiting the number of hours we work each week (they propose something ridiculous like 60), we'd have to extend the neurosurgical residency by about 4 years I would imagine (it's already 7). Not only that, you can't "sign out" a surgery to another surgeon like you would a service of patients. The nuances of all the steps that ensue, the opening, the microvascular dissection, the surgical decisions regarding positioning and anatomy exposure, would take the near length of actual OR time to sufficiently pass on. Surgeons become surgeons because they can tolerate this brutal lifestyle. You make surgery shift work, and soon we'll find surgeons that need their nap times after a 12 hour shift. How do you tell a patient's family, sorry, the surgeon has to take a nap, we'll just keep the skull open until he gets back in five hours.

Enough ranting.

Oh wait, one more rant. Someone was in my parking spot when I came home post call today. The person that gets in between me and my bed after a call night beware. Thoughts of keying, kicking, smashing windows, and the sort passed my mind. I tried to have it towed, but ultimately just parked elsewhere and called the landlord to have him deal with it. I guess I'm a pacifist after all.