Duty Hours Pre-Form Part 1: Can you even do that?

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When I was an intern I was once on a rotation where we took call every third night. While it wasn't as bad as the "24 on/24 off" schedule that the Surgery residents did--it was still pretty sucky.

So yeah. One in three. That meant that on any given day you were either on call, post call, or post-post call (which everyone knows is twenty times worse than being post call.) Anyways. For those still confused, it meant that every single weekend you were guaranteed a crappy schedule.

Friday: On Call
Saturday: Post Call
Sunday: Exhausted and dreading on call.

Your weekdays were equally crappy:

Monday: On call
Tuesday: Post call and staying around because there's only two other interns.
Wednesday: Post-post call and stuck with all the work because you're the one nobody feels sorry for.

That's pretty much how it worked. This was also before anyone gave a hoot about duty hours or sweatshop working conditions which meant that this little schedule was even more heinous than it sounds. Let's examine the old school, pre-ACGME Duty Hour Rules era call schedule a wee bit closer, shall we?

The dreaded post call in clinic schedule:


Wednesday: On call and with out a single drop of sleep all night.
Thursday: Post Call
Thursday morning: Post call morning report in front of the whole department.
Thursday later in the morning: Getting grilled on rounds with more questions as if the ones you got on morning report weren't enough.
Thursday at noon: Sitting in noon conference while writing progress notes because you have to be at noon conference yet you have clinic at one p.m. and need to get them done.
Thursday at 1 PM: If this were today, you'd be starting your car. But back then, you bought a cup of coffee, jumped into a call room to change clothes, and then sprinted to clinic.
Thursday 3PM: Asking patients the same questions over and over and over. Because you are sick with exhaustion.
Thursday 4PM: A bizarre second wind comes over you. Seeing patients, answering pages, kicking ass and taking names. Who's better than you? Answer: Nobody.
Thursday 5PM: Running from clinic back to the UNIT to join the sign out rounds. YES. I said "Go back to the unit." At 5PM. Post call.
Thursday 5:30: Leaving the unit because you "got to go first since you're post."
Thursday 6PM: Fall asleep at every single stop sign on the way home.
Thursday 6:20PM: Eat two poptarts. Fall asleep with all of your clothes on. On the couch.
Thursday 7:30 PM: Classmate calls and asks, "What's up!?"
Thursday 8:00PM: Jump in the shower to get ready to meet your classmates because you know that this is the only chance to do anything fun and this is your "Friday."
Friday 5:30 AM: Staring at alarm clock tearfully and fearfully.
Friday all day: Walking around like a zombie and getting worked to death because you are the only one who isn't "on call" or "post call" -- which is why that day always sucked.


So here is what's extra crazy. That month with that schedule, my co-resident and I decided that we each wanted two consecutive days off. So like the sleep-deprived idiots that we were, we made this executive decision to each take two calls in a row. Yes. In a row. Oh, and did we ask anybody's permission to do this? Uhhhh, of course not. That would be too much like right.

So check it. That was the plan. I take call on Friday-Saturday, my classmate would do Saturday-Sunday the next week. Stupid as hell! I know! Anyways. I come in with my bag on a Friday go through my heinous work day and then admit all night. And that night? Oh it was a rough one. No sleep whatsoever. So Saturday morning I'm sitting at the nurses' station with my head down on my folded elbow likely in a pool of disgusting slobber. Then I hear my attending's voice:

"Rough night, Kim?"

I popped up and looked at him with blood shot eyes. "Uuuuhhh, huh?"

"How many did you get?"

"Many what? What patients? Uuuhhh, I think we got like. . ." I pulled out my cards and started counting, "uuuhhh, like six people. They were okay. Well, one was kind of. . .uuuhhh. . .no, it was fine."

The attending narrowed his eyes and looked at me like I was a little off. This guy was just covering for the weekend so didn't really know me so well. If he had known me well, he would have known that I was off because not only was I nauseatingly tired but simultaneously stupid enough to be admitting for the next twenty four hours. Again.

"So, you're post call obviously," he said. I'm still not so sure I appreciated that little "obviously" dig. Then he looked around the unit and asked the dreaded question. "Where's the on call intern? It's 7:30 and I'm ready to rock and roll."

I wanted to splash my face with water or something to convince him that I wasn't as dangerous as I looked. No time for that. "Uhhh. . .yeah. . . the funny thing about that. . .yeah. . .well, I'm the on call intern."

He furrowed his brow and froze. "You? But you're post call."

"I know, sir. But I'm taking Kevin's call today so that we could each get some time off."

"You're taking two calls in a row? Can you even do that?"

I shrugged my shoulders and tried to smile. I wanted to give him as few words as possible. Besides--Kevin was no where near that hospital and he damn sure wasn't coming in to take call.

"Have you seen all of the patients and written notes already?"

"Yes, sir. I did." Which was true. Haggard, yes. Sloppy with work, no.

He shook his head and sighed. "Okay, then. Let's rock and roll." And that was that. No threats to call my chiefs or my program director. No screaming fit about how awful it is to put my patient's--his patients--in danger with our selfishly asinine plan. Nope. Just a head shake and a request to do what the man came to do. Rock and roll.

So that's exactly what we did. We rocked and we rolled. And then he left. And I stayed to admit seven more people that night. I did get like twenty minutes of sleep--which everyone knows is twenty times worse than getting no sleep when you're that tired.

Anyways.

On Sunday morning, I was in a stupor and I had altered mental status for real. I fell asleep standing up twice and wrote notes in charts that looked eerily like hieroglyphics. Not good. Not good at all.

I am pretty sure that nobody got hurt, but really? Two calls in a row--voluntarily? Really?

Okay. So today I'm reflecting on this new rule effective July 1 that prevents interns from working more than 16 hours straight. The hours can be longer for upper level residents, but first year-fresh outta med schoolers must keep it under 16. Wow. I'm so marveling at how sharply the pendulum has swung in less than fifteen years.

That two call in a row story used to be funny to me. But you know what? It's really not. It was one of the stupidest and most dangerous things I ever did in my entire residency. My friend Kevin and I told that story like old Army Rangers talking to young privates; "when WE were interns we worked for 53 hours straight!" Now that I am actually writing what we both did, it sounds even worse.

But the thing is. . . .as an intern and now, I intensely yearned to have a personal life away from work. I needed a minute, a real minute, just to be me and to breathe. And I needed some time to do it. Even if it meant working for 53 hours straight.

Isn't that terrible? Needing to risk my life and that of my patients just to have a minute to breathe? That's a damn shame.

Okay. So now it's kind of built into the rules for residents to have balanced personal lives--or at least to have time to try.

So what's the moral of this story?

It's good that things are different now. It really is.

Oh. And if you are currently an intern and you don't have a life? Blame yourself for being lame. Not temporary insanity. Or your crappy schedule.

***
Stay tuned for part 2: "No sleep 'til Brooklyn"-- The story about when Dr. Winawer mowed down a row of parked cars post call in Manhattan. You think I had temporary insanity? Laaaawwwwdddd. . .