Exhaustion Can Hinder Ability

Dear Ann Landers: I am a resident in medical training, three years out of medical school. Many of us must work through every third night. This means we are on duty for 36 hours straight. Sometimes, we get a nap but not always.

The physicians in charge also worked 36-hour shifts when they were training, but that was 25 years ago. Hospitals were different then. Patients stayed for a week after an appendectomy. Now, they’re in and out in two days. Mothers with newborn infants used to be in the hospital for seven or eight days. Now they are expected to check out after 24 hours unless there are complications. We see many more patients in a shorter period of time and often feel guilty about it. After 24 hours without sleep, our problem-solving abilities decline.

Patients have no idea how sleep-deprived we are and how this affects our ability to perform. Please tell them. - An Anonymous Resident

Dear Resident: You’ve hit on a sensitive subject, one I’ve been hearing a lot about lately. I shared your letter with a New York physician, and this is what he said:

Dear Ann: The problems cited by your correspondent are fairly standard in medical training. Interns and residents are often expected to make life-or-death decisions while in a state of near exhaustion. The results can be disastrous.

Several years ago, a young woman named Libby Zion died partially because of mistakes made by a chronically sleep-deprived resident. After her death, her father, Sidney Zion, now a New York Daily News columnist, pushed for legislation to restrict the number of on-call hours worked by doctors. As a result of his efforts, several states now have laws limiting shifts worked by interns and residents.

Unfortunately, those laws are widely flouted, and the grueling work schedules continue. The reason, of course, is financial. It is much cheaper to staff an emergency room with four physicians working 100 hours a week than with 10 physicians working 40 hours a week.

Your “Anonymous Resident” probably knows this. Chances are, he will not make a fatal error, but he is right to be concerned. He may fear that challenging the establishment could affect the evaluation he receives from whoever runs the program, so he keeps quiet. The greatest pressure is felt by interns, who are the most junior physicians and yet do the bulk of the physical work. It’s scary when people suddenly turn to you in a crisis and ask, “What should we do now, doctor?” Suddenly, you find yourself facing a life-or-death decision. To make such a decision with little or no sleep and minimal supervision from a senior staff member can be terrifying.

I sympathize with “Anonymous Resident.” Every physician has been through it. Unquestionably, brutal hours and sleep deprivation teach self-reliance and build self-confidence, but there are inherent dangers that need to be addressed by the medical establishment. The sooner the better.

Dear Ann Landers: When I read in your column about the couple on a Minnesota cross-country ski trip who had sex while on skis, it brought to mind the couple I saw having sex on a tram going down Aspen Mountain. His bare behind was right up in the window!

- C.G. in Birmingham, Ala.

Dear C.G.: Maybe it’s the altitude. Regardless - shame on them!