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On July 1, a revolutionary change in medical education is scheduled to take place. That day, the Accreditation Council for Graduate Medical Education will impose new guidelines on the nation’s medical schools, restricting the working hours of doctors serving medical and surgical residencies.
Under the new rules, residents like me will have our average workweek capped at 80 hours. Meanwhile, Congress is pursuing legislation that would set even tighter limits, keeping us from working more than 24 hours at a stretch.
Preposterous! As a resident currently working 34-plus-hour shifts, I find the so-called reforms to be an egregious curtailment of my education.
Throughout medical school and my training, I have studied at the foot of imperious, impressive physicians, full of stories about their labors back in the “days of giants”working 24-hour days, without break, for four years straight. If I can’t do the same, how will I impress upon them that I am competent to be a physician?
My entire academic career, in fact, has been about impressing my teachers. While my elementary-school classmates spent their time at piano lessons or Little League, I pulled rotator-cuff muscles training to raise my hand the fastest. Instead of finger paints or crayons, I had sharpened No. 2 pencils and practiced filling in perfect circles on multiple-choice Scantron sheets. Whereas during college my peers couldn’t wait to reach 21, I aspired only to the number 4.0. That’s how I got into medical school. How can I quell my overachieving now?
I perform better when I work more. Stockholm syndrome is part of a resident’s professional identity: The longer we work, the more we forget that existence has anything else to offer.
And questioning our ability to make life-or-death decisions when we’ve been up for 24 hours? God doesn’t need to sleep.
This is how my typical “on-call” experience goes: I get up at 5 a.m., just in time for the first train of the day. Alone in the subway station, I experience a quiet serenity waiting 20 minutes for my transfer. The world is pausing, but I go on.
As I bound up the escalator toward the hospital, I’m already strategizing a plan of action. I have just 15 minutes to examine 20 patients and find their well-hidden recorded vitals (crafty nurses). After that, it’s time for rounds.
The most important feature of rounds is remaining upright for hours on end while moving from patient to patient. Outside each room, a member of the medical team presents the case as the rest of the doctors promote a nurturing environment of competitive questioning. I can feel my brain swelling from the exchange of information. The veins of my legs are swelling even more. I grow more ponderous by the minute.
Then comes a quick break for breakfast.
For the next 12 hours, through daylight and into the night, I follow my pager. It beeps to call me down to the ER. From the ER, it beeps to call me up to a patient’s room. From the patient’s room, it beeps to call me down to Radiology. Beep! Up to the lab. Office workers have to pay gym fees and use their spare time sweating on a Stairmaster. My buttocks are firmed by a higher purpose.
As the night pushes on, I often try to lie down on the floorboards of the nearest closet, but every attempt at REM sleep is countered by that familiar piercing sound. In the dead of night, when I’m not checking a patient’s stool for blood, I might be sucking out her spinal fluid with a syringe or up in the ghostly lab spinning her urine down into a sediment. And as the rosy fingers of dawn penetrate the hospital stairwells, I splash water on my face, drag a toothbrush across my teeth, and…Voilà! Yesterday has been recycled into today. The ultimate in energy conservation.
If the regulators have their way, my work will have to end here. Yet now is the time when I can truly prove myself. It’s Hour 25. Time to do rounds again, making crucial decisions for all the patients just admitted. Before, I was just groggy; now I’m making essential judgments as I fight off the inclination to faint. What fortitude and perseverance I am honing!
As the morning pushes on, my usual peevish reservations against foul breath and body odor dissipate and my kinship with humanity in its most natural state becomes complete. My mind is no longer distracted by petty concerns about appearance and fashion; it has become focused solely on survival. Ahhh, to feel truly alive, to have complete focus on such intrinsic human functions as walking and talking, without the superficial distractions of society. This is Zen meditation born of a most extreme asceticismand they pay me to do it.
If I didn’t work these hours, imagine what I’d do with my free time: Cut my hair, buy different clothes from the ones I’ve worn since college, shower regularly, and, God forbid, clean my apartment. I might even be driven to contemplate the utility and effectiveness of our health-care system and realize there are greater things to achieve than my own ambition.
By Hour 29, just my when reserves are almost exhausted, the manna of residency appears: pharmaceutical-company-sponsored lunches. Spread out on conference tables are delicious concoctions, from mozzarella-and-basil panini to saag paneer. Thank God for ludicrously inflated prescription medicine costs.
And then it’s back to the patients’ bedsides for Hours 31, 32…my woozy brain struggling to address the questions asked by concerned family members. The patients I call only “Sir,” because I can’t even remember my own name. It doesn’t get any more selfless than that.
Around Hour 33, I am transported to a place of great emotional clarity, and often feel like Rutger Hauer at the end of Blade Runner attempting to explain to Harrison Ford what it is like to be an android, saying, “I’ve seen things…”
Actually by this point, I am close to seeing things.
But what I truly value about these experiences (when I finally make it home) are all the little thingssuch as silence. And three days later I get to do it all again. CP
Art accompanying story in the printed newspaper is not available in this archive: Illustration by Fred Harper.