Confessions of an Intern

Week Thirty-six

This week has been horrible, busier both at the hospital and at home. I took my own son for treatment at the pediatricians office and we were sent to the ER. At the children's hospital, I was even less reassured when every doctor we came in contact with said they'd never seen anything like what he had. He had an expanding lump on his cheek that had started to bruise. We still don't know exactly what is going on, but he is going to be on antibiotics for a month!? We will see in a week what the deal is when we follow up with ENT on Thursday.

Then, the inpatient night float blew up. I mean literally, I had more business this last week than I have had in all the weeks of night float combined. We joke with each other about who is a 'white cloud' or a 'black cloud'. These don't need much explanation, one is good and the other is bad. I feel like the black cloud on OB for instance. Well, the third year I was working with this last week is considered a black cloud on inpatient medicine. They weren't kidding. I did so many admissions, I could dictate almost in my sleep...that is if I was getting any. I averaged about three to four hours of sleep a day this past week. I am really not sure how I was able to function except out of necessity. I guess this week I am going to write about fatigue. Not a topic I ever thought much to pontificate about, but I will say am I ever glad they instituted work hour restrictions. As an intern, we are limited to 80 patient contact hours. Just last year they were still doing 30 hour calls, where you would work all day, and take call at the hospital every 3rd or 4th night. This night float system replaced that type of schedule and what a blessing. While, yes, I am not sleeping well, that is the exception. The week before I got enough sleep.

This week, I was dealing with crisis phone calls much of the day, with the school nurse, my son's teacher, my clinic nurse, the pediatric office, and family calls. Regardless of the fact I can turn the ringer on my phone off, I don't usually because I don't typically get unnecessary phone calls. I don't have a hopping social phone network, I hate talking on it unless I have to. So all of the calls that came in were essential. I also broke up the limited sleep I was getting taking my son to the doctor's office. Nothing like being able to sleep 9 am to 3:30 pm and having to get up at 12:50 to get you kid to a 1:30 appt and trying to get back home quick enough to catch another little nap. Oh, and that morning you didn't get to sleep until 10 because of other phone calls, and then the last half hour of your afternoon nap you are awakened by the nurse at the ENT follow up office. She called and I ended up listening to her fret about not having an appointment available. Instead of finding the appointments that were available before calling me (I had told her I worked nights) she had me on the phone for ten minutes listening to her mildly curse and sigh, unable to decide what to do. I ultimately said put us in with anyone available, because he hadn't actually seen the doctor who he was to follow up with. Wow...that ended the conversation in about a minute with an appointment successfully made.

I also realized I could sympathize with those doctors who are grumpy when awakened. Without trying to be I was gruff and impatient when on the phone with those who called me. I turned into a very direct, focused person, the goal being getting me off the phone and back to sleep as quickly as possible. I realized I could probably come across as a real b!tch. I need to work on that, as I do not want to be that way. Yes, I signed up for this, and it is what I have fallen in love with, but the fatigue is the ugly side of that lover you wish you never had to see.

On a recovery note, I came home Monday morning, crashed into bed, slept solid until 4 pm, woke up long enough to cook dinner for my family and then fell back asleep around 8 pm. Wonder of wonders, I slept right through to 6:30 the next morning. My body took what it needed. I have not felt so refreshed in such a long time. Funny thing about not sleeping...it makes everything worse: sadness, concentration issues, health. You can become suicidal if you become too fatigued. It leads to hopelessness. There was a study they told us about in med school. It studied the effects of sleeplessness on college students and lab rats. In two weeks, many of the rats who were sleep deprived (2 hours or so sleep a day) DIED! The college students got so bad they had to cancel the study. Sleep is a necessity, not a luxury, so enjoy it!